SEARCHLIGHT
Navigating the Global Medical Network
Of Sexual Health Issues for Sexual Health Matters
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Mr Ibrahim Bolaji, MD, FRCPI, FRCOG. Consultant Obstetrician and Gynaecologist, Diana Princess of Wales Hospital, Grimsby, DN3 2BA
Honorary Senior Clinical lecturer, Section of Reproductive and Developmental Medicine, University of Sheffield.
It is estimated that worldwide in 2003, more than 5 million people were newly infected with HIV. This is the largest ever in a single year and 25% of the new infections occurred in Asia.
UNAIDS.
In a retrospective review of people with HIV disease, the authors studied a cohort of 1504 adult patients seen at the national referral centre in Singapore between 1985 and 2001. Among the group, 504 have died. The most frequent principal causes of death were: Mycobacterium avium (17.5%); Mycobacterium tuberculosis (9.7%); Cryptococcus neoformans (6.7%); unspecified pneumonia (6.5%). It is evident that opportunistic infections still make substantial contributions to causes of death in people with HIV disease.
Bellamy R, Sayantha S, Paton N. Causes of death among patients with HIV in Singapore from 1985-2001: results from Singapore HIV Observational Cohort Study (SHOCS). HIV Medicine 2004; 5:289-295.
Single dose treatment for uncomplicated gonorrhoea
This retrospective study involved more than 300 patients who were treated with 1gm. Azithromycin on the diagnosis of genital gonorrhoea. Among the challenging factors in the management of gonorrhoea are antibiotics resistance and co-infections. Within the studied cohort, 38.2% had co-infections with C. trachomatis, and 32.2% of all isolated N. gonorrhoea strains were resistant to at least one antibiotic, including azithromycin. Although single dose regimens are desirable, the search continues for the perfect solution.
Habib AR, Fernando R. Efficacy of azithromycin 1g single dose in the management of uncomplicated gonorrhoea. Int. J. STD. AIDS 2004; 15: 240-242.
Aetiological agents of urethritis and cervicitis
Despite the use of modern diagnostic methods like nucleic acid amplification tests, the aetiological agents of urethritis and cervicitis remain elusive. Although tests are negative for C. trachomatis and N. gonorrhoea, some patients are still symptomatic. This review article examines the role of Mycoplasma genitalium in non-gonococcal and non-chlamydial urethritis in men and cervicitis in women. The optimal treatment of M. genitalium remains to be determined, but antibiotics of the macrolide group appear to be more active than the tetracyclines.
Jensen JS. Mycoplasma genitalium: the aetiological agents of urethritis and other sexually transmitted diseases. Journal of European Academy of Dermatology and Venereology (JEADV) 2004; 18: 1-11.
Menstrual blood loss
Menorrhagia is one of the most significant causes of ill health in women. About 5% of women aged between 30-49 years consult their general practitioners each year with heavy menstrual loss, and a significant number of them end up with hysterectomy. This review article discusses the objective and subjective amounts of blood loss and the various ways of quantifying the amounts. In their opinion, the menstrual pictogram appears to be an accurate and acceptable way of measuring menstrual blood loss for both research and clinical purposes.
The menorrhagia research group. Quantification of menstrual blood loss. The Obstetrician and Gynaecologist. 2004; 88-92.
Neonatal and infant adverse outcomes after operative vaginal delivery
This population based retrospective study took place in the United States of America (USA), comparing the outcomes of forceps delivery and vacuum extraction in the state of New Jersey and USA. The results showed that neonatal mortality was comparable between vacuum and forceps deliveries in the US births (odds ratio 0.94; Confidence Interval 0.79 to1.12). Vacuum delivery was associated with a lower risk of birth injuries, neonatal seizures and assisted ventilation. Among births in New Jersey, vacuum extraction was more likely to be complicated by post partum haemorrhage and shoulder dystocia. Sequential use of vacuum and forceps was associated with an increased risk of need for mechanical ventilation in the infant and third and fourth degree perineal tears. Infants delivered by forceps or vacuum are at similar risk of mortality.
Demissie K, Rhoads GG, Smulian JC et al. BMJ 2004; 329: 24-26.
Abortion and post abortion care
Maternal mortality rates are high in developing countries and it is reported to be about 1500 per 100,000 live births in Nigeria. Unsafe abortions make a large contribution (20-50%) to maternal deaths. This article reports on the knowledge, attitudes and practices of private medical practitioners in Calabar, Nigeria. The research showed that only 18.2% of the doctors used standard procedure for the management of patients with abortion and complications of abortion. There is an urgent need for continuing professional development for private medical practitioners.
Etuk SI, Ebong IF, Okonofua FE. Knowledge, attitude and practice of private medical practitioner in Calabar towards post abortion care.
Afr. J. Reprod. Health 2003; 7(3): 55-64.
Erectile dysfunction and its subsequent treatment
Impotence carries a social stigma and is a source of jokes hence the reluctance of men to admit it and seek medical help. The incidence of this condition increases with age and it causes a lot of distress. The introduction of sildenafil (Viagra) for its treatment has caused a raised expectation in the men and it has attracted a lot of media attention. This qualitative study of 40 affected men concluded that further study is needed to explore the feelings of men affected by erectile dysfunction and their perception of treatment.
Tomlinson JM, Wright D. Impact of erectile dysfunction and its subsequent treatment with sildenafil: qualitative study. BMJ 2004; 328: 1037-9
©2004 Sexual Health Matters. Published Quarterly by Express
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ISSN 1469-7556
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