Christine Bates

2014 UK national guideline on the management of vulval conditions

This guideline offers recommendation on the management of a range of vulval disorders which may present to genitourinary medicine (GUM) clinics. Vulval disorders represent a disparate group of conditions with a variety of causes, affecting a particular anatomical site and may affect women of any age. These guidelines concentrate on a selected group of conditions, whichmay bemanaged by genitourinary physicians, either alone or in conjunction with other specialists, dependent on local expertise. Guidance for onward referral is also included. It is not intended as a comprehensive review of the treatment of all vulval diseases. The main categories of non-infective vulval diseases are dermatoses, pain syndromes and pre-malignant conditions. This guideline offers recommendations on the diagnostic tests and treatment regimens needed for the effective management of the following vulval conditions:

Vulvodynia—new and more effective approaches to therapy

Two cases are described of treatment-resistant vulvodynia that responded well to gabapentin. Gabapentin, an anti-epileptic drug, has been used in the treatment of neuropathic pain such as diabetic neuropathy and post-herpetic neuralgia. However, there has been little experience of its use in the relief of symptoms in vulvodynia and we add our observations to the one report of its use in these circumstances that has been published so far.

Molluscum contagiosum—a novel presentation

A case history is described of an HIV-seropositive man who presented with a swelling on the right cheek and a history of disseminated molluscum contagiosum. Electron microscopy of the abscess aspirate showed pox virions indicative of molluscum contagiosum. This is an unusual presentation of molluscum contagiosum and the authors review the literature of other presentations.

Survey of genitourinary medicine specialist registrars in the United Kingdom regarding genital dermatology training.

The British Association for Sexual Health and HIV Genital Dermatology Special Interest Group (SIG) conducted a survey of specialist registrar training in genital dermatology (GD) to inform future training provision provided by the group and other services. The survey shows that training in GD is variable with most trainees receiving GD training through formal lectures or ad hoc clinical teaching, with fewer trainees having access to specialist GD clinics. There is mixed confidence in diagnosis and use of topical steroids, and few trainees are independent in GD practical procedures. Many trainees feel training could be improved with requests for a formalised attachment, formal qualification and greater training in practical procedures. The GD SIG, in liaison with British Association for Sexual Health and HIV (BASHH), aims to optimise GD training for registrars. Plans for improved resources are in progress, including a practical skills course and e-learning. It is hoped this survey will also inform GD training at both local and national levels.

Importance of genitourinary and urology colleagues working in harmony

We disagree with Arya and colleagues’ conclusion, based on just one paper, that initial referral to specialties other than urology is an “error.”1 One of us (CB) runs a penile clinic in a genitourinary service that refers patients to the regional centre surveyed in that paper but was not asked about reasons for …

Identification of risk factors in blood donors found to have HIV infection.

To ascertain whether current screening procedures for human immunodeficiency virus (HIV) infected blood can be improved, a study of blood donors found by Mersey and North Wales Blood Centre to be HIV positive was made. In total 22 donors were identified, of which 16 were referred to the Department of Genito-Urinary Medicine (GUM) in Liverpool. Most (9/16) should have been excluded from donating because of recognized risk factors. However, in 7 cases no such identifiable factors were found. Although the risk of transfusion transmitted infection is small, there is an argument for testing donated blood for HIV RNA by nucleic acid technology.

Genital dermatology special interest group

The BASHH Genital Dermatology (GD) Special Interest Group (SIG) evolved from the Joint Colