International joumal of srD & AIDS 199P; 1: 366-370
Letters to the Editor Sexually transmitted diseases and rape
(intrauterine contraceptive device) and who subsequently had a termination. In our series'', 36 (29%) Sir: We were interested to read the comprehensive women had adequate protection against pregnancy. review on rape, sexually transmitted diseases (SID) Postcoital hormonal contraception was prescribed and human immunodeficiency virus (HIV) infection for 13 women. Three pregnancies were associated by Dr S M Murphy]. We offer screening to women with rapes. All three women presented more than for these conditions and arrange follow-up at 2 and 5 weeks after the assault and in 2 cases, terminations 12weeks after presentation, as recommended by the were performed. It is therefore important to offer Centers for Disease ControI2. In our series of 124 postcoital contraception, if appropriate, and to rape victims', 104 women (84%) were reviewed at exclude sexually transmitted infections, where a mean of 31 days and 76 women (61%) returned termination may be a possibility. for a second follow-up at a mean of 11 weeks. In Screening for sexually transmissible infections an earlier study4/ 27 of 46 women (59%) reattended should be offered to all women who have been for follow-up 2-48 days after presentation. Therefore raped. However, it may not always be possible to rape victims may not necessarily be poor clinic confidently attribute the presence of an infection to the rape. attenders. Whilst acknowledging that concerns about HIVI G E Forster AIDS are experienced by many women who have S Estreich been sexually assaulted, there is only one case report The Ambrose King Centre, of HIV seroconversion within 3 months of a rapes/ The London Hospital, where no other identifiablerisk factors were present. Whitechapel, London El lBB Discussion about HIV with a woman at her initial visit following rape may not be appropriate in all References cases. Our practice is to save a serum sample at presentation for possible paired HIV testing after 1 Murphy SM. Rape, sexually transmitted diseases and human immunodeficiency viNs infection. Int I SrD AIDS 1990;1:79-82 informed consent has been obtained. In the low prevalence areas so far studieds, the risk of HIV 2 Centers for Disease Control. 1989 Sexually transmitted diseases treatment guidelines. MMWR 1989;38:40-1 transmission appears to be small. However, this 3 Estreich S, Forster GE, Robinson A. The frequency of nonmay well change over time. viral sexually transmitted diseases in rape victims. Genitourin Neisseria gonorrhoeae and Trichomonas vaginalis were Med (in press) the commonest organisms present in our series of 4 Forster GE, Pritchard J, Munday PE, Goldmeier D. Incidence 124womere', each being found in 15 (12%) patients. of sexually transmitted diseases in rape victims during 1984. Chlamydia trachomatis was isolated in 6 (5%) of Genitourin Med 1986;62:267-9 women. These results are comparable with earlier 5 Murphy S, Kitchen V, Harris JRW, Forster SM. Rape and subsequent seroconversion to HIV. BM/1989;299:718 studiesl. Genital warts were diagnosed in 5 of 11 women with this condition (authors' unpublished 6 Jenny C, Hooton TM, Bowers A, et al. Sexually transmitted diseases in victims of rape. N Engl I Med 1990;322:713-6 data) at the first follow-up visit (mean 8 weeks). None had a past history of condyloma accuminata. Multiple SIDs were detected in 8 of this group. Cases of wart virus infection could have been missed because of their long incubation period and Single-dose fluconazole in the treatment of timing of follow-up. A pelvic examination should Candida albicans balanoposthitis therefore be included in the final review to exclude their presence. Should condyloma accuminata be Sir: Single-dose treatment with oral fluconazole, reported with greater frequency in victims of rape, a novel bis-triazole antifungal agent', is becoming the length of follow-up may need to be extended. well established as an effective, safe treatment of Whilst it is important to consider the menstrual vaginal candidiasiss-'. The treatment has high and contraceptive history of the victim and whether patient acceptability. or not the assailant used a condom, postcoital Between 1976 and 1986, the number of cases of contraception should be available. In an earlier genital candidiasis diagnosed in men presenting to study', 18 (39%) women were using adequate genitourinary medicine clinics in the UK rose from contraception at the time of the rape. Five patients 6601 to 11535, an increase of 75%. Many more men had been prescribed postcoital hormonal contra- obtain treatment for this condition from their ception before their clinic attendance. One general practitioner. pregnancy resulted as a consequence of the rape in We therefore conducted a pilot open nona woman who had declined postcoital contraception comparative study to assess the efficacy and
Downloaded from std.sagepub.com at University of Manitoba Libraries on June 18, 2015
Letters to the Editor
tolerance of a single oral dose of 150mg fluconazole in the treatment of men presenting with symptomatic balanitis. A total of 14 men presenting with preputial soreness and signs of erythema of the glans and prepuce, who were culture-positive for Candida albicans, gave oral informed consent to enter the study. One patient was an insulin-dependent diabetic and another had recently been treated with antibiotics for a sore throat; none of the others had predisposing systemic or local conditions. All1~ of the patients who returned for follow-up evaluation 7-10 days later were found to be mycologically cured. All were symptomatically improved. No side effects were reported by any of the patients: This small preliminary study suggests that singledose oral fluconazole is an effective, well tolerated and convenient treatment for penile candidiasis. Larger studies comparing fluconazole with existing topical therapy for penile candidiasis should now be considered. G R Kinghorn P D Woolley
