Background One in six volunteers said they had skills that they would like to use in their volunteering role which they currently are not (McGarvey, Jochum, Davies, Dobbs, et al., 2019). We recognise the need to understand the wealth of skills and experiences within our volunteer team and to offer opportunities for these skills to benefit our aims. Aims To understand the previously unknown skills and experience of current volunteers and develop roles to match; To set in motion a cultural change in staff at all levels with regards to the possibilities and opportunities of how volunteers might get involved; To improve volunteer retention and satisfaction. Method Engaged 921 volunteers to complete a volunteer experience survey; Delivered a Volunteer Management training course to 39 staff members; Introduced a volunteer management system with a facility to log and report on volunteers’ skills and qualifications; Adapted interview questions to establish existing skills and experience; Conducted an internal communications drive to encourage the flexing of volunteer roles around skills and/or creating roles requiring specialist skills. Results Funded by the Health Innovation Network (HIN), we recruited six volunteers with training backgrounds to co-produce a training course for local non-hospice volunteers on talking about death, dying and loss. All volunteers reported high satisfaction levels with using their skills in this project. We have recruited 16 people with professional coaching qualifications to coach senior staff in their ongoing development on a voluntary basis. Volunteers are joining staff working groups to provide new perspective. Conclusions Every successful role and initiative is breathing more confidence in staff to focus their volunteer involvement around assets rather than boundaries. Limitations to consider: Ensuring potential volunteers are not put off by roles that may feel too much like a paid job; Ensuring that skills are welcomed whilst being mindful of focusing on organisational need. Acknowledgments With thanks to the HIN for funding some of this work.
OBJECTIVE: To describe the recent epidemiology of genital Chlamydia trachomatis infection in England and Wales. DESIGN: Retrospective study of routinely available surveillance datasets and ad hoc prevalence studies. METHODS: Numbers of new cases of genital C trachomatis infection, obtained from the Department of Health and Welsh Office, were combined with the estimated mid-year resident population of England and Wales. Rates were analysed for trend over time using a log linear age period model in GLIM4. Ad hoc prevalence and case finding studies carried out over the past 20 years were critically assessed in terms of study design and testing methodologies. RESULTS: Attendance rates at genitourinary medicine (GUM) clinics were higher for women than men over the period 1989 to 1994 as were the number of laboratory reports. The highest rate of attendance (GUM clinic data) was for women aged 16 to 19 years. There was an overall significant linear decrease in the attendance rates over time for both men (p = 0.0172) and women (p = 0.0000) between 1989 and 1994. There was considerable variation in the prevalence of genital C trachomatis infection detected within different clinical settings, together with a substantial level of asymptomatic infection. CONCLUSIONS: Genital C trachomatis infection is broadly distributed throughout the sexually active population, with a substantial reservoir of asymptomatic infection among those generally perceived to be at low risk of a sexually transmitted infection. Young people, particularly women aged 16 to 19 years, are at highest risk of genital C trachomatis infection. This is of concern since younger women are more susceptible than older women to developing complications of chlamydial infection, such as pelvic inflammatory disease. The broad distribution of infection across all sexually active health service attenders and the high level of asymptomatic infection suggest that a new, screening based, approach to the control of genital C trachomatis infection is required. Recommendations are made as to the epidemiological research required to guide such work.
