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Biomedical subjects

J Winceslaus

Publications and source records attributed to J Winceslaus.

6 recordsLinked to original sources

Sexually transmitted diseases and communications with general practitioners.

OBJECTIVES: To devise a method of communicating with the general practitioners (GPs), overcoming the constraints imposed by patient confidentiality and the low levels of staffing in genitourinary medicine (GUM) clinics. To assess the GPs' responses to this method of communication. SETTING: GUM clinics at two centres in Kent-Maidstone and Tunbridge Wells. METHODS: Patients were recruited if they attended the clinic of their own accord without a letter of referral from their GPs; a definitive or provisional diagnosis was made and the patient was managed in the clinic; the patient's GP had received a conventional reply from the GUM clinic for other patients referred in the past. Separate GP letters were developed for male and female patients. These handwritten study letters were read by the patients who took the responsibility to deliver them to their GPs. This was followed by a questionnaire to the GPs. RESULTS: 75 patients were eligible. Seven patients refused to participate. All questionnaires were returned by the GPs for the 68 participating patients (100%). Seven GPs failed to receive the study letter. For these unreferred patients, this was an improvement in communication level from 0% to 80%. 79% (95% confidence interval: 67%-87%) preferred the study letter, 97% (89%-99%) would like to receive a similar letter for future patients. All GPs thought that the study letter was at least as good as the standard letter 52% (40%-64%) thought it was better. For 82% (70%-90%) it was the preferred format for future communication. CONCLUSION: The study has shown a way of establishing communication with GPs for patients who do not object to this. The results also suggest that in the study districts neither the GPs nor the majority of study patients had any objection to the sharing of information between the GUM clinics and GPs.

Ambulatory Care↗

Genital herpes masquerading as anal fissures.

Sexually transmitted genital infections in women may affect the vulva, vagina, cervix and urethra, or more rarely the rectum. Proctitis, a common finding in surgical clinics, can be caused by sexually transmitted infections including gonococcal and chlamydial. This possibility should be considered by coloproctologists and general surgeons when sexually active young women present to them with relevant anorectal symptoms, particularly if the symptoms are of a relapsing nature. Unless specifically questioned, the patient may fail to see the relevance of a history of an anogenital infection. The case reported provides an example.

Adult↗

Diagnosis of ophthalmia neonatorum.

Ninety consecutively seen babies with eye discharge in the first three weeks of life were examined. Four babies had "sticky eyes" with no evidence of ophthalmia and had uniformly negative cultures and test results for antichlamydial antibody; these babies were excluded. Of the 86 babies with ophthalmia neonatorum, Neisseria gonorrhoeae was isolated from eight, Chlamydia trachomatis from 44, other bacteria alone from 20, and 14 had negative cultures. Three babies with negative cultures had longstanding conjunctivitis and had been treated with chloramphenicol eye ointment; all had antichlamydial IgM antibodies, indicating that the conjunctivitis was chlamydial. Hence the total number of babies whose conjunctivitis was chlamydial was 47. The result of the Gram stained conjunctival smear correlated well with that of culture and final assessment by the microimmunofluorescence test, enabling an immediate presumptive diagnosis to be made of gonococcal, chlamydial, or bacterial conjunctivitis. Prompt and effective treatment of babies was started. Explanation to the mother and contact tracing were carried out when the confirmatory cultures and antibody tests were completed. The Gram stained conjunctival smear is a highly sensitive, specific, and predictive test for the aetiological agent of ophthalmia neonatorum. By virtue of its simplicity and rapidity the test may be useful in developing countries.

Antibodies, Bacterial↗