Characteristics and smoking cessation outcomes of patients returning for repeat tobacco dependence treatment

Previous studies of tobacco dependence treatment have reported very low cessation rates among smokers who relapse and return to make a subsequent formal attempt to quit. This retrospective cohort study examined 1745 patients who attended a tobacco dependence clinic between 2001 and 2005, and the characteristics and outcomes of those who relapsed and returned for repeat treatment. Patients who returned for repeat treatment showed higher markers of nicotine dependence and were more likely to have a history of treatment for mental health problems than patients who attended the clinic for only one treatment episode. Among patients who relapsed and returned for repeat treatment, the 26-week abstinence rates were similar for each consecutive quit attempt (23%, 22% and 20%). Clinicians should encourage smokers who relapse after an initial treatment episode to return for treatment, and repeat treatment should focus on addressing high nicotine dependence and potentially co-occurring mental health problems in order to improve cessation outcomes.

The influence of acute progressive hypoxia on bioelectrical activity of the brain

Hypoxia, a noxious and hyperventilatory stimulus and a modifier of neuronal metabolism, could influence cortical function. In this study we attempted to assess any such influence, its determinants, and particularly the role in it of the accompanying hypoxic emotional distress. We addressed the issue by examining the associations among EEG, ventilation, and anxiety during progressive poikilocapnic hypoxia (end-point SaO(2) approximately 75%) in 12 awake healthy volunteers (mean age 27.5 +/-0.7 yr). All subjects hyperventilated in response to hypoxia and 3 of them had a high level of anticipatory anxiety that forced one person to discontinue the test. We failed to show any major effect of hypoxia on the EEG pattern analyzed by visual inspection or wavelet power spectra. Therefore, no relationship between the ventilatory and cortical activity responses to hypoxia could be established. Cortical activity changes appeared, however, in the subjects who experienced emotional distress during the test. These changes were apparent on an expanded analysis of the EEG signal by the use of the Lempel-Ziv complexity that takes into account the ordering of variations in the signal, rather than only the relative frequency of events analyzed by the Shannon entropy. The Lempel-Ziv complexity offers promise as a novel method for unraveling fine and otherwise unexpressed alterations in cortical bioelectrical activity.

Cervical human papillomavirus infection and squamous intraepithelial lesions in rural Gambia, West Africa: viral sequence analysis and epidemiology

The development of effective strategies against cervical cancer in Africa requires accurate type specific data on human papillomavirus (HPV) prevalence, including determination of DNA sequences in order to maximise local vaccine efficacy. We have investigated cervical HPV infection and squamous intraepithelial lesions (SIL) in an unselected cohort of 1061 women in a rural Gambian community. Squamous intraepithelial lesions was diagnosed using cytology and histology, HPV was typed by PCR-ELISA of DNA extracts, which were also DNA sequenced. The prevalence of cervical HPV infection was 13% and SIL were observed in 7% of subjects. Human papillomavirus-16 was most prevalent and most strongly associated with SIL. Also common were HPV-18, -33, -58 and, notably, -35. Human papillomavirus DNA sequencing revealed HPV-16 samples to be exclusively African type 1 (Af1). Subjects of the Wolof ethnic group had a lower prevalence of HPV infection while subjects aged 25-44 years had a higher prevalence of cervical precancer than older or younger subjects. This first report of HPV prevalence in an unselected, unscreened rural population confirms high rates of SIL and HPV infection in West Africa. This study has implications for the vaccination of Gambian and other African populations in the prevention of cervical cancer.

Comparison of non-invasive sampling methods for detection of HPV in rural African women

BACKGROUND

The prevalence of cervical cancer is extremely high in low income countries, primarily because of a lack of cytological screening. The link between human papillomavirus (HPV) and cervical cancer has long been recognised, and it has been suggested that isolated HPV testing in women who do not participate in existing screening programmes may be used to identify women at higher risk of developing cervical cancer. This community based study compares two self administered techniques for detecting HPV (tampons and self administered swabs) with a clinician directed technique, the cervical cytobrush.

METHODS

377 rural women were interviewed and of these 210 women had full gynaecological examination, and accepted all three sampling methods for HPV. HPV typing of DNA extracts was performed using polymerase chain reaction and enzyme linked immunosorbent assay techniques.

RESULTS

Using the cervical cytobrush as the gold standard, self administered swabs (SAS) showed a sensitivity of 63.9%, and tampons showed a sensitivity of 72.4%. The acceptability of these two tests was 97.1% and 84.6% respectively. When combining acceptability with sensitivity, the SAS detected 61.9% and the tampons detected 60.9% of the true positives.

CONCLUSION

In a setting where women are at a considerable risk of developing cervical cancer, with no access to a formal screening programme, self directed HPV testing could be a useful screening tool in identifying those women at increased risk who may require further investigation.

Bacterial vaginosis in relation to menstrual cycle, menstrual protection method, and sexual intercourse in rural Gambian women

OBJECTIVE

To examine the occurrence of bacterial vaginosis (BV) over the menstrual cycle and in relation to menstrual protection materials and sexual intercourse in a rural African setting.

METHODS

Married, regularly menstruating female volunteers were asked to collect self administered swabs on alternate days through four menstrual cycles. BV was assessed using Nugent scores. Menstruation and reported sexual intercourse data were recorded contemporaneously. A crossover design comparing traditional and modern menstrual protection methods was incorporated. Multivariate logistic regression was used to examine associations with BV.

RESULTS

30 women completed four menstrual cycles in the study. Completeness and validity of data from the self administered swabs was high. Greater frequencies of BV were found for all women in the second week of the menstrual cycle relative to days 14+, and markedly higher frequencies of BV were found in the first week in women with infrequent BV. BV was (non-significantly) more frequent when modern pads were used compared with traditional cloths. No association was found between BV and intercourse reported in the previous 4 days; or between the frequency of reported intercourse in one menstrual cycle and BV in either the same menstrual cycle or the next.

CONCLUSIONS

Similar transient fluctuations over the menstrual cycle were found to those in industrialised countries. We found no evidence that sexual intercourse was associated with increased frequency of BV. Our data do not support hypotheses that menstrual hygiene materials might explain the high prevalences of BV found in sub-Saharan Africa compared to industrialised countries.

An immunogold investigation of the distribution of calmodulin in the apex of cochlear hair cells

Calmodulin is found in the mechanosensitive stereociliary bundle of hair cells where it plays a role in various calcium-sensitive events associated with mechanoelectrical transduction. In this study, we have investigated the ultrastructural distribution of calmodulin in the apex of guinea-pig cochlear hair cells, using post-embedding immunogold labelling, in order to determine in more detail where calmodulin-dependent processes may be occurring. Labelling was found in the cuticular plate as well as the hair bundle, the rootlets of the stereocilia being more densely labelled than the surrounding filamentous matrix. In the bundle, labelling was found almost exclusively at the periphery rather than over the centre of the actin core of the stereocilia, and was clearly associated with the attachments of the lateral links that connect them to their nearest neighbours. It was also found to be denser towards the tips of stereocilia compared to other stereociliary regions and occurred consistently at either end of the tip link that connects stereocilia of adjacent rows. The contact region between stereocilia that is found just below the tip link was also clearly labelled. These concentrations of labelling in the bundle are likely to indicate sites where calmodulin is associated with calcium/calmodulin-sensitive proteins such as the various myosin isoforms and the plasma membrane ATPase (PMCA2a) that are known to occur there, and possibly with the transduction channels themselves. At least one of the myosin isoforms, myosin 1c, is thought to be associated with slow adaptation, and PMCA2a with control of calcium levels in the bundle. The concentration of calmodulin in the contact region further supports the suggestion that this is a functionally distinct region rather than a simple geometrical association between adjacent stereocilia.

Performance of the rapid plasma reagin and the rapid syphilis screening tests in the diagnosis of syphilis in field conditions in rural Africa

OBJECTIVES

To assess the rapid plasma reagin (RPR) test performance in the field and to evaluate a new rapid syphilis test (RST) as a primary screen for syphilis.

METHODS

1325 women of reproductive age from rural communities in the Gambia were tested for syphilis seropositivity using a RPR 18 mm circle card and a RST strip. Within 1 week a repeat RPR and a TPHA test were carried out using standard techniques in the laboratory.

RESULTS

Comparing field tests to a diagnosis of "active" syphilis defined as laboratory RPR and TPHA positive, the RPR test was 77.5% sensitive and 94.1% specific; the RST was 75.0% sensitive and 95.2% specific. The RST was easier to use and interpret than the RPR test especially where field conditions were difficult. In this setting with a low prevalence of syphilis in the community (3%), the chance of someone with a positive test being confirmed as having serologically active syphilis was less than 50% for both tests.

CONCLUSIONS

The appropriateness of syphilis screening using RPR testing in antenatal clinics and health centres should be questioned if there is a low prevalence in the population, conditions for testing are poor, and resources limited. There is still an urgent need for an appropriate rapid syphilis test for field use.

Prevalence of herpes simplex type 2 and syphilis serology among young adults in a rural Gambian community

OBJECTIVES

To estimate prevalence and risk factors for herpes simplex 2 (HSV2) positivity, syphilis and Chlamydia trachomatis infection among rural people aged 15-34 in the Gambia.

METHODS

Questionnaires and serum samples were collected from 1076 men and women aged 15-34 during a cross sectional prevalence survey in a rural area of the Gambia. Sera were screened for antibodies to herpes simplex virus type 2 (HSV2), and for syphilis using Treponema pallidum haemagglutination assay (TPHA) and rapid plasma reagin (RPR) tests. Urine was tested by polymerase chain reaction (PCR) for C trachomatis infection.

RESULTS

28% of women and 5% of men were HSV2 ELISA positive; 10% of women and 2% of men were TPHA positive; and 7% of women and 1% of men were both RPR and TPHA positive. Out of 1030 urine sample tested only six were positive for C trachomatis. 7% of those who reported never having sex were positive for one or other of these tests. Prevalences of all STIs increased with age and were higher in women than men. Women were much less likely than men to seek treatment for STI symptoms at a health centre. Married people were at increased risk of an STI compared with single people. Jola and Fula women had a higher prevalence of HSV2 than women from other ethnic groups, and Fulas also had a higher prevalence of RPR/TPHA positivity. The limited number of sexual behaviour questions were not significantly associated with STIs after adjustment for age, marital status, and ethnic group.

CONCLUSIONS

The prevalences of the ulcerative infections HSV2 and syphilis in this population are a cause for concern. In a setting where HIV1 prevalence remains low this indicates an urgent need for STI control and behaviour change programmes to prevent an HIV epidemic. Concerns about the validity of reported sexual behaviour data high light the necessity of biological markers in the evaluation of behaviour change programmes.

The long-term reproductive health consequences of female genital cutting in rural Gambia: a community-based survey

This paper examines the association between traditional practices of female genital cutting (FGC) and adult women's reproductive morbidity in rural Gambia. In 1999, we conducted a cross-sectional community survey of 1348 women aged 15-54 years, to estimate the prevalence of reproductive morbidity on the basis of women's reports, a gynaecological examination and laboratory analysis of specimens. Descriptive statistics and logistic regression were used to compare the prevalence of each morbidity between cut and uncut women adjusting for possible confounders. A total of 1157 women consented to gynaecological examination and 58% had signs of genital cutting. There was a high level of agreement between reported circumcision status and that found on examination (97% agreement). The majority of operations consisted of clitoridectomy and excision of the labia minora (WHO classification type II) and were performed between the ages of 4 and 7 years. The practice of genital cutting was highly associated with ethnic group for two of the three main ethnic groups, making the effects of ethnic group and cutting difficult to distinguish. Women who had undergone FGC had a significantly higher prevalence of bacterial vaginosis (BV) [adjusted odds ratio (OR)=1.66; 95% confidence interval (CI) 1.25-2.18] and a substantially higher prevalence of herpes simplex virus 2 (HSV2) [adjusted OR=4.71; 95% CI 3.46-6.42]. The higher prevalence of HSV2 suggests that cut women may be at increased risk of HIV infection. Commonly cited negative consequences of FGC such as damage to the perineum or anus, vulval tumours (such as Bartholin's cysts and excessive keloid formation), painful sex, infertility, prolapse and other reproductive tract infections (RTIs) were not significantly more common in cut women. The relationship between FGC and long-term reproductive morbidity remains unclear, especially in settings where type II cutting predominates. Efforts to eradicate the practice should incorporate a human rights approach rather than rely solely on the damaging health consequences.

