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Obeyesekera S, Jones K, Forster GE, Welch J, Brook MG, Daniels D. Management of rape/sexual assault cases within genitourinary medicine clinics: results from a study in North Thames. Int J STD AIDS 2016; 18:61-2. [PMID: 17326866 DOI: 10.1258/095646207779949952] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A regional audit was undertaken to evaluate current practice in the management of survivors of sexual assault (SA) seen in genitourinary (GU) medicine clinics in the North Thames. The majority of the survivors were women. Most were fast-tracked, or seen in dedicated SA clinics. Over 60% of staff had specific training in management of SA. Core services provided included screening and treatment for sexually transmitted infections, emotional support, emergency contraception and hepatitis B vaccination. The sexual health needs of these survivors of SA are being met by most clinics. The development and use of a standardized care proforma across the region may be a means to further improve the care provided.
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Affiliation(s)
- S Obeyesekera
- Ambrose King Centre, Royal London Hospital, Whitechapel Road, London E1 1BB, UK.
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Dhairyawan R, Muckart L, Forster GE. P21 Post-exposure prophylaxis following sexual assault. Br J Vener Dis 2012. [DOI: 10.1136/sextrans-2012-050601c.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Williams A, McManus T, Noonan M, Forster GE. P156 Survivors of male sexual assault attending an inner city sexual assault referral centre (SARC). Br J Vener Dis 2012. [DOI: 10.1136/sextrans-2012-050601c.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
Mental health issues following sexual assault in young people are common but early intervention may improve outcome. A retrospective case-note review of 58 female patients aged between 13 and 18 attending The Haven Whitechapel, a sexual assault referral centre, demonstrated past emotional problems in 72% of those seen, and current emotional problems in 95% of those being followed up. Fifteen percent were already involved with adolescent mental health services (AMHS). All patients requiring and not already receiving input were referred to AMHS or in-house. Of 23 patients referred to AMHS, eight (35%) were accepted and the patients attended, seven (30%) were accepted but did not attend, six (26%) were declined and the outcome of two referrals was unknown. The prevalence of emotional problems and inconsistent referral outcomes demonstrate a need for closer links with AMHS, clearer referral criteria and improved referral pathways.
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Affiliation(s)
- R J Sacks
- The Haven Whitechapel, Whitechapel, London, UK.
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Sethi G, Forster GE, Brook MG, Jones K, Daniels D, Horner PJ, Miller RF. Treatment of Chlamydia trachomatis in North Thames region 2003. Int J STD AIDS 2005; 15:831-2. [PMID: 15643698 DOI: 10.1258/0956462042563657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Following on from the survey of techniques used for testing chlamydia, a multi-centre re-audit of the treatment of C. trachomatis in genitourinary clinic attendees in the North Thames region from February to March 2003 was performed. This showed an improvement since our previous audit with a significant increase in the number of centres following national guidelines in antibiotic prescribing and offering test of cure in clinically indicated cases.
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Affiliation(s)
- G Sethi
- Jefferiss Wing, St Mary's Hospital, London W2 1NY, UK.
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Sethi G, Forster GE, Brook MG, Jones K, Daniels D, Horner PJ, Miller RF. Diagnosis of Chlamydia trachomatis in North Thames region 2003. Int J STD AIDS 2005; 15:829-30. [PMID: 15643697 DOI: 10.1258/0956462042563648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A multi-centre re-audit of tests used for chlamydia diagnosis in GU medicine clinic attendees from February 2003 to March 2003 in the North Thames region showed improvements since our previous audit in 1999, with a significant increase in the proportion of clinics using nucleic acid amplification tests and non-invasive testing.
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Affiliation(s)
- G Sethi
- Jefferiss Wing, St Mary's Hospital, London, W2 1NY, UK.
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Kawsar M, Anfield A, Walters E, McCabe S, Forster GE. Prevalence of sexually transmitted infections and mental health needs of female child and adolescent survivors of rape and sexual assault attending a specialist clinic. Sex Transm Infect 2004; 80:138-41. [PMID: 15054179 PMCID: PMC1744817 DOI: 10.1136/sti.2003.007252] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To determine the prevalence of sexually transmitted infections (STIs) and the mental health needs of female child and adolescent survivors of rape and sexual assault who were referred to a specialist genitourinary medicine (GUM) clinic. METHOD Retrospective case notes review of 98 females aged 16 or less, who attended over a 5 year period (1996-2000). RESULTS The overall prevalence of STIs was 26%. Among the girls who were aged 0-12 years (n = 16), one had gonorrhoea and another had Trichomonas vaginalis infection. Prevalence of STIs in those aged 13-16 years, who were not sexually active before the index assault, was 24% and in those who gave a history of previous consensual sexual activity it was 39% (p = 0.17). Chlamydial infection was more common among the girls who disclosed previous consensual sexual activity than in those did not disclose previous sexual activity (p = 0.012). The overall prevalence of vaginal candidiasis was 17% and bacterial vaginosis 13%. More than one third of the study population gave a history of previous sexual, physical, or other abuse. 81% reported having current psychological difficulties. Mood changes and sleep disturbances were reported more frequently than other psychological symptoms; 15% attempted self harm. All types of psychological difficulties, except mood changes, were not affected by the time interval between index assault and first presentation to the clinic and the type of assailant. 29% had no involvement with social and mental health services before their attendance at the clinic CONCLUSIONS The prevalence of STIs among female child and adolescent survivors of rape and sexual assault attending a specialist clinic was high. The range of mental health and social difficulties was wide and multiple. The importance of an early assessment for the presence of STIs and mental health difficulties was demonstrated.