Department of Genitourinary Medicine Royal Hallamshire Hospital Glossop Road, Sheffield S10 2JF References 1 Marriott MS, Richardson K. Fluconazole-a significant advance in the management of human fungal disease. Recent Trends in the Discovery, Development and Evaluation of Antifungal Agents. Ed. Fromtling RA. J R Prous Science. 2 Kutzer E, et al. A comparison of fluconazoleand ketoconazole in the oral treatment of vaginal candidiasis; report of a double blind multicentre trial. Eur J Obstet Gynecol 1988;29:
305-13 3 Brammer KW. A comparison of single dose oral fluconazole with 3 day intravaginalclotrimazolein the treatment of vaginal candidiasis. A report of an International multicentre trial. Br J Obstet Gynaecol 1989;96:226-32
367
analysis, The following recurrent themes were discernible: • • • •
Prevention of transmission and of complications Research Diagnosis, treatment, cure and follow-up Training and education of staff, patients and public • Control of disease and reduction of impact • Monitoring, evaluation and quality assurance • Cooperation, participation and organization
Those institutions that had clearly defined goals, objectives and/or philosophies also tended to have: • Strong identity, self-esteem and self-image • Long-term achievements and/or long-term ambitions • A need to attract substantial funding and/or professional support It is concluded that several key features are common to the goals, objectives and philosophies of a broad range of SID/HN institutions worldwide, and that they assist these institutions in their shortterm and long-term successes both materially and professionally. Therefore, clinic directors, managers and administrators at all levels may benefit greatly from developing and using their own set of such guidelines into the 1990s. C R Philpot
Adelaide,
Austra~ia
References 1 Thin RNT. Genitourinary medicine and sexually transmitted diseases in the 199Os. Int J STD AIDS 1990;1:2-6 2 Morton RS. Control of sexually transmitted disease today and tomorrow. Genitourin Med 1987;62:202-9 3 Cates W. Prioritiesfor sexually transmitted diseases in the late 1980s and beyond. Sex Transm Dis 1986;13:114-17
A proposal for slowing HIV contagion among Africans Goals and objectives for STD/AIDS control into the 1990s Sir: Forward thinking and future planning are slowly and belatedly becoming part of the international literature on sexually transmissible diseases/ AIDS/genitourinary medicine'
Letters to the Editor Sexually transmitted diseases and rape
(intrauterine contraceptive device) and who subsequently had a termination. In our series'', 36 (29%) Sir: We were interested to read the comprehensive women had adequate protection against pregnancy. review on rape, sexually transmitted diseases (SID) Postcoital hormonal contraception was prescribed and human immunodeficiency virus (HIV) infection for 13 women. Three pregnancies were associated by Dr S M Murphy]. We offer screening to women with rapes. All three women presented more than for these conditions and arrange follow-up at 2 and 5 weeks after the assault and in 2 cases, terminations 12weeks after presentation, as recommended by the were performed. It is therefore important to offer Centers for Disease ControI2. In our series of 124 postcoital contraception, if appropriate, and to rape victims', 104 women (84%) were reviewed at exclude sexually transmitted infections, where a mean of 31 days and 76 women (61%) returned termination may be a possibility. for a second follow-up at a mean of 11 weeks. In Screening for sexually transmissible infections an earlier study4/ 27 of 46 women (59%) reattended should be offered to all women who have been for follow-up 2-48 days after presentation. Therefore raped. However, it may not always be possible to rape victims may not necessarily be poor clinic confidently attribute the presence of an infection to the rape. attenders. Whilst acknowledging that concerns about HIVI G E Forster AIDS are experienced by many women who have S Estreich been sexually assaulted, there is only one case report The Ambrose King Centre, of HIV seroconversion within 3 months of a rapes/ The London Hospital, where no other identifiablerisk factors were present. Whitechapel, London El lBB Discussion about HIV with a woman at her initial visit following rape may not be appropriate in all References cases. Our practice is to save a serum sample at presentation for possible paired HIV testing after 1 Murphy SM. Rape, sexually transmitted diseases and human immunodeficiency viNs infection. Int I SrD AIDS 1990;1:79-82 informed consent has been obtained. In the low prevalence areas so far studieds, the risk of HIV 2 Centers for Disease Control. 