Reducing waiting times for sleep apnoea hypopnoea syndrome and snoring using a questionnaire and home oximetry: results of a second audit cycle

As a result of a previous audit on the management of sleep apnoea hypopnoea syndrome (SAHS) which showed long waiting times that were primarily due to unnecessary interspecialty referrals, a change in practice was adopted. All referrals are now sent a questionnaire about symptoms suggestive of SAHS, the Epworth Sleepiness Scale score and their body mass index (BMI) which when returned are categorized into having a high, intermediate or low risk of SAHS. Those patients with a high probability have home overnight oximetry and those with intermediate probability have video oximetry. Those with a low probability are referred directly to ENT. We audited the first 100 patients referred. All were General Practitioner referrals to either ENT or respiratory medicine. Only two patients had a low probability score and were seen directly in ENT. Following sleep study analysis, 10 patients were referred directly to ENT with no respiratory medicine follow-up and nine were discharged back to the General Practitioner with no apnoea or snoring. Eighty-one patients were followed up by respiratory medicine. Of these, 49 received a trial of nasal continuous positive airway pressure (nCPAP) and six were referred to ENT. Therefore the majority justified an investigation to exclude SAHS in the first instance and an unnecessary initial ENT appointment was avoided. We have reduced the average waiting times to sleep study by approximately 90 days and to nCPAP trial by 32 days, mostly due to decreased delays in interspeciality referrrals. We have also demonstrated a greater than 50 per cent reduction in ENT clinic visits, a small increase in the number of sleep studies but no increase in respiratory clinic workload.

Endoscopy-negative, computed tomography-negative facial pain in a nasal clinic

OBJECTIVES

To establish the etiology of facial pain in individuals attending the nasal clinic of the Department of Otorhinolaryngology, University Hospital, Nottingham, U.K., with normal nasal endoscopy and computed tomography of the paranasal sinuses.

STUDY DESIGN

A retrospective analysis of a cohort of 973 patients consecutively presenting to the nasal clinic with symptoms of rhinosinusitis and/or facial pain.

METHODS

We reviewed the case notes of 973 consecutive patients who presented to the nasal clinic with either symptoms of rhinosinusitis or facial pain, and in particular 101 who had facial pain without any objective evidence of nasal disease as detected by nasal endoscopy or computed tomography. The diagnosis was based on the outcome and response to treatment after a mean of 2 years 2 months.

RESULTS

One hundred one patients had pain as a predominant symptom with normal nasal endoscopy and computed tomography of the paranasal sinuses. None of these patients responded to either medical or surgical treatment for what some workers have hypothesized could be "occult" sinonasal disease. A neurological diagnosis was made in 99 patients. Eighty patients received successful medical treatment for "neurological" diagnoses, 8 patients experienced spontaneous resolution of their symptoms, 7 failed to respond to any treatment modality, 2 were lost to follow-up, and 2 refused any treatment.

CONCLUSION

The majority of patients presenting to a rhinologic clinic with facial pain and no objective evidence of sinus disease, as detected by endoscopy and computed tomography, responded well to neurological treatment and surgical intervention was unnecessary. These patients should receive a trial of medical therapy, such as low-dose amitriptyline for 6 weeks in the first instance, before any surgical intervention is considered.

Telemedicine in rural care. Part 2: Assessing the wider issues

BACKGROUND

The first article about this development (Macduff et al 2001) described the evolution of a nurse-led telemedicine service in the village of Hamlet (population 1,600), north-east Scotland, and presented the findings of an evaluation study. In this second article, those findings are discussed in relation to the wider picture of nursing involvement in teleconsultation. The village has no medical practice or pharmacy and the majority of Hamlet's residents aged over 65 are registered with the Bradieslea Road surgery, one of three general practices six miles away in the town of Bradieslea. The community nursing service is based in small rooms at a sheltered housing complex in the village. This service covers all patients in the Hamlet area. It is staffed by one full-time district nurse/health visitor (who acts as team leader) and one part-time district nurse. Both are qualified nurse prescribers.

CONCLUSION

Opportunities now exist for nurses to use teleconsultation for the benefit of their patients. A systematic development of this type of nursing role through integration with broader service development would be valuable.

Telemedicine in rural care. Part 1: Developing and evaluating a nurse-led initiative

AIM

To develop and evaluate a nurse-led telemedicine service over a six-month period, linking the senior citizens of a rural village with the town-based general practice.

METHOD

Patients, doctors and nurses were asked to complete a questionnaire following video-link sessions. Interviews were also carried out at home with patients, while interviews with nurses and doctors took place in the workplace.

RESULTS

Of the 173 consultations with villagers aged over 65, 29 (17 per cent) were conducted by video-link. All those who used this service were sent questionnaires and 18 were returned (62 per cent). Seven of the patients who had received one video-link consultation were interviewed in their homes. All of the patients initially found the video consultation experience strange. Generally, patients found the nurses to have a pivotal role in explaining the service and interpreting their needs. All those interviewed said they would use the service again. The GPs spoke favourably of the service and said that it had saved them time. The nurses involved were positive about the service. Negative comments generally related to technology, for example picture and sound quality.

CONCLUSION

All involved in the nurse-led telemedicine service viewed it favourably and patients said that they would use it again. Part two, to be published in next week's Nursing Standard, will discuss the findings of the evaluation in relation to the wider picture of nursing involvement in teleconsultation.

The burden of reproductive-organ disease in rural women in The Gambia, West Africa

BACKGROUND

Data on the epidemiology of reproductive-organ morbidity are needed to guide effective interventions, to set health-care priorities, and to target future research. This study aimed to find out the prevalence of reproductive-organ disease in a sample of rural Gambian women.

METHODS

A questionnaire on reproductive health was administered by fieldworkers to women aged 15-54 years living in a rural area under demographic surveillance. A female gynaecologist questioned and examined the women (including speculum and bimanual pelvic examinations). Vaginal swabs were taken to test for Trichomonas vaginalis, Candida albicans, and bacterial vaginosis, cervical smears for cytology, cervical swabs for Chlamydia trachomatis PCR and Neisseria gonorrhoeae culture, and venous blood for haemoglobin, HIV, herpes simplex virus 2, and syphilis serology.

FINDINGS

1348 (72.0%) of 1871 eligible women took part. Reproductive-organ symptoms were more likely to be reported to the gynaecologist (52.7% of women) than to the fieldworker (26.5%). Menstrual problems, abnormal vaginal discharge, and vaginal itching were the most commonly reported symptoms. A minority of women said they had sought health care for their symptoms. The frequencies of reproductive-organ morbidity were high: menstrual dysfunction 34.1% (95% CI 29.6-39.1), infertility 9.8% (8.2-11.6), reproductive-tract infections 47.3% (43.7-51.0), pelvic tenderness 9.8% ((7.0-13.5), cervical dysplasia 6.7% (5.2-8.4), masses 15.9% (12.5-20.1), and childbirth-related damage to pelvic structures 46.1% (40.1-52.3). 948 (70.3%) women had at least one reproductive-organ disorder.

INTERPRETATION

For these rural women, whose lives depend heavily on their reproductive function, reproductive-organ disease is a large burden. In inadequately resourced rural areas, with poor education, heavy agricultural and domestic labour, and limited access to quality health care, many women are not able to attain and maintain reproductive health and wellbeing.

Program budgeting and marginal analysis: a priority-setting framework for Canadian Regional Health Authorities

Health regions in Canada are responsible for meeting the needs of local populations with limited resources. However, relatively little attention has been given to this within-region resource allocation problem. An economic approach to needs assessment, namely program budgeting and marginal analysis, may be of benefit. Its potential for use in Canada is examined, in particular with examples from two Alberta health regions, the Calgary Regional Health Authority and the Chinook Health Region.

Internal locus of control and social support associated with some dietary changes by elderly participants in a diet intervention trial

OBJECTIVE

Measure relationships of locus of control and social support to diet changes in an intervention trial.

DESIGN

Participants in the Polyp Prevention Trial (PPT) completed Multidimensional Health Locus of Control (MHLC) and Norbeck Social Support Questionnaires (NSSQ) and modified Block food frequency questionnaires. Data were collected at baseline and 1 year later.

SUBJECTS/SETTING

A convenience sample of PPT intervention (N = 68) and control (n = 43) participants at 1 clinical center participated in this ancillary study.

MAIN OUTCOME MEASURES

Mean daily dietary intakes after 1 year were compared with baseline values. Intervention participants' scores for MHLC internal locus of control and NSSQ total functional network were correlated with diet changes.

STATISTICAL ANALYSES PERFORMED

Group percentages were compared using the Fisher exact test; means were compared by t test.