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Affiliation(s)
- M Kawsar
- Department of Genitourinary Medicine, Luton and Dunstable Hospital NHS Trust, Lewsey Road, Luton LU4 0DZ, UK.
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Abstract
Our objective was to assess whether antibiotic prophylaxis should be offered to women post sexual assault by considering acceptability of prophylaxis, follow up attendance rates and the prevalence of sexually transmitted infections (STIs) in these women. Retrospective case notes review of female survivors of rape or sexual assault attending the Rose Clinic, Ambrose King Centre, Royal London Hospital between 1 January 1997 and 31 May 1999 was carried out. The following selection criteria were applied: age greater than 16 years; attending within two weeks of assault; having experienced vaginal and/or anal penetration. All women were screened for STI using standard investigation methods detailed below. Antibiotic prophylaxis was offered within two weeks of the assault, the antibiotic regimens used as recommended. The women were invited to attend for results at two weeks and offered a further screen at three months post assault. Bacterial vaginosis was present in 32% of the women screened, Chlamydia trachomatis was identified in 8%, none tested positive for Neisseria gonorrhoeae. Of the 25 women who were offered antibiotic prophylaxis, 88% accepted. Follow up attendances were 57% at two weeks and 30% at three months. Antibiotic prophylaxis was acceptable to women. Among recent rape victims, follow-up rates are low confirmed by our study. These factors support the use of antibiotic prophylaxis post sexual assault. There was an apparently high prevalence of STIs amongst women in this study. More research is required with respect to this aspect of the work and to consider the cost-benefit analysis of antibiotic prophylaxis.
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Affiliation(s)
- A M Gibb
- Department of GU Medicine, Ambrose King Centre, Royal London Hospital, Whitechapel, London E1 1BB, UK
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Khunda A, Kawsar M, Parkin JM, Forster GE. Successful use of valciclovir in a case of recurrent urticaria associated with genital herpes. Sex Transm Infect 2002; 78:468. [PMID: 12473820 PMCID: PMC1758364 DOI: 10.1136/sti.78.6.468] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- A Khunda
- Infection and Immunity Clinical Group, Barts and The London NHS Trust, UK.
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Dale AWS, Wilkinson C, Forster GE, Daniels D, Brook MG. Provision of Chlamydia trachomatis screening in family planning clinics and emergency contraception in genitourinary medicine clinics: a collaborative cross-speciality survey. J Fam Plann Reprod Health Care 2002; 28:185-8. [PMID: 12419057 DOI: 10.1783/147118902101196810] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Two surveys were undertaken to review (1) provision of Chlamydia trachomatis screening by family planning (FP) clinics in the London region and (2) access to emergency contraception (EC) from genitourinary#10; medicine (GUM) clinics within the former North Thames region. The findings from the first survey suggest that there is insufficient screening (and treatment) in vulnerable groups attending FP clinics. Results#10; from the second survey show that hormonal EC is widely available from within GUM clinics, and those clinics also provide a range of other contraception services. However, these details may not be widely#10; recognised either by policymakers or the general public. #10;
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Affiliation(s)
- A W S Dale
- Clinical Governance Support Unit, Camden & Islington CHS NHS Trust, St Pancras Hospital, London, UK.
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Abstract
OBJECTIVES To review the provision, uptake and outcome of HIV post-exposure prophylaxis (HIV-PEP) after sexual assault. METHODS A retrospective case note review of patients attending a sexual assault service in London during 1999. RESULTS Ten out of 150 patients were considered eligible for PEP after a careful risk assessment. Eight patients accepted HIV-PEP. Highly active antiretroviral therapy (HAART) consisted of Combivir/indinavir in six patients and Combivir/nelfinavir in two patients. Two patients changed their combination due to adverse events. Five patients completed the recommended 28 days of treatment. Three patients discontinued therapy due to adverse events. Two patients who completed HIV-PEP were noted to have raised cholesterol at follow-up. All patients who took PEP were HIV-1 and -2 antibody negative at six months. CONCLUSIONS Compared with other published studies the completion rate of HIV-PEP in our study was high. The uptake and adverse events of HAART in this scenario were similar to previously published studies. A multidisciplinary approach to the management of this patient group will improve adherence to PEP.
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Affiliation(s)
- S Limb
- Ambrose King Center, Department of Genitourinary Medicine, Royal London Hospital, Whitechapel, London E1 1BB, UK.
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Affiliation(s)
- M Garg
- Department of Genitourinary Medicine, Ambrose King Centre, Barts and The London NHS Trust, The Royal London Hospital, Whitechapel, London, UK.
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Dale AW, Wilson JD, Forster GE, Daniels D, Brook MG. Management of epididymo-orchitis in Genitourinary Medicine clinics in the United Kingdom's North Thames region 2000. Int J STD AIDS 2001; 12:342-5. [PMID: 11368810 DOI: 10.1258/0956462011923066] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A questionnaire survey and case notes audit reviewing management of epididymo-orchitis (E-O) by 34 Genitourinary Medicine (GUM) clinics located in the North Thames was undertaken. Twenty-two clinics (65%) returned completed questionnaires and audited a total of 83 newly diagnosed cases. All participating clinics offer microscopy of urethral smears and screening for Neisseria gonorrhoeae and Chlamydia trachomatis to all patients, regardless of age. However, greater numbers of clinics would offer routine microbiology of mid-stream urine (MSU) samples (20/22, 91% versus 16/22, 73%) and scrotal ultrasound (5/22, 23% versus 1/22, 5%) to patients aged over 35, compared with men under 35. Half of the cases audited were due either to sexually transmitted infections (STIs) (41/83, 49%), or associated with ascending urinary tract infections (4/83, 5%). No obvious infectious cause was identified for 38/83 cases (46%). Reported management was appropriate for the causative conditions diagnosed and accorded with the UK National Guidelines for this and related conditions.
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Affiliation(s)
- A W Dale
- Clinical Governance Support Unit, First Floor, East Wing, St Pancras Hospital, 4 St Pancras Way, London, UK
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Dale AW, Horner PJ, Forster GE, Daniels D, Tomlinson D, Brook MG. Management of Chlamydia trachomatis genital tract infection in Genitourinary Medicine clinics in the United Kingdom's North Thames Region 1999. Int J STD AIDS 2001; 12:204-8. [PMID: 11231875 DOI: 10.1258/0956462011916910] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Assessment of clinical management of Chlamydia trachomatis genital tract infection was made, with particular regard to the UK National Guideline. Questionnaires for self-completion, mailed to lead clinicians in 31 Genitourinary Medicine (GUM) clinics in the North Thames Region between May and June 1999, focused on policies and practice. Audit of actual management of up to 10 most recent cases (5 male and 5 female) attending each clinic within the past 2 years was also undertaken. Twenty-two units (71% response) completed the survey questionnaire and 23 units (74% response) audited a total of 229 cases (males=108, females=118, sex not stated=3). Findings indicate that GUM clinics are managing these infections largely as recommended in the national guideline. Nucleic acid amplification techniques will supersede established diagnostic tests for GUM clinics in North Thames, increasing costs for the service, but also sensitivity of detection.
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Affiliation(s)
- A W Dale
- North Thames Regional GU/HIV Audit Group, London, UK
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Lewis SA, Corden JM, Forster GE, Newlands M. Combined effects of aerobiological pollutants, chemical pollutants and meteorological conditions on asthma admissions and A & E attendances in Derbyshire UK, 1993-96. Clin Exp Allergy 2000; 30:1724-32. [PMID: 11122210 DOI: 10.1046/j.1365-2222.2000.00947.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The effect of outdoor aeroallergen exposure in asthma may be enhanced by air pollutants, including ozone, nitrogen dioxide and particulates, and by certain weather conditions. It is not yet established whether these interactions are important in determining asthma morbidity at the population level. OBJECTIVE We have investigated the joint effects of aeroallergens, rainfall, thunderstorms and outdoor air pollutants on daily asthma admissions and Accident and Emergency (A & E) attendance using routinely collected data between 1993 and 1996 from Derby in central England. METHODS Daily counts during the aeroallergen season of grass and birch pollen, basidiospores, Didymella, Alternaria and Cladosporium, maximum 1 hour ozone and nitrogen dioxide and daily average black smoke measurements, all made in the vicinity of the city centre, were categorized in tertiles. Rainfall was classified as dry, light (</= 2 mm) or heavy (> 2 mm). The modifying effect of outdoor pollutant levels, and rainfall or the occurrence of a thunderstorm, upon the effects of individual aeroallergens on asthma admissions and A & E attendance were investigated by fitting appropriate interactions in log linear autoregression models with adjustment for potential confounders. RESULTS We found a significant interaction between the effects of grass pollen and weather conditions upon A & E attendance, such that the increase with grass pollen count was most marked on days of light rainfall (adjusted rate ratio for >/= 50 vs < 10 grains/m3 at lag 2 days = 2.1, 95% CI 1.4, 3.3). Asthma admissions increased with Cladosporium count. We found no statistically significant interactions between effects of any individual aeroallergen and outdoor air pollutant upon either measure of asthma morbidity. CONCLUSIONS Rainfall and thunderstorms are important effect modifiers in the relation between grass pollen and measures of acute asthma morbidity. Interactions between ambient levels of aeroallergens and chemical pollutants in the Derby area do not play a major role in determining asthma admissions and A & E attendance.
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Affiliation(s)
- S A Lewis
- Division of Respiratory Medicine, University of Nottingham, City Hospital, Nottingham, UK
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Smith PR, Cavenagh JD, Milne T, Howe D, Wilkes SJ, Sinnott P, Forster GE, Helbert M. Benign monoclonal expansion of CD8+ lymphocytes in HIV infection. J Clin Pathol 2000; 53:177-81. [PMID: 10823134 PMCID: PMC1731162 DOI: 10.1136/jcp.53.3.177] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND A transient expansion of the CD8+ T cell pool normally occurs in the early phase of HIV infection. Persistent expansion of this pool is observed in two related settings: diffuse infiltrative lymphocytosis syndrome (DILS) and HIV associated CD8+ lymphocytosis syndrome. AIM To investigate a group of HIV infected patients with CD8+ lymphocytosis syndrome with particular emphasis on whether monoclonality was present. METHODS A group of 18 patients with HIV-1 infection and persistent circulating CD8+ lymphocytosis was compared with 21 HIV positive controls. Serum samples were tested for antinuclear antibodies, antibodies to extractable nuclear antigens, immunoglobulin levels, paraproteins, human T lymphotropic virus type 1 (HTLV-1), Epstein-Barr virus, and cytomegalovirus serology. Lymphocyte phenotyping and HLA-DR typing was performed, and T cell receptor (TCR) gene rearrangement studies used to identify monoclonal populations of T cells. CD4+ and CD8+ subsets of peripheral blood lymphocytes were purified to determine whether CD8+ populations inhibited HIV replication in autologous CD4+ cells. RESULTS A subgroup of patients with HIV-1 infection was found to have expanded populations of CD8+ T cell large granular lymphocytes persisting for 6 to 30 months. The consensus immunophenotype was CD4- CD8+ DRhigh CD11a+ CD11c+ CD16- CD28+/- CD56- CD57+, consistent with typical T cell large granular lymphocytes expressing cellular activation markers. Despite the finding of monoclonal TCR gene usage in five of 18 patients, there is evidence that the CD8+ expansions are reactive populations capable of mediating non-cytotoxic inhibition of HIV replication. CONCLUSIONS A subgroup of HIV positive patients has CD8+ lymphocytosis, but despite the frequent occurrence of monoclonal TCR gene usage there is evidence that this represents an immune response to viral infection rather than a malignant disorder.
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Affiliation(s)
- P R Smith
- Department of Genitourinary Medicine, Royal Hospitals NHS Trust, Whitechapel, London, UK
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Skinner CJ, Estcourt CS, Grant L, Forster GE. Prevention of pelvic infection: room for improvement. Int J STD AIDS 1999; 10:351. [PMID: 10361928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Crowe G, Theodore C, Forster GE, Goh BT. Acceptability and compliance with daily injections of procaine penicillin in the outpatient treatment of syphilis-treponemal infection. Sex Transm Dis 1997; 24:127-30. [PMID: 9132978 DOI: 10.1097/00007435-199703000-00002] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND In the United Kingdom, it is recommended that syphilis should be treated with intramuscular daily procaine penicillin with or without oral probenecid for 8 to 21 days. However, it has been argued that this regimen would be unacceptable to patients in terms of daily attendance and volume of drug administered, resulting in poor compliance. GOAL To assess the acceptability of and compliance with daily procaine penicillin for 10 to 17 days in patients attending an East London Genito-Urinary Medicine Clinic with a diagnosis of syphilis-treponemal infection. STUDY DESIGN The notes of 210 consecutive patients attending with syphilis-treponemal infection who had been offered treatment with daily procaine penicillin, with or without oral probenecid for 10 to 17 days, were reviewed retrospectively. RESULTS Of 210 patients who were offered daily procaine penicillin, 42 (20%) declined and were given oral doxycycline, amoxicillin, or depot penicillin injections. Of 168 patients who accepted daily procaine penicillin, depending on the stage of infection, 90 (54%) had 1.8 g of daily procaine penicillin together with oral probenecid 500 mg every 6 hours for 17 days (high-dose regimen), 57 (34%) had 0.6 g of daily procaine penicillin for 10 to 17 days (low-dose regimen), and 21 (12%) had mixed-dose regimens ranging from 0.5 to 2.4 g. Of the 90 who had high-dose regimen, 76 (84%) complied with treatment compared with 50 (88%) of 57 who had low-dose regimen. All 21 patients who had mixed-dose regimens complied fully. CONCLUSIONS Daily procaine penicillin is a well-accepted out-patient regimen with excellent compliance (88% overall) and minimal side effects. Because the high-dose regimen has been shown to achieve treponemicidal levels of penicillin in the cerebrospinal fluid, it is recommended for patients with neurosyphilis or those in whom neurosyphilis cannot be excluded. It also could be considered for patients with concomitant human immunodeficiency virus infection in view of the possible progression to neurosyphilis in those treated with depot penicillin.
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Affiliation(s)
- G Crowe
- Ambrose King Centre, Department of Genito-Urinary Medicine, Royal London Hospital, Whitechapel
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Hillman RJ, Beck EJ, Mandalia S, Satterthwaite H, Rogers PA, Forster GE, Goh BT. Survival and treatment of AIDS patients 1984-1993: experience of a smaller east London HIV centre. Genitourin Med 1997; 73:44-8. [PMID: 9155555 PMCID: PMC1195759 DOI: 10.1136/sti.73.1.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To assess changes in survival from diagnosis of AIDS for patients managed in a small East London HIV clinic and the impact of therapeutic interventions on these survival patterns. DESIGN Prospective observational study. SETTING Grahame Hayton Unit, Royal London Hospital. SUBJECTS 156 AIDS patients managed between 1984 and 1993. MAIN OUTCOME MEASURE Survival from diagnosis of AIDS. RESULTS Median survival for those diagnosed with AIDS before 1 January 1987 was 9.4 months compared with 27.2 months after 1 January 1987 (logrank chi 2 = 10.3, p = 0.001): CD4 count at time of AIDS and treatment with zidovudine or PCP prophylaxis were significantly associated with survival from time of AIDS. Of the 156 AIDS patients, 93 had been treated with zidovudine sometime during their follow up, 60 had received primary and 50 secondary Pneumocystis carinii pneumonia (PCP) prophylaxis. After controlling for gender, sexual orientation, age at time of AIDS, CD4 count at time of AIDS, diagnosis when first presenting to the clinic (AIDS/non-AIDS) and year of AIDS diagnosis, all patients who received either zidovudine or PCP prophylaxis had significant reductions in the risk of dying compared with those who received neither PCP prophylaxis nor zidovudine: a reduction in risk of dying between 71% (95% CI 40% to 86%) and 83% (95% CI 50% to 94%) was observed depending on the combination of zidovudine and PCP prophylaxis. CONCLUSION A debate is currently taking place about the format and value of HIV service provision with increasing numbers of HIV infected individuals managed at smaller HIV clinics. Larger clinics concentrate clinical expertise on a single site and facilitate clinical trials. Smaller well run HIV units staffed by competent health professionals not only provide clinical outcomes similar to those obtained in the larger centres, but may also allow a more informal and intimate setting for HIV infected individuals who want to be treated nearer their area of residence.
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Affiliation(s)
- R J Hillman
- Grahame Hayton Unit, Ambrose King Centre, Royal London Hospital, Whitechapel, UK
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Lewis DA, Ison CA, Forster GE, Goh BT. Tetracycline-resistant Neisseria gonorrhoeae. Characteristics of patients and isolates at a London Genitourinary Medicine Clinic. Sex Transm Dis 1996; 23:378-83. [PMID: 8885068 DOI: 10.1097/00007435-199609000-00006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To compare auxotypes, serovars, and antibiograms of tetracycline-resistant Neisseria gonorrhoeae (TRNG) and non-TRNG isolated from patients attending an East London Genitourinary Medicine (GUM) Clinic. To obtain plasmid profiles for penicillinase-producing gonococci (PPNG) as well as presumptive TRNG. To identify differences in patient characteristics for the TRNG and non-TRNG patient groups. STUDY DESIGN Gonococcal isolates were collected from 400 patients attending the GUM clinic at the Royal London Hospital GUM Clinic over a 1-year period. Isolates (378) were tested for susceptibility to various antibiotics, auxotyped, and serotyped. Plasmid profiles were obtained for PPNG and isolates exhibiting high-level tetracycline resistance (TRNG). The presence of the tet M determinant was confirmed using the polymerase chain reaction (PCR). The PCR product was digested with the restriction endonuclease (RE) Hpa II and electrophoresed on a 2.5% agarose gel to determine an "RE pattern." Patient data were collected by retrospective case-note review. RESULTS TRNG (n = 42) accounted for 11% of the 378 isolates tested, and the remaining 336 (89%) isolates were non-TRNG. Non-requiring auxotrophy and P1B-2 serovar expression occurred more frequently among TRNG. PPNG accounted for 31% of TRNG and 5% of non-TRNG. Chromosomal resistance to penicillin (CMRNG) was absent among TRNG but accounted for 11% of non-TRNG. One TRNG isolate showed decreased susceptibility to ciprofloxacin (MIC 0.25 mg/l). All isolates were sensitive to cefotaxime, cefixime, spectinomycin, and azithromycin. All TRNG possessed the 25.2 MDa plasmid and produced a PCR product of appropriate size after tet M gene sequence amplification. RE digests of the PCR product gave a single pattern. None of the TRNG in contrast to 18% of the non-TRNG were acquired homosexually. Ethnic distribution differed between the patients with TRNG and patients without non-TRNG (Afro-Caribbean 81% versus 58%; white 19% versus 36%). Most TRNG were acquired in the United Kingdom. CONCLUSIONS TRNG differ from the non-TRNG in their auxotype and serovar distribution. PPNG are more common among the TRNG isolates, whereas CMRNG appear absent. TRNG are isolated more commonly from Afro-Caribbean patients and were not represented among homosexually acquired isolates.