1995, this problem has been rectified in data from Scottish GUM clinics. Scotland is now in a unique position in the UK, in that we now collect statistics on individuals (with all due attention to preserving anonymity, by using unique identifiers), rather than diagnostic events. These changes have been introduced in tandem with a major review of case definitions and more clinically relevant coding categories. Our data can now be linked to both demographic and sexual behaviour data, as well as to a clearly definable denominator population. To this end, therefore, the deficiencies to which the authors refer in their paper will no longer apply in Scotland. We are shortly due to commence a local study of sexual behaviour in GUM clinic attenders in Glasgow compared with a control population (in a nearby family planning centre) and we hope that many similar developments will be possible in the future, as a result of this fundamental improvement in the methodology of our data collection. ANNE SCOULAR Department of Genitourinary Medicine & Sexual Health, Glasgow Royal Infirmary University NHS Trust, Queen Elizabeth Building, 16 Alexandra Parade, Glasgow G31 2ER, UK AVRIL TAYLOR DAVID GOLDBERG Scottish Centre for Infection and Environmental Health, Ruchill Hospital, Glasgow PETER KNIGHT Information Services Division, NHS in Scotland, Trinity Park House, Edinburgh
OBJECTIVE: To examine ethnic, relationship, health, and mental health factors for a cohort of women with HIV infection attending an inner London clinic. DESIGN AND METHODS: Structured schedules were utilised to analyse ethnic group, family, and reproduction issues, mental and physical health for 100 women drawn consecutively from attenders at an inner London HIV clinic RESULTS: 51% of the women were non-ethnic minority groups and 49% were from ethnic groups. HIV testing was often as a result of symptoms or partner illness. One in five had disclosed their status to one person only or no one. Ethnic minority women were more likely to restrict disclosure. Forty seven per cent of the women had 100 children with more children reported in ethnic minority families; 28% of the children had been tested for HIV and five were confirmed HIV positive; 9% of children were born after HIV diagnosis. Nineteen women reported one or more termination of pregnancy, the majority before HIV diagnosis. Three quarters had a partner of whom 56 knew the partner's status. Women with HIV positive partners were more likely to have children. Women kept in ignorance of partner status were more likely to be ethnic minority women. Thirty two per cent had an AIDS diagnosis, diagnosed mostly in the UK. Medical and counselling service uptake was high. Gynaecological problems were common (49% had one or more problem) and 34% had at least one hospital admission. A wide range of counselling issues were recorded, with variations over time. Suicidal issues were relevant for 13% of women (69% ideation, 31% attempts). Significant life events were noted for many women with allied coping demands. CONCLUSIONS: There are a wide range of issues for women with HIV and systematic differences between ethnic and non-ethnic women and those with or without children.
AIMS:To evaluate demographic characteristics of women terminating their pregnancy for sentinel surveillance of Chlamydia trachomatis infection and to report changing prevalences of C trachomatis over time within this study population.DESIGN:Screening for C trachomatis in women seeking induced abortion was introduced in 1984 at the Department of Gynecology, Regional Hospital, Trondheim, Norway. Over the study years our department has used a precoded medical record covering sociodemographic, medically relevant data, also recording outcome of the C trachomatis test. Throughout the study the Department of Microbiology applied cell culture, enzyme immunoassay, and, during the most recent years a nucleic acid test to identify C trachomatis.STATISTICAL METHODS:Chi square test for linear trend and unconditional logistic regression.RESULTS:Over the study period, women having induced abortion were characterised by being most often single and more often at younger age. The overall age-adjusted prevalence of C trachomatis declined from 9.2% in 1985 to 3.6% in 1995, the major decline occurring from 1987 to 1991, and affected all age-groups simultaneously. There was a 60% decrease in odds ratio of having a C trachomatis infection from 1985 to 1991, and the crude and the adjusted odds ratios did not differ for any year examined.CONCLUSION:Women deciding on pregnancy termination have demographic characteristics that identify high-risk groups for C trachomatis infection. Despite these characteristics, which were relatively constant over the study period, the study population changed from being a high- to a low-prevalence population of C trachomatis.
