I think there has also to be some consideration of NHS resources in
deciding where STI testing takes place.
To do take a full sexual history, contact history, then perform an
intimate examination, take swabs, then explain examination findings to the
patient while throughout respecting the patients dignity does not fit into
a ten minute slot.
If there is an issue of contact tracing this certainly goes bey...
I think there has also to be some consideration of NHS resources in
deciding where STI testing takes place.
To do take a full sexual history, contact history, then perform an
intimate examination, take swabs, then explain examination findings to the
patient while throughout respecting the patients dignity does not fit into
a ten minute slot.
If there is an issue of contact tracing this certainly goes beyond
the remit of a GP.
This might be desirable for a significant proportion of patients -
but GP's can only take on extra work like this is they have the training,
support, and time to do so.
A GP service might be offered as a LES - but it would need to be
adequately resourced, it certainly could not be expected to be a service
the practice provides free of charge.
Dr Martin Rankin,
GP Partner and LMC Member.
Conflict of Interest:
I am a GP partner and member of the Plymouth Sub Committee of Devon LMC
The recently published editorial by Ingham highlights the importance
of ascertaining etiologies of misuse of condoms to plan and implement
effective public health interventions1.
Crosby et al. outline a prospective study demonstrating the
effectiveness of condoms when used consistently and properly to
considerably lower the acquisition of non-viral sexually transmitted
diseases. The authors also address the gl...
The recently published editorial by Ingham highlights the importance
of ascertaining etiologies of misuse of condoms to plan and implement
effective public health interventions1.
Crosby et al. outline a prospective study demonstrating the
effectiveness of condoms when used consistently and properly to
considerably lower the acquisition of non-viral sexually transmitted
diseases. The authors also address the global problem of incomplete and
improper use of condoms requiring targeted education for improvement2.
Another recently published article discusses inconsistency of condom
use and its ramifications. Goyal et al. have focused on high risk
behavior and sexually transmitted infections among U.S. Active Duty
Servicewomen and Veterans. The authors state that the group of unmarried,
young and new to military service, in particular, inconsistently use
condoms resulting in greater probability of acquisition of sexually
transmitted infections. Potential barriers to condom use for these women
have been proposed and include being stigmatized as promiscuous if
requesting condoms and evidence of violation of the military policy
prohibiting sexual intercourse during deployment. Binge drinking by women
in the military may also be resulting in inconsistent use of condoms with
resulting unwanted pregnancies and greater incidence of sexually
transmitted infections. The rate of Chlamydial infection in female active
duty soldiers is significantly greater than in comparative groups of women
in the general population3.
Ingham and Crosby et al. substantiate that the etiology of improper
and inconsistent use of condoms must be identified to plan and implement
effective public health interventions to eradicate the global problem of
sexual transmission of infection. It is likewise imperative that the
etiologies of risky sexual behavior of young women in the military be
understood. This vulnerable group should have targeted education to
prevent unwanted pregnancies and sexually transmitted infections. Clearly
U.S. Active Duty Servicewomen and Veterans face unique and difficult
challenges regarding their reproductive health and this issue needs more
focus1-3.
References
1. Ingham R. Condoms, bloody condoms; yet more problems. Sex Transm
Infect. 2012;8 :479-480. Published Online First: 23 October 2012
doi:10.1136/sextrans-2012-050793
2. Crosby RA, Chamigo RA, Weathers C, et al. Condom effectiveness
against non-viral sexually transmitted infections: a prospective study
using electronic daily diaries. Sex Transm Infect. 2012;88:484-489.Doi:
10.1136/sextrans-2012-050618.
3. Goyal V, Mattocks KM, Sadler AG. High Risk Behavior and Sexually
Transmitted Infections Among U.S. Active Duty Servicewomen and Veterans. J
of Women's Health. 2012; 21:1155-1169.DOI: 10.1089/jwh.2012.3605.
