British Journal of Venereal Diseases, 1979, 55, 230
Correspondence TO THE EDITOR, British Journal of is the only means of determining the extent 'Anal canal versus rectal wall sampling'; it of the disease in dark-skinned patients, and appears to me that he does not understand Venereal Diseases it shows areas of which the patient may be the word anorectal. Sir, May I point out to Dr Morton once again unaware. Five cases of pityriasis versicolor Pityriasis versicolor of the glans penis affecting the penile skin were diagnosed what I was attempting to prove. The study I Pityriasis versicolor is a common disease, among 70 men during a six-month series did was to compare the results of more so in tropical than in temperate here. The patient described above had gonococcal cultures taken from the same lesions on the skin and on the glans, and site, namely the rectum, using two different climates. An Indian man, aged 20, employed as a this association has not been reported methods for obtaining the necessary cook's assistant in the government hospital, before, even in such detailed studies as that material. I used the words 'blind anorectal swab' because it is not possible to pass a attended the dermatology and venereology of Roberts (1968) or El-Hefnawi (1971). It is interesting that pityriasis versicolor blind swab into the rectum without first clinic complaining of loss of pigmentation and scaly patches on his body and tip of his does not affect the genitals more, con- passing it through the anal canal. I conpenis. The condition had first developed sidering the role that heat and moisture are cluded from this study that both methods three years previously with lesions on the considered to play in its aetiology. On the gave satisfactory culture results. This being the conclusion, what I would upper trunk. He had never taken any treat- other hand, it is easy to understand why the ment but became alarmed when the con- surface of the glans is unaffected, because like to know from Dr Morton is how more cases of gonococcal proctitis could be dition spread progressively and appeared of its different structure. diagnosed if a proctoscope had been used. on the genitals, occasionally causing Yours faithfully, irritation. His general health was good and A. Karim Nia Another misquotation is, 'he reached the E. L. Smith conclusion that rectal wall sampling should he gave no past or family history of notable be confined to the first visits and to patients illnesses. Department of Dermatology, with symptoms'. What I wrote was, 'It is, On examination there was a depigmented Government Hospital, however, not suggested that proctoscopic area on the chest, back, and buttocks Abu Dhabi, examination should not be done at all but formed by coalescence of smaller areas of United Arab Emirates that it could be confined to the first visit pityriasis versicolor, which were present References and to patients who complain of elsewhere including the shaft of the penis. The patient had been circumcised in child- El-Hefnawi, H., El-Gothamy, Z., and Refai, M. symptoms'. The word 'should' cannot be (1971). Studies in pityriasis versicolor in Egypt. substituted for the word 'could' without hood and on the left side of the glans penis Mykosen, 14 (5), 223-231. changing the meaning. there were two circinate, discrete areas of Roberts, S. 0. B. (1968). Pityriasis versicolor: a Is he really serious when he says, fine scaling, slightly raised, the smaller clinical and mycological investigation. British 'Vaginal sampling is not the best way to Journal of Dermatology, 81, 315-326. being on the rim of the glans. These lesions E. L. (1978). Pityriasis versicolor of diagnose gonococcal endocervicitis'? Is this were unlike any other forms of balanitis Smith, the penis. British Journal of Venereal Diseases, not obvious? It is certainly not advisable to which we had seen. 54, 441. take a swab from one site to make a Radiation with Wood's light showed diagnosis of an infection at another site; if yellow fluorescence of some of the lesions one does this the results are likely to be on the trunk and all of those on the glans unsatisfactory. Despite Dr Morton's and shaft of the penis. With flashlight implication, this is not what I did. photography of the lesions under Wood's Finally, it was notable that Dr Morton light the yellow fluorescence was lost but the glandular lesions showed as areas of TO THE EDITOR, British Journal of did not quote any figures to support his argument. scaly white. Scrapings from both trunk and Venereal Diseases Yours faithfully, glans gave positive results for spores and Sir, P. Deheragoda mycelium typical of pityriasis versicolor. Department of Genitourinary Medicine, The patient was treated with twice-daily Anal canal versus rectal wall sampling application of miconazole cream, and the Dr R. S. Morton's criticism of my paper Croydon General Hospital, glandular lesion had resolved to hypopig- (Morton, 1978) has surprised me. It is not London Road, mentation when he was seen a week later. that I feel I am beyond criticism, but it is Croydon, the totally uncalled for manner in which he Surrey CR9 2RH He did not attend again. References Four hundred cases of pityriasis has done so. To add insult to injury he has even made Deheragoda, P. (1977). Diagnosis of rectal versicolor were diagnosed out of a total of more than 8000 new referrals in a six-month incorrect statements. Even the title of my gonorrhoea by blind anorectal swabs compared with direct vision swabs takenvia a proctoscope. period, which gives an incidence of paper has not been correctly interpreted; British Journal of Venereal Diseases, 53, 311approximately 5%. In hot climates involve- my paper was entitled 'Diagnosis of rectal 313. ment of the skin is frequently extensive but gonorrhoea by blind anorectal swabs Morton, R. S. (1978). Anal canal versus rectal wall the genitals are less commonly affected. compared with direct vision swabs taken via sampling. British Journal of Venereal Diseases, 54, 206. Total body examination with Wood's light a proctoscope'. He has changed this to
230
