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be endemic for it. It is otherwise likely to be done among women aged 18–25 years and Sex Transm Infect: first published as 10.1136/sti.76.4.321 on 1 August 2000. Downloaded from missed. men 18–30 years. What happens with people LETTERS TO GURVINDER P THAMI below the age of 18? We know that Chlamydia SUKHJOT KAUR trachomatis prevalence is associated with THE EDITOR AMRINDER J KANWAR young age, but can we also send home Department of and , screening kits to 15 year olds? What about the Government Medical College and Hospital, parental opinions and legal implications—for Chandigarh 160 047, India example, for the partner of a C trachomatis Correspondence to: Dr Kanwar positive youngster? [email protected] Lymphatic filariasis—lest we forget In two surveys performed in general practice in Amsterdam, Netherlands, using 1 Perine PL, Stamm WE. Lymphogranuloma systematic and opportunistic screening, EDITOR,—Lymphatic filariasis is character- venereum. In: Holmes KK, Sparling PF, Mardh ised by a wide range of clinical manifesta- PA, et al,eds.Sexually transmitted diseases. New prevalence was strongly associated with young tions. In a non-endemic area the diagnosis York: McGraw-Hill, 1999:423–50. age but also with ethnicity. Among young 2 Schachter J, Osaba AO. Lymphogranuloma Surinam-Antillian women aged <25 years, may be missed unless the index of suspicion is venereum. Br Med Bull 1983;39:151–4. high. 3WHO.Lymphatic filariasis: the disease and its con- prevalences ranged from 5.4% in the system- An 18 year old sexually active male trol. Fifth Report of a WHO Expert Committee atic survey up to 22.4% in the opportunistic 23 presented with a progressively increasing on lymphatic filariasis. Technical report series survey. In the systematic survey an unex- 1992;821:1–71. pectedly high prevalence of 10% painless nodular swelling in the right in- 4 Micheal E, Bundy DAP, Grenfell BT.Reassessing C trachomatis guinal region of 4 months’ duration. The the global prevalence and distribution of lym- was found among young Surinam-Antillian patient had an unprotected vaginal contact phatic filariasis. Parasitology 1996;112:409–28. men. Among the 15–19 year olds visiting our with a commercial sex worker 6 months ear- health centre in Amsterdam which is located Accepted for publication 15 May 2000 lier. There was no history of genital ulcer or in a multiethnic neighbourhood, half of the urethral discharge. The general health of the population having a Surinam-Antillian back- ground, C trachomatis prevalence was 25%.4 patient was preserved. Examination revealed Canary to sparrow; what is in a name? enlarged right inguinal and external iliac Thus, the question is not only how accept- lymph nodes, 1–3 cm in size, firm, mobile, EDITOR,—The Contagious Diseases Act of able home screening is for the youngest age group, who might be most at risk, but also non-tender, and matted with normal overly- 1864 allowed for the compulsory arrest, exam- how acceptable home testing is for people ing skin. Examination of genital, anal, and ination, and treatment of women considered with diVerent ethnic backgrounds and people buccal mucosae was normal. There was no (by an all male board) to be of loose morals. living in low socioeconomic status and high other . A diVerential diag- Women were detained in the so called “Canary risk environments. nosis of lymphogranuloma venereum (LGV) wards” and their identity made clear by the We piloted a assisted approach and tubercular lymphadenitis was consid- bright yellow garments they were made to wear. In the year 2000, there is still perceived oVering urine home testing to all sexually ered. Complete blood count revealed mild active women age 15–30 years who come to leucocytosis and eosinophilia. Renal and stigma and blame associated with the diagno- sis of sexually transmitted infections (STIs) our pharmacy to collect their contraceptives. hepatic functions, urinalysis, and chest x ray Since the start 4 months ago 189 people were normal. Mantoux test and VDRL were and this must be minimised if a screening pro- gramme for chlamydia is to be successful. It received an information leaflet and home test negative. A complement fixation test will help reduce stigma if people know and package together with their contraceptives. for chlamydia group specific antibody was accept that it is not a disease of a few readily Fifty nine participated and sent their urine; negative. Fine needle aspiration cytology 5 identifiable people but that it is common and four were positive (6.7%). The participation from the nodes revealed reactive hyperplasia easy to acquire. It has been estimated that one rate was 31%, lower than the reported rate for with occasional giant cells and micro- in 14 young people will acquire it at some time. women in the article of Stephenson et al. filariae of Wuchereria bancrofti. Nocturnal In the NHS chlamydia pilot screening pro- The assumption by the authors that people blood samples for microfilariae were nega- gramme in Wirral and Portsmouth we are who do not participate for home screening tive. confirming that this infection is indeed will turn up for opportunistic screening at the http://sti.bmj.com/ The patient was given diethylcarbamazine endemic. Information material for the pilot general practice is, however, merely a hypoth- 100 mg thrice daily for 2 weeks. The lymph study clearly states that it is a very common esis, and not a strong one, especially not for nodes regressed and no relapse was observed infection. To reduce the element of blame, we boys and men. in 6 months of follow up. have included testing of men in some settings Tackling issues like risk perception and risk The diVerential diagnosis of inguinal and have introduced instead of sexually trans- environment and changing healthcare seek- lymphadenopathy in a sexually active mitted, the term “sexually shared infection.” ing behaviours is not an easy task. Moreover, male includes syphilis, genital herpes, We hope that by measures such as these, a community based C trachomatis prevention chancroid, LGV, pyogenic adenitis, tuber- programme will require not only secondary young people will avoid stigmatisation as on September 25, 2021 by guest. Protected copyright. culosis, and .1 In the present “canaries.” prevention by active case finding but also pri- case a diagnosis of LGV was considered We do not, however, suggest that you mary prevention. What is needed is an in view of a history of sexual contact, change the name of your journal again! integrated set of strategies, which are mutu- painless and non-suppurative lymphaden- ally reinforcing and that are age, sex, culture, JENNIFER HOPWOOD and context specific. Quite a challenge! opathy not apparently preceded by a genital HARRY MALLINSON ulcer. SALLY WELLSTEED JEAMVANBERGEN Demonstration of microfilariae was deci- Chlamydia Pilot OYce, Evidence Based Practice Netherlands’ Foundation for STD control, PO Box sive in clinching the diagnosis of filariasis Centre, St Catherine’s Hospital, Church Road, 8198 3503 RD, Utrecht, Netherlands which was not considered in the diVerential Birkenhead CH42 0LQ [email protected] diagnosis. Presentation with inguinal lym- Correspondence to: Dr Hopwood phadenopathy is a feature common to both Accepted for publication 7 June 2000 LGV and filariasis. The most frequent mani- 1 Stephenson J, Gardner C, Copas A, et al. Home screening for chlamydial infection: is it accept- festation of secondary stage of LGV in men able to young men and women? Sex Transm Inf is unilateral inguinal lymphadenopathy Acceptability of home screening for 2000;76:25–7. 2 Valkengoed IGM, Boeke AJP, Brule van den which does not suppurate in two thirds of chlamydial infection: some remaining 1 AJC, et al. Systematic screening for asympto- cases. Iliac lymphadenopathy often develops issues matic Chlamydia trachomatis infections by in LGV as was observed in our patient.2 home obtained mailed urine samples in men and women in general practice (Dutch). Painful enlargement of inguinal lymph nodes EDITOR,—In the recent article by Stephenson Ned 1 Tijdsch Geneesk 1999;143:672–6. with fever is the usual presentation in et al the authors describe participation rates 3 Hoek JAR van den, Minder-Folkerts DKF, lymphatic filariasis. Lymphangitis can of 39% for women and 46% for men for Coutinho RA, et al. Opportunistic screening accompany recurrent attacks. Other com- home screening and comment “that this for genital Chlamydia trachomatis infections plications include orchitis, funiculitis, might form a useful component of a commu- among the sexually active population of 34 Amsterdam. I (Dutch). Ned Tijdschr Geneeskd and epididymitis. These were, however, nity based chlamydial screening programme 1999;143:668–72. absent in our patient. It is suggested that in which non-responders could be oVered 4 Van Bergen JEAM, Stroucken J, Spanjaard L, et lymphatic filariasis should be considered in opportunistic screening at the general prac- al. The need for more active case-finding of genital infections with Chlamydia trachomatis diVerential diagnosis of inguinal lymphaden- tice.” However, certain crucial issues remain in general practice in Amsterdam (Dutch). opathy even in areas which are not known to unanswered. This acceptability survey was Huisarts Wet 2000;43:210–2.