I would like to report two cases of oropharyngeal gonorrhoea in twin children in whom the transmission occurred via sweets passed from their infected sister. A 16 year old girl, victim of multiple rape, attended the GUM department in Coventry for a check up. Throat culture grew penicillin sensitive Neisseria gonorrhoeae while cervical and urethral Gram stained smears and cultures were negative. A swab taken from the cervix for Chlamydia trachomatis was also positive. The patient received treatment for both infections and tests after treatment were negative. The mother was worried as the patient had the habit of exchanging sweets with her twin sisters (sweets were passed by mouth). On the doctor's advice, the twin sisters of the patient, who were 2j years old, were brought to the clinic by their mother. Throat cultures for N gonorrhoeae from the twins were positive. Both were treated with penicillin and tests after treatment were negative. When the cultures were found to be positive, the mother brought the rest of her children to the clinic. Throat cultures for gonorrhoea from the mother, 14 year old boy, and 6 and 4 year old girls were all negative. The raped girl denied having direct oral contacts with her twin sisters. Non-sexual transmission of gonorrhoea seems to be extremely rare in adults. Only one case of non-sexual transmission of genital N gonorrhoeae is documented in adults' and in another transmission possibly occurred through an inflatable doll.2 Non-sexual acquisition of gonococcal infection occurs more often in infants and children.34 Transmission of pharyngeal gonorrhoea is usually oro-oral or through oro-genital sex or fellatio. Transmission of pharyngeal gonorrhoea without direct oral contact has not been studied. The susceptibility of N gonorrhoeae to drying is a major factor in limiting the non-sexual transmission of this organism.3 Gonococci can survive for up to 24 hours on a towel when periodically rinsed with warm, physiological saline.5 Gonococci were recovered from a wide variety of hard and soft materials for up to 3 days6; therefore, the risk of transmitting pharyngeal infection through contaminated food or utensils is theoretically possible. This might have implications in suspected child abuse cases. To the best of my knowledge, no case of pharyngeal transmission of gonorrhoea has been documented through exchanging sweets or chewing gum. L M DAVID GUM Department, Stoney Stanton Road, Coventry, CVI 4FH
OBJECTIVES: To investigate how attenders with sexually transmitted disease (STD) differ from the general population with respect to sexual behaviour, and to identify which attenders at genitourinary medicine (GUM) clinics are at particular behavioural risk for acquiring STD. DESIGN: Multicentre cross sectional survey. SETTING: Two genitourinary medicine clinics, one in London and one in Sheffield SUBJECTS: 20,516 patients attending the two clinics over an 18 month period. MAIN OUTCOME MEASURES: Behavioural and demographic characteristics and clinical diagnoses were recorded for each patient. RESULTS: 8862 patients, in whom 12,506 diagnoses were made, were seen in the Sheffield clinic, and 11,654 patients, in whom 20,243 diagnoses were made, were seen in the London clinic. When compared with the reported results from a general population survey, there were higher proportions of clinic attenders reporting two or more sexual partners in the preceding 12 months (p < 0.001), and a higher proportion of males reporting homosexual contact (13% compared with 1%, p < 0.001). Only age and number of sexual partners in the past 12 months were significantly associated with acute STDs for each sex in each clinic. Acute STDs tended to occur with greater frequency in the younger age groups, peaking among 16-19 year olds, particularly among females. CONCLUSIONS: The results have confirmed that patients with STDs exhibit higher risk sexual behaviour than the general population, and have highlighted the problem of continuing high risk behaviour among younger attenders, particularly younger homosexual men. This study has demonstrated that among GUM clinic attenders age and number of sexual partners are key risk factors for the acquisition of an acute STD. The results of this survey also indicate, however, that half of the females and more than one quarter of males with acute STDs reported only one sexual partner in the past 12 months, suggesting that health education messages should point out that it is not only those who have multiple recent sexual partners, or who have recently changed sexual partner, that are at risk of STD, including HIV.
OBJECTIVE: To determine the presence of Chlamydia trachomatis in hydrocele fluid. METHODS: 90 male patients with hydrocele of tunica vaginalis from an endemic area for bancroftian filariasis were investigated for the presence of Chlamydia trachomatis in their hydrocele fluids. C trachomatis antigen detection tests-a direct immunofluorescence assay and an enzyme immunoassay along with polymerase chain reaction assay for amplification of a 517 bp fragment of C trachomatis endogenous plasmid-were used in this study. The patients were also tested for the presence of microfilaria in their hydrocele fluids and night blood. Histopathological examination was carried out to detect adult filarial worm in tunica vaginalis testes. RESULTS: Eight (8.88%) patients had chlamydia antigen in the hydrocele fluids; C trachomatis plasmid sequences could be amplified from five of these. Seven (7.77%) patients had microfilaria in the hydrocele fluids, three of them having adult worm in tunica vaginalis. CONCLUSION: C trachomatis infection might be associated with hydrocele in some of these patients.
OBJECTIVE: To reassess the in vivo and in vitro efficacy of cefaclor for the treatment of uncomplicated gonococcal infection. DESIGN: Open clinical trail conducted in South Africa among consecutive male patients with symptoms and signs of uncomplicated urethritis and laboratory evidence of gonorrhoea. METHODS: Patients were treated with 3 g of cefaclor plus 1 g probenecid as a single dose. Urethral specimens were cultured for Neisseria gonorrhoeae at the initial visit and at follow up. Patients were considered cured if follow up cultures were negative. Treatment was considered to have failed in the patients infected with identical gonococcal strains at the initial and at the control visit. Those with evidence of infection at the follow up visit were administered 400 mg of ofloxacin and doxycycline 100 mg twice daily for 7 days. Minimal inhibitory concentrations (MICs) of cefaclor were determined by an agar dilution technique on the gonococcal isolates from the study subjects. The results were compared with those of isolates from three other African countries. RESULTS: Of 155 patients evaluated, 151 were cured (97%). Thirty per cent of the patients complained of adverse effects, mainly gastrointestinal. Even though MICs for the isolates from the three other African countries were significantly higher than those for the isolates from the study, none was considered resistant to cefaclor in vitro. MICs were markedly influenced by the type of test medium used. CONCLUSION: The trial demonstrated the efficacy of a single oral dose of cefaclor with probenecid for the treatment of uncomplicated gonococcal urethritis in South Africa. Its potential as an alternative therapy to third generation cephalosporins deserves to be further investigated.
OBJECTIVES: To asses changes in sexual behaviour and use of contraceptive methods in Danish adolescents from the period before the advent of AIDS up to the present. DESIGN: Comparative study comparing data obtained from two identical cross sectional surveys SETTING: Grenaa Gymnasium, Denmark. SUBJECTS: 626 high school students in 1982 and 499 high school students in 1996. METHODS: An anonymous standardised self administered questionnaire handed out to high school students at Grenaa Gymnasium in spring 1982. In spring 1996 an identical questionnaire was handed out to every high school student at the same gymnasium. MAIN OUTCOME MEASURES: Age at first sexual intercourse, contraceptive use, and reasons for choice of contraceptive strategy. RESULTS: Today more males had experienced the first sexual intercourse before their 16th birthday (p = 0.047) compared with 1982, the reverse held for females (p = 0.003). From 1982 to 1996 condom use increased in males with no regular partner (p = 0.009). In females with no regular partner, there was during the same period an increase in considering the condom a personal contraceptive method (p = 0.017). In 1982 and 1996 protection from sexually transmitted diseases was given as reason for the choice of contraceptive strategy by 21% and 72% of males with no regular partner (p < 0.001), and by 7% and 32% of males with a regular partner (p < 0.001). The corresponding figures for females in 1982 and 1996 were 10% and 71% (p < 0.001) for those with no regular partner and 4% and 21% (p < 0.001) for those with a regular partner. CONCLUSION: Condom use has increased among adolescents with no regular partner brought up under the widespread awareness of AIDS, and the reason for this is to be protected from sexually transmitted diseases. A future decline in the incidence of various sexually transmitted diseases may be expected, and information on safe sexual practices should be continued.
BACKGROUND: It has been established that lack of circumcision increases the risk of urinary tract infection in infants. During the first six months, the presence of foreskin is associated with a greater quantity and a higher concentration of uropathogens in the periurethral area. Very little is known about this association in older males. OBJECTIVE: To compare the periurethral bacteriology of uncircumcised healthy males of more than one year of age. METHODS: The periurethral area of 125 uncircumcised and 46 circumcised healthy males (mean age, 26.5 and 28.3 years, respectively) was swabbed and cultured for facultative and anaerobic bacteria, genital mycoplasmas and Chlamydia trachomatis. RESULTS: Facultative Gram positive cocci predominated in both groups (62% and 80%, respectively). Pure culture of facultative Gram negative rods was more common in uncircumcised males (17% v 4% in circumcised males, p = 0.01). Streptococci, strict anaerobes and genital mycoplasmas were found almost exclusively in uncircumcised males of more than 15 years of age. No case of C trachomatis was identified. CONCLUSIONS: The higher prevalence of potential uropathogens in the subpreputial space is in accordance with a previous finding of increased risk of urinary tract infection in uncircumcised young men. Our results also support the role of the prepuce as a reservoir for sexually transmitted organisms.
The main question in this paper was to look at the distribution of auxotypes and serovars of Neisseria gonorrhoeae and check whether they correlate with clinical symptoms/signs among female sex workers (FSW) from Kinshasa, Zaïre. The subject were 1233 FSW enrolled in a cross sectional study on STDs and HIV infection in 1988; 771 of them were followed prospectively for a median duration of 23 months. At each visit, clinical symptoms and signs of cervicitis were recorded and the subjects were screened for gonococcal and chlamydial infection. The pre-dominant auxotypes were prototrophic (35.2%), proline requiring (29.6%), and proline requiring phenylalanine inhibition (19%). Serovars 1A-6 (42.5%) and 1B-1 (16.7%) were the commonest. Infection with auxotype prototrophic and phenylalanine inhibition (Proto/Phenali) was significantly associated with both mucopurulent cervicitis and pelvic inflammatory disease; (OR = 8.9; p = 0.002 and OR =19 x9; p = 0.002; respectively). Despite the few associations found in this study, there was not clear pattern linking clinical manifestations to auxotype/serovar profiles.
OBJECTIVES: To measure cerebrospinal fluid (CSF) ferritin in HIV infected patients with acute neurological episodes and to correlate the findings with the type and severity of neurological disease. METHODS: CSF ferritin and the ratio of CSF to serum albumin (QAlb) were prospectively measured in 27 consecutive HIV infected patients admitted to a specialist unit for investigation of acute neurological episodes; the results were compared with their clinical diagnoses. RESULTS: Ten patients had HIV associated dementia complex, six had cryptococcal meningitis, two had primary CNS lymphoma and nine had miscellaneous conditions including herpes simplex virus encephalitis, cytomegalovirus encephalitis, cerebral toxoplasmosis and mononeuritis multiplex. Overall, 16 (59%) patients had raised CSF ferritin levels, ranging from 13.0 to 50.2 micrograms/l, (median = 16.1 micrograms/l: normal range = 1.0-12.0 micrograms/l). Thirteen of the 16 also had normal QAlb values, implying an intact CSF-blood barrier, and thus that local synthesis of ferritin had occurred. Elevated ferritin levels were not associated with particular neurological diagnoses. In those with HIV associated dementia complex there was no correlation between CSF ferritin levels and the severity of clinical cognitive deficit or the extent of magnetic resonance imaging abnormalities. CONCLUSIONS: An elevated CSF ferritin level is a non-specific finding in HIV infected patients presenting with acute neurological episodes.
To evaluate the diagnostic utility of bone marrow (BM) sampling in HIV positive patients.Retrospective cohort analysis.Specialist HIV/AIDS service in London.215 consecutive HIV infected patients undergoing 246 BM samplings for investigation of pyrexia without localising signs, haematological abnormalities, or staging/investigation of lymphoma.Diagnostic yield from (and impact on management of) BM sampling.Of 122 BM samples taken to investigate pyrexia, 33 (27%) revealed the cause on microscopy: unexpected lymphoma in seven (6%), mycobacteriosis in 25 (20%), and toxoplasmosis in one (1%). Marrow infiltration was confirmed in 11 of 38 BM samples taken for staging/investigation of lymphoma/leukaemia. In afebrile patients, of 22 with pancytopenia, BM samples showed HIV associated changes in 17 and specific diagnoses in five (mycobacterial infection in three, haemophagocytic syndrome in one, and megaloblastic change due to vitamin B-12 deficiency in one); of 21 with isolated thrombocytopenia, 20 (95%) BM samples showed immune thrombocytopenic purpura to be the cause and the remaining patient had BM changes of aplasia; of 29 with isolated anaemia, 28 had BM changes of HIV associated dysplasia/erythroid dysplasia and one had unsuspected iron deficiency; all 10 with isolated leucopenia/neutropenia had BM changes ascribed to HIV infection exacerbated by concurrent sepsis or medication; of four BM samples taken for other reasons, one showed mycobacterial infection.BM sampling has diagnostic utility in HIV infected patients with pyrexia without localising signs, pancytopenia, and staging/investigation of lymphoma; this test has little value in the investigation of afebrile patients with isolated thrombocytopenia, anaemia, or leucopenia as HIV is usually the underlying cause.
Management of a 42 year old female patient diagnosed with trichomoniasis is described. She failed to respond to recommended oral and high dose oral and topical metronidazole. Various options used in previously reported cases of metronidazole resistant trichomoniasis also failed to cure her condition. MIC showed the organism to be resistant to metronidazole. Cure was achieved with the use of topical intravaginal paromomycin.
MATTERS ARISINGHSV type specific antibody tests I welcome the imminent arrival of type spe- cific antibody tests for herpes' which will help in the management of certain clinical situations.However, I am not convinced that these tests should be used to screen large sections of the population until a more thorough evaluation of the costs, benefits, and harm that such a programme would gen- erate has been undertaken.There are other pressing needs in sexual health and GU medicine cannot afford to back a poor horse.Given the high prevalence of HSV 2 in STD clinic patients further attention to promoting safer sex in these patients and in the wider population may be more beneficial than costly technological interventions.
OBJECTIVES:To screen for certain STD markers in a group of male clients of female sex workers.METHOD:Condoms with seminal fluid were collected at 10 "massage parlours" in Copenhagen. The seminal fluid samples were examined for HIV antibodies, markers of hepatitis B virus (HBV), Chlamydia trachomatis, and Mycoplasma genitalium.RESULTS:All samples (n = 332) were negative for HIV antibodies. Out of 327 samples examined for HBV markers 32 (9.8%) were positive for HBV core antibodies, one of which was also positive for HBV antigen. C trachomatis could be demonstrated in six out of 122 (4.9%) samples and M genitalium in one out of 122 samples.CONCLUSIONS:The finding of a C trachomatis prevalence of 4.9% is considerable higher than expected in men with a presumed age of 35-55 years. The demonstration of a prevalence of HBV markers of 9.8% indicates that these clients have an increased risk of HBV infection, a finding that further consolidates the recommendation of HBV vaccination of sex workers. As shown in this study, STD transmission in commercial sex may also have the client as the source.
In their review of sexually transmitted diseases in South Africa, Pham-Kanter and colleagues state that donovanosis may have disappeared only to reemerge in 1981 in Johannesburg, with subsequent case reports from other areas including Durban.' This scenario is exceedingly unlikely if the Annual reports of the Medical Officer of Health (MOH) for Durban of the Durban City Health Department are taken into account. Throughout South Africa STD clinics are administered under the statutory authority of the local MOH. Returns from these clinics are published in the annual reports of the MOH which contain a wealth of information compiled from STD clinics throughout the country. In Durban cases of donovanosis are reported almost every year in the MOH's reports from 1959 onwards, when the current STD reporting classification system was introduced. Peaks of infection were reported in 1973 and 19882 but a dramatic increase in the numbers of donovanosis cases has apparently occurred in recent years. The most recent data show that 2385 cases (2225 men, 160 women) donovanosis cases were diagnosed in 1995 (table). If these figures reflect accurate diagnoses they represent a significant epidemic of donovanosis and the largest in recent times. Despite this reported increase, the true nature of the current status of donovanosis is uncertain. Cases diagnosed in 1988 were usually confirmed by examination of tissue smears using a rapid technique. Subsequently the decision to decentralise STD services led to staff cuts and discontinuation of laboratory testing for the detection of Donovan bodies. Although the overall accuracy of specific clinical diagnosis in genital ulceration may be low, this is not necessarily so for donovanosis which can be predicted accurately on clinical grounds.3 Further investigation is urgently required to determine whether or not a true current epidemic of donovanosis exists. Genital ulcer disease and donovanosis in particular, are playing a major role in the rapid escalation of the HIV epidemic in Durban/KwaZulu/Natal4 and it is therefore vital to maintain and strengthen local STD surveillance so that STD/HIV prevention strategies can be targeted to have the maximum impact. N O'FARRELL
1 Hay PE, Thomas BJ, Homer PJ, MacLeod E, Renton AM, Taylor-Robinson D. Chlamydia trachomatis in women: the more you look, the more you find. Genitourin Med 1994;70: 97-100. 2 Paul ID, Crowley T, Milne JD, Caul EO. A comparison of urine and urethral swabbing for the diagnosis of C trachomatis infection in males. Serodiagn Immunother Infect Dis 1995; 4:476-80. 3 Sexually transmitted diseases quarterly report: genital infection with Chlamydia trachomatis in England and Wales. Communicable Disease Report Weekly 1996;6:190-1. 4 British Co-operative Clinical Group. Survey of diagnostic facilities for Chlamydia trachomatis and herpes simplex virus, 1984. Genitourin Med 1987;61:26-7. 5 Royal College of Physicians Committee on Genitourinary Medicine. Chlamydial diagnostic services in the UK and Eire: current facilities and perceived needs. Genitourin Med 1987;63:371-4. 6 Radcliffe KW, Rowen D, Mercey DE, Bingham JS. Survey of the management of Chlamydia trachomatis infection of the cervix. Genitourin Med 199 1;67:41-3.