I wish to distance myself from Colm O'Mahony's rather hysterical editorial on the selection of Cervarix for the human papillomavirus immunization programme (O'Mahony C. Government decision on national human papillomavirus vaccine (HPV) programme is a sad day for sexual health. Sex
Transm Infect 2008;84:251). I do not yet know why Cervarix was selected ahead of Gardasil and until I do I wish to reserve my...
I wish to distance myself from Colm O'Mahony's rather hysterical editorial on the selection of Cervarix for the human papillomavirus immunization programme (O'Mahony C. Government decision on national human papillomavirus vaccine (HPV) programme is a sad day for sexual health. Sex
Transm Infect 2008;84:251). I do not yet know why Cervarix was selected ahead of Gardasil and until I do I wish to reserve my judgement on the decision. It is tempting to believe that immunizing against HPV types 6 and 11 in addition to types 16 and 18 would produce an added benefit.
However the aim of the immunization programme is to prevent carcinoma of the cervix and as far as I know there is no evidence that immunizing against HPV types 6 and 11 will achieve that aim. We might argue that there should have been trials to allow the added benefit of immunizing
against HPV types 6 and 11 to be shown but there were not so perhaps in selecting Cervarix the Department of Health has simply practised evidence based medicine.
The recently published editorial by Ingham highlights the importance
of ascertaining etiologies of misuse of condoms to plan and implement
effective public health interventions1.
Crosby et al. outline a prospective study demonstrating the
effectiveness of condoms when used consistently and properly to
considerably lower the acquisition of non-viral sexually transmitted
diseases. The authors also address the gl...
The recently published editorial by Ingham highlights the importance
of ascertaining etiologies of misuse of condoms to plan and implement
effective public health interventions1.
Crosby et al. outline a prospective study demonstrating the
effectiveness of condoms when used consistently and properly to
considerably lower the acquisition of non-viral sexually transmitted
diseases. The authors also address the global problem of incomplete and
improper use of condoms requiring targeted education for improvement2.
Another recently published article discusses inconsistency of condom
use and its ramifications. Goyal et al. have focused on high risk
behavior and sexually transmitted infections among U.S. Active Duty
Servicewomen and Veterans. The authors state that the group of unmarried,
young and new to military service, in particular, inconsistently use
condoms resulting in greater probability of acquisition of sexually
transmitted infections. Potential barriers to condom use for these women
have been proposed and include being stigmatized as promiscuous if
requesting condoms and evidence of violation of the military policy
prohibiting sexual intercourse during deployment. Binge drinking by women
in the military may also be resulting in inconsistent use of condoms with
resulting unwanted pregnancies and greater incidence of sexually
transmitted infections. The rate of Chlamydial infection in female active
duty soldiers is significantly greater than in comparative groups of women
in the general population3.
Ingham and Crosby et al. substantiate that the etiology of improper
and inconsistent use of condoms must be identified to plan and implement
effective public health interventions to eradicate the global problem of
sexual transmission of infection. It is likewise imperative that the
etiologies of risky sexual behavior of young women in the military be
understood. This vulnerable group should have targeted education to
prevent unwanted pregnancies and sexually transmitted infections. Clearly
U.S. Active Duty Servicewomen and Veterans face unique and difficult
challenges regarding their reproductive health and this issue needs more
focus1-3.
References
1. Ingham R. Condoms, bloody condoms; yet more problems. Sex Transm
Infect. 2012;8 :479-480. Published Online First: 23 October 2012
doi:10.1136/sextrans-2012-050793
2. Crosby RA, Chamigo RA, Weathers C, et al. Condom effectiveness
against non-viral sexually transmitted infections: a prospective study
using electronic daily diaries. Sex Transm Infect. 2012;88:484-489.Doi:
10.1136/sextrans-2012-050618.
3. Goyal V, Mattocks KM, Sadler AG. High Risk Behavior and Sexually
Transmitted Infections Among U.S. Active Duty Servicewomen and Veterans. J
of Women's Health. 2012; 21:1155-1169.DOI: 10.1089/jwh.2012.3605.