www.sextransinf.com 322 Letters, Book review, Notices, Correction, Current publications

5 Van Bergen JEAM, Spaargaren PGH, Peer- with seven of 38 (18.4%) women not receiving 1 Duncan ID, ed. Guidelines for clinical practice and Sex Transm Infect: first published as 10.1136/sti.76.4.321 on 1 August 2000. Downloaded from booms PAS. Active case-finding of CT- a verbal explanation; p= 0.03 Fisher’s exact programme management.Oxford: NHSCSP, 1992. infections in a family practice in a high 2 Kavanagh AM, Broom DH. Women’s under- prevalence area in Amsterdam: preliminary test; OR 0.21 (95% CI 0.03–1.03). Of the standing of abnormal cervical smear test findings of a pharmacy-assisted approach using study group, 81 should have attended for results: a qualitative interview study. BMJ mailed urine-samples. Abstract 25, p25. follow up cytology 6 months after colposcopy 1997;314:1388–9. Rotterdam: International STD conference, 3 Marteau TM, Kidd J, Cuddeford L, et al. STDs in a changing Europe, 14–15 April 2000. or smear showing borderline changes; 12 Reducing anxiety in women referred for (15%) defaulted compared with 37 of 95 colposcopy using an information booklet. Br J (38.9%) women not receiving a verbal expla- Health Psychol 1996;1:181–9. 4 Lerman C, Miller SM, Scarborough R, et al. Nurse counselling for women with 2 nation; p= <0.001 ÷ test; OR 0.18 (95% CI Adverse psychologic consequences of positive abnormal cervical cytology improves 0.08–0.41). Eventually only one (1.5%) in the cytologic cervical screening. Am J Obstet Gyne- colposcopy and cytology follow up study group and two (5.3%) of the controls did col 1991;165:658–62. 5 Luesley D, ed. Standards and quality in colposcopy. attendance rates not attend for colposcopy, and 11 (13.8%) and SheYeld: NHSCSP Publication No 2, 1996. 24 (25.3%) for follow up cytology. 6 Peters T, Somerset M, Baxter K, et al. Anxiety EDITOR,—A well organised cervical screening Despite the leaflet the women in our study among women with mild dyskaryosis: a ran- programme has considerable benefits; how- domised trial of an educational intervention. Br ever, one negative aspect is anxiety associated still had misunderstandings and anxieties. J Gen Pract 1999;49:348–52. with abnormal results. The NHSCSP guide- The verbal explanation helped clarify these. Accepted for publication 19 June 2000 lines state that an explanatory leaflet should Verbal information can be tailored to the be given to women with abnormal cytology individual, some requested detailed descrip- and those being referred for colposcopy, with tions, others preferred a simpler explanation Phone sex: information technology (IT) a verbal explanation wherever possible.1 We (as reported previously2). This is not possible and sexually transmitted infection in assessed if there is any additional benefit from with written information. Marteau et al found young people a verbal explanation, following written infor- that a brief, simple booklet increased knowl- EDITOR,—The recent article on the acceptabil- mation, when an abnormal smear result is edge and reduced anxiety whereas a more 1 given, in understanding and future attend- complex booklet increased knowledge but ity of home testing for chlamydia was noted. We would like to extrapolate this concept. ance for colposcopy and cytology follow up. did not reduce anxiety.3 Youngpeople could be accessed via an internet Between April and December 1998 we The default rates were lower in those clinic. Our experience during the chlamydia recruited 89 women with abnormal cytology. receiving the verbal explanation. Lerman et al All women attending for results are given the pilot study is that this population makes exten- found that women with abnormal cytology sive use of technology, in particular mobile NHSCSP leaflet “What your abnormal result who defaulted colposcopy appointments means” if their smear shows borderline phones. The presence of sex on the internet were more worried about cancer with impair- has been widely publicised. We propose that changes, mild, moderate, or severe dyskaryo- ment of mood and sleep.4 Following the sis. The study women completed a question- testing for sexually transmitted infection (STI) explanation our default rate for colposcopy via the internet is the next logical step. naire after reading the leaflet. A nurse (BH) was within the 15% recommended target,5 then gave a verbal explanation about the smear The chlamydia pilot study was funded by and follow up cytology was similar to the result. They then completed the questionnaire the Department of Health, to investigate the rates reported in primary care.6 again. Attendance for colposcopy and cytology feasibility of screening 16–25 year old women There are deficits in this study. The lack of follow up was recorded, default being defined (and some men), for chlamydia, using a urine as non-attendance without cancellation. De- randomisation means the improvement in specimen. Antibiotics for chlamydia are fault rates were compared with other women default rates could be the result of baseline cheap and eVective. The cost of complica- diVerences rather than the verbal explanation. tions to the individual is enormous, as is the with abnormal cytology during the same 2 period. They were not included in the study as However, it has shown benefit to the women cost to the NHS—£200 million per year. by improving understanding. The department Screening reduced the prevalence of infection they attended when the specified nurse was 3 not available. They had all received the leaflet has also benefited; although extra nursing in Sweden and the United States. Computer but not a structured explanation. time has been required, the lower default rates modelling suggests that screening in this country would be cost eVective.4 The explanation for each woman took for colposcopy and cytology has reduced the http://sti.bmj.com/ approximately 15 minutes. The results of the clerical, medical, and secretarial time nor- After screening for chlamydia, a means of questionnaire before and after explanation are mally required recalling non-attendees. contacting clients to give results was shown in table 1. There was a significant arranged—for example, letter or phone call. On JANET D WILSON the Wirral, 2651 patients were screened in the improvement in understanding and reduction BLANCHE HINES in anxiety. The control group comprised 104 first 4 months—2332 women and 285 men Department of Genitourinary , The General (34, sex not recorded). Sixty eight (2.6%) gave women. In the study group 65 required Infirmary at Leeds, Great George Street, a mobile phone number, half (35) using this as colposcopy; three (4.6%) defaulted, compared Leeds LS1 3EX their only means of contact. Sixty five were on September 25, 2021 by guest. Protected copyright. Table 1 The questionnaire results before and after the verbal explanation female and two male (one patient not re- corded). Thus, women (2.8%) were more likely Question Response (n=89) Before After ÷2 test p value to use mobile phones than men (0.7%) (p = 0.03). The genitourinary medicine (GUM) How well do you understand the result Not at all 26 1 clinic screened 358 patients. Only 68 (19%) you have been given? A little 36 13 <0.0001 gave an address. The results of a further 469 A lot 27 75 (17.7%) of the screened population went back Are you worried about the result of your Ye s 4 5 1 3 smear test? A little 42 60 <0.0001 to the screening site. These clients could be No 2 16 interested in contact via mobile phone if it was Will it worry you if we need to do further Ye s 3 6 1 1 openly oVered (data collected from the Public investigations? A little 40 46 <0.0001 Health Laboratory Service (PHLS) database No 13 32 and analysed on EPI-INFO 6). Are you worried that further investigations Ye s 5 5 2 8 According to a survey by NOP Social and will be painful? Don’t know 11 14 0.0002 No 23 47 Political, confidentiality is important to peo- Do you think that any abnormality found Ye s 6 1 8 5 ple in the target age group (unpublished can be treated? Don’t know 25 4 <0.0001 data). Patients consider their mobile phones No 3 0 to be a secure method of communication Do you think you have cancer? Yes 5 1 between themselves and us. The advent of Don’t know 34 9 <0.0001 DNA amplification in the detection of STIs No 50 79 56 Do you think this smear result will aVect Ye s 1 5 2 has opened up new possibilities. There are your ability to have children? Don’t know 34 10 <0.0001 30 000 websites pertaining to chlamydia. An No 40 77 internet clinic would be aimed at mildly Do you think this result will change your Ye s 1 8 1 3 symptomatic or asymptomatic patients. The attitude to sex with your partner? Don’t know 30 14 0.004 client would access the website and request No 41 62 swabs or urine pots through the post then Do you think this result will aVect the Ye s 8 4 return them the same way. way your partner thinks of you? Don’t know 13 10 0.36 No 68 75 If the patients were positive, they would need to attend a GUM clinic or equivalent.