1989 Sexually transmitted diseases treatment guidelines. MMWR 1989;38:40-1 transmission appears to be small. However, this 3 Estreich S, Forster GE, Robinson A. The frequency of nonmay well change over time. viral sexually transmitted diseases in rape victims. Genitourin Neisseria gonorrhoeae and Trichomonas vaginalis were Med (in press) the commonest organisms present in our series of 4 Forster GE, Pritchard J, Munday PE, Goldmeier D. Incidence 124womere', each being found in 15 (12%) patients. of sexually transmitted diseases in rape victims during 1984. Chlamydia trachomatis was isolated in 6 (5%) of Genitourin Med 1986;62:267-9 women. These results are comparable with earlier 5 Murphy S, Kitchen V, Harris JRW, Forster SM. Rape and subsequent seroconversion to HIV. BM/1989;299:718 studiesl. Genital warts were diagnosed in 5 of 11 women with this condition (authors' unpublished 6 Jenny C, Hooton TM, Bowers A, et al. Sexually transmitted diseases in victims of rape. N Engl I Med 1990;322:713-6 data) at the first follow-up visit (mean 8 weeks). None had a past history of condyloma accuminata. Multiple SIDs were detected in 8 of this group. Cases of wart virus infection could have been missed because of their long incubation period and Single-dose fluconazole in the treatment of timing of follow-up. A pelvic examination should Candida albicans balanoposthitis therefore be included in the final review to exclude their presence. Should condyloma accuminata be Sir: Single-dose treatment with oral fluconazole, reported with greater frequency in victims of rape, a novel bis-triazole antifungal agent', is becoming the length of follow-up may need to be extended. well established as an effective, safe treatment of Whilst it is important to consider the menstrual vaginal candidiasiss-'. The treatment has high and contraceptive history of the victim and whether patient acceptability. or not the assailant used a condom, postcoital Between 1976 and 1986, the number of cases of contraception should be available. In an earlier genital candidiasis diagnosed in men presenting to study', 18 (39%) women were using adequate genitourinary medicine clinics in the UK rose from contraception at the time of the rape. Five patients 6601 to 11535, an increase of 75%. Many more men had been prescribed postcoital hormonal contra- obtain treatment for this condition from their ception before their clinic attendance. One general practitioner. pregnancy resulted as a consequence of the rape in We therefore conducted a pilot open nona woman who had declined postcoital contraception comparative study to assess the efficacy and
Downloaded from std.sagepub.com at University of Manitoba Libraries on June 18, 2015
Letters to the Editor
tolerance of a single oral dose of 150mg fluconazole in the treatment of men presenting with symptomatic balanitis. A total of 14 men presenting with preputial soreness and signs of erythema of the glans and prepuce, who were culture-positive for Candida albicans, gave oral informed consent to enter the study. One patient was an insulin-dependent diabetic and another had recently been treated with antibiotics for a sore throat; none of the others had predisposing systemic or local conditions. All1~ of the patients who returned for follow-up evaluation 7-10 days later were found to be mycologically cured. All were symptomatically improved. No side effects were reported by any of the patients: This small preliminary study suggests that singledose oral fluconazole is an effective, well tolerated and convenient treatment for penile candidiasis. Larger studies comparing fluconazole with existing topical therapy for penile candidiasis should now be considered. G R Kinghorn P D Woolley
Department of Genitourinary Medicine Royal Hallamshire Hospital Glossop Road, Sheffield S10 2JF References 1 Marriott MS, Richardson K. Fluconazole-a significant advance in the management of human fungal disease. Recent Trends in the Discovery, Development and Evaluation of Antifungal Agents. Ed. Fromtling RA. J R Prous Science. 2 Kutzer E, et al. A comparison of fluconazoleand ketoconazole in the oral treatment of vaginal candidiasis; report of a double blind multicentre trial. Eur J Obstet Gynecol 1988;29:
305-13 3 Brammer KW. A comparison of single dose oral fluconazole with 3 day intravaginalclotrimazolein the treatment of vaginal candidiasis. A report of an International multicentre trial. Br J Obstet Gynaecol 1989;96:226-32
367
analysis, The following recurrent themes were discernible: • • • •
Prevention of transmission and of complications Research Diagnosis, treatment, cure and follow-up Training and education of staff, patients and public • Control of disease and reduction of impact • Monitoring, evaluation and quality assurance • Cooperation, participation and organization
Those institutions that had clearly defined goals, objectives and/or philosophies also tended to have: • Strong identity, self-esteem and self-image • Long-term achievements and/or long-term ambitions • A need to attract substantial funding and/or professional support It is concluded that several key features are common to the goals, objectives and philosophies of a broad range of SID/HN institutions worldwide, and that they assist these institutions in their shortterm and long-term successes both materially and professionally. Therefore, clinic directors, managers and administrators at all levels may benefit greatly from developing and using their own set of such guidelines into the 1990s. C R Philpot
Adelaide,
Austra~ia
References 1 Thin RNT. Genitourinary medicine and sexually transmitted diseases in the 199Os. Int J STD AIDS 1990;1:2-6 2 Morton RS. Control of sexually transmitted disease today and tomorrow. Genitourin Med 1987;62:202-9 3 Cates W. Prioritiesfor sexually transmitted diseases in the late 1980s and beyond. Sex Transm Dis 1986;13:114-17
A proposal for slowing HIV contagion among Africans Goals and objectives for STD/AIDS control into the 1990s Sir: Forward thinking and future planning are slowly and belatedly becoming part of the international literature on sexually transmissible diseases/ AIDS/genitourinary medicine'
