In the UK, despite its low sensitivity, wet mount microscopy is often the only method of detecting Trichomonas vaginalis infection. A study was conducted in symptomatic women to compare the performance of five methods for detecting T. vaginalis: an in-house polymerase chain reaction (PCR); Aptima T. vaginalis kit; OSOM ®Trichomonas Rapid Test; culture and microscopy. Symptomatic women underwent routine testing; microscopy and further swabs were taken for molecular testing, OSOM and culture. A true positive was defined as a sample that was positive for T. vaginalis by two or more different methods. Two hundred and forty-six women were recruited: 24 patients were positive for T. vaginalis by two or more different methods. Of these 24 patients, 21 patients were detected by real-time PCR (sensitivity 88%); 22 patients were detected by the Aptima T. vaginalis kit (sensitivity 92%); 22 patients were detected by OSOM (sensitivity 92%); nine were detected by wet mount microscopy (sensitivity 38%); and 21 were detected by culture (sensitivity 88%). Two patients were positive by just one method and were not considered true positives. All the other detection methods had a sensitivity to detect T. vaginalis that was significantly greater than wet mount microscopy, highlighting the number of cases that are routinely missed even in symptomatic women if microscopy is the only diagnostic method available.

Cervical cancer during pregnancy is rare, occurring in approximately 3% of cervical cancer cases. Considerable controversy exists as to the long-term prognosis of patients diagnosed during pregnancy. A 32-year-old female presented with vaginal spotting in April 1998. A prenatal smear in December 1996 revealed atypical glandular cells of undetermined significance. A sterile speculum exam in April 1997 at 31-week gestational age revealed a polyp on the anterior lip of the cervix, pathology consistent with a well-differentiated villoglandular adenocarcinoma. In August 1997, the patient underwent a radical hysterectomy with pelvic/para-aortic lymphadenectomy. In April 2001, she represented with nodular perineal mass in the episiotomy incision. She received preoperative radiotherapy with a near-complete response and remained without disease for >10 months. It appears that a less radical procedure can offer significant therapeutic value. Preoperative radiotherapy proved effective at achieving a near-complete response. The patient underwent a wide local excision of the perineal area with resultant negative margins.

Pipelle, and the tissue was split for microbiological and histological assessment. Cultivated microorganisms were identified using phenotypic and genotypic characteristics. Fisher's exact tests were used to assess the association between microorganisms and endometritis (plasma cells ± neutrophils). Results Of 136 women with clinical PID, 55 (40%) had histologic evidence of endometritis, and endometrial GC and/or CT was associated with endometritis (29% vs. 6%, P < 0.001). In addition to STIs, a broad range of bacteria representing 63 different species were recovered from 53 (39%) of the endometrial biopsy samples, including 8 novel species. The recovery of any non-GC/non-CT organisms from the endometrium was associated with histologic endometritis (53% vs. 30%, P = 0.008). Both G. vaginalis (35% vs. 16%, P = 0.01) and A. vaginae (22% vs. 3%, P < 0.001) were associated with histologic endometritis. Other anaerobic bacteria associated with bacterial vaginosis including Prevotella timonensis, P. amnii and Peptoniphilus harei were also more frequent in the endometrium of women having endometritis (11% vs. 3%, P = 0.06) but this did not reach statistical significance. After excluding women having GC and/or CT, A. vaginae was still independently associated with endometritis (17% vs. 3%, P = 0.03). Conclusions Health Protection Agency, London, UKBackground TV is the most common non-viral STI in the world. Despite this, TV infection in UK Genitourinary clinics is mainly (and often exclusively) diagnosed by wet mount microscopy alone. Microscopy is known to have a low and variable sensitivity and therefore greatly underestimates the true prevalence of TV infection. Objectives A clinical trial was conducted to evaluate the performance of five methods for detecting TV: an in-house PCR; the Aptima TV kit; the OSOM Trichomonas Rapid Test (POCT); culture and microscopy to diagnose infection in symptomatic women. The results of the study were used to power a financial model for clinical implementation of a molecular test. Methods Symptomatic women were recruited for testing. Results and resource costs from the study were extrapolated to calculate the cost of implementing POCT and in house PCR compared to wet mount microscopy in the clinic. Results A composite reference standard of 2 more or more positives was used. 246 women were recruited of which 24 had a positive test by 2 or more of the 5 methods. Aptima TV kit, POCT, Real-time PCR and culture (sensitivities 92, 92, 88 and 88%) all out performed wet-mount microscopy (sensitivity 38%). The prevalence based on two tests as reference standard was 9.75%. Conclusions Cost modelling showed although initial outlay costs for PCR and POCT were high, savings were made in labour costs. PCR and POCT would improve the rate of TV diagnosis in this group and therefore reduce repeat visits due to false positive results. PCR requires additional clinical time for recalling the patient for a further visit to give a positive result, treatment and contact tracing. Implementation of newer test...

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THERE is a well-known saying of Lord Kelvin that "When you can measure what you are speaking about and express it in numbers, you know something about it, but when you cannot measure it, when you cannot express it in numbers, your knowledge is of a meagre and unsatisfactory kind." Those who were interested in mortality in the seventeenth, eighteenth and early nineteenth centuries were in the unsatisfactory situation which Kelvin had in mind; they could not measure what they were speaking about. The means of measurement were provided outstandingly by William Farr, who "found medical statistics in such a state that only men of genius like Graunt could use them at all without reaching false conclusions, and when he [Farr] retired from the public service, left them so organized and arranged that any reasonably intelligent man could draw accurate conclusions from thern'Yl), On the foundations laid by Farr many men have built. It is unnecessary-indeed, it would be inappropriate-for me to attempt to trace the development of mortality statistics down to the present day. I hope, however, that I may take this opportunity of referring to the work of the present Medical Statistician of the General Register Office, Dr. Percy Stocks, upon whose studies in mortality statistics so much reliance is placed by all whose work requires them to venture into this field. An immense amount of information, remarkably detailed when one realizes the small number of facts which are recorded on death certificates, has been and still is extracted by Dr. Stocks year after year, and the tables he produces have formed the basis of published works by many people-and perhaps one or two reputations.Mortality statistics, however, greatly as they have grown in accuracy and in range of detail in the past century, do not and, by definition, cannot remain the only source of knowledge concerning the prevalence of disease in the community. They are the most selective of all medical statistics in the sense that they relate only to illnesses and injuries which have a fatal issue, and these are but a tiny proportion (perhaps not one-half of one per cent.) of the gross total of separate illnesses and injuries suffered by the population as a whole during a single calendar year. Moreover, the prevalence of fatal illness or injury among the older members of the population is relatively much greater than it is among the young and the middle-aged: the risk of a fatal issue must increase (for many diseases) with advancing years. Mortality statistics, therefore, are "overloaded" in the upper age-brackets. They are probably overloaded in the lowest age-brackets; also, since the newborn have at least one thing in common with the aged, namely, both are separated by many years from their prime of life. In particular (if a single point of detail may be raised here), mortality statistics bearing upon the occupational distribution of disease are subject to a special disability. Many old people-I do not know how many-at the time of death are following occupations quite diffe...