www.sextransinf.com Letters, Book review, Notices, Correction, Current publications 323

Other infections should not be overlooked. changed from a trend of steady decline to a young females, may be useful and this can be, Partner notification is necessary. Contact recent increase in many parts of the world.12 to start with, combined with the cervical slips could be supplied but the health The pattern of incidence is closely related to smear screening programme at very little adviser’s role should not be underestimated. socioeconomic conditions.34 additional cost. Short term programmes, like Security on the internet would have to be An incidence graph of Mersey Region vigorous media campaigns nationally and addressed. However, the anonymity and con- figures (fig 1) for the 1990s and a discussion poster and leaflet campaigns locally in high venience of participating from home may on the possible factors associated with the risk recreational areas like pubs and clubs, increase testing for STIs. This may appeal to changing pattern is presented here. The inci- may have an educational value and help younger patients particularly, in view of their dence from the Mersey Region shows a reduce the incidence. experience with IT. steady decline until the mid 1990s followed B BHATTACHARJEE In summary, STI is rising in the younger by a recent increase and represents the trend A K GHOSH population. Their utilisation of technology is in most areas. In spite of the advances in the Department of GU Medicine, Royal Liverpool demonstrated by mobile phone use in the diagnostic and therapeutic field, organised University Hospital, Prescot Street, Liverpool L7 8XP chlamydia pilot study. Health providers should health advisory system, easy access walk-in Correspondence to: Dr Bhattacharjee, Department respond using media with which the target clinics, complete confidentiality, and free of Genitourinary Medicine, Arrowe Park Hospital, population is comfortable. We might just access treatments; the incidence of gonorrhoea is Upton, Wirral, Merseyside L49 5PE a whole generation. The future’s bright . . . rising. From the broader analysis of the situ- Conflicts of interest: None. ation, it is possible to say that most of the fac- 1 Commun Dis Report. Increase in gonorrhoea cases. CDR Weekly 1998;34:297. Funding of chlamydia pilot study: Department of tors behind this changing pattern are socio- Health. 2 Annual Report of the Australian Gonococcal Sur- MARY HERNON economic. The factors may include advances veillance. Commun Dist Intell 1998;22:212–16. in contraceptives, sexual liberalisation, in- 3 Heygi E, Heygi V, Danilla T. Long term trends JENNIFER HOPWOOD of the incidence of syphilis and gonorrhoea in HARRY MALLINSON crease in the mobility of population, and the the Slovak Republic during 1947–1994 with Liverpool Laboratory, PHLS North West changing economic environment. The cumu- special regard to young age groups. Bratisl Lek lative result of all these factors is an increase Listy 1997;98:563–71. A K GHOSH 4 Evans BA, Bond RA, MacRae KD. Sexual rela- Arrowe Park Hospital in casual relationships. Casual sex is made tionship, risk behaviour, and condom use in the Correspondence to: Dr M Hernon, Department of riskier when it is performed unprotected and spread of sexually transmitted infections to Genitourinary Medicine, Arrowe Park Hospital, without much knowledge about the partner heterosexual men. Genitourin Med 1997;73: 368–72. Upton, Wirral, CH49 5PE and is possibly the main reason behind the 5 Fitzgerald M. Can the management of gonor- [email protected] poor contact tracing of only 0.5 out of an rhoea be improved? Genitourin Med 1997;73:3–4. average of 1.5 per patient.5 Accepted for publication 19 June 2000 1 Stephenson J, Carder C, Copas A, et al. Home Some of these factors are part of the wider screening for chlamydial genital infection: is it evolutionary process and are diYcult issues to acceptable to young men and women? Sex deal with, but preventive measures may be Transm Inf 2000;76:25–7. Russian STI 2 CMO’s Expert Advisory Group. Report on Chlamy- taken against the others. In spite of the recent dia trachomatis. Chapter 5. The need for screening. advances and better understanding of the dis- EDITOR,—We would like to inform you that London: Department of Health, 1998:3. ease in the recent years, there is still a lack of we translated into Russian and published in 3 Scholes D, Stergachis A, Heidrich FE, et al. Prevention of pelvic inflammatory disease by awareness, in the general population, of the 1999 in the Russian journal of STI the screening for cervical chlamydial infection. N possible mental and physical eVects of such following reviews from Sexually Transmitted Engl J Med 1996;334:1362–6. infection. The significant fall in the incidence Infections: Cohen CR, Brunham RC, Patho- 4 CMO’s Expert Advisory Group. Report on of gonorrhoea seen in the late 1980s, second- genesis of chlamydia induced pelvic inflam- Chlamydia trachomatis. Summary and conclu- sions. London: Department of Health, 1998:5. ary to extensive media coverage of HIV infec- matory disease, Sex Transm Inf 1999;75:21– 5 Lee HH, Chernesky MA, Schachter J, et al. Diag- tion, shows how eVective such campaigns can 24; Fleming DT, Wasserheit DN, From nosis of chlamydia trachomatis genitourinary be. The present rise in the incidence of gonor- epidemiological synergy to infection in women by ligase chain reaction assayofurine.Lancet 1995;345:213–16. rhoea in the past few years shows clearly that policy and practice: the contribution of other

