This retrospective study was undertaken to evaluate the prevalence of the viral types and temporal epidemiology in patients with ano-genital herpes between 1983-92. One thousand one hundred and thirty-five patients with anogenital herpes were available for analysis. The annual incidence of anogenital herpes nearly tripled over the period of 7 years (1986-92) from 59 to 171 cases. The percentage of HSV-1 infection in female cases (63-79%) was much higher than in other reported studies and remained relatively constant over the study period.

Diseases, General Hospital, Newcastle upon Tyne NE4 6BESUMMARY. Motile curved rods seen in vaginal secretions have been isolated on Columbia agar supplemented with 5% human blood and vitamin K. Growth occurred anaerobically and in 5% oxygen but not in more aerobic conditions. There were two distinct groups of these organisms, distinguishable by morphology, biochemical activity and susceptibility to metronidazole. All isolates were sensitive to a wide range of antimicrobial agents, with the exception of nalidixic acid and polymyxin, but one group was resistant to metronidazole. There was little difference between the results of tests of susceptibility to aminoglycosides or to metronidazole performed in anaerobic and microaerophilic conditions. Motile curved rods were isolated from 18 of 80 patients with a clinical diagnosis of non-specific vaginitis, but from only two of 39 without the disease.

Objectives: To assess the effectiveness of a newly developed triage tool to provide urgent access to genitourinary medicine (GUM) for patients. To appraise its value in compiling statistics for patients attending the department without appointments or those telephoning for advice. Method: Retrospective evaluation of triage forms completed by healthcare professional (HCP). Randomly selected triage forms completed for 250 male and 250 female patients attending a GUM clinic over a 3 month period. Result: Patients attending or telephoning with acute symptoms such as ulceration or abdominal pain, or as a result of sexual assault were offered same day or next day appointments in 100% of cases. However, for untreated chlamydial infection, testicular pain, and male urethritis the success rate fell to between 54-86%. Conclusion:The new form is easy to complete and allows a more structured triage of patients. It provides a standardised template for staff employed in GUM triage and facilitates accurate documentation and data collection of this important activity. All targets are not being met and patient distress is not adequately addressed or recorded to help service planning. However, accountable standardised data can be collected, which is important in defining the extent of the service and provides useful information for commissioners.T he continuing increase in sexually transmitted infections (STIs) throughout the United Kingdom has resulted in enormous pressures on genitourinary medicine (GUM). Many clinics are unable to cope with the numbers attending, and waiting lists throughout the United Kingdom are increasing daily. Within our own department a waiting time of 14 days is routine and we are aware that there are longer waiting times at clinics elsewhere.In 1986 the minister for health recommended that all patients suspected of having an STI should be seen within 48 hours. This recommendation has been reaffirmed over the past several years (Monks Report 1988; 1 Health Select Committee Report 2003 2 ). Although STIs declined in the early 1990s the subsequent rapid escalation in infection and patient demand with, until recently, static resources have stretched GUM services to the limit. It is clear that we do not, and are unlikely to, have the resources needed to meet this target and should consider all options in an effort to meet the increasing demand in a manner which best addresses the urgency of the situation. To address this different systems of triage have been introduced in an attempt to ameliorate the problem, with varying levels of success. There is little scope for those operating appointment systems to incorporate urgent cases and, inevitably, those attending following triage are seen in addition to those in already full clinics, further exacerbating an already unsatisfactory situation. The authors found that very little published information was available on triage systems utilised elsewhere and therefore devised a system to produce a numerical indicator on which to base triage urgency. In addition, it...

Following concerns about asymptomatic people having to wait 2-3 weeks for a standard appointment for screening a new 'I'm OK?' drop-in, nurse-led clinic for the worried well was devised and evaluated after the first 21 weeks (509 patients). Without overt advertising the clinic has run to near capacity and has proved popular, with 98% stating that they would attend such a clinic in the future. The chlamydia detection rate was 9% in women and 4% in men, with one case of asymptomatic rectal gonorrhoea and two of HIV infection diagnosed allowing early treatment intervention. HIV testing was accepted by 94% of attendees and initial hepatitis B vaccination by 93% of homosexual/bisexual men. This approach deflects such routine cases, potentially allowing increased time at standard clinic sessions for those with clinical problems staffed by more experienced nurses and doctors. Its success has encouraged us to develop this concept as a cost-effective way of addressing 48-hour genitourinary medicine access.

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.