Letters to the Editor 323

Sexual health: what's in a name? to partially destigmatise them. Alternatively photosensitivity due to saquinavir.2 This there may be a true cultural difference. adverse reaction is recognised in the USA as Sonnex et al presented the results of a survey Notably, one quarter of the British patients reflected by the product labelling and patient of 150 of their British patients' preference for liked "sexual health" despite their lack of information leaflets.' According to Roche's

signposting for their clinic: 65% chose previous exposure to the term. international drug safety expert, the Genitourin Med: first published as 10.1136/sti.73.4.323-a on 1 August 1997. Downloaded from "clinic 1A", 23% opted for another Australia's choice of "sexual health European Medicines Evaluation Agency euphemistic name-for example, "Lydia clinic/centre" was driven by a new service considered a causal relation unlikely and clinic", 25% chose "department of genitouri- philosophy rather than euphemism. We note therefore did not include the risk of photo- nary medicine" or "GU clinic", 25% chose that most New Zealand clinics and a number sensitivity in the SmPC for saquinavir. "department of sexual health" or "sexual of new services in the United Kingdom have Stavudine induced photosensitivity has not health clinic" and only 8% chose "genito- also adopted the term. Dissatisfaction with been reported. medical clinic" (more than one choice was the name "genitourinary medicine" is Because UVB is useful in manag- allowed). At that time their clinic apparently becoming increasingly explicit.3 ing skin eruptions associated with HIV infec- operated under the name "clinic 1A-genito- In accordance with this new name and tion, photosensitivity is an important adverse medical clinic".' philosophy for our health services we have drug reaction even if it is rare. A San Beginning with the then new Parramatta developed professional titles: sexual health Francisco AIDS Foundation patient infor- sexual health clinic in 1979, Australian counsellor (previously health adviser, contact mation leaflet wams those taking saquinavir "STD clinics" have, one by one, adopted the tracer, etc), sexual health nurse, and sexual to avoid ultraviolet light and use sunblock.3 title "sexual health clinic/centre". Our own health physician (previously venereologist, In spite of the current lack of warning in the clinic changed its name in 1990. The new consultant, etc). A vote for a UK SmPC, we believe patients taking name was intended to reflect the broader name change from The Australasian College saquinavir should follow the same advice and clinical base: which includes family plan- of Venereologists to The Australasian UVB therapy should be administered warily ning/, sexuality and College of Sexual Health Physicians if at all. relationship counselling, and other general achieved an 84% approval by those who A J WINTER aspects of sexual health medicine. The name voted in 1996.4 There has also been a well J M PYWELL reasoned call for a new specialty of sexual A ILCHYSHYN also implies a proactive population health J FEARN approach rather than just providing a clinical health promotion.5 D NATIN service.2 Only time will tell us whether we have Walsgrave Hospitals NHS Trust, As there has been little consumer consul- found the right name. Coventry, CV2 2DX tation about our name change, we included a ANNETTE DILLON question on patients' preference for a clinic BRONWYN ANDERSON 1 Physicians' Desk Reference. Denver, CO, USA: name as part of a satisfaction survey. BASIL DONOVAN Computerised Clinical Information System, Sydney Sexual Health Centre, Micromedex Inc, 1996. In all, 563 consecutive general clinic Sydney Hospital, 2 Fothergill GA. Drug surveillance manager, patients completed a satisfaction survey PO Box 1614, Roche, UK. Personal communication 24 questionnaire in 1996. Exclusion criteria Sydney, NSW 2001, February 1997. were inability to read English and attendance Australia 3 SFAF leaflet available at http://www.sfaf. at a special clinic-for example, HIV eye org/factsaq.htm clinic, colposcopy/, Thai, or 1 Sonnex C, Came CA, Edwards S. Re-thinking Accepted for publication 13 May 1997 Chinese clinic. The M:F ratio mean sexual health clinics: patients prefer to have (1:0-6), non-descriptive titles (letter). BMJ age (30 years), ratio of new to return patients 1995;310:1 194-5. (1:1.6), and proportion bom in Australia 2 Donovan B, Neilsen G, Mindel A. Re-thinking (61 %) were all consistent with the clinic's sexual health clinics: Australia and New general patient profile. The patients' (mutu- Zealand have taken the lead (letter). BMJ Sexually acquired 1995;310:1 194. of oropharyngeal cavity ally exclusive) responses appear in the table. 