6 Macleod J, Rowsell R, Horner P, et al. Postal our prevention campaigns are not eVective. sexually transmitted diseases to sexual trans- http://sti.bmj.com/ urine specimens: are they a feasible method for The young teenagers who make up the mission of HIV infection, Sex Transm Inf genital chlamydial infection screening? Br J 1999; :3–17; Hammerschlag MR, Sexually Gen Pract 1999;49:455–8. pool of supply and the young females who 75 make up the pool of asymptomatic reservoirs transmitted diseases in sexually abused chil- of the infection, are the two core groups our dren: medical and legal implications, Sex Gonorrhoea: an incidence graph of campaigns should be targeting. Transm Inf 1998;74:167–174; Dallabetta GA, Mersey region data for the 1990s and At present there is no programme in the Gerbase AC, Holmes KK, Problems, solu- discussion on the factors behind the school curriculum about sexual health and no tions and challenges in syndromic managa- regular screening programme for sexually ment of sexually transmitted diseases, Sex changing pattern of incidence on September 25, 2021 by guest. Protected copyright. active young females. Transm Inf 1998;74 (Suppl 1):S1–11. EDITOR,—Gonorrhoea is one of the oldest and A programme of long term measures, such We hope for further collaboration. We shall a highly infectious sexually transmitted infec- as education on sexual health and sexually inform you about our future plans. tion. Its prevalence is dynamic and fluctuates transmitted infections in schools, and a M A GOMBERG over time and is influenced by a number of programme of regular screening for gonor- Acting editor rhoea (and chlamydia) for all sexually active factors. The incidence of this infection has L G DOUGACHEVA Assistant editor 700 SANAM, Russian Association for the Prevention of Sexually Transmitted Infections, WHO Collaborating Sum total 605 Centre, Dovator Strasse, 13. 119048 Moscow, Russia 600 [email protected] Accepted for publication 19 June 2000 500 Cheilitis in association with indinavir 400 381 EDITOR,—There is increasing speculation 314 288 that indinavir may cause side eVects which 300 267 have been previously associated with high 221 199 concentrations of retinoids. In the presence of 200 all-trans-retinoic acid (ATRA), indinavir, but 144 123 118 not other protease inhibitors (PIs), alters stem cell diVerentiation in vitro, not seen in 100 the presence of ATRA alone.1 Alopecia and cheilitis are two side eVects associated with 0 both retinoids and the protease inhibitor 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 indinavir (but not with any of the other Figure 1 Total incidence of gonorrhoea in the Mersey Region in 1990–9 (in absolute numbers). protease inhibitors). These side eVects can be

www.sextransinf.com 324 Letters, Book review, Notices, Correction, Current publications Sex Transm Infect: first published as 10.1136/sti.76.4.321 on 1 August 2000. Downloaded from BOOK REVIEW NOTICES

Chlamydia Intercellular Biology International Herpes Alliance and Inter- national Herpes Management Forum Pathogenesis and Immunity. Ed Richard The International Herpes Alliance has intro- S Stevens. $84.95. American Society for duced a website (www.herpesalliance.org) Microbiology, 1999. ISBN 1-55581-155-8 from which can be downloaded patient infor- mation leaflets. Its sister organisation the This book is a must for anyone interested in International Herpes Management Forum how this fascinating organism causes dam- (website: www.IHMF.org) has launched new age. The first part reviews the knowledge on guidelines on the management of herpesvirus the molecular phylogeny, genomic autobiog- infections in pregnancy at the 9th Inter- raphy, developmental biology, and metabo- national Congress on Infectious Disease lism of chlamydiae. It shows how far our (ICID) in Buenos Aires. knowledge of the organism has broadened in the past few years, particularly as gene sequencing has changed our view of chlamy- Pan-American Health Organization, re- diae. Until this was made available, metabolic gional oYce of the World Health Organi- Figure 1 (A) Shows the indinavir related studies on chlamydiae were hampered by its zation cheilitis and (B) after discontinuation of intracellular obligate nature, lack of knowl- A catalogue of publications is available online indinavir. edge of the enzyme pathways, and the (www.paho.org). The monthly journal of relatively small genome which suggested very PAHO, the Pan American Journal of Public reversed on changing from indinavir to an limited metabolic activity. It now becomes alternative PI.2 We report a case of cheilitis Health, is also available (subscriptions: apparent that the organism, which we be- [email protected]). associated with indinavir which resolved rap- lieved to be biologically crippled, has quite idly on changing treatment. sophisticated biosynthetic capabilities. This A 35 year old African man developed opens the way to creating a non-cell depend- MSSVD Clinical Developments Fund cheilitis (fig 1A) 5 months after commencing ent culture system in the future. HAART with stavudine, lamivudine, and The MSSVD Clinical Developments Fund is A chapter by Ted Hackstadt on the cell indinavir. His CD4 lymphocyte count at that asking for applications for funding to support biology shows a whole spectrum of novel time was 238 cells ×106/l, with an HIV viral projects that advance the understanding and interactions with the host cell that contribute load of 78 copies per ml (Chiron bDNA assay practice of genitourinary medicine. An to the success of the genus as pathogens. This version 3) He had a medical history of granu- amount of £10 000 is available to one or is followed by an excellent chapter by Julius lomatous uveitis of undetermined cause, more successful applicant(s). Closing date for Schachter on infection and disease epidemi- which developed before HAART. It re- application is 25 August 2000. Further ology. He makes the interesting point that sponded to prolonged treatment with oral details: Dr Keith RadcliVe, Honorary Assist- given that some individuals lose antibody prednisolone 40 mg daily and has since ant Secretary MSSVD, Whitall Street Clinic, over time it is possible that almost all humans remained quiescent. The oral corticosteroids Whitall Street, Birmingham B4 6DH (tel: have met the organism at sometimes in their were tailed oV and finally discontinued a 0121 237 5719; fax: 0121 237 5729; email: lives. This may be quite important in under- month before the cheilitis developed. Follow- [email protected]). ing the development of cheilitis, further standing some of the longer term conse- investigations showed: positive IgG antinu- quences of chlamydial infections, where the http://sti.bmj.com/ organism may not be isolated and antibody clear antibodies with a homogeneous pattern 3rd Congress of the Baltic Association of tests may be negative. These sequelae are and a titre of 1 in 320; rheumatoid factor Dermatovenereology, 7–9 September covered in subsequent chapters by Michael positive 1 in 40; anti-Ro and anti Scl-70 both 2000, Riga, Latvia Ward, Robert Brunum, and Roger Rank. negative; serum angiotensin converting en- Further details: Professor Andris Y Rubins, Since all three concentrate on immunological zyme 75 U/l (normal range 20–95); chest x Department of Dermatovenereology, Medi- response to chlamydia there is bound to be ray normal; C reactive protein 1 mg/l; eryth- cal Academy of Latvia, K Valdemara Street, some overlap, but also some diVerences and rocyte sedimentation rate 4 mm in the first 76–75, Riga, LV-1013, Latvia (tel: +(371) hour. Biopsy of the lip showed acanthosis and interesting emphasis. For example Ward plays on September 25, 2021 by guest. Protected copyright. 7370395; fax: +(371 7361615; email: parakeratosis without associated inflamma- down the current obsession with cross [email protected]). tion. It was initially considered that the reactions between chlamydia and human heat cheilitis might be an autoimmune phenom- shock proteins. enon, but topical treatment with Eumovate A lot of our information, particularly on (clobetasone butyrate, GlaxoWellcome) the , comes from animal studies National NCCG Update Meeting, failed to improve the condition, which and their relevance to human Bromsgrove Stakis Hotel, 23–24 Septem- persisted for 10 months until the indinavir remains to be established. In an excellent ber 2000 Further details: Kathy Taylor (tel: 01384 was changed to efavirenz. At the time of final chapter Penelope Hitchcock points to 235207; email: [email protected]). changing his CD4 count was 418 the future directions of research. In particu- cells ×106/l, with an HIV viral load below lar, she laments that little research has been detection. Within a week of changing therapy done in men with chlamydia. Certainly the the cheilitis resolved completely (fig 1B). book is rather short on discussion of the male. 11th Regional Meeting of International There is also a need to find a male model for Union against Sexually Transmitted In- PAFOX fections, South East Asian and Western D A HAWKINS pathogenesis. Non-gonococcal urethritis R C D STAUGHTON maybe a suitable, and easily accessible, Pacific Branch and 24th National Con- Departments of HIV medicine and Dermatology, marker of chlamydial infection in men and ference of Indian Association for the Chelsea and Westminster Hospital, 369 Fulham Road, deserves more in-depth study. Much more Study of Sexually Transmitted Diseases London SW10 9NH research also needs to be done, particularly, and AIDS, 13–15 October 2000, Chandi- Correspondence to: Dr Fox on clinically inapparent infections in the garh, India human. This book is a must for all those Further details: Dr Bhushan Kumar, Organ- 1 Lenhard JM, Weiel JE, Paulik MA, et al. Stimu- interested in this fascinating organism. Per- ising Secretary, 11th Regional Meeting of lation of vitamin A1 acid signalling by the HIV IUSTI–Asia Pacific (SE Asia and W Pacific protease inhibitor indinavir. Biochem Pharmacol haps while not losing site of the “why” and 2000;59:1063–8. the “how” of sexual transmission we should Branch), Department of Dermatology, Ve- 2 Bouscarat F, Prevot MH, Matheron S. Alopecia also divert some resources into the “how” of nereology and Leprosy, PGIMER, Chandi- associated with indinavir therapy. N Engl J Med garh - 160 012, India (tel: +91 (0172) 1999; :618. its damage. 341 745330; fax: +91 (0172) 744401/745078; Accepted for publication 19 June 2000 M SHAHMANESH email: [email protected]).