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Affiliation(s)
- D A Lewis
- Department of Medical Microbiology, Royal London Hospital, United Kingdom
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Abstract
OBJECTIVES To evaluate and compare the range of genital infections diagnosed in a group of lesbians attending an inner city genitourinary clinic with a control group of heterosexual women attending the same clinic. SETTING The Ambrose King Centre, the Royal London Hospital, a genitourinary clinic within which the Audre Lorde Clinic, a specialist sexual health clinic for women identifying as lesbians, is operated. SUBJECTS Two hundred and forty one women attending the specialist clinic between October 1993 and September 1994. Heterosexual controls matched for age and ethnicity were selected from the same time period. METHODS A retrospective case note analysis was made of 241 lesbians and 241 matched heterosexual controls. Data were collected on age, ethnicity, symptoms, diagnoses and services used. RESULTS An infection was diagnosed in 129 (65%) of the lesbians and 126 (62%) of the heterosexual women. Only 23 (10%) of the lesbians exclusively practised same gender sexual contact. Genital herpes (p = 0.05) and genital warts (p = 0.005) were more common in the heterosexual women. Gonorrhoea and chlamydia infection were infrequent diagnoses in both groups, occurring in four (2%) lesbians and 14 (7%) heterosexuals (p = 0.05). Bacterial vaginosis occurred in 65 (33%) of the lesbians and 27 (13%) of the heterosexuals (p < 0.0001). Cervical cytology abnormalities were uncommon but only found in the lesbians. CONCLUSIONS Screening for genital infections in lesbians is appropriate. The high prevalence of bacterial vaginosis in this group is unexplained but suggests a possible sexual transmission. Lesbians should be included within the cervical cytology screening programme.
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Affiliation(s)
- C J Skinner
- Ambrose King Centre, Royal London Hospital, Whitechapel, UK
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Abstract
OBJECTIVE To assess the indications for usage of emergency hormonal contraception amongst a population of London genitourinary medicine clinic attenders. METHODS In a prospective study, 150 consecutive women receiving emergency hormonal contraception (EHC) were enrolled. The attending doctor completed a questionnaire of patient details and prescribed EHC with prophylactic prochlorperazine. Follow-up was arranged three weeks later, at which time outcomes and side-effects of therapy were recorded. For those women who did not reattended as planned case notes were reviewed at three months. RESULTS Of 150 women surveyed, 100 (66%) reported contraceptive method failure, 48 (32%) had used no contraception at the time of last sexual intercourse and two requested EHC after sexual assault. Ninety three (62%) reported condom failure, 7 (5%) oral contraceptive pill failure. Seventy five (50%) had used EHC before (range 1-10 times). Seventy one (47%) women reattended within three months. Five (3.3%) of the 150 women were pregnant; none of these cases had experienced nausea or vomiting whilst taking EHC. Side-effects were reported by 22 (31%) of the 71 patients who reattended. Nine (6%) women had been followed-up in the family planning advisory clinic. Of the 71 women who reattended, 39 (55%) reported that their preferred future method of contraception would be condoms. Of the 150 women 19 (13%) underwent tests for sexually transmissible infections within one month of presentation. CONCLUSIONS EHC usage in this population was associated with a failure rate of at least 3.3% and an overall side effect rate of 31%. Despite requests for emergency contraception because of condom failure many elected to continue using condoms as their preferred method of contraception. The majority of women (53%) did not return for follow-up or family planning advice, and so we believe that future contraceptive plans must be addressed at the time EHC is prescribed.
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Affiliation(s)
- J K Evans
- Ambrose King Centre, Royal London, Hospital, Whitechapel, UK
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Affiliation(s)
- C Crowe
- Department of Genito-Urinary Medicine, Royal Victoria Hospital, Belfast, Ireland, UK
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Abstract
A retrospective study of 55 HIV-1 seropositive African patients living in the UK, seen between January 1986 and November 1993, showed a total of 26 (47%) patients with AIDS. Thirty-one (56%) had symptomatic HIV disease at the time of presentation of whom 19 (34.5%) had an AIDS defining condition. Tuberculosis was the most common AIDS defining illness, accounting for 27% of all initial AIDS diagnoses, followed by by Pneumocystis carinii pneumonia and oesophageal candidiasis in 19% each and chronic mucocutaneous genital herpes in 15%. The mean CD4 count at the time of the first AIDS defining event was 91 x 10/mm3 (range 4-320 x 10/mm3). The profile of AIDS defining illnesses was different to published data of homosexual men and injecting drug users in the UK. This has practical implications when considering differential diagnoses and screening as well as prophylaxis for opportunistic infections in this group of patients.
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Affiliation(s)
- J Del Amo
- Ambrose King Centre, Department of Genitourinary Medicine, Royal London Hospital, Whitechapel, UK
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Crowe G, Harris CJ, Forster GE, Goh BT. Integrating pharmacy into the primary care team. "One stop clinic" has advantages for patients. BMJ 1995; 311:753. [PMID: 7549718 PMCID: PMC2550751 DOI: 10.1136/bmj.311.7007.753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Ramasubramanian V, Sampson M, Forster GE, Goh BT. Falling prevalence of Chlamydia trachomatis infection--an alternative explanation. Int J STD AIDS 1995; 6:368-9. [PMID: 8547426 DOI: 10.1177/095646249500600518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Lewis DA, Forster GE, Goh BT. The falling accuracy of microscopy in the diagnosis of gonorrhea--a cause for concern? Genitourin Med 1995; 71:136. [PMID: 7744413 PMCID: PMC1195478 DOI: 10.1136/sti.71.2.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Evans JK, McOwan A, Hillman RJ, Forster GE. Incidence of symptomatic urinary tract infections in HIV seropositive patients and the use of cotrimoxazole as prophylaxis against Pneumocystis carinii pneumonia. Genitourin Med 1995; 71:120-2. [PMID: 7744401 PMCID: PMC1195467 DOI: 10.1136/sti.71.2.120] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES To determine the incidence of symptomatic urinary tract infections in HIV seropositive patients and to assess whether this varies with stage of disease, risk group or the use of co-trimoxazole as prophylaxis against Pneumocystis carinii pneumonia. METHODS A retrospective case note review of 175 HIV-infected patients attending The Royal London Hospital between July 1988 and December 1992 was performed. A urinary tract infection was defined as a pure culture of > or = 10(5) colony forming units in a mid-stream specimen of urine from a patient with symptoms consistent with a urinary tract infection. RESULTS Urinary tract infections occurred in 10 (5.7%) of 175 patients, with an incidence of 1.49 per hundred patient years. Urinary tract infections were significantly more common in patients with AIDS or a CD4 lymphocyte count below 0.2 x 10(9)/l (or both) when compared to those without AIDS and a CD4 lymphocyte count above 0.2 x 10(9)/l (5.4 vs. 0.5 urinary tract infections per hundred patient years, p = 0.00005). Women with AIDS or a CD4 count below 0.2 x 10(9)/l (or both) had an incidence of urinary tract infection of 18.5 per hundred patient years. No significant difference was found between the incidence of urinary tract infections in those taking co-trimoxazole as Pneumocystis carinii pneumonia prophylaxis and those taking alternative or no prophylaxis (2.6 vs 6.4 per hundred patient years, p = 0.39). CONCLUSIONS Urinary tract infection represents a considerable health problem amongst HIV infected patients. Our data show that urinary tract infections are more common in patients with advanced compared with early HIV infection. Cotrimoxazole, when taken by patients as prophylaxis against Pneumocystis carinii pneumonia did not appear to reduce the incidence of urinary tract infection.
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Affiliation(s)
- J K Evans
- Ambrose King Centre, Royal London Hospital, UK
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Abstract
A prospective study was carried out to assess the value of routine skin tuberculin testing and chest radiography in HIV seropositive patients, attending the Genitourinary Medicine (GUM) clinic between July 1991-May 1992. 144 consecutive HIV seropositive patients had tuberculin Tine tests and chest radiographs performed. Ten patients were treated for active tuberculosis (TB) on the basis of abnormal radiography with or without strongly positive (Grade 3/4) skin tuberculin tests. A further 10 patients received prophylaxis on the basis of abnormal chest radiography consistent with previous tuberculous infection or strongly positive tuberculin tests. Active or previous tuberculous infection was found in the UK born Caucasian homosexual population as well as in injecting drug users and patients who were born in areas of high TB prevalence. Screening for TB in HIV seropositive patients is important both for detecting asymptomatic tuberculous infection and for recognizing patients at risk for reactivation of latent TB. We showed a high pick-up rate with 20 out of 144 patients having treatment as a result of screening.
