Objectives To investigate the psychosocial impact for women of a diagnosis of Chlamydia trachomatis and discuss the implications for the proposed UK chlamydia screening programme. Design Qualitative study with semistructured interviews. Interview transcripts analysed to identify recurrent themes. Participants Seventeen women with a current or recent diagnosis of chlamydia. Setting A family planning clinic and a genitourinary medicine clinic in Glasgow.

BackgroundPreventative medicine has become increasingly important in efforts to reduce the burden of chronic disease in industrialised countries. However, interventions that fail to recruit socio-economically representative samples may widen existing health inequalities. This paper explores the barriers and facilitators to engaging a socio-economically disadvantaged (SED) population in primary prevention for coronary heart disease (CHD).MethodsThe primary prevention element of Have a Heart Paisley (HaHP) offered risk screening to all eligible individuals. The programme employed two approaches to engaging with the community: a) a social marketing campaign and b) a community development project adopting primarily face-to-face canvassing. Individuals living in areas of SED were under-recruited via the social marketing approach, but successfully recruited via face-to-face canvassing. This paper reports on focus group discussions with participants, exploring their perceptions about and experiences of both approaches.ResultsVarious reasons were identified for low uptake of risk screening amongst individuals living in areas of high SED in response to the social marketing campaign and a number of ways in which the face-to-face canvassing approach overcame these barriers were identified. These have been categorised into four main themes: (1) processes of engagement; (2) issues of understanding; (3) design of the screening service and (4) the priority accorded to screening. The most immediate barriers to recruitment were the invitation letter, which often failed to reach its target, and the general distrust of postal correspondence. In contrast, participants were positive about the face-to-face canvassing approach. Participants expressed a lack of knowledge and understanding about CHD and their risk of developing it and felt there was a lack of clarity in the information provided in the mailing in terms of the process and value of screening. In contrast, direct face-to-face contact meant that outreach workers could explain what to expect. Participants felt that the procedure for uptake of screening was demanding and inflexible, but that the drop-in sessions employed by the community development project had a major impact on recruitment and retention.ConclusionSocio-economically disadvantaged individuals can be hard-to-reach; engagement requires strategies tailored to the needs of the target population rather than a population-wide approach.

Background: A stigma is a pejorative social label. Stigmatisation is a process by which individuals are made to experience isolation and reduced opportunities in life. Some diseases are particularly associated with stigmatising attitudes; this applies particularly to sexually transmitted infections. Although several studies report the eVects of stigma, no study to date has attempted to investigate its nature, which is a prerequisite to designing health interventions. Methods: This qualitative, exploratory study investigated the experience of stigma among young women recently diagnosed with an STI and considered the implications of these experiences in terms of maximising access to GUM clinics. Results: Three themes were identified from interviews undertaken with women recruited in family planning and genitourinary medicine (GUM) clinics: the perception of STIs as a condition of "others," the threatening nature of the GUM clinic, and the evolution of the experience of stigma within the GUM clinic. Conclusion:More open discussion and education about sexual health services and STIs should take place at a general population level; awareness of sexual health services should be raised in inclusive ways, which are seen as relevant to the needs of a wide range of individuals; medical, nursing, and counselling staV in GUM clinics should be supported in their eVorts to reduce the experience of stigma. Finally, future interventions designed to improve access to sexual health services should formally assess their impact on stigma. (Sex Transm Inf 2001;77:340-343)

and the likelihood of finding healthy elderly people colonised with MRSA is relatively small. Carriage of MRSA can, however, be expected in patients who have chronic conditions or who have had recent admissions to hospital. MRSA in the community seems to be a consequence of a "spill over" of an uncontrolled hospital epidemic, and the few isolates found in the community are classic hospital strains. It continues to be safe to treat community acquired S aureus infections in England with conventional antistaphylococcal agents effective against methicillin sensitive strains, and third line antibiotics should be considered only when typical risk factors can be ascertained.Contributors: HG designed and coordinated the study. AT took part in every aspect of the study and carried out the statistical analysis. SH and MH carried out the bacteriological investigations and the genetic typing. All authors were involved in collecting samples and recording data. RS coordinated the general practitioner and community participation. HG wrote the manuscript and was supported by AT and RS in the final draft. HG and RS are the guarantors.Funding: The study was supported by a grant from Nottingham Health Authority.Competing interests: None declared. Recurrence rates, viral shedding, and the mode of acquiring HSV-1 infection are different from those for HSV-2, so counselling and clinical management strategies may need to be revised. We studied longitudinal trends in laboratory reports of genital HSV-1 infection. Methods and resultsThe West of Scotland Specialist Virology Centre processes 99% of all herpes simplex virus culture samples in the region. All genital samples of herpes simplex processed between 1 January 1986 and 31 December 2000 were reviewed for source of referral, patient's sex and age (stratified into seven bands: <20, 21-25, 26-30, 31-35, 36-40, 41-45, and > 45 years), and the type of virus isolated.Samples were cultured and then typed using fluorescein labelled monoclonal antibodies to HSV-1 and HSV-2 (Syva Microtrak). From January 1999, the virus was detected and typed using a polymerase chain reaction method and restriction fragment length polymorphism. 2 The referral patterns and age and sex profiles of patients did not change during the period of analysis.We compared the proportion of HSV-1 in all positive swabs between sexes and ages using 2 tests, and over the three year time bands by the Cochran Armitage trend test (both overall and within four subgroups with age categorised as <25 years or > 25 years for each sex) using SAS 8.2.Of 10 547 swabs, the virus was identified in 3181 (30%); 3126 were typed, 1530 (49%) as HSV-1 and 1596 (51%) as HSV-2. Of the swabs testing positive for HSV, 2004 (63%) were from women and 1177 (37%) were from men. Age was recorded for 3099 (97.4%) patients, with 555 (18%) aged <20, 885 (29%) aged 21-25, 686 (22%) aged 26-30, 413 (13%) aged 31-35, 239 (8%) aged 36-40, 159 (5%) aged 41-45, and 162 (5%) aged > 45 years. The origin of the request to detect the virus was recorded for 10 47...

Background: Polymerase chain reaction (PCR) has well established advantages over culture for diagnosis of herpes viruses, but its technical complexity has limited its widespread application. However, recent methodological advances have rendered PCR more applicable to routine practice. Aim: To compare automated PCR with viral culture for diagnosis of genital herpes. Methods: We studied 236 patients presenting with clinical features suggestive of genital herpes at an inner city genitourinary medicine clinic. Two swabs were taken from each patient. Cell culture and typing were performed by standard methods. Automated PCR was performed using the LightCycler instrument and the infecting viral type was determined by restriction endonuclease digestion of amplicons. Results: 109 patients (46%) had a positive test for herpes simplex virus (HSV). In 88, both PCR and culture were positive; in 21 PCR only was positive. With both detection methods, lesion duration and morphology were associated with HSV detection. Compared with culture alone, use of PCR increased sensitivity by 13.3% in specimens from vesicular lesions, by 27.4% from ulcerative lesions, and by 20.0% from crusting lesions. Conclusions: We advocate adoption of automated PCR as an efficient HSV detection and typing method for diagnosis of genital herpes in routine clinical practice. PCR allowed rapid laboratory confirmation of the diagnosis and increased the overall HSV detection rate by 24%.