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Biomedical subjects

P E Munday

Publications and source records attributed to P E Munday.

At least 19 recordsLinked to original sources
PubMed2003

The acceptability of the introduction of a type specific herpes antibody screening test into a genitourinary medicine clinic in the United Kingdom.

OBJECTIVE: To determine the uptake of a type specific herpes simplex antibody test if it were offered as part of routine screening in a genitourinary medicine clinic in a district general hospital in the United Kingdom. METHODS: Stage 1. A series of 207 consecutive new attenders and 205 patients who had attended the clinic previously were given written information about the test and asked whether they would want to have the test if it were available. They were asked whether they would wish to discuss it further with a counsellor before making a decision. Stage 2. Another series of 434 consecutive patients were offered the test after reading an information leaflet detailing the advantages and disadvantages of being tested. They were also offered the opportunity to see a counsellor for further information. RESULTS: In stage 1 of the study, 51% of men and 54% of women said they would want the test if it were available. 32% of men and 40% of women requested counselling. In stage 2, when the test was offered, 41% of men and 37% of women chose to have it, and 23% of men and 7% of women requested further information from the counsellor. 20 patients were herpes simplex virus type 2 (HSV-2) positive-four of whom would have been diagnosed on clinical grounds at the time of presentation. A further 12 men and 20 women excluded themselves from the study because they were known to have genital herpes. Therefore, type specific serology contributed 30% to total diagnoses in this population-16 out of a population of 52 would have remained undiagnosed without having had the test. CONCLUSION: In this population, the uptake of the type specific herpes simplex antibody test was much less than expected and screening was of limited benefit in identifying large numbers of previously unrecognised HSV-2 positive patients.

Ambulatory Care↗
PubMed2003

Audit of HIV partner notification in a district general hospital.

We evaluated partner notification for HIV in a district general hospital over a two-year period. The majority of current partners were notified and 60% were found to be HIV-positive. No previous partners were successfully notified. We make recommendations intended to improve the rate of notification and testing.

Contact Tracing↗
PubMed2001

Response to treatment in dysaesthetic vulvodynia.

Thirty-three women (mean age 45 years) attending a vulval pain clinic based in a department of genitourinary medicine were followed-up for a minimum of 6 months. All women had dysaesthetic vulvodynia and 11 (33%) also had features compatible with vulval vestibulitis. Thirty-two patients were treated with a tricyclic antidepressant drug and a complete response was recorded in 47%. Only four patients obtained less than 50% improvement in their symptoms. Treatment with tricyclic drugs was part of a package of interventions including intensive support and the opportunity to take up counselling. Under these circumstances, it is difficult to attribute the success of treatment to the effect of the medication alone and there is a need for well-designed randomised controlled trials to evaluate this and other therapeutic approaches.

Journal Article↗
PubMed2001

Clinical uses of herpes simplex virus type-specific serology.

Type-specific serological tests to distinguish between infection with herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2) have largely been used for studies which have contributed to our knowledge of the epidemiology and natural history of these infections. Such tests could be used as diagnostic tools in clinical situations provided that clinician and patient are aware of the test characteristics, which may result in false negative and false positive results. The use of serological tests in the screening of populations or sub-populations, such as pregnant women, has been advocated to attempt to halt the worldwide spread of the infection. However, there is little evidence currently to support this strategy.

Adult↗
PubMed1999

Pemphigus vulgaris localized to the vagina presenting as chronic vaginal discharge.

Involvement in pemphigus vulgaris of the female genital tract including the vulva, vagina and cervix has previously been described. In all these cases other cutaneous and mucosal sites have also been affected at some time. We describe a case of pemphigus vulgaris which only involved the vaginal mucosa. The patient presented with a persistent vaginal discharge and examination showed extensive vaginal erosions. Histology of vaginal biopsies was non-diagnostic. The recognition that the vaginal changes may represent an immunobullous disease led to further vaginal biopsies on which direct immunofluorescence studies were performed. These biopsies showed IgG and C3 in the intercellular epidermis, suggesting a diagnosis of pemphigus vulgaris. During the 3-year period that the patient has been under review there have never been any other cutaneous or mucosal lesions. To our knowledge, this is the first case of pemphigus vulgaris localized exclusively to the vaginal mucosa. There was considerable delay in diagnosis and this case highlights how important it is to recognize that chronic mucosal lesions at genital sites may be caused by immunobullous diseases such as cicatricial pemphigoid and pemphigus, and to institute appropriate investigations.

