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Biomedical subjects

R N Thin

Publications and source records attributed to R N Thin.

At least 37 records · Page 2Linked to original sources
PubMed1992

Acyclovir vs isoprinosine (immunovir) for suppression of recurrent genital herpes simplex infection.

OBJECTIVE: To compare the efficacy and safety of oral acyclovir (400 mg twice daily) with oral isoprinosine (500 mg twice daily) in the suppression of recurrent genital herpes. DESIGN: Double-blind, double-dummy, randomised, controlled, parallel group trial. SETTING: 13 centres in UK, Belgium and Germany. SUBJECTS: 127 immunocompetent patients with frequently recurring genital herpes. MAIN OUTCOME MEASURES: Proportions of patients reporting recurrences, recurrence frequency, and mean duration of lesions during breakthrough recurrences in each treatment group during a 6 month treatment period; time to first recurrence during treatment and follow-up after treatment cessation. RESULTS: During treatment, acyclovir recipients showed significant differences (p < 0.05) when compared with isoprinosine recipients in terms of a lower proportion reporting recurrences (31% vs 96%), a reduced mean number of reported recurrences per patient (0.6 vs 3.6), a shorter mean duration of breakthrough lesions (6.4 days vs 8.2 days), and a longer mean time (standard error) to first recurrence (143.7 (9.1) days vs 40.5 (5.4) days. The mean time to first recurrence after treatment cessation did not differ between the two groups. As compared with placebo recipients, isoprinosine treated patients had an increased recurrence frequency (3.6 vs 2.5) during treatment, and a shorter time to first recurrence after treatment cessation. All treatments were well tolerated without serious adverse events or toxicity. CONCLUSIONS: Acyclovir is very effective in suppressing recurrent genital herpes and is clearly superior to isoprinosine which is not clinically useful in the dosage studied.

Acyclovir↗
PubMed1991

Episodic acyclovir therapy to abort recurrent attacks of genital herpes simplex infection.

Frequent recurrence of genital herpes simplex infection can be a distressing condition. Continuous suppressive oral acyclovir is effective but expensive. Hitherto episodic therapy has given disappointing results. An open comparative study of patient initiated therapy is reported here. Acyclovir 200 mg five times daily for five days aborted 44% of recurrences and shortened 38% by greater than or equal to 50%, giving useful response in 82% of 34 recurrences. Acyclovir 400 mg twice daily for five days aborted 60% and shortened 17% giving useful benefit in 77% of 20 recurrences. Acyclovir 200 mg twice a day for five days gave unsatisfactory results. Patients were selected for frequent recurrences and a recognized prodrome, and care was taken to help to identify early prodromal symptoms. In these patients acyclovir in dosages of 200 mg five times daily for five days and 400 mg bd for five days proved convenient and cost effective.

Acyclovir↗
PubMed1991

Vulvar vestibulitis syndrome: a clinico-pathological study.

Twenty four patients with the vulvar vestibulitis syndrome formed the basis of this clinicopathological study. Entry dyspareunia was the constant presenting complaint and vestibular erythema with acute superficial tenderness the invariable clinical finding. In our series there was a marked predominance of Caucasians, patients were most often of social classes I and II and most frequently in the third decade. The results of laboratory investigation revealed that this syndrome has a diverse range of potential aetiologies including vulval infections, dysplasia and in one instance acute vasculitis.

Age Factors↗
PubMed1990

Guidance for the planning and design of genitourinary medicine clinics.

The number of patients attending genitourinary medicine (GUM) clinics in Britain has risen greatly in recent years. In contrast there have been very modest increases in staff and there are no data on accommodation or facilities. The Department of Health therefore set up a team to provide guidance on the planning and design of GUM clinics. After a survey the team concluded that GUM clinics in England were poorly and inappropriately accommodated. In their guidance they recommended that GUM clinics are sited in general outpatient departments (OPDs) of general hospitals; this improves patient care simplifying cross referral, consultation and other aspects of operational efficiency and convenience for patients, improves cost effectiveness and increases convenience for staff. Some facilities may be shared. Reception should be an attractive focal point and allow patients to be received and registered in privacy. Facilities for clinical examination are the central part of a clinic. Rooms which allow consultation and examination (CE) rooms of male and female patients maximise efficiency, flexibility and confidentiality. Sound attenuation is vital and decor should be attractive so inspiring confidence by producing a non-institutional atmosphere. An adequate number of CE rooms is essential and the waiting area should be sufficient for booked and walk in patients plus companions. There must be rooms for venepuncture, treatment and colposcopy. Interviewing rooms and offices are important, and there must be a secure health records store. A childrens play area and staff accommodation can be shared. An area for handling and simple investigation of patients' specimens is essential. This guidance should be interpreted flexibly. Though commissioned by the Department of Health for England, it is hoped that it will be useful for planning and designing genitourinary medicine clinics throughout Britain and in other countries.

