• self treatment
• genitourinary medicine clinics

Editor,—Many people self medicate or seek advice from others before attending a medical consultation and while this has been documented for a number of conditions, there is little reason to suppose the behaviour will be different for a sexually transmitted infection (STI). There may be specific problems with self medication for STIs since they may mask signs and symptoms and unprescribed use of antibiotics may select for resistance among strains of Neisseria gonorrhoeae and other bacteria residing within and outside the genital tract.¹ We examined all aspects of self care in a sample of first time attenders at a GUM clinic in the United Kingdom. There were 492 consecutive first time attenders in a 3 month period, of which we achieved the participation of 188 clients (128 females, 60 males).

Information was collected via structured interview carried out by a health adviser. We asked about a range of issues concerning treatment seeking and symptoms experienced by clients. We specifically asked clients what measures they had taken between suspecting an STI and attending the clinic. Forty four respondents (23%) reported using a medication or remedy before attending the clinic. A total of 80 remedies were mentioned. The most commonly reported treatment was the use of Canesten (n=15), followed by paracetamol (n=5), antibiotics (n=5), Diflucan (n=3), and unspecified pessaries (n=3). Sixteen other medications were reported, of which 12 were identified by brand name. Two respondents (one on the recommendation of her mother) reported drinking lemon barley water and one drank cranberry juice. One person drank more water than usual, another drank less. Avoiding milk and bread, eating live yoghurt, and taking bicarbonate of soda were all mentioned by at least one respondent. Most medications were acquired either from the chemist or from trusted others; these latter included a wife, a sister, two friends, and two mothers.

These findings fit well with data from other countries and support a large US study.² The wide range of self treatments attests to the lack of knowledge about what might or might not “work” as a treatment for the symptoms of a sexually transmitted infection. The very large number of named “products” is striking. Remedies involving changing eating and drinking patterns are fairly common and are usually the consequence of advice from others. Given the stigma associated with having a suspected STI it is not surprising that only a few respondents discussed their treatment strategy with others.

It is important that genitourinary clinic staff recognise that a significant proportion of people attending will have tried some form of self medication. It would be desirable to establish which products have been tried and how recently. There is also an opportunity here for offering advice and education for the future and ensuring that there is good understanding of the role of antibiotics.