3 Shahmanesh M. On a new road (editorial). The majority of our patients responded Genitourin Med 1996;72:81-2. favourably or indifferently to the centre's 4 Moran J. Honorary Secretary's Report. Unprotected orogenital sexual activity has http://sti.bmj.com/ Australasian Sexual Health Physician 1996; increased in recent years and the reported new name. About one in five preferred 6(3):4-5. "Nightingale clinic" (a name that had been 5 Winn M. Sexual health promotion. Venereology, prevalence varies between 40% and 70%.1 2 promoted in the 1980s) but it was unclear 1996;9:68-73. This altered sexual behaviour could in part be the result of media coverage of the HIV whether this was an expression of preference Accepted for publication 9 May 1997 for a euphemistic name or a desire to com- epidemic, which seems to have promoted the memorate the fact that the building in which belief that orogenital sex is a low risk activity the centre is located is the cradle of nursing in relation to transmission of HIV and other in Australia. We were surprised at the STDs. Investigations on the effect of such on September 25, 2021 by guest. Protected copyright. unpopularity of the names "STD clinic" and Photosensitivity due to saquinavir sexual activity on pharyngeal bacterial flora "genitourinary medicine clinic" given that have shown a twofold increase in pharyngeal the former was the name of the centre 6 Photosensitivity induced by the HIV pro- carriage of Neisseria meningitides in homo- years previously and, relevant to the latter teinase inhibitor saquinavir (Invirase, Roche) sexual men' but no increase in asymptomatic name, 15% of the sample were from the is listed as a rare adverse effect in the US carriage or infection with N gonorrhoeae.2 United Kingdom or the Republic of Ireland. Physician's Desk Reference' but is not However, transmission of HSV infection Interpreting Sonnex et al's and our studies recorded in the patient information sheet nor from the anogenital region to the oropharyn- together, it appears that patients are rela- in the Summary of Product Characteristics geal cavity in healthy adults resulting from tively accepting of a variety of names for (SmPC) available in the UK. We wish to sexual activity (fellatio and cunnilingus) has STD/HIV medicine services, particularly the highlight this discrepancy. A 38 year old man not been reported. We report a case of name in current usage. However, "STD with AIDS (CD4+ count < 10 cells x 106/1) oropharyngeal ulcers due to herpes simplex clinic" and "genitourinary medicine clinic" and no prior history of photosensitivity virus type 1 (HSV-1) infection without asso- have not achieved wide acceptance. The underwent 11 sessions of biweekly UVB ciated anogenital herpes, which occurred fol- British patients' apparent preoccupation therapy for a lichenified papular eruption. lowing orogenital sexual activity (fellatio) in with euphemism seems to contrast with the The UVB dose was chosen according to the a homosexual male. Australian patients' open minded attitude. It patient's skin type and then increased by A 33 year old homosexual man presented is possible that the broader service profile of 40% every other treatment. Meanwhile, to the genitourinary clinic with a 4 day Australian sexual health services has helped because of intolerance of both zidovudine history of "sore throat", dysphagia and and lamivudine he commenced saquinavir flu-like symptoms and a 2 day history of (1800 mg daily) and stavudine (60 mg dysuria and urethral discharge. He reported Response ofpatients to a question about their daily), continuing on didanosine (250 mg to have had unprotected, active, and passive preference for a clinic name (n = 563) daily) and monthly inhaled pentamidine. orogenital sex (fellatio) with a casual male Sydney sexual health centre 40.5% Three days after starting the new drugs he partner 1 week previously. An examination No preference 32-5% attended for his twelfth UVB treatment (80 revealed multiple shallow ulcers with irregular Nightingale clinic 20-2% seconds, 40% UVB) and sustained a severe margins, and marked surrounding inflamma- STD clinic 4-6% Genitourinary medicine clinic 1-4% painful sunburn reaction which settled with tion on the pharynx, palate, and fauces (fig). Other 0.7% topical steroids. There were no lesions on the anogenital This is the first officially reported case of region but a copious amount of purulent