Anti-Inflammatory Agents↗
PubMed1999

Encouraging HIV testing in GUM clinics--can we dispense with the pre-test discussion? Genitourinary Medicine.

In a genitourinary medicine (GUM) clinic on the periphery of the London conurbation, HIV testing was promoted during a one-month period by offering testing without preliminary pre-test discussion to patients who assessed themselves to be low risk. The testing rate rose from 5.9% to 10.8% in women and 12.6% to 20% in men. One new HIV-positive patient was identified.

AIDS Serodiagnosis↗
PubMed1998

Role of type specific herpes simplex virus serology in the diagnosis and management of genital herpes.

OBJECTIVES: To investigate the indications for the use of a type specific antibody test for herpes simplex virus in a department of genitourinary medicine in the United Kingdom. METHOD: Retrospective analysis of case records of 127 patients who accepted the test during a 20 month period. RESULTS/CONCLUSION: The test contributed to patient management in 79% of patients with recurrent genital ulceration of unknown cause. It was also useful for counselling a number of patients with initial episodes of disease and the asymptomatic partners of some patients when the partners were shown to possess antibodies specific to herpes simplex virus type 2. When evaluating sexual partners, the test was difficult to interpret if an isolate from the index case had not been typed. Access to viral typing may therefore be a greater priority than serological testing. As adverse psychological sequelae may follow the identification of an asymptomatic chronic infection, guidelines for the use of a type specific serological test are proposed.

Antibodies, Viral↗
PubMed1998

A comparison of PCR with virus isolation and direct antigen detection for diagnosis and typing of genital herpes.

Patients attending the genitourinary medicine clinic at Watford General Hospital, UK, were examined for clinical signs of genital herpes infection. Genital swabs were taken from 194 patients (126 female, 68 male) who presented with genital ulceration or symptoms which were suggestive of genital herpes infection. Swabs from these patients were tested by three methods: (i) Detection of herpes simplex virus (HSV) antigen by direct HSV enzyme immunoassay (EIA), (ii) HSV isolation in Vero cell culture and (iii) HSV polymerase chain reaction (PCR). HSV was detected in 76 patients (39%) by EIA, in 93 (48%) by isolation in cell culture, and in 115 (59%) by PCR. Isolation by cell culture has been considered as the "gold standard" for the detection of HSV in genital lesions, but in this study HSV PCR was significantly more sensitive. Comparison of the three methods was as follows: Cell culture vs. PCR: Sensitivity 93/115 (80.9%), Specificity 79/79 (100%). HSV EIA vs. PCR: Sensitivity 75/115 (65.2%), Specificity 78/79 (98.7%). HSV EIA vs. Cell culture: Sensitivity 75/93 (80.7%), Specificity 100/101 (99%). EIA was less effective in detecting HSV among recurrent than among first episode infections, in comparison to culture or HSV PCR. This is the first comparison of HSV PCR with two other routine diagnostic methods for confirming genital herpes infection in a symptomatic population. The infecting HSV type was identified by restriction digestion of 108 HSV amplicons: HSV-1:37/108 (34%), HSV-2:71/108 (66%). In this population HSV-1 causes a significant proportion of genital herpes cases, and HSV-1 genital infection was detected in significantly more first episode infections (40.3%) than among recurrent infections (22.2%).

Animals↗
PubMed1997

Clinical aspects of pelvic inflammatory disease.