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Affiliation(s)
- C M Theodore
- Department of Genitourinary Medicine, Royal London Hospital, UK
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31
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Lewis DA, Forster GE, Goh BT. Ciprofloxacin resistant gonococci arriving from Thailand. Genitourin Med 1994; 70:360. [PMID: 8001957 PMCID: PMC1195289 DOI: 10.1136/sti.70.5.360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Forster GE. STDs and the sexual abuse of children. Br J Hosp Med (Lond) 1994; 51:206-8. [PMID: 8038920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Affiliation(s)
- B T Goh
- Ambrose King Centre, Royal London Hospital, London, UK
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Sheldon CD, Middleton GW, Hughes DT, Forster GE. Rapid pulmonary cavitation due to Mycobacterium tuberculosis and infection with human immunodeficiency virus (HIV 1). Postgrad Med J 1992; 68:302-3. [PMID: 1409205 PMCID: PMC2399279 DOI: 10.1136/pgmj.68.798.302-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Affiliation(s)
- S Estreich
- Department of Genitourinary Medicine, St Helier Hospital, Carshalton, Surrey
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39
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Forster GE, Estreich S. STDs and rape. Int J STD AIDS 1991; 2:217. [PMID: 1863656 DOI: 10.1177/095646249100200320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Courtney G, Estreich S, Forster GE. Sexual assault of men: a series. Genitourin Med 1991; 67:175. [PMID: 2032714 PMCID: PMC1194660 DOI: 10.1136/sti.67.2.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Forster GE, Estreich S, Hooi YS. Screening for STDs. Ann Emerg Med 1991; 20:324-5. [PMID: 1996836 DOI: 10.1016/s0196-0644(05)80956-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Abstract
From 1 January 1986 to 1 September 1989 124 women presented to the Ambrose King Centre (the department of genitourinary medicine of the London Hospital) alleging rape. Sexually transmitted diseases were found in 36 (29%) women (excluding candidosis and bacterial vaginosis). The commonest organisms detected were Neisseria gonorrhoeae and Trichomonas vaginalis, each being present in 15 patients. Eleven women had genital warts. Chlamydia trachomatis was isolated in six patients, two had herpes simplex virus infection and one patient had pediculosis pubis. Serological evidence of past hepatitis B infection was detected in five women and one patient had antibodies to human immunodeficiency virus. Eighteen of the 36 women (50%) had multiple infections. Six women had abnormal cervical cytology smears, three being suggestive of cervical intraepithelial neoplasia grades II-III. Although it is rarely possible to attribute infection to an assailant, these patients require further counselling, treatment and review. Rape victims are thus a population at risk of having sexually transmitted diseases and screening should be offered.
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Affiliation(s)
- S Estreich
- Ambrose King Centre, Royal London Hospital, UK
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44
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Goh BT, Forster GE. Choice cuts for patients with AIDS? BMJ 1990; 301:816. [PMID: 2224277 PMCID: PMC1663930 DOI: 10.1136/bmj.301.6755.816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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45
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Forster GE, Estreich S. Sexually transmitted diseases and rape. Int J STD AIDS 1990; 1:366. [PMID: 2098156 DOI: 10.1177/095646249000100515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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46
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Powell K, Middleton GW, Forster GE. Chlamydia trachomatis in infants: a prospective study. Arch Dis Child 1990; 65:336. [PMID: 2334228 PMCID: PMC1792310 DOI: 10.1136/adc.65.3.336-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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49
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Middleton GW, Forster GE. Treating chancroid: summary of studies in South Africa. Genitourin Med 1989; 65:348. [PMID: 2583721 PMCID: PMC1194393 DOI: 10.1136/sti.65.5.348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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50
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Goh BT, Jawad AS, Chapman D, Winceslaus SJ, Forster GE, Perry JD. Osteomyelitis presenting as a swollen elbow in a patient with the acquired immune deficiency syndrome. Ann Rheum Dis 1988; 47:695-6. [PMID: 3415369 PMCID: PMC1006725 DOI: 10.1136/ard.47.8.695] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A patient suffering from the acquired immune deficiency syndrome (AIDS), who developed swelling of the left elbow four weeks after Staphylococcus aureus septicaemia is reported. The cause was osteomyelitis of the olecranon process.
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Affiliation(s)
- B T Goh
- Whitechapel Clinic, London Hospital
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