I note Dr Watson wishes to "reserve his judgement" about the Cervarix versus Gardasil decision until he knows the details. Unfortunately he will be reserving his judgment ad infinitum because despite requests from
me and others the Department of Health refused to release the details of the decision. They have issued the criteria and it appears to have been a tick boxing exercise where cost was paramoun...
I note Dr Watson wishes to "reserve his judgement" about the Cervarix versus Gardasil decision until he knows the details. Unfortunately he will be reserving his judgment ad infinitum because despite requests from
me and others the Department of Health refused to release the details of the decision. They have issued the criteria and it appears to have been a tick boxing exercise where cost was paramount.
Dr Watson is also sceptical about additionally vaccinating with HPV types 6 and 11 giving added benefit. There are many studies, showing that Gardasil is almost 100% effective at preventing genital warts the majority
of which are caused by types 6 and 11. Not only that, but many abnormal smears are caused by 6 and 11, although they do not progress to severe dyskaryosis. So there is no question that there would have been an enormous clinical benefit by using Gardasil. It is untrue to say that the
programme was always about cervical cancer, it was about HPV vaccination and indeed in the reply I received from Dawn Primrolo and Alan Johnson in February 2008 (before any decision was made) they encouragingly used the
sentence “It is expected the vaccination of girls would reduce the transmission of infection to boys, by herd immunity, and reduce the number of genital wart cases in boys as well as girls”.
Finally Dr Watson criticises my use of words like "shocked and appalled", but my editorial was only reflecting the opinion of every single Sexual Health/GUM Doctor who has offered me an opinion on this issue. The editorial was approved by the BASHH media committee in response to the outrage expressed by most of the members and other doctors
they had been in touch with. Even in the small hamlet of Aberystwyth in Wales, I am sure Dr Watson spends considerable amount of his clinical time managing genital warts with all their physical and psychological consequences. Sexual Health/GUM Physicians should be advocates for their patient’s misery. Our
patients can not do it for themselves. It is interesting that there are many well funded charities for cervical cancer who can attract publicity and lobby successfully, but there is none for genital warts. We owe it to our patients to complain loudly when political considerations override the benefits that would have accrued to our patients had the quadrivalent vaccine been chosen.
Khryanin and Reshetnikov describe screening men and women in Siberia
for M.genitalium and C.trachomatis 1. They suggest falls in detection
rates in 2010-11 may be due partly to the increasing numbers of healthy
persons who had attended medical clinics for routine examination. We
investigated whether it might be possible to increase frequency of STI
testing among female students in London, UK. This is particularly
import...
Khryanin and Reshetnikov describe screening men and women in Siberia
for M.genitalium and C.trachomatis 1. They suggest falls in detection
rates in 2010-11 may be due partly to the increasing numbers of healthy
persons who had attended medical clinics for routine examination. We
investigated whether it might be possible to increase frequency of STI
testing among female students in London, UK. This is particularly
important in those with a new sexual partner or recently treated for a STI
who may be more at risk2;3.
In September 2012 for a medical student project we conducted a
confidential questionnaire survey of consecutive female students aged 20-
24 in the common room areas at St George's, University of London. The
response rate was 100% (50/50). The students described their ethnicity as
Asian 42%, white 28%, black 22% or other 8%. Over half (56%, 28) said they
would be willing to post self-taken vaginal swabs for STI screening every
6 months. Incentives are often used in STI research4, and 93% (26/28) of
responders said that an Amazon voucher would make them more likely to
return samples. We also asked about a proposed pelvic inflammatory disease
(PID) hotline which women could telephone for advice if they thought they
had symptoms of possible PID: pelvic discomfort, pain during sex, abnormal
vaginal discharge or bleeding between periods. Forty women (80%) said they
would use a PID hotline if available.
Although superficially encouraging, results from this small sample
may not apply to students from other universities: and agreeing to return
samples is very different from actually doing it. However, we agree with
Khryanin and Reshetnikov1 that increasing use of online services and
texting may also be useful in increasing screening and treatment of STIs.