Pelvic inflammatory disease (PID) is a common and poorly managed condition. Untreated or inadequately treated, it leads to tubal infertility, ectopic pregnancy and chronic pelvic pain. Diagnostic difficulties are compounded by the wide variety of clinical presentations and the insensitivity and poor specificity of laboratory tests. Better recognition of mild and atypical disease needs a high index of suspicion whenever young, sexually active women present with gynaecological symptoms. Laparoscopy supplemented by microbiological tests and fimbrial minibiopsy should be regarded as the diagnostic 'gold standard' for research studies; new studies are required to identify techniques which might reduce under- and over-diagnosis. Early treatment reduces the risk of an adverse effect on fertility. Any therapeutic regimen selected should be effective against the common aetiological agents Chlamydia trachomatis, Neisseria gonorrhoeae, genital mycoplasmas and aerobic and anaerobic bacteria. Since at least 60% of cases of PID can be attributed to infection with a sexually transmitted organism, partner notification forms an essential part of management.

Chlamydia Infections↗
PubMed1996

Asymptomatic shedding of herpes simplex virus from the genital tract: uncertainty and its consequences for patient management. The Herpes Simplex Virus Advisory Panel.

A frequent component of the management of patients with genital herpes concerns the possibility of asymptomatic shedding and potential sexual transmission of the virus. Approaches intended to provide supportive counselling and reassurance of patients about these issues need now to be modified in the light of increasing data of the frequency of asymptomatic detection of virus and the effects of antiviral therapy on this phenomenon. Further studies to delineate the relationship between asymptomatic detection of HSV in the genital tract and the mechanism of sexual transmission of this virus need to be conducted before clinicians instigate antiviral suppressive treatment primarily to prevent sexual transmission of HSV. However, it is important that the new data and our greater understanding of the natural history of genital herpes is translated into accurate and comprehensible information for our patients.

Acyclovir↗
PubMed1995

Infrequent detection of Chlamydia trachomatis in a longitudinal study of women with treated cervical infection.

OBJECTIVE: To determine how often Chlamydia trachomatis cervical infections are detected in women following completion of a currently recommended treatment regimen and the reason for recurrence. METHODS: A longitudinal follow-up study of 43 initially C trachomatis-positive women for periods of up to two years. RESULTS: C trachomatis was detected in three women, 19, 16 and about four months, respectively after completion of treatment. All specimens from the other 40 women which were taken during visits two to seven, that is periods of three to 700 days after treatment, were chlamydia-negative. CONCLUSION: Although C trachomatis is usually eradicated from the genital tract by conventional treatment, occasionally it may be found again. It is difficult to determine whether detection after treatment is due to persistence or reinfection and further studies are required.

Adult↗
PubMed1992

A longitudinal study of pelvic inflammatory disease.

OBJECTIVE: To study the microbiology and long term prognosis of pelvic inflammatory disease (PID). DESIGN: A prospective study of women with laparoscopically confirmed PID. SETTING: Teaching hospital in central London. SUBJECTS: 23 women with PID. OUTCOME MEASURES: Microbiological investigations at the time of diagnosis and at follow up; subsequent fertility and the occurrence of pelvic pain. RESULTS: PID diagnosed by laparoscopy was regarded as moderate to severe in 15 cases. Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma hominis and Ureaplasma urealyticum or a combination of these micro-organisms were detected most frequently in the cervix, less often in the endometrium and least in the tubes, C. trachomatis being the micro-organism found most commonly in the tubes. There was serological evidence of acute chlamydial infection in 13 of 20 cases in which paired sera were available and a serological response to M. hominis in 9 of 12 cases in which it was possible to evaluate the results. On the basis of microbiological and serological results, C. trachomatis appeared to be the most important aetiological agent in 10 cases, N. gonorrhoeae in four cases, M. hominis in three cases and U. urealyticum in none; in five cases, two of these micro-organisms appeared to be of equal importance. After 1 to 3 years, 33% of the women were having difficulty conceiving and 56% continued to complain of pelvic pain. CONCLUSION: It is difficult to be certain of the infectious cause of PID in any given case. However, the evidence that N. gonorrhoeae and C. trachomatis are pathogens is very strong. M. hominis may be responsible for a few cases on its own or together with other micro-organisms.

Cervix Uteri↗