www.sextransinf.com Letters, Book review, Notices, Correction, Current publications 325

New Zealand Venereological Society were all susceptible to penicillin, tetracycline, Sex Transm Infect: first published as 10.1136/sti.76.4.321 on 1 August 2000. Downloaded from Conference, Centennial Convention and erythromycin and were highly suscepti- Centre, Palmerston North, New Zea- CURRENT ble to broad spectrum cephalosporins and land, 18–20 October 2000 fluoroquinolones. The number of cases rose Ka Hikoitia Ka Korerotia Mo Te Tau Rua PUBLICATIONS from 57 to 75 per year in the 1980s to 125 Mano (Maori) “Walk the Talk 2000.” Fur- and 115 in 1996 and 1997 respectively ther details: Sue Peck, Conference Organiser, despite a fall in the total number of cases of SP Conference Management, PO Box 4400, Selected titles form recent reports pub- gonorrhoea seen. The CU auxotype was also Palmerston North, New Zealand (tel: 64 6 lished worldwide are arranged in the fol- isolated more frequently than other types 357 1466; fax 64 6 357 1426; email lowing sections: from healthcare facilities other than GU clin- [email protected]). Gonorrhoea ics. Chlamydia The demographic and behavioural data Consortium of Thai Training Institutes Candidiasis showed that men infected with the CU auxo- for STDs and AIDS—10th STDs/AIDS Bacterial vaginosis type were more often black, heterosexual, diploma course, Bangkok Hospital, Bang- Trichomoniasis younger, less likely to seek care for symptoms kok (30 Oct−12 Nov) and Prince of Song- Pelvic inflammatory disease and to be co-infected with Chlamydia tracho- kla University, Hat Yai, Thailand (13–23 Syphilis and other treponematoses matis than were men infected with other Nov) 30 October–23 November 2000 Hepatitis auxotypes. Among heterosexual men, infec- Further details: Hat Yai Secretariat, Herpes tion with the CU auxotype produced symp- Dr Verapol Chandeying, Dept of OB-GYN, Human papillomavirus infection toms of urethral discharge or dysuria or signs Faculty of Medicine, Prince of Songkla Cervical cytology and colposcopy of moderate or profuse urethral discharge less University, Hat Yai, Songkla 90110, Other sexually transmitted infections often than in men infected with other Thailand (fax: (66-74) 446 361; email: Public health and social aspects auxotypes. Symptoms of dysuria and dis- [email protected] or Bangkok Secre- Microbiology and immunology charge were also of longer duration and ure- tariat, Dr Thanit Palanuvej, Bangkok Hospi- Dermatology thral smears showing intracellular Gram tal, 189 Sathorn Road, Bangkok 10120, Miscellaneous negative diplococci were found in only 67% of patients with the CU auxotype compared Thailand (fax: (66-2) 286 3013; email: with 95% of men with other types. [email protected]). The characteristics of the CU auxotype Consortium of Thai Training Institutes Gonorrhoea may enable these strains to evade detection for STDs and AIDS—International and hence confer a selective advantage for Reunion and Refresher Course on Sexual survival. This is of particular concern when Health, Lee Garden Plaza Hotel, Hat Yai, total numbers have fallen and the pressure for screening asymptomatic populations has de- Thailand 24–26 November 2000 Gonorrhea, chlamydia and the sexual Further details: Hat Yai Secretariat, network—pushing the envelope (Edito- creased. Dr Verapol Chandeying, Dept of OB-GYN, rial). Concurrent gonococcal and chlamydial Faculty of Medicine, Prince of Songkla JM ZENILMAN. Sex Transm Dis 2000;27:224–5 infection—how best to treat. University, Hat Yai, Songkla 90110, Gonorrhea in male adolescents and AJ ROBINSON, GL RIDGWAY. Drugs 2000;59:801– Thailand (fax: (66-74) 446 361; email: 14 [email protected] or Bangkok Secre- young adults in Newark, New Jersey— implications of risk factors and patient tariat, Dr Thanit Palanuvej, Bangkok Hospi- Neisseria gonorrhoeae MS11 mkC opac- preferences for prevention strategies. tal, 189 Sathorn Road, Bangkok 10120, ity protein expression in vitro and during KJ MERTZ, L FINELLI, WC LEVINE et al. Sex Transm Thailand (fax: (66-2) 286 3013; email: human volunteer infectivity studies. Dis 2000;27:201–7 [email protected]). KA SCHMIDT, CD DEAL, MKWANet al. Sex Transm Dis 2000;27:278–83 http://sti.bmj.com/ Royal Society of Medicine and National Comparative epidemiology of hetero- sexual gonococcal and chlamydial Institutes of Health International Confer- Gonococcal lipo-ologosaccharide is a networks—implications for transmission ence, RSM London, 7–8 December 2000 ligand for the asialoglycoprotein recep- patterns. The RSM in London, UK, and the NIH in tor on human sperm. BP STONER, WL THITTINGTON, JP HUGHES et al. Bethesda, Maryland, US, are organising an HA HARVEY, N PORAT, CA CAMPBELL et al. Mol Sex Transm Dis 2000;27:215–23 international conference to be held at the RSM Microbiol 2000;36:1059–70 on “New trends in HIV management and Trends of gonorrhea and chlamydial research.” Further details: Victoria Boswell, on September 25, 2021 by guest. Protected copyright. infection during 1985–1996 among Academic Conference Assistant, Royal Society active-duty soldiers at a United States of Medicine (tel: +44 (0)20 7290 2965; Army installation. Chlamydia fax:+44 (0)20 7290 2977; email: AC SENA, WC MILLER, IF HOFFMAN et al. Clin [email protected]). Infect Dis 2000;30:742–9

