The emergence of a clonal group of gonococci showing decreased susceptibility to cefixime in England and Wales highlights the need for continued surveillance.

Successful treatment of gonorrhoea is the mainstay of public health control. Cefixime and ceftriaxone, highly active third generation cephalosporins, are today the recommended first-line agents in most countries and azithromycin is a second-line agent. However, there is increasing evidence of decreasing susceptibility and emergence of therapeutic failures. In this report two cases of clinical failure to cefixime are described, one of which additionally shows failure to azithromycin and selection of a less susceptible strain during treatment.

Recent increases in the incidence of early infectious syphilis have been particularly noted in men who have sex with men (MSM). Case-notes of 40 consecutive patients with infectious syphilis and follow-up data for one year were audited. Of the 40 patients, six were HIV co-infected. In all, 31 men received benzathine penicillin as first line while the remaining had other treatments. About 17 (42.5%) failed to attend for any post-treatment serological tests. Of the remainder, 17 (42.5%) attended for the first appointment and only 13 (32.5%) attended for the full one year follow-up. In all, 40 men in the study had 362 sexual contacts of which only 44 (12.2%) elected to be screened. This study illustrates the successful use of benzathine penicillin as first-line treatment, lack of patient compliance with post-treatment serological follow-up and difficulty with partner notification.

An audit of outcomes from the first year of implementation of a super-accelerated hepatitis B vaccination schedule was performed. One hundred and sixteen patients commenced vaccination for hepatitis B in the study period. All notes were located and reviewed. In all, 72.4% of patients completed three vaccinations compared with 61.5% in an earlier period using the old schedule. Serological response for 39 patients was measured at approximately 12 weeks post commencement of vaccination. Of these 69.2% had mounted some serological response, 48.7% a good response. As expected, a faster vaccination schedule improves completion rates for the first three injections. Early serological responses are encouraging and comparable to published data for new schedule vaccination responses at 12 weeks. It is anticipated that serological response will continue to improve over the year before a booster dose of hepatitis vaccination is due.

Objective To elicit the level of knowledge, training and preferences of men in relation to Testicular Self Examination (TSE). Setting The Genito Urinary Medicine (GUM) department of a large teaching hospital in the North East of England. The open access clinic serves patients from Newcastle upon Tyne, Northumberland, Gateshead and surrounding areas. Newcastle is a city with two universities and therefore a large student population. We sought to estimate the current knowledge and practice of Testicular Self Examination amongst men attending a large Genito Urinary Medicine Clinic and ascertain whether they performed TSE, if they could articulate the signs or symptoms of testicular cancer, whether they felt instruction on TSE was necessary and who, if anyone, should provide training. This information was obtained using a simple questionnaire distributed to all new male patients attending GUM at Newcastle General Hospital, during a 12-week period in early 2006. Results demonstrated that only 67 (8%) of the men performed TSE as recommended in health education leaflets (monthly) with 576 (67%) carrying it out on a random basis. In total, 980 (98%) of the men felt that all men should be given instruction on TSE, with 59 per cent stating that school was the most appropriate place to receive the training.Whilst almost all men were aware that testicular lumps may be a sign of testicular cancer, few were able to identify any other potential signs or symptoms.