RESULTS

Groups were comparable in demographics, baseline diet, and scores for internal locus of control and total functional network. Intervention group participants made greater diet changes than control participants in intake of fat (-27 g vs -8 g), fat as a percentage of kilocalories (-8% vs -2%), fiber as grams per 1,000 kcal (7 g vs 0.3 g), and daily fruit/vegetable servings (2.0 vs 0.2). Pearson correlations of diet changes with internal locus of control scores (all P > .05) were fat grams, r = 0.031; fat as percentage of kilocalories, r = 0.023; fiber grams per 1,000 kcal; r = 0.230; and fruit/vegetable servings, r = 0.186. Correlations with total functional network scores were: fat grams, r = 0.022 (P > .05); fat as percentage of kilocalories, r = -0.108 (P > .05); fiber grams per 1,000 kcal, r = 0.276, P < .05; and daily fruit/vegetable servings, r = 0.326, P < .05.

APPLICATIONS/CONCLUSIONS

Intensive and skillful dietary intervention can succeed whether or not clients bring strong internal locus of control or social support to the diet change program.

Opportunity for audit: establishing and monitoring the use of protocols for nurse-led treatments of minor injuries

During the last three years an integrated initiative has evolved in the casualty units of nine community hospitals in the Grampian region of Scotland. This has involved the development of nurse-led treatments for minor injuries based on a large number of assessment/treatment protocols. This paper describes how this change was used as an opportunity to initiate audit within clinical practice. Methods of auditing the use of the new protocols are detailed and baseline results are reported and discussed. In this way it is hoped that nurses involved in similar developments can learn from the strengths and weaknesses of this initiative.

Runaway sexual selection when female preferences are directly selected

We introduce models for the runaway coevolution of female mating preferences and male display traits. The models generalize earlier results by allowing for direct natural selection on the preference, arbitrary forms of mate choice, and fairly general assumptions about the underlying genetics. Results show that a runaway is less likely when there is direct selection on the preference, but that it is still possible if there is a sufficiently large phenotypic correlation between the female's preference and the male's trait among mated pairs. Comparison of three preference functions introduced by Lande (1981) shows that open-ended preferences are particularly prone to a runaway, and that absolute preferences require very large differences between females in their preferences. We analyze the causes of the runaway seen in a model developed by Iwasa and Pomiankowski (1995).

High prevalence of trichomoniasis in rural men in Mwanza, Tanzania: results from a population based study

OBJECTIVES

To measure the prevalence of urethral infections including trichomoniasis in rural Tanzanian men, to assess the prevalence of symptoms and signs among men with Trichomonas vaginalis, and to analyse the risk factors for trichomoniasis.

DESIGN

A cross sectional study of 1004 men aged 15-54 years in a rural community in north west Tanzania.

METHODS

Participants were interviewed about sexual behaviour and symptoms of sexually transmitted diseases. First fraction urine samples and urethral swabs were collected and used to test for T vaginalis by wet preparation and culture, Neisseria gonorrhoeae by culture, Chlamydia trachomatis by ligase chain reaction and non-specific urethritis by Gram stain. Urine was also tested for the presence of leucocytes using a leucocyte esterase dipstick. Men were re-interviewed 2 weeks later to document new symptoms and signs of urethritis.

RESULTS

Complete laboratory results were available on 980 men. One in four men had laboratory evidence of urethritis. T vaginalis was found in 109 individuals (11%), gonorrhoea in eight (0.8%), and chlamydial infection in 15 (1.5%). Over 50% of men with urethritis were asymptomatic. The prevalence of signs and symptoms was similar among men with T vaginalis alone compared with men with other urethral infections. The sensitivity and specificity of the leucocyte esterase dipstick (LED) test for detecting T vaginalis were 80% and 48% respectively in symptomatic men and 60% and 68% in asymptomatic men. Factors associated with trichomoniasis included religion, type of employment, and marital status.

CONCLUSIONS

A high prevalence of urethritis was found in men in this community based study. More than half of the urethral infections detected were asymptomatic. The most prevalent pathogen was T vaginalis. Studies are needed on the prevalence of trichomoniasis in men presenting to health services with complaints suggestive of urethritis since treatment for T vaginalis is not included in the syndromic management of urethritis in most countries. The performance of the LED test as a screening test for trichomoniasis was unsatisfactory in both symptomatic and asymptomatic men. Improved screening tests are urgently needed to identify urethral infections that are asymptomatic and which are not covered by current syndromic management algorithms.

Herpes simplex viral laryngitis

The true incidence of herpetic infections of the larynx is unknown. This entity may be underreported because of the difficulty in establishing the diagnosis. This report describes an immune-competent patient in whom extubation failed because of mass lesions of the posterior glottis. A biopsy specimen of the lesions revealed herpes simplex virus. We review the clinical presentation and histopathologic findings in this patient.