Ambulatory Care Facilities↗
PubMed1990

A comparison of four cytological sampling techniques in a genitourinary medicine clinic.

Four cytological sampling techniques (the Ayre's spatula alone, the Ayelesbury spatula, the Ayre's spatula in conjunction with a Cytobrush (Medscand), and the Cervex (Steriseal] were compared when used in a genitourinary medicine clinic. Over a period of two years 6991 smears were taken. No difference was found between the methods with regard to detection of dyskaryosis, although there were significant differences in the percentage of smears containing endocervical cells.

Adult↗
PubMed1990

Sexually transmitted diseases in lesbians.

The limited published data support the assumption that lesbians are a low risk group for sexually transmitted diseases (STDs). However, there are virtually no contemporary data and the older papers do not take into account genital wart virus infection, now the third most prevalent STD in Britain. One of the dangers in assuming that lesbians are a 'safe group' for STD and allied disorders is that patients may not attend for regular cervical cytology and could be at risk of developing cervical cancer. In an unselected series of 27 lesbians attending a genitourinary medicine clinic, the most important findings were a relatively high prevalence of the viral STDs, herpes simplex and human papillomavirus. Additionally, 10 patients had abnormal cytology ranging from inflammation to dyskaryosis. There is a need for more information about the true prevalence of STDs in this group and evaluation of the risk factors for female-to-female transmission of infections. Lesbians should continue to have regular cervical smears, especially as many have had earlier heterosexual intercourse.

Adult↗
PubMed1990

Aetiology of non-gonococcal urethritis: a possible relation to other infections.

Chlamydia trachomatis can be identified in up to 60% of cases of nongonococcal urethritis (NGU) and the aetiology of most of the remainder is obscure. This paper reports a role for other genitourinary (GU) infections such as candidiasis, warts and herpes simplex, in the causation of NGU. One hundred and ten men fulfilled the entry criteria which included the probability that their contacts would attend the department. Fifty-four of the 110 men had GU infections other than NGU; 56 had no other infections. NGU was detected in 31 (57%) of cases with other GU infections and 8 (26%) were chlamydiae-positive: in contrast NGU was found in only 10 (18%) of those with none of the other infections and 3 (30%) were chlamydiae-positive. Chlamydiae-negative NGU was, therefore, more common in those with other GU infections. Forty-five (86%) of 52 contacts of 41 patients with NGU had various GU infections such as candidosis and anaerobic vaginosis, in contrast with other GU infections in only 7 (23%) of 30 contacts of men with no other GU infections. Other GU infections in patients and their contacts appeared significantly related to the presence of chlamydiae-negative NGU.

Adult↗
PubMed1989

Nephrotic syndrome and hepatitis in early syphilis.

A 54 year old man presented with features of acute hepatitis and the nephrotic syndrome. A diagnosis of active syphilis was only made by chance after extensive investigation. Syphilis should be considered in the differential diagnosis of both acute hepatitis and the nephrotic syndrome occurring separately as well as together.

Hepatitis↗
PubMed1989

STD and contraception in adolescents.

The prevalence of sexually transmitted diseases (STDs) in adolescents is poorly documented, as published studies consider single diseases or subgroups of adolescents. To obtain a broader view we examined STDs in unselected adolescent boys and girls at two contrasting genitourinary medicine (GUM) clinics, a large one at St Thomas's Hospital in inner London, which serves commuters and an inner city population, the other a smaller one at Swansea in south Wales, which serves a mixed urban and rural population. Contraception was also assessed in the girls. The STDs in adolescents were compared with the total diagnoses in patients of all ages attending the two GUM clinics, and with total diagnoses in all patients attending GUM clinics in England and Wales. The most striking finding was that all adolescents had at least one infection, whereas 18% of diagnoses in patients of all ages were of no infection. This contrasts with results of previous studies of selected groups, which suggested that the prevalence of STDs is similar in adults and adolescents. The percentages of infections, other than herpes at both clinics and trichomoniasis at Swansea, were higher in adolescents than in patients of all ages. High incidences of pelvic inflammatory disease in London and genital warts at Swansea suggest future problems. Only 66% of adolescent girls practised contraception, and only 8% stated that condoms were used. All people caring for adolescents should consider whether they are sexually active and, if they are, whether they need contraceptive advice or referral to a GUM clinic.