Call for papers—6th European Forum on Unique gonococcal phenotype associated Reexamining the prevalence of Chlamy- Quality Improvement in Health Care, with asymptomatic infection in men and dia trachomatis infection among gay 29–31 March 2001, Bologna, Italy with erroneous diagnosis of nongonococ- men with urethritis—implications for Further details: BMA/BMJ Conference Unit, cal urethritis. STD policy and HIV prevention activi- BMA House, Tavistock Square, London WLH WHITTINGTON, KK HOLMES. J Infect Dis ties. WC1H 9JP, UK (tel: +44 (0) 20 7383 6409; 2000;1044–8 EL CIEMINS, J FLOOD, CK KENT et al. Sex Transm fax: +44 (0) 20 7383 6869; email: Asymptomatic infections have been associ- Dis 2000;27:249–51 [email protected]; website: www.quality. ated with strains of Neisseria gonorrhoeae bmjpg.com). belonging to certain phenotypes; arginine, Pooling of urine specimens for detection hypoxanthine, and uracil requiring (AHU) of asymptomatic Chlamydia trachoma- and proline, citrulline, and uracil requiring tis infections by PCR in a low-prevalence (PCU). This study describes an outbreak population: cost-saving strategy for epi- caused by a new phenotype, citrulline and demiological studies and screening pro- CORRECTION uracil requiring, which has unique clinical grams. presentation. The authors report an increase SA MOORE, CJLM MEIJER, C MUNK et al. J Clin in the prevalence of gonococci belonging to Microbiol 2000;38:1679–83 the CU auxotype from 1.6% in 1987 to An error occurred in the editorial by R D 16.5% in 1997 in King County, Washington, Multiple drug-resistant Chlamydia tra- Maw which was published in the June issue USA. The characteristics of these strains chomatis associated with clinical treat- (STI 2000;76:153). In the second column, were that they belonged to one of two closely ment failure. lines 3–6, podophyllin should be replaced by related serovars, IB-1 and IB-3 that diVer J SOMANI, VB BHULLAR, KA WORKOWSKI et al. J podophyllotoxin in each case. only by reactivity with a single antibody, they Infect Dis 2000;181:1421–7

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Prevalence of Chlamydia trachomatis in Posterior uveitis in patients with positive Sex Transm Infect: first published as 10.1136/sti.76.4.321 on 1 August 2000. Downloaded from urine of male patients with ankylosing Bacterial vaginosis serology for syphilis. spondylitis is not increased. AV VILLANUEVA, ML SAHOURI, LD ORMEROD et al. M VANDERPAARDT, JC VANDENDEREN, AJC Clin Infect Dis 2000;30:479–85 VANDENBRULE et al. Ann Rheum Dis 2000;59:3000–2 Treponema pallidum surface immun- Bacterial vaginosis. ofluorescence assay for serologic diagno- JD SOBEL. Annu Rev Med 2000;51:349–56 The value of Chlamydia trachomatis sis of syphilis. antibody testing as part of routine infer- A MARANGONI, V SAMBRI, E STORNI et al. Clin Urinary tract infections in women with Diag Lab Immunol 2000;7:417–21 tility investigations. bacterial vaginosis. K THOMAS, L BOUGHLIN, PT MANNION, NG OH HARMANLI, GY CHENG, P NYIRJESY et al. Obstet A pilot study evaluating ceftriaxone and HADDAD. Hum Reprod 2000;15:1079–82 Gynecol 2000;95:710–2 penicillin G as treatment agents for neu- rosyphilis in human immunodeficiency Low correlation of serology with detec- Characterisation and selection of a tion of Chlamydia trachomatis by ligase virus-infected individuals. Lactobacilllus species to re-colonise the CM MARRA, P BOUTIN, JC MCARTHUR . chain reaction and antigen EIA. et al Clin vagina of women with recurrent bacte- Infect Dis 2000;30:540–4 HF RABENAU, E KIHLER, M PETERS et al. Infection rial vaginosis. 2000; :97–102 28 NW MCLEAN, IJ ROSENSTEIN. J Med Microbiol Opsonic potential, protective capacity 2000;49:543–52 and sequence conservation of the The relationship of inflammation in the Treponema pallidum subspecies palli- Papanicolaou smear to Chlamydia tra- Induction of human immunodeficiency dum Tp92. chomatis infection in a high-risk popula- virus type 1 expression by anaerobes CE CAMERON, SA LUKEHART, C CASTRO et al. J tion. associated with bacterial vaginosis. Infect Dis 2000;181:1401–13 RJ PALER, DR SIMPSON, AM KAYE et al. Contracep- RB HASHEMI, M GHASSEMI, S FARO et al. J Infect tion 2000;61:231–4 Dis 2000;181:1574–80

In situ analysis of the evolution of the primary immune response in murine Hepatitis Chlamydia trachomatis genital tract Trichomoniasis infection. SG MORRISON, RP MORRISON. Infect Immun Natural history of hepatitis C: its impact 2000; :2870–87 68 on clinical management. Consider diagnosis and treatment of tri- AM DIBISCEGLIE. 2000;31:1014–9 chomoniasis in men (Editorial). JN KRIEGER. Sex Transm Dis 2000;27:241–7 Seroprevalence and risk factors of hepa- Candidiasis titis B, hepatitis C and human cytome- Comparative prevalence of infection galovirus among HIV-infected and high- with Trichomonas vaginalis among men risk uninfected adolescents—findings of attending a sexually transmitted diseases the REACH study. Practice guidelines for the treatment of clinic. CA HOLLAND, YMA,AB MOSCICKI et al. Sex candidiasis. JL JOYNER, JM DOUGLAS, S RAGSDALE et al. Sex Transm Dis 2000;27:296–302 JH REX, TH WALSH, JD SOBEL et al. Clin Infect Dis Transm Dis 2000;27:236–40 2000;30:662–78 A meta-analysis of the Papanicolaou Candida vaginitis—self-reported inci- smear and wet mount for the diagnosis of Herpes http://sti.bmj.com/ dence and associated costs. vaginal trichomoniasis. B FOXMAN, R BARLOW, H DARCY et al. Sex Transm W WIESE, SR PATEL, SC PATEL et al. Am J Med Dis 2000;27:230–5 2000;108:301–8 A novel cysteine proteinase (CP65) of Herpes simplex virus type 1 as a cause of Experimental candidosis. Pathogenesis, genital herpes: impact on surveillance prevention, therapy. Trichomonas vaginalis involved in cyto- toxicity. and prevention. E SEGAL. Mycoses 2000;42:55–60 WE LAFFERTY, L DOWNEY, C CELUM, A WALD. ME ALVAREZSANCHEZ, L AVILAGONZALEZ, C J Infect Dis 2000;181:1454–7 on September 25, 2021 by guest. Protected copyright. Estrogen eVects on Candida albicans:a BECERRILGARCIA et al. Microbial Pathogen 2000;28:198–202 potential virulence-regulating mech- Testing for herpes simplex virus type anism. 2—full steam ahead? (Editorial). XQ ZHANG, M ESSMANN, ET BURT, B LARSEN. J J MILLS. Sex Transm Dis 2000;27:270–1 Infect Dis 2000;181:1441–6 Pelvic inflammatory disease HSV-2 specific serology should be of- Investigation of á-glucosidase as a poten- fered routinely to antenatal patients. tial virulence factor of Candida albicans. ZA BROWN. Rev Med Virol 2000;10:141–4 K FEKETEFORGACS, A JENEY, G VARGA, B LENKEY. J Basic Microb 2000;40:105–10 Risk factors for pelvic inflammatory dis- HSV-2 specific serology should not be ease in inner-city adolescents. oVered routinely to antenatal patients. Cytokine modulation of specific and AL SUSS, P HOMEL, M HAMMERSCHLAG, K BROMB- D WILKINSON, S BARTON, FCOWAN.Rev Med nonspecific immunity to Candida albi- ERG. Sex Transm Dis 2000;27:289–91 Virol 2000;10:145–54 cans. L ROMANI. Mycoses 2000;42:45–8 Seroprevalence of herpes simplex virus type 2 infection among attendees of a Histidine kinase, two-component signal Syphilis and other sexually transmitted disease clinic in transduction proteins of Candida albi- Italy. cans and the pathogenesis of candidosis. treponematoses M CUSINI, M CUSAN, C PAROLIN et al. Sex Transm JA CALERA, R CALDERONE. Mycoses 2000;42:49– Dis 2000;27:292–5 54 Herpes simplex virus-type 2 seropositiv- DiVerential activation of a Candida Potential for community-based screen- ity in a Danish adult population denying albicans virulence gene family during ing, treatment and antibiotic prophy- previous episodes of genital herpes. infection. laxis for syphilis prevention. CS PETERSEN, FG LARSEN, C ZACHARIAE, M P STAIB, M KRETSCHMAR, T NICHTERLEIN et al. RH KAHN, KE MOSELEY, G JOHNSON, TA FARLEY. HEIDENHEIM. Acta Dermato-Venereol Proc Nat Acad Sci USA 2000;97:6102–7 Sex Transm Dis 2000;27:188–92 2000;80:158

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Seroprevalence of herpes simplex virus Hydrogels containing monocaprin pre- High prevalence of serum antibodies to Sex Transm Infect: first published as 10.1136/sti.76.4.321 on 1 August 2000. Downloaded from type 1 and type 2 in selected German vent intravaginal and intracutaneous Ras and type 16 E4 proteins of human populations—relevance for the incidence infections with HSV-2 in mice: impact on papillomavirus in patients with precan- of genital herpes. the search for vaginal microbicides. cerous lesions of the uterine cervix. P WUTZLER, HW DOERR,IFARBER et al. J Med J NEYTS, T KRISTMUNDSDOTTIR, E DECLERCQ, H A PEDROZASAAVEDRA, ACRUZ,F ESQUIVEL et al. Virol 2000;61:201–7 THORMAR. J Med Virol 2000;61:107–10 Arch Virol 2000;145:603–24

Valaciclovir—a review of its long term 1,3-dihydroxyacridone derivatives as in- Boosting with recombinant vaccinia in- utility in the management of genital her- hibitors of herpes virus replication. creases HPV-16 E7-specific T cell pre- pes simplex virus and cytomegalovirus P AKANITAPACHAT, CT LOWDEN, KF BASTOW. cursor frequencies of HPV-16 E7- infections. Antiviral Res 2000;45:123–34 expressing DNA vaccines. D ORMROD, LJ SCOTT, CM PERRY. Drugs CH CHEN, TL WANG, CF HUNG et al. Vaccine 2000;59:839–64 2000;18:2015–22 Characterization of an acyclovir- Human papillomavirus Human tumor growth is inhibited by a resistant herpes simplex virus type 2 vaccinia virus carrying the E2 gene of strain isolated from a premature ne- infection bovine papillomavirus. onate. VV GRAHAM, G SUTTER, MV JOSE et al. Cancer RJ ORAM, D MARCELLINO, D STRAUSS et al. J Infect 2000;88:1650–62 Dis 2000;181:1458–61 Papillomaviruses causing cancer: eva- Human papillomavirus type 16 E7 onco- HSV.com: Maneuvering the internet- sion from host-cell control in early protein represses transcription of works of viral neuropathogenesis and events in carcinogenesis. human fibronectin. evasion of the host defense. H ZURHAUSEN. J Nat Cancer Inst O REY, S LEE, NH PARK. J Virol 2000;74:491218 SL TAN, MG KATZE. Proc Natl Acad Sci USA 2000;92:690–8 2000;97:5684–6 Interleukin-10 increases Th1 cytokine production and cytotoxic potential in Contemporary theories of cervical car- human papillomavirus-specific CD8(+) Molecular epidemiology of herpes sim- cinogenesis: the virus, the host and the plex virus type 1 genital infection in stem cell. cytotoxic T lymphocytes. association with clinical manifestations. AD SANTIN, PL HERMONAT, A RAVAGGI et al. J CP CRUM. Mod Pathol 2000;13:243–51 K UMENE, T KAWANA. Arch Virol 2000;145:505– Virol 2000;74:4729–37 22 International trends in incidence of cer- Cytokine profile of draining lymph node Evaluation of an enzyme-linked viral vical cancer: II. Squamous-cell carci- lymphocytes in mice grafted with syn- inducible system for the rapid detection noma. geneic keratinocytes expressing human AP VIZCAINO, V MORENO, FX BOSCH . of herpes simplex virus. et al Int J papillomavirus type 16 E7 protein. Cancer 2000;86:429–35 MT LAROCCO. Eur J Clin Microbiol Infect Dis MC LOPEZ, M STANLEY. J Gen Virol 2000;19:233–5 2000; :1175–82 A simplified and reliable HPV testing of 81 archival Papanicolaou-stained cervical Premarket evaluation of the POCkit smears: application to cervical smears HSV-2 type-specific serologic test in culture-documented cases of genital from cancer patients starting with cyto- Cervical cytology and herpes simplex virus type 2. logical normal smears. MV JACOBS, C ZIELINSKI, CJLM MEIJER et al. J RL ASHLEY, A WALD, M EAGLETON. Sex Transm colposcopy Cancer 2000;82:1421–6 Dis 2000;27:266–9 http://sti.bmj.com/ High prevalence of human papillomavi- Immunisation with phage displaying rus type 16 infection among children. peptides representing single epitopes of Advances in cervical screening technol- PS RICE, C MANT, J CASON et al. J Med Virol the glycoprotein G can give rise to ogy. 2000;61:70–5 partial protective immunity to HSV-2. MH STOLER. Mod Pathol 2000;13:275–84 AM GRABOWSKA, R JENNINGS, P LAING . et al Virol- Human papillomaviruses and vulvar 2000; :47–53 ogy 269 vestibulitis. Clinical significance of the qualification

of atypical squamous cells of undeter- on September 25, 2021 by guest. Protected copyright. C MORIN, C BOUCHARD, J BRISSON et al. Obstet Use of herpes simplex virus type 1 Gynecol 2000;95:683–7 mined significance: an analysis on the ISCOMS 703 vaccine for prophylactic basis of histologic diagnoses. and therapeutic treatment of primary Human papillomavirus DNA in penile NP VLAHOS, KG DEAGISIC, EE WALLACH et al. Am and recurrent HSV-2 infection in guinea carcinomas in Argentina: analysis of J Obstet Gynecol 2000;182:885–90 pigs. primary tumors and lymph nodes. JR SIMMS, AW HEATH, R JENNINGS. J Infect Dis MA PICCONI, AM EIJAN, AL DISTEFANO et al. J Med Qualitative analysis of value judgments 2000;181:1240–8 Virol 2000;61:65–9 in interpreting cervicovaginal smears using the Bethesda System Antibody responses, cytokine levels and Comparison of human papillomavirus L WORKMAN, MR SCHWARTZ, LB MCCULLOUGH. protection of mice immunized with genotypes in archival cervical cancer Arch Pathol Lab Med 2000; 124:556–62 HSV-2 antigens formulated into NISV or specimens from Alaska natives, Green- ISCOM delivery systems. land natives and Danish Caucasians. Papanicolaou smear history and diagno- SA MOHAMEDI, JM BREWER, J ALEXANDER et al. AM SEBBELOV, M DAVIDSON, S K KJAER et al. sis of invasive cervical carcinoma among Vaccine 2000;18:2083–94 Microbes Infect 2000;2:121–6 members of a large prepaid health plan. HY SUNG, KA KEARNEY, M MILLER et al. Cancer Interferon-ã up-regulates intercellular Warty (condylomatous) squamous cell 2000;88:2283–9 adhesion molecule-1 and vascular cell carcinoma of the penis—a report of 11 adhesion molecule-1 and recruits lym- cases and proposed classification of ‘ver- Cytologic and histologic diagnosis and phocytes into the vagina of immune mice ruciform’ penile tumors. significance of controversial squamous challenged with herpes simplex virus-2. AL CUBILLA, EF VELAZQUES, VE REUTER et al. Am lesions of the uterine cervix. MB PARR, EL PARR. Immunology 2000;99:540–5 J Surg Pathol 2000;24:505–12 MA DUGGAN. Mod Pathol 2000;13:252–60

Evaluation of the inactivation of infec- Type of human papillomavirus and ex- Photodetection of cervical intraepithe- tious herpes simplex virus by host- pression of p53 in elderly women with lial neoplasia using 5-aminolevulinic defense peptides. cervical cancer. acid-induced porphyrin fluorescence. B YASIN, M PANG, JS TURNER et al. Eur J Clin J SAITO, H HOSHIAI, K NODA. Gynecol Obstet P HILLEMANNS, H WEINGANDT, R BAUMGARTNER Microbiol Infect Dis 2000;19:187–94 Invest 2000;49:190–3 et al. Cancer 2000;88:2275–82

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Glandular lesions of the uterine cervix, Cutaneous metastatic carcinoma of the Sex Transm Infect: first published as 10.1136/sti.76.4.321 on 1 August 2000. Downloaded from RJ ZAINO. Mod Pathol 2000;13:261–74 penis: suspected metastasis implanta- Microbiology and tion from a bladder tumor. T MIYAMOTO, A IKEHARA, M ARAKI et al. J Urol The eVects of loop excision of the trans- immunology 2000;163:1519 formation zone on cervical length: impli- cations for pregnancy. DJ GENTRY, MS BAGISH, K BRADY et al. Am J Obstet Gynecol 2000;182:516–20 Pathogenesis of abnormal vaginal bacte- Miscellaneous rial flora. Treatment of vaginal dysplasia: just a GGG DONDERS, E BOSMANS, A DEKEERSMAECKER simple loop electrosurgical excision pro- et al. Am J Obstet Gynecol 2000;182:872–8 cedure? When is a sexually transmitted disease Wet mount microscopy reflects func- not an ‘STD’? JL POWELL, DS ADBERY. Am J Obstet Gynecol tional vaginal lactobacillary flora better PD GRIFFITHS. Rev Med Virol 2000;10:71–4 2000;182:731–2 than gram stain. Notify or not to notify—STD patients’ GGG DONDERS, A VEREECKEN, A DEKEERSMAE- Needle excision of the transformation perspectives of partner notification in CKER et al. J Clin Pathol 2000;53:308–13 Seattle. zone: a new method for treatment of cer- PM GORBACH, SO ARAL, C CELUM et al. Sex vical intraepithelial neoplasia. Induction of mucosal immune responses Transm Dis 2000;27:193–200 AL SADEK. Am J Obstet Gynecol 2000;182:866– in the human genital tract. 71 J MESTECKY, MW RUSSELL. Fems Immunol Med Treatment of sexually transmitted bacte- Microbiol 2000;27:351–6 rial diseases in pregnant women. GGG DONDERS. Drugs 2000;59:477–86 Surface characteristics of lactobacilli Traditional intravaginal practices and Other sexually transmitted isolated from human vagina. the heterosexual transmission of VS OCANA, EBRU,AAPD HOLGADO, ME NADERMA- diseases—a review. infections CIAS. J Gen Appl Microbiol Tokyo 1999;45: JE BROWN, RC BROWN. Sex Transm Dis 203–12 2000;27:183–7

Cytokine profile in genital tract secre- Extent of regretted sexual intercourse tions from female adolescents: impact of among young teenagers in Scotland: a Mycoplasma genitalium in males with cross sectional survey. human immunodeficiency virus, human nongonococcal urethritis—prevalence D WIGHT, M HENDERSON, G RAAB et al. BMJ and clinical eYcacy of eradication. papillomavirus and other sexually trans- 2000;320:1243–4 D GAMBINI,IDECLEVA, L LUPICA et al. Sex mitted pathogens. Transm Dis 2000;27:226–9 PA CROWLEYNOWICK, JH ELLENBERG, SH VERMUND Sexually transmitted infections in Euro- et al. J Infect Dis 2000;181:939–45 pean HIV-infected women: incidence in relation to time from infection. Development of a serological test for Evidence that anoreceptive intercourse BHB VANBENTHEM, M PRINS, C LARSEN et al. Haemophilus ducreyi for seroprevalence with ejaculate exposure is associated AIDS 2000;14:595–604 studies. with rapid CD4 cell loss. Prevalence and characteristics of sexual C ELKINS, KC YI, B OLSEN et al. J Clin Microbiol DJ WILEY, BR VISSCHER, S GROSSER et al. AIDS abuse in a national sample of Swedish 2000;38:1520–6 2000;14:707–16 seventeen-year-old boys and girls. http://sti.bmj.com/ K EDGARDH, K ORMSTAD. Acta Paediat 2000;89: An isogenic hemoglobin receptor- 310–9 deficient mutant of Haemophilus Antibiotics for bacterial prostatitis. ducreyi is attenuated in the human Dermatology JC NICKEL. J Urol 2000;163:1407 model of experimental infection. JA ALTAWFIQ, KR FORTNEY, BP KATZ et al. J Infect Saw palmetto for the treatment of men Dis 2000;181:1049–54 with lower urinary tract symptoms. GS GERBER. 2000; :1408–12 Recurrent squamous cell carcinoma of J Urol 163 on September 25, 2021 by guest. Protected copyright. the vulva—clinicopathologic determi- Cost utility analysis of sildenafil com- nants identifying low risk patients. pared with papaverine-phenotolamine Public health and social M PRETI, G RONCO, B GHIRINGHELLO, L injections. MICHELETTI. Cancer 2000;88:1869–76 EA STOLK, JJV BUSSCHBACH, M CAFFA et al. BMJ aspects 2000;320:1165–7 Anaerobic blanoposthitis: two cases and Non-Hodgkin’s lymphoma involving the review of the literature. vagina—a clinicopathologic analysis of S TAVAKOLITABASI, RJ HAMILL, SB GREENBERG. 14 patients. A prospective study on condom slippage Anaerobe 2000;6:11–4 R VANG, LJ MEDEIROS, EG SILVA et al. Am J Surg and breakage among female brothel- Pathol 2000;24:719–25 based sex workers in Singapore. Proliferative epidermal lesions associ- ML WONG, RKW CHAN, D KOH, SWEE.Sex Transm ated with anogenital Paget’s disease. Father-son testicular tumors: evidence Dis 2000;27:208–14 JA BRAINARD, WR HART. Am J Surg Pathol for genetic anticipation? A case report 2000;24 543–52 and review of the literature. S HAN,RE PESCHEL. Cancer 2000;88:2319–25 Condom acceptance is higher among Caruncles at the external urethral mea- travelers in Uganda. Finger-length ratios and sexual orienta- tus. M MARRIS, MJ WAWER, F MAKUMBI et al. AIDS tion. D AOKI, K NOMATA, S KANDA et al. J Urol TJ WILLIAMS, ME PEPITONE, SE CHRISTENSEN . 2000; 14:733–42 et al 2000;163:1518 Nature 2000;404–455

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