Ethical review: The protocol, patient information leaflet and
questionnaire were reviewed by Dr Phillip Sedgwick, Reader in Statistics
and course organiser at St George's, University of London.
Reference List
(1) Khryanin A, Reshetnikov O. Detection rates of Mycoplasma
genitalium and Chlamydia trachomatis Sex Transm Infect 2012; 88(6):469.
(2) Woodhall SC, Atkins JL, Soldan K, Hughes G, Bone A, Gill ON.
Repeat genital Chlamydia trachomatis testing rates in young adults in
England, 2010 Sex Transm Infect 2012.
(3) Oakeshott P, Kerry S, Aghaizu A, Atherton H, Hay S, Taylor-
Robinson D et al. Randomised controlled trial of screening for Chlamydia
trachomatis to prevent pelvic inflammatory disease: the POPI (prevention
of pelvic infection) trial. Br Med J 2010; 340:1642.
(4) Walker J, Fairley CK, Urban E, Chen MY, Bradshaw C, Walker SM et
al. Maximising retention in a longitudinal study of genital Chlamydia
trachomatis among young women in Australia BMC Public Health 2011; 11:156.
I have read the editorial from Dr O’Mahony and the comment from Dr Watson with interest. It may be helpful in this discussion to note that the criteria for selection of an HPV vaccine were spelt out by the Minister Dawn Primarolo on the 2cd of July 2008 in response to a Parliamentary question and is detailed in Hansard
http://www.parliament.the-stationery-office.co.uk/pa/cm200708/cmhansrd/cm080702/text/...
I have read the editorial from Dr O’Mahony and the comment from Dr Watson with interest. It may be helpful in this discussion to note that the criteria for selection of an HPV vaccine were spelt out by the Minister Dawn Primarolo on the 2cd of July 2008 in response to a Parliamentary question and is detailed in Hansard
http://www.parliament.the-stationery-office.co.uk/pa/cm200708/cmhansrd/cm080702/text/80702w0013.htm
It is clear from this that the decisions were not based exclusively on potential effects on HPV 16 and HPV 18 associated cervical disease but also considered the contribution of the low risk types HPV 6 and 11 to
genital disease in women. An analysis of the published literature shows clearly that in the large Phase III trial HPV6/11 related external genital warts and cervical, vulval, vaginal disease was 100% prevented over a 3
year period by immunization with a vaccine containing HPV6/11 L1 VLPs (1 Garland et al 2007). Furthermore the published literature (2 Paavonen et al 2007 3 Ault 2007) if analysed objectively, indicates that there is that
there is no difference between the two commercially available vaccines, in terms of efficacy, against HPV 16 or 18 caused high grade cervical intra-epithelial neoplasia (CIN2/3) the surrogate end point for cervical cancer in the trials.
The quadrivalent vaccine had an advantage from the public health perspective of significantly reducing a common sexually transmitted disease, genital warts, and this was reflected in the cost effectiveness analyses undertaken by the Health Protection Agency and others (4 Jit et al
2008, 5 Kulasingam et al 2008). Cost effectiveness is a critical part of health programmes particularly in the context of vaccine policy (6 Kinman et al 2006). A recent publication in the BMJ (4 Jit et al 2008) described
cost effectiveness models that show the price differential, £13-£ 21 less per dose, that would need to exist for the bivalent vaccine to be as cost effective as the quadrivalent and indeed the cost price of the vaccine was, very sensibly, one of the criteria employed by the Government and its
advisers. In view of all this it does suggest that the decision to buy Cervarix rather than Gardasil was not, as Dr Watson thinks, based entirely on evidence based medicine but that cost was an important, possibly
crucial factor.