Adolescent↗
PubMed1989

Workloads in genitourinary medicine clinics in England.

Work loads in venereal disease--sexually transmitted disease (STD)--genitourinary medicine (GUM) clinics have risen greatly in recent years. The increase in viral infections which are more difficult and time consuming to manage than those caused by bacteria and the higher expectations and demands of patients have combined to increase workloads more than the case figures indicate. This prompted the Department of Health and Social Security in 1988 to set up a survey of clinics in England with the following terms of reference: "To examine current and forecast workloads on GUM clinics, taking account of AIDS and other STDs, and to recommend any action which may need to be taken on manpower (including nursing manpower), training, resources and accommodation". The team concluded that the GUM service was ill equipped to meet the demands for its services, and made 36 recommendations. The priority recommendations included: the need to provide more resources; government ministers should give a lead in developing the service; all health districts should provide care for STD and HIV infection; all new patients should be seen on the day of presentation or failing that on the next occasion the clinic was open. Other recommendations included: location of all GUM clinics in the general outpatient department of general hospitals; accommodation of the same standard as other outpatient departments; review of the distribution of clinics; review of staffing levels and roles; and coordination of care of HIV infection. Many of these recommendations have already led to action including a lead from government ministers and provision of more funds. Many of the problems and recommendations will apply in other countries.

Data Collection↗
PubMed1988

Management of genital herpes simplex infections.

Genital herpes simplex infection is a common and troublesome condition that is more often due to herpes simplex type II virus than to type I virus. The first step in management is accurate diagnosis by virus culture or antigen recognition. General management involves explaining the natural history to the patient, giving advice on sexual behavior, contact tracing, and hygiene. Oral or intravenous acyclovir provides the most useful therapy for first attacks. Acyclovir cream has a similar effect with external lesions in mild attacks. A course of acyclovir, however, has no effect on subsequent recurrence. Recurrent attacks, being brief compared with first attacks, are less influenced by acyclovir therapy, which should be given early for maximal effect. Oral and intravenous therapy are effective in the treatment of genital and anal herpes simplex infection in patients with acquired immune deficiency syndrome. When oral therapy is used, doses may need to be increased. Acyclovir therapy is a valuable development compared with previously available antivirals for genital herpes simplex infection.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Prophylaxis against infection in Singaporean prostitutes.

One hundred prostitutes were interviewed about the prophylactic measures they took against infection. The use of contraceptive diaphragms and clandestine antibiotics correlated significantly with fewer gonococcal infections.

Anti-Bacterial Agents↗
PubMed1988

Penicillin treatment for gonorrhoea in relation to early syphilis in prostitutes.

A retrospective study of prostitutes in Singapore showed that they had received less antigonorrhoeal treatment with penicillin derivatives during the three month period before early syphilis was diagnosed than in other three month periods when they had not developed syphilis. This suggests that penicillin derivatives in doses sufficient to treat gonorrhoea will abort coincidental early syphilis.

Female↗
PubMed1988

Podophyllotoxin 0.5% v podophyllin 20% to treat penile warts.

The increasing incidence of genital warts has led to more public awareness of this infection and its possible sequelae. Currently available treatment remains unsatisfactory, and there is pressure to develop effective and convenient alternatives. Podophyllotoxin is standardised and stable, whereas podophyllin has a variable composition. In an open comparison of self applied podophyllotoxin 0.5% versus podophyllin 20% applied by a doctor to treat external penile warts, podophyllotoxin was more effective and gave quicker resolution than podophyllin. Side effects were similar for both preparations, and few patients experienced complications severe enough to stop treatment. Podophyllotoxin can therefore be used safely and effectively for home treatment monitored at an outpatient clinic and provides a useful alternative to treatment with podophyllin at overburdened genitourinary medicine clinics.

Adult↗