Correspondence TO THE EDITOR, British Journal of is the only means of determining the extent 'Anal canal versus rectal wall sampling'; it of the disease in dark-skinned patients, and appears to me that he does not understand Venereal Diseases it shows areas of which the patient may be the word anorectal. Sir, May I point out to Dr Morton once again unaware. Five cases of pityriasis versicolor Pityriasis versicolor of the glans penis affecting the penile skin were diagnosed what I was attempting to prove. The study I Pityriasis versicolor is a common disease, among 70 men during a six-month series did was to compare the results of more so in tropical than in temperate here. The patient described above had gonococcal cultures taken from the same lesions on the skin and on the glans, and site, namely the rectum, using two different climates. An Indian man, aged 20, employed as a this association has not been reported methods for obtaining the necessary cook's assistant in the government hospital, before, even in such detailed studies as that material. I used the words 'blind anorectal swab' because it is not possible to pass a attended the dermatology and venereology of Roberts (1968) or El-Hefnawi (1971). It is interesting that pityriasis versicolor blind swab into the rectum without first clinic complaining of loss of pigmentation and scaly patches on his body and tip of his does not affect the genitals more, con- passing it through the anal canal. I conpenis. The condition had first developed sidering the role that heat and moisture are cluded from this study that both methods three years previously with lesions on the considered to play in its aetiology. On the gave satisfactory culture results. This being the conclusion, what I would upper trunk. He had never taken any treat- other hand, it is easy to understand why the ment but became alarmed when the con- surface of the glans is unaffected, because like to know from Dr Morton is how more cases of gonococcal proctitis could be dition spread progressively and appeared of its different structure. diagnosed if a proctoscope had been used. on the genitals, occasionally causing Yours faithfully, irritation. His general health was good and A. Karim Nia Another misquotation is, 'he reached the E. L. Smith conclusion that rectal wall sampling should he gave no past or family history of notable be confined to the first visits and to patients illnesses. Department of Dermatology, with symptoms'. What I wrote was, 'It is, On examination there was a depigmented Government Hospital, however, not suggested that proctoscopic area on the chest, back, and buttocks Abu Dhabi, examination should not be done at all but formed by coalescence of smaller areas of United Arab Emirates that it could be confined to the first visit pityriasis versicolor, which were present References and to patients who complain of elsewhere including the shaft of the penis. The patient had been circumcised in child- El-Hefnawi, H., El-Gothamy, Z., and Refai, M. symptoms'. The word 'should' cannot be (1971). Studies in pityriasis versicolor in Egypt. substituted for the word 'could' without hood and on the left side of the glans penis Mykosen, 14 (5), 223-231. changing the meaning. there were two circinate, discrete areas of Roberts, S. 0. B. (1968). Pityriasis versicolor: a Is he really serious when he says, fine scaling, slightly raised, the smaller clinical and mycological investigation. British 'Vaginal sampling is not the best way to Journal of Dermatology, 81, 315-326. being on the rim of the glans. These lesions E. L. (1978). Pityriasis versicolor of diagnose gonococcal endocervicitis'? Is this were unlike any other forms of balanitis Smith, the penis. British Journal of Venereal Diseases, not obvious? It is certainly not advisable to which we had seen. 54, 441. take a swab from one site to make a Radiation with Wood's light showed diagnosis of an infection at another site; if yellow fluorescence of some of the lesions one does this the results are likely to be on the trunk and all of those on the glans unsatisfactory. Despite Dr Morton's and shaft of the penis. With flashlight implication, this is not what I did. photography of the lesions under Wood's Finally, it was notable that Dr Morton light the yellow fluorescence was lost but the glandular lesions showed as areas of TO THE EDITOR, British Journal of did not quote any figures to support his argument. scaly white. Scrapings from both trunk and Venereal Diseases Yours faithfully, glans gave positive results for spores and Sir, P. Deheragoda mycelium typical of pityriasis versicolor. Department of Genitourinary Medicine, The patient was treated with twice-daily Anal canal versus rectal wall sampling application of miconazole cream, and the Dr R. S. Morton's criticism of my paper Croydon General Hospital, glandular lesion had resolved to hypopig- (Morton, 1978) has surprised me. It is not London Road, mentation when he was seen a week later. that I feel I am beyond criticism, but it is Croydon, the totally uncalled for manner in which he Surrey CR9 2RH He did not attend again. References Four hundred cases of pityriasis has done so. To add insult to injury he has even made Deheragoda, P. (1977). Diagnosis of rectal versicolor were diagnosed out of a total of more than 8000 new referrals in a six-month incorrect statements. Even the title of my gonorrhoea by blind anorectal swabs compared with direct vision swabs takenvia a proctoscope. period, which gives an incidence of paper has not been correctly interpreted; British Journal of Venereal Diseases, 53, 311approximately 5%. In hot climates involve- my paper was entitled 'Diagnosis of rectal 313. ment of the skin is frequently extensive but gonorrhoea by blind anorectal swabs Morton, R. S. (1978). Anal canal versus rectal wall the genitals are less commonly affected. compared with direct vision swabs taken via sampling. British Journal of Venereal Diseases, 54, 206. Total body examination with Wood's light a proctoscope'. He has changed this to
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