References
1. Garland, S et al. N Engl J Med 2007;356:1928-43.
2. Paavonen, J et al. Lancet 2007;369:2161-70
3. Ault, KA. Lancet 2007;369:1861-8.
4. Jit, M et al. BMJ 2008;337:a769
5. Kulasingam S et al. Cost Effectiveness and Resource Allocation 2008;6:4
HIV (Point of Care Tests) POCTs are increasingly popular and overcome
many barriers to testing. Yet POCTs have false reactive results requiring
confirmation. Teague et al,(2009) looked at using a second POCT as
confirmation. The first line POCT was the INSTI? HIV-1/HIV-2 Rapid
Antibody Test; the confirmatory test the Alere Determine. The serum of 91
individuals with a positive INSTI was retrospectiv...
HIV (Point of Care Tests) POCTs are increasingly popular and overcome
many barriers to testing. Yet POCTs have false reactive results requiring
confirmation. Teague et al,(2009) looked at using a second POCT as
confirmation. The first line POCT was the INSTI? HIV-1/HIV-2 Rapid
Antibody Test; the confirmatory test the Alere Determine. The serum of 91
individuals with a positive INSTI was retrospectively tested; Determine
successfully identified all false reactive INSTIs.1 These data led us to
introduce a testing algorithm using Determine (4th generation) as rapid
confirmation for all reactive INSTIs alongside the standard laboratory
test. This letter presents a review of its use from January to December
2010.
RESULTS
In this period, 220 INSTI reactive patients received both
confirmatory tests: 213 of these were reactive on Determine and laboratory
tests confirmed HIV infection.
7 had a negative Determine, with 5 proven to be false reactive by
laboratory testing. However, 2 were found to be lab positive and were
experiencing HIV seroconversion.
DISCUSSION
The results suggest reactive samples on both POCTs are extremely
unlikely to be falsely positive.
Although all false reactive INSTIs were identified by Determine, Determine
missed 2 patients with HIV seroconversion. Determine now includes a
p24antigen component. However, laboratory tests have a greater sensitivity
so it is expected that Determine will miss some seroconverters; Rosenberg
et al (2011) and Fox (2012) report the sensitivity of Determine in
detecting acute HIV infection at 25% and 50% respectively.2 3 Our data
goes further; indicating that while Determine is currently the only 4th
generation POCT, there are instances where 3rd generation POCTs may detect
infection earlier.
However, our data cannot say whether Determine could detect some acute
infections that INSTI may miss.
Significantly, these data highlight the importance of running laboratory
4th generation tests in parallel with POCTs when clinical history suggests
acute HIV infection, and when there has been significant risk of HIV
acquisition within the window period.
REFERENCES
1. Teague A, Rossi M, Gilmour C, et al. Use of two HIV-POCT tests to
identify false reactives. International Journal of STD & AIDS
2009;20:808-9.
2. Fox J, Dunn H, O'Shea S. Low rates of p24 antigen detection using
a fourth-generation point of care HIV test. Sexually Transmitted
Infections 2011;87:178-9.
3. Rosenberg NE, Kamanga G, Phiri S, et al. Detection of Acute HIV
Infection: A Field Evaluation of the Determine? HIV-1/2 Ag/Ab Combo Test.
Journal of Infectious Diseases 2012;205(4):521-4.
The points made by Dr O’Mahony in response to the government’s decision to support a bivalent HPV 16/18 prophylactic vaccine in preference to a quadrivalent HPV 6/11/16/18 vaccine are well made and will be appreciated by practitioners managing the wide spectrum of ano-genital
HPV disease.1 The British Association for Sexual Health and HIV (BASHH) has already expressed concerns with respect to the clinica...
The points made by Dr O’Mahony in response to the government’s decision to support a bivalent HPV 16/18 prophylactic vaccine in preference to a quadrivalent HPV 6/11/16/18 vaccine are well made and will be appreciated by practitioners managing the wide spectrum of ano-genital
HPV disease.1 The British Association for Sexual Health and HIV (BASHH) has already expressed concerns with respect to the clinical, psychological and financial implications of HPV 6 and 11 infection. An editorial and article in the British Medical Journal have recently shed light on the
financial reasoning behind a decision seemingly at odds with clinical sense.2,3
Parents and adolescents, in particular, should be made aware of the two available vaccines and of the clinical problems associated with HPV 6,11, 16 and 18 infection. Some parents may subsequently want their daughters protected against genital warts and low grade cervical dysplasia
associated with HPV 6 and 11 infection, in addition to HPV 16 and 18 associated cervical cancer. One suspects this would require opting out of the national HPV vaccination programme and self-payment for the quadrivalent vaccine. This should lead to interesting discussion.
