Biomedical subjects
P S Allan
Publications and source records attributed to P S Allan.
Prevalence of HSV-1/HSV-2 antibodies in HIV seropositive patients in Coventry, United Kingdom.
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Genital herpes serotesting: a study of the epidemiology and patients' knowledge and attitude among STD clinic attenders in Coventry, UK.
OBJECTIVES: To examine the seroprevalence and correlates of antibodies to herpes simplex viruses type 1 (HSV-1) and type 2 (HSV-2), and to assess patients' knowledge and attitude towards genital herpes infection and its serotesting, before and after counselling. METHODS: A cross sectional study among genitourinary medicine (GUM) clinic attenders in Coventry, a UK metropolitan city. Participants were asked to complete a self administered questionnaire before and after counselling. Patients were counselled before testing and after receiving the result. A commercially available enzyme immunoassay (EIA) was used to identify HSV-1 and HSV-2 antibodies (Gull/Meridian EIA). RESULTS: 223 patients participated in the study (97% of eligible patients). Overall, prevalence of HSV-2 antibody was 43/216 (20%) (19/103, 18% for males and 24/113 (21%) for females, p=0.61) while prevalence of HSV-1 antibody was 129/215 (60%) (60% for both sexes, p=0.91). In the multivariate analysis HSV-2 seropositivity was higher among black people and those with a history of genital herpes. HSV-1 seropositivity was independently associated with less education, increased years of sexual activity (between 14-25 years), and history of cold sores. The majority of patients wanted this serotesting to be available in the clinic (204/222 (92%) before and 216/218 (99%) after counselling, p=0.0003) and 97% accepted the test when offered. Only three patients regretted having the test and four patients contacted the department within 6 months of receiving the results for more counselling. CONCLUSION: The vast majority of the study population not only wanted to be tested, but accepted the test when offered. HSV-2 infection is common and largely unrecognised among our study population. The psychological impact of introducing type specific HSV serological testing in a clinical setting seems to be minimal. Counselling could improve patients' awareness of the infection and the acceptability of the test and its results.
Offering the vaccine and accepting it: an audit of hepatitis B vaccination in West Midlands region.
The practice of hepatitis B screening and vaccination in genitourinary medicine clinics in the West Midlands Region is audited against the standards set by 1999 Medical Society for the Study of Venereal Disease National Guidelines.
Genital herpes: general practitioners' knowledge and opinions.
OBJECTIVES: To evaluate GPs' knowledge about genital herpes, especially recent information and to assess their attitudes towards serotesting. METHODS: GPs working in Coventry and the surrounding area were asked to complete an anonymous questionnaire. RESULTS: 70% of GPs (183 out of 261) responded to the questionnaire. Overall, 56% of the questions were answered correctly. 73% of participants knew that source partners in most transmission events are unaware of their infection and 77% were aware that patients shed the virus and transmit it even in the absence of clinical signs. As many as 43% did not know that the majority of infected individuals are unaware of their infection and 44% only knew that most transmission occurs during periods of asymptomatic shedding. Only 53% were aware that the proportion of genital herpes caused by HSV-1 is not decreasing. The majority (78%) supported the availability of its serotesting. CONCLUSIONS: This study demonstrates the lack of knowledge, among studied GPs, in some areas about genital herpes, especially recent information and indicates the need for more education about the condition. Most GPs in the study support the availability of genital herpes serotesting, although more studies need to be done before the wide availability of this testing.
A retrospective study of the clinical effectiveness of the treatment of genital co-infection with N. gonorrhoeae and C. trachomatis in Coventry.
