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ANOTHER FEMALE-ITIS?
Cervicitis, salpingitis, vaginitis, vestibulitis, urethritis—all challenges for diagnosis and management of women with or without symptoms. Now we can add endometritis to that list. In an informative editorial, Jonathan Ross addresses the question “What is endometritis and does it require treatment?” The short answers are (a) inflammation of the endometrium, which may occur in the absence of PID in women with otherwise uncomplicated lower genital tract infection, and (b) yes, if there are symptoms. Interestingly, in a large RCT, almost half the patients failed to clear endometritis (based on endometrial biopsy) despite having a good clinical response, but reassuringly there was no association between endometritis and long term adverse reproductive outcome. See p 252
LOCATION, LOCATION
Sexual networks are crucial in determining the transmission of infection—just ask the next monogamous patient you see with gonorrhoea. While a person may appear to be at low risk based on their own behaviour, the picture changes when you look at their partner, their partner’s partners, and their partner’s partner’s partners. But studying these sexual networks is very difficult. De and colleagues describe sexual networks identified during a gonorrhoea outbreak investigation in Alberta, Canada. They found that the numbers of people known to be linked sexually was limited, but if they added in a geographical link—namely, patronage of a popular motel bar, suddenly the network looked a lot more connected. Finding these locations may help in targeting interventions (and condom machines?). See p 280
ETHNIC DIFFERENCES IN SEXUAL HEALTH IN YOUNG PEOPLE
Marked ethnic differences exist in reported rates of STIs—for example, in England rates of gonorrhoea and chlamydia are reported to be up to 10 times higher in black Caribbean compared with white ethnic groups. Connell and colleagues held focus group discussions with 16–25 year olds from black Caribbean, black African, and white ethnicity in an area with a high background prevalence of STIs. The authors found that participants from black ethnic groups were more aware of gonorrhoea than white participants, but all participants regarded STIs as being less important than unplanned pregnancy or HIV/AIDS. Surprisingly most participants felt that they could determine the cleanliness of a sexual partner simply by visual and behavioural cues. Participants also believed that they would have obvious symptoms if they had an STI. Some black Caribbean women described negative attitudes from genitourinary medicine clinic staff from the same ethnic background. Despite the ethnic differences identified in this study, it is clear that the low priority given to STIs by young people in general needs to be addressed if they are to be tackled successfully. See p 300
IF THE CONDOM FITS, WEAR IT
Crosby and colleagues interviewed young African-American men with newly diagnosed STIs and asked them about their experiences with condoms. The men were all highly motivated to use condoms as a means of protecting against STIs but had experienced problems—particularly in relation to comfort (condom size and drying out during sex), condom associated erection difficulties, and reduced sexual satisfaction in their female partners. The authors conclude that with the exception of loss of skin to skin contact, the majority of problems encountered by this group of men are amenable to behavioural interventions. See p 306
WHOOPS!—MEASUREMENT ERROR IN STUDIES OF STIs
Unfortunately errors of many types may be introduced as part of the measurement process in both clinical and epidemiological research. These errors are widespread in research yet their impact on data and its interpretation are frequently overlooked. Myer et al review the basic concepts of measurement errors that are most relevant to the study of STIs and demonstrate the impact of several of the most common forms of measurement error on study results. See also p 328 for answers to MCQs! See p 318
See p 315. Unusual muscle disease in HIV infected patients
Linked Articles
- Editorial
- Gonorrhoea
- Public health
- Condoms
- Correction
- Research methods
- Book Review
- Research methods
- Case report