Competing Interests: CS has received lecture fees from Sanofi Pasteur MSD
References
1. O’Mahony C. Government decision on national human papillomavirus vaccine programme is a sad day for sexual health. Sex Transm Infect 2008;84:251
2. Kim JJ. Human papillomavirus vaccination in the UK. BMJ 2008;337:a842
3. Jit M, Choi YH, Edmunds WJ. Economic evaluation of human papillomavirus vaccination in the United Kingdom.
BMJ 2008;337:a769
Chris Sonnex
Chair BASHH HPV Special Interest Group
Department of GU Medicine,
Addenbrooke’s Hospital
Cambridge University Hospitals NHS Foundation Trust
Cambridge CB2 2QQ
Immy Ahmed
President, British Association for Sexual Health and HIV
Dept of GU Medicine
Nottingham University Hospitals
Nottingham City Hospital
Nottingham NG5 1PB
Acute nongonococcal urethritis (NGU) is one of the commonest sexually
transmitted infections affecting man and woman. The diagnosis of NGU has
traditionally required microscopic evidence of urethritis. However, a
significant proportion of patients with urethral symptoms do not have
microscopic evidence of urethritis.
A recently published article by Orellana MA et al [1] highlighted the low
sensitivity of Gram stain in th...
Acute nongonococcal urethritis (NGU) is one of the commonest sexually
transmitted infections affecting man and woman. The diagnosis of NGU has
traditionally required microscopic evidence of urethritis. However, a
significant proportion of patients with urethral symptoms do not have
microscopic evidence of urethritis.
A recently published article by Orellana MA et al [1] highlighted the low
sensitivity of Gram stain in the diagnosis of urethritis in men, and the
low negative predictive value of microscopic results in symptomatic
patients.
Whereas, we recently evaluated the analytical performance of the UF-1000i
(Sysmex Co, Japan, Supplied by Dasit SpA, Cornaredo, Italy), a recently
introduced fluorescence flow cytometer intended for urinalysis purposes [2],
which provides new analytical features that seem particularly suitable for
microbiological diagnostics, for ruling out NGU or predicting the presence
of infection [3].
The Sysmex UF-1000i is a flow cytometry analyzer capable of quantifying a
lot of particles, including bacteria and white blood cells (WBCs). To
evaluate the analytical performance of the UF-1000i as a method for ruling
out NGU, we examined 200 urethral smear samples, collected in a liquid
transport medium (Eswab, Copan, Brescia, Italy).
We compared the UF-1000i results with microscopic Gram stain, and with
results obtained from standard cultures and molecular methods available in
our laboratory to detect NGU main pathogens (Chlamydia trachomatis,
Mycoplasma genitalium, Ureaplasma urealyticum, Ureaplasma parvum,
Mycoplasma hominis, Trichomonas vaginalis, Adenovirus, Herpes simplex) .
With instrument cut-off values of 200 BACT x10^6/L and 500 WBCs x10^6/L,
we obtained a sensitivity of 84%, a specificity of 82%, and a high
negative predictive value (96%).
Our data demonstrated that Sysmex UF-1000i represents a real tool for
ruling out NGU, capable of improving the efficiency of NGU presumptive
diagnosis, providing results in a few minutes, with a good value of
sensitivity and, above all, a very high negative predictive value.
References
1. Orellana MA, Gomez-Lus ML, Lora D. Sensitivit? of Gram stain in the
diagnosis of urethritis in men. Sex Transm Infect 2012; 88: 284-287.