Concomitant infection of Neisseria gonorrhoeae and Chlamydia trachomatis is frequent and it is common practice to prescribe ancillary treatment for chlamydial infection when infection with N. gonorrhoeae is suspected or confirmed. In Coventry cases are treated as they are diagnosed. Our objective was to determine the clinical effectiveness of treating gonorrhoea and chlamydial infection separately in cases of co-infection. Case notes of co-infection with N. gonorrhoeae and C. trachomatis diagnosed in Coventry GU clinic from March 1989 to February 2000 were reviewed retrospectively. There were 1250 episodes of gonorrhoea, 4127 of chlamydial infections, and both infections were found in 332 cases. The two infections were treated in 322 cases and in 235 cases were treated separately. Ten cases did not come back for treatment of chlamydial infection, which is less than one case per year and 0.2% of total chlamydial infection in 11 years. On the other hand, 918 (73%) of total number of gonorrhoea patients did not have to take unnecessary treatment for chlamydial infection. In some clinical settings co-infection with N. gonorrhoeae and C. trachomatis could be treated separately with significant success and in the long run this might prevent development of antibiotic resistance of C. trachomatis infection.
Imiquimod and HIV transmission.
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Access to infertility investigations and treatment in couples infected with HIV: questionnaire survey.
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Adverse effects of nevirapine.
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Why do children attend the genitourinary medicine clinic?
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Investigation of the increased incidence of gonorrhoea diagnosed in GUM clinics in England, in 1994-6.
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Penile granuloma annulare.
A case of granuloma annulare (GA) localised to the shaft of the penis is reported with a brief review of the current literature. We concluded that penile GA, although rare, should be considered in the differential diagnosis of granulomatous lesions of the penis and that histopathological examination of the lesion is essential for the diagnosis.
Can basal cell carcinoma develop on the site of a healed gumma?
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Penile intraepithelial neoplasia--a veiled lesion in genitourinary medicine.
Penile intraepithelial neoplasia (PIN) is a clinically well known condition. However, its diagnosis is often difficult. We present four cases of PIN, seen in our department. Various histological patterns ranging from PIN I to PIN III were noted in these cases.
Sexually transmitted infections in elderly people.
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Sustained efficacy of nevirapine in combination with two nucleoside analogues in the treatment of HIV-infected patients: a 48-week retrospective multicenter study.
BACKGROUND: Nevirapine, a nonnucleoside analogue, has demonstrated suppression of human immunodeficiency virus (HIV) replication alone and in combination therapy. However, the durable suppression of HIV with nevirapine when used along with other nucleosides in HIV-infected patients who are treated in clinical practice needs further evaluation. PURPOSE: To evaluate the sustained efficacy of nevirapine in combination with two nucleoside analogues in the treatment of HIV-infected patients in routine clinical practice. DESIGN: A multicenter study from January 1997 to December 2000, with follow-up through 48 weeks, was conducted at four different genitourinary medicine clinics in the United Kingdom. Forty-four HIV-infected patients received nevirapine and two nucleoside analogues. Information from case notes regarding age, sex, side effects, viral load, and CD4 lymphocyte counts at baseline, 24 weeks, and 48 weeks was collected and analyzed. Virologic suppression, defined as HIV RNA concentration of less than 400 copies/mL at Weeks 24 and 48, was considered as the main outcome measure. RESULTS: Out of 44 patients, 41 were men with a mean age of 39.3 years (95% CI 36.7-41.8). The baseline viral load was 2.11 x 10(2) to 9.74 x 10(5) copies/mL (median 7.7 x 10(4) and CD4 counts 6 to 605 cells/dL (M = 247; 95% CI 198-295). Of 39 patients who completed 48 weeks of treatment, viral load suppression was attained in 31 patients (79.4%; 95% CI 66.8-92.0) at 24 weeks and in 27 patients (69.2%; 95% CI 54-83) at 48 weeks. The CD4 lymphocyte count increased in 32 (82%) patients (mean 106 cells/dL, 95% CI 73-139, p =.0001, Wilcoxon signed rank test) after 24 weeks and in 33 (84.6%) patients (mean 160 cells/dL, 95% CI 115-204, p =.0001, Wilcoxon signed rank test) after 48 weeks of treatment. Of 20 patients whose baseline viral load was <100000, 16 had viral load suppressed at 24 weeks and 15 at 48 weeks (p =.6, chi-square test). CONCLUSION: A regime of nevirapine with two nucleoside analogues provided durable suppression of plasma viral load in HIV infected patients, with significant improvement in the CD4 cell count.