PubMed Health⌕ Search

Biomedical subjects

R S Pattman

Publications and source records attributed to R S Pattman.

At least 19 recordsLinked to original sources
PubMed2006

Audit of the use of benzathine penicillin, post-treatment syphilis serology and partner notification of patients with early infectious syphilis.

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.

Adolescent↗
PubMed2006

'I'm OK?' Evaluation of a new walk-in quick-check clinic.

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.

Adult↗
PubMed2003

Does bacterial vaginosis alter the sensitivity of screening tests for Chlamydia trachomatis? An analysis of patient characteristics.

The aim of this study was to assess if patient characteristics could influence the sensitivity of enzyme immunoassay (EIA) testing used for chlamydia screening. Our cohort consisted of 56 patients who were known polymerase chain reaction-positive for chlamydia, but with variable EIA results. Characteristics analysed included those already known to influence the EIA (menstruation, pregnancy, difficult examination) and those suspected from clinical observation (including presence of symptoms or signs, coexistent gonorrhoea, duration from last sexual exposure). An unexpected finding was that significantly more cases of bacterial vaginosis were found in those chlamydia EIA-negative compared to those with positive results. We postulate that an enzyme produced in bacterial vaginosis, proline aminopeptidase, may cause destruction of the chlamydial cell wall, therefore affecting the EIA adversely. Further research is needed to explore this hypothesis.

Chlamydia Infections↗
PubMed2003

Audit of gonorrhoea test of cure at the genitourinary medicine department in Newcastle upon Tyne, UK.

The aim of the audit was to assess the need for a microbiological test of cure for gonorrhoea when a sensitive antibiotic has been used. All cases of gonorrhoea attending our clinic in 2001 were reviewed. One hundred and seventy-three cases were diagnosed, 137 men and 36 women. Of the 126 cases where tests of cure were taken, none were positive from an infective site when a sensitive antibiotic was used. Cases of gonorrhoea from year 2000 were then analysed for test of cure. Of 125 tests of cure again none were positive. These results question the need for routine tests of cure which current national guidelines state are usually performed in UK practice. The implications of abandoning a test of cure visit are discussed.

Anti-Bacterial Agents↗
PubMed2002

Reiter's syndrome and keratoderma blennorrhagica on glans penis--is this unusual?

Current teaching on Reiter's syndrome is that keratoderma blennorrhagica lesions appear characteristically on the soles of feet, although they can be seen on other parts of the body infrequently. We therefore thought that it would be interesting to report the case of keratoderma blennorrhagica lesions found on the glans penis of a circumcised patient with Reiter's syndrome.

Arthritis, Reactive↗
PubMed2002

What is new with antibiotic-resistant gonorrhoea in Newcastle, England?

Neisseria gonorrhoeae isolates that were resistant to ciprofloxacin and/or penicillin were analysed to investigate the escalating problem of antibiotic-resistant gonorrhoea in the north east of England. Opa-typing (outer membrane opacity protein) was carried out on isolates resistant to ciprofloxacin and of nutrient nonrequiring (NR) auxotype. In the year 2000 there were 265 cases of gonorrhoea, of which 44 (16.6%) were resistant to penicillin and 12 (4.5%) were resistant or had reduced sensitivity to ciprofloxacin (with only four of these acquired outside the UK). Three (7.5%) of the non-beta-lactamase penicillin-resistant isolates were imported from abroad. By Opa-typing of ciprofloxacin-resistant strains, one pair of the isolates was similar, two were unique and one was similar to the Oldham/Rochdale outbreak strain described early in 2000. This marked increase in the prevalence of indigenous ciprofloxacin resistance requires continued surveillance and may soon necessitate an alteration in our first line treatment.

Adolescent↗
PubMed1999

Neisseria gonorrhoeae in Newcastle upon Tyne 1995-1997: increase in ciprofloxacin resistance.

Fluoroquinolones and third generation cephalosporins are the most effective antimicrobial agents for the treatment of gonorrhoea. However, clinically significant resistance to fluoroquinolones in Neisseria gonorrhoeae has been reported worldwide including Britain. The aim of this analysis was to study the factors relating to ciprofloxacin resistance and treatment failure. A total of 201 patients attending the Newcastle Genitourinary Medicine (GUM) clinic from 1995-1997 who were diagnosed with culture positive gonorrhoea was analysed. Treatment failure rates for ciprofloxacin were determined and the minimum inhibitory concentration (MIC) was measured for all cases of treatment failure. The case notes of all patients who had strains with MICs of ciprofloxacin in the resistant range (>0.05 microg/ml) were reviewed to determine the clinical outcome. The ciprofloxacin resistance with treatment failure was seen in 5% (8/160). All the 8 cases of treatment failure were heterosexual and had isolates resistant to penicillin and 4 cases (50%) were also resistant to tetracycline. All were sensitive to spectinomycin and ceftriaxone. Most of the cases probably acquired their infection from the Far East. As ciprofloxacin resistance seems to be associated with overseas exposure, changes in the standard treatment of gonorrhoea are not justified but consideration should be given to appropriate alternatives when the infection may have arisen from where such resistant strains are endemic. Monitoring fluoroquinolone resistance is now essential for ensuring adequate treatment of infections with resistant strains and for maximizing the time of usage of fluoroquinolones to treat gonorrhoea.