2. Grosso S, Bruschetta G, Camporese A. Experimental evaluation of the
Sysmex UF-1000i for ruling out non-gonococcal urethritis. Infez Med 2012;
20 (3):188-194.
3. De Rosa R, Grosso S, Bruschetta G, et al. Evaluation of the Sysmex
UF1000i flow cytometer for ruling out bacterial urinary tract infection.
Clin Chim Acta 2010; 411 1137-1142.
I think there has also to be some consideration of NHS resources in deciding where STI testing takes place.
To do take a full sexual history, contact history, then perform an intimate examination, take swabs, then explain examination findings to the patient while throughout respecting the patients dignity does not fit into a ten minute slot.
If there is an issue of contact tracing this certainly goes bey...
The recently published editorial by Ingham highlights the importance of ascertaining etiologies of misuse of condoms to plan and implement effective public health interventions1.
Crosby et al. outline a prospective study demonstrating the effectiveness of condoms when used consistently and properly to considerably lower the acquisition of non-viral sexually transmitted diseases. The authors also address the gl...
Dear Editor,
I wish to distance myself from Colm O'Mahony's rather hysterical editorial on the selection of Cervarix for the human papillomavirus immunization programme (O'Mahony C. Government decision on national human papillomavirus vaccine (HPV) programme is a sad day for sexual health. Sex Transm Infect 2008;84:251). I do not yet know why Cervarix was selected ahead of Gardasil and until I do I wish to reserve my...
The recently published editorial by Ingham highlights the importance of ascertaining etiologies of misuse of condoms to plan and implement effective public health interventions1.
Crosby et al. outline a prospective study demonstrating the effectiveness of condoms when used consistently and properly to considerably lower the acquisition of non-viral sexually transmitted diseases. The authors also address the gl...
Dear Editor,
I note Dr Watson wishes to "reserve his judgement" about the Cervarix versus Gardasil decision until he knows the details. Unfortunately he will be reserving his judgment ad infinitum because despite requests from me and others the Department of Health refused to release the details of the decision. They have issued the criteria and it appears to have been a tick boxing exercise where cost was paramoun...
Khryanin and Reshetnikov describe screening men and women in Siberia for M.genitalium and C.trachomatis 1. They suggest falls in detection rates in 2010-11 may be due partly to the increasing numbers of healthy persons who had attended medical clinics for routine examination. We investigated whether it might be possible to increase frequency of STI testing among female students in London, UK. This is particularly import...
Dear Editor,
I have read the editorial from Dr O’Mahony and the comment from Dr Watson with interest. It may be helpful in this discussion to note that the criteria for selection of an HPV vaccine were spelt out by the Minister Dawn Primarolo on the 2cd of July 2008 in response to a Parliamentary question and is detailed in Hansard http://www.parliament.the-stationery-office.co.uk/pa/cm200708/cmhansrd/cm080702/text/...
INTRODUCTION
HIV (Point of Care Tests) POCTs are increasingly popular and overcome many barriers to testing. Yet POCTs have false reactive results requiring confirmation. Teague et al,(2009) looked at using a second POCT as confirmation. The first line POCT was the INSTI? HIV-1/HIV-2 Rapid Antibody Test; the confirmatory test the Alere Determine. The serum of 91 individuals with a positive INSTI was retrospectiv...
Dear Editor,
The points made by Dr O’Mahony in response to the government’s decision to support a bivalent HPV 16/18 prophylactic vaccine in preference to a quadrivalent HPV 6/11/16/18 vaccine are well made and will be appreciated by practitioners managing the wide spectrum of ano-genital HPV disease.1 The British Association for Sexual Health and HIV (BASHH) has already expressed concerns with respect to the clinica...
Acute nongonococcal urethritis (NGU) is one of the commonest sexually transmitted infections affecting man and woman. The diagnosis of NGU has traditionally required microscopic evidence of urethritis. However, a significant proportion of patients with urethral symptoms do not have microscopic evidence of urethritis. A recently published article by Orellana MA et al [1] highlighted the low sensitivity of Gram stain in th...
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