A study of diagnostic patterns in patients attending sexually transmitted disease clinics in England and Wales during 1978 showed that homosexuals contributed 10% of all male cases but 15% of gonococcal infections. In heterosexual and homosexual men only 6% of disease episodes included more than one positive diagnosis compared with 16% in women. One or more diseases occurred concurrently in over 30% of cases of gonorrhoea, trichomoniasis, candidosis, genital herpes, and genital warts in women. Men with multiple episodes of disease contributed a disproportionate number of gonococcal infections but were less likely to have candidosis or genital herpes than patients with only one disease episode. Thus, counting cases treated appears to be an inadequate way of measuring the problems caused by STDS. To enable more rapid identification of the diseases which are the most difficult to control, STD statistics should include the sexual orientation of male patients and differentiate between genuine "new" attenders at clinics and those previously seen.
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