Adult↗
PubMed1998

An indolent penile herpetic ulcer in a patient with previously undiagnosed human immunodeficiency virus infection.

We report a case of an atypical penile herpetic ulcer in a man with previously undiagnosed human immunodeficiency virus (HIV) infection. Swabs of the lesion were negative for herpes simplex virus (HSV) by culture and electron microscopy. However, histopathology of biopsy material showed characteristic herpetic multinucleate giant cells. Immunochemistry using polyclonal antibodies was positive for HSV1 and HSV2. The lesion completely resolved after treatment with aciclovir and the patient subsequently tested positively for HIV antibodies.

Adult↗
PubMed1994

A randomised, double-blind, parallel group study to compare subcutaneous interferon alpha-2a plus podophyllin with placebo plus podophyllin in the treatment of primary condylomata acuminata.

OBJECTIVES: The primary objective was to determine if six weeks treatment with subcutaneous interferon alpha-2a (IFN) and podophyllin 25% W/V administered twice per week, preceded by IFN alpha-2a three times weekly for one week showed a greater complete response rate in patients with primary condylomata acuminata when assessed at week 10 than treatment with podophyllin and placebo injections in the same schedule. The secondary objective was to compare recurrence rates in complete responders at six months in the two treatment groups. DESIGN: Randomised, double-blind parallel group study. SETTING: Multicentre study in six genitourinary clinics within the U.K. PATIENTS: One hundred and twenty-four patients with primary anogenital warts. MAIN OUTCOME MEASURES: Complete response rate at week 10, and recurrence rate at week 26 in complete responders. RESULTS: At week 10 analysis of the efficacy population showed complete response in 36% (15/42 patients) of IFN-treated group and 26% (11/43 patients) in the placebo group (no significant difference). Analysis of the safety population at week 26 showed persistence of the complete response in 57% (8/14 patients) of the IFN-treated group and 80% (12/15 patients) of the placebo group (no significant difference). Adverse effects were more common in IFN-treated patients, involved particularly application site reaction and malaise but were generally mild. CONCLUSIONS: At the dose and with the regime described treatment with IFN alpha-2a in combination with podophyllin is no more effective in the treatment of primary anogenital warts than podophyllin alone and is associated with more adverse events.

Adolescent↗
PubMed1993

Partner notification for HIV infection in the United Kingdom: a look back on seven years experience in Newcastle upon Tyne.

OBJECTIVE: To examine the outcome of partner notification for HIV infection. DESIGN: Retrospective analysis of medical, health adviser and counsellor records. SETTING: Teaching hospital, Newcastle upon Tyne. PATIENTS: All newly diagnosed cases of human immunodeficiency virus (HIV) infection and their sexual partners. MAIN OUTCOME MEASURES: Attendance of contact at genitourinary medicine clinics for counselling and testing. Seropositivity rate of people attending as a result of partner notification. RESULTS: Of the 80 partners attending as a result of partner notification 79 were tested. Twenty-five of these (31.6%) were seropositive. This was 21.9% of our newly diagnosed caseload. Seventy-five attended following patient referral and five as a result of provider referral. Discrepancies between districts in policies of provider referral prevented two partners being notified. CONCLUSIONS: Partner notification is an effective method of ensuring that people with a very high risk of HIV infection have access to counselling and medical care. Complete integration of notification services throughout the UK is required.

Contact Tracing↗
PubMed1989

Yersinia pseudotuberculosis infection as a cause of reactive arthritis as seen in a genitourinary clinic: case report.

Patients are often referred to the genitourinary clinic for screening for urethral infections after a clinical diagnosis of Reiter's syndrome or reactive arthritis. We report a case of reactive polyarthritis in which serological evidence of Yersinia pseudotuberculosis infection was found in the absence of the other common precipitating organisms, such as Chlamydia spp, Klebsiella spp, Shigella spp, Campylobacter spp, or Yersinia enterocolitica.

Adult↗