An open letter to the BMA and the Academy of Medical Royal Colleges calls on them to make a joint public statement of opposition to the amended section 75 regulations

This guideline is appropriate for use in genitourinary (GU) medicine/sexually transmitted infections (STIs) clinics, and by other National Health Service (NHS) or other services providing sexual health advice, management or treatment to young people, e.g. sexual health clinics, young person’s clinics, contraceptive clinics, gynaecology/antenatal services, termination services, Sexual Assault Referral Centres (SARCs), paediatric services and general practice in the UK. The principles apply wherever young people are seen for sexual health care or where there are concerns about child sexual abuse (CSA) or where a STI has been detected. It includes recommendations on the assessment, examination, diagnostic tests, treatment regimens and prophylaxis for the effective management of children and young persons under 16 at risk of, or who have, an STI. It offers guidance on consent and confidentiality on children and young people presenting to health-care professionals working in sexual health services. It is also applicable to young people aged 16–18 who have learning difficulties or who are ‘vulnerable’. Some parts of the guidelines are relevant to all those providing sexual health services, but other parts are only relevant to Level 3 service providers. Prevention of STIs through health education and one-to-one interventions as recommended by the National Institute of Health and Clinical Excellence (NICE) is an integral part of sexual health care of young people but is outside the scope of the guidelines. Stakeholder involvement, rigour of development, levels of evidence and grading of recommendations are available online only in the full version of this guideline at http://ijsa.rsmjournals.com/cgi/content/full/21/4/229/DC1 This guideline is laid out in specific sections: Part 1: Introduction and discussion of issues concerning consent, confidentiality, child protection and basic principles of care. Part 2: The diagnosis and management of specific STIs and related conditions in the under 16s. Correspondence to: K Rogstad

An analysis was undertaken of data pertaining to over 100 women with lower abdominal pain who were laparoscoped. Prior to laparoscopy, 11 of the women were considered to almost certainly have salpingitis, of whom six (55%) had salpingitis at laparoscopy; 17 to probably have salpingitis, of whom six (35%) did; 28 to possibly have salpingitis, of whom five (18%) did; and 56 to be very unlikely to have salpingitis, of whom five (9%) did. Of the 22 women who had salpingitis at laparoscopy, 14 (64%) had a Chlamydia trachomatis IgG antibody titre of ≥1:128 and might reasonably be regarded as having chlamydial disease on this basis; six without such a titre probably did not have chlamydial disease as C. trachomatis could not be detected at any genital site. At laparoscopy, 18 women had adhesions without obvious tubal inflammation; clinically, 15 of them had been regarded as possibly having salpingitis or unlikely to have it, with 12 having chronic pelvic pain. Twelve (67%) of the 18 women had a chlamydial IgG antibody titre of ≥1:128. IgM antibody was also detected most often in the ‘salpingitis’ group. Of 49 women without any abnormality detected at laparoscopy, nine (18%) had a high chlamydial IgG antibody titre. Overall, a woman who had a high titre of chlamydial IgG antibody and acute pelvic pain, together with a clinical picture of pelvic inflammation, was more likely to have salpingitis than adhesions alone. Likewise, a woman who had a high titre of chlamydial IgG antibody and chronic pelvic pain, together with a clinical picture suggesting that salpingitis was unlikely, was more likely to have adhesions alone than acute chlamydial salpingitis. However, while antibody measurement and seeking cervical C. trachomatis may help in formulating a diagnosis, there seems no simple way of detecting the small proportion of women who are infected by C. trachomatis in the upper genital tract but whose laparoscopic findings indicate normality. So far as patient care is concerned, the only way of preventing damage to the upper genital tract is to treat early on the basis of suspicion.

OBJECTIVE: To evaluate women's experiences of accessing help and treatment for vulvodynia.STUDY DESIGN: Women who had participated in a vulvar pain management program were evaluated in a retrospective, qualitative, in-depth interview study.RESULTS: The women described their distressing symptoms of vulvodynia and their previous experiences of seeking help. The women thought that the delay to diagnosis contributed to the severity of their symptoms and that achieving a diagnosis was the first step on a path toward the acceptance of a chronic condition and a commitment to a management program.CONCLUSION: Vulvodynia is poorly recognized, and the delay to diagnosis adversely affects patients, exacerbating the severity of their symptoms.

OBJECTIVETo evaluate the response of a group of women with vulvodynia who were participating in an integrated, multidisciplinary management program comprising medical evaluation and treatment, psychotherapy, physiotherapy and dietary advice.STUDY DESIGNRetrospective, qualitative, in-depth interview study.RESULTSTwenty-seven of 29 women reported a significant benefit, and 9 who had completed the program were pain free. All women appreciated the integrated approach, and even those who were not completely pain free found that they were able to manage their condition satisfactorily.CONCLUSIONFurther evaluation of this program is warranted to assess whether it would be helpfulfor other women with this problem.

The prevalence of vulval vestibulitis was evaluated in a prospective observational study. Four hundred women from West Hertfordshire, 100 each from community family planning, antenatal, general practice and genitourinary clinics were investigated. Participants completed a questionnaire and were examined for vulval erythema and point tenderness. An algesiometer was also used to evaluate tenderness. The prevalence of vestibulitis varied from 2.9% to 9.8% depending on the stringency of diagnostic criteria and the method of ascertaining pain. Vulval vestibulitis cannot be accurately defined by current criteria, but superficial dyspareunia appears to be a frequent problem in the community in women consulting for unrelated matters.

We allocated 278 patients, who said they were asymptomatic and agreed to be randomized to a nurse or doctor clinic, to appointments using a random number system. In all, 35 patients did not attend and 16 were excluded because they did not meet the entry criteria. We used a screening protocol which excluded microscopy from the immediate assessment of patients. The outcome measures were completeness of documentation, proportion of patients accepting HIV tests, infections detected and patient satisfaction. Overall, 3% of items were not completed by doctors and 6% by nurses. HIV tests were carried out on 65% of patients who saw a doctor and 52% who saw a nurse. Thirteen infections were detected by doctors and 27 by nurses. No new cases of gonorrhoea, syphilis or HIV infection were identified. Eighty-eight patients completed a questionnaire after their attendance. Almost all patients were very satisfied with the service and most were prepared to see a nurse on a subsequent visit. We concluded that there are few differences between the performance of doctors and nurses in routine screening of asymptomatic patients.

Is a common and poorly recognised cause of dyspareunia

Introduction Gliomas are the most common primary tumour of the central nervous system (CNS), with an estimated annual incidence of 6.6 per 100,000 individuals in the USA and around 14 deaths per day from brain tumours in the UK. The genomic and biological landscape of brain tumours has been increasingly defined and, since 2016, the WHO classification of tumours of the CNS incorporates molecular data, along with morphology, to define tumour subtypes more accurately. The Tessa Jowell BRAIN MATRIX Platform (TJBM) study aims to create a transformative clinical research infrastructure that leverages UK NHS resources to support research that is patient centric and attractive to both academic and commercial investors. Methods and analysis The TJBM study is a programme of work with the principal purpose to improve the knowledge of glioma and treatment for glioma patients. The programme includes a platform study and subsequent interventional clinical trials (as separate protocols). The platform study described here is the backbone data-repository of disease, treatment and outcome data from clinical, imaging and pathology data being collected in glioma patients from secondary care hospitals. The primary outcome measure of the platform is time from biopsy to integrated histological-molecular diagnosis using whole genome sequencing and epigenomic classification. Secondary outcome measures include those that are process-centred, patient-centred and framework-based. Target recruitment for the study is 1000 patients with interim analyses at 100 and 500 patients. Ethics and dissemination The protocol was approved by West Midlands - Edgbaston Research Ethics Committee. Participants will be required to provide written informed consent. The results of this study will be disseminated through national and international presentations and peer-reviewed publications. Trial registration number ClinicalTrials.gov Identifier: NCT04274283; 18-Feb-2020 ISRCTN 14218060; 03-Feb-2020 Strengths and limitations of this study The TJBM study is a programme of work, which will improve the knowledge of glioma, and treatment for glioma patients. This platform study is a backbone data-repository of disease, treatment and outcome data from clinical, imaging and pathology data The TJBM study will aim to provide rapid and accurate molecular diagnosis, a network of clinical hubs with robust protocols for the collection, processing, analysis and storage of tissue, images, and clinical and quality of life data Gliomas occur at all ages and their specific subtype is difficult to predict preoperatively, therefore, the patient population eligible for the study is broad but currently excludes <16-year-old patients

OBJECTIVE:To determine the uptake of a type specific herpes simplex antibody test if it were offered as part of routine screening in a genitourinary medicine clinic in a district general hospital in the United Kingdom.METHODS:Stage 1. A series of 207 consecutive new attenders and 205 patients who had attended the clinic previously were given written information about the test and asked whether they would want to have the test if it were available. They were asked whether they would wish to discuss it further with a counsellor before making a decision. Stage 2. Another series of 434 consecutive patients were offered the test after reading an information leaflet detailing the advantages and disadvantages of being tested. They were also offered the opportunity to see a counsellor for further information.RESULTS:In stage 1 of the study, 51% of men and 54% of women said they would want the test if it were available. 32% of men and 40% of women requested counselling. In stage 2, when the test was offered, 41% of men and 37% of women chose to have it, and 23% of men and 7% of women requested further information from the counsellor. 20 patients were herpes simplex virus type 2 (HSV-2) positive-four of whom would have been diagnosed on clinical grounds at the time of presentation. A further 12 men and 20 women excluded themselves from the study because they were known to have genital herpes. Therefore, type specific serology contributed 30% to total diagnoses in this population-16 out of a population of 52 would have remained undiagnosed without having had the test.CONCLUSION:In this population, the uptake of the type specific herpes simplex antibody test was much less than expected and screening was of limited benefit in identifying large numbers of previously unrecognised HSV-2 positive patients.

What is an atlas? My dictionary was of little help, referring only to the word in its geographical and mythical contexts. Medical atlases that come to mind are largely pictures of the common and the obscure, of varying quality, and accompanied by the minimum of text. Such books are useful when it comes to reassuring young men that pearly penile papules are common and of no clinical significance, and for showing students conditions which they are unlikely to see in real life; but otherwise they tend to sit on the bookshelf after a rash purchase at a …

We evaluated partner notification for HIV in a district general hospital over a two-year period. The majority of current partners were notified and 60% were found to be HIV-positive. No previous partners were successfully notified. We make recommendations intended to improve the rate of notification and testing.

We describe the case of a 12 year old girl who presented requesting screening for sexually transmitted infections and discuss a conflict between concerns of clinicians to maintain confidentiality and concerns of social workers to investigate the possibility of sexual abuse.

Type-specific serological tests to distinguish between infection with herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2) have largely been used for studies which have contributed to our knowledge of the epidemiology and natural history of these infections. Such tests could be used as diagnostic tools in clinical situations provided that clinician and patient are aware of the test characteristics, which may result in false negative and false positive results. The use of serological tests in the screening of populations or sub-populations, such as pregnant women, has been advocated to attempt to halt the worldwide spread of the infection. However, there is little evidence currently to support this strategy.

Thirty-three women (mean age 45 years) attending a vulval pain clinic based in a department of genitourinary medicine were followed-up for a minimum of 6 months. All women had dysaesthetic vulvodynia and 11 (33%) also had features compatible with vulval vestibulitis. Thirty-two patients were treated with a tricyclic antidepressant drug and a complete response was recorded in 47%. Only four patients obtained less than 50% improvement in their symptoms. Treatment with tricyclic drugs was part of a package of interventions including intensive support and the opportunity to take up counselling. Under these circumstances, it is difficult to attribute the success of treatment to the effect of the medication alone and there is a need for well-designed randomised controlled trials to evaluate this and other therapeutic approaches.

We sought to analyze the prevalence and clinical manifestations of Mycoplasma genitalium infection in a heterogeneous population of women.The study was designed as a cross-sectional case-control study. Women attending a gynecological outpatient service from 2003 through 2008 were invited to participate.The prevalence of M genitalium was 2.1% and of Chlamydia trachomatis was 2.8% among 5519 tested women. A total of 679 women were included. Both pelvic inflammatory disease (PID) and cervicitis were independently associated with M genitalium (odds ratio, 9.00; 95% confidence interval, 1.62–49.89 and odds ratio, 3.80; 95% confidence interval, 2.06–7.03, respectively). Women with C trachomatis had a higher frequency of both PID (18.3% vs 4.9%, P < .001) and cervicitis (33.4% vs 22.3%, P < .001) than women with M genitalium.M genitalium was an independent and strong risk factor for both cervicitis and PID although, compared to C trachomatis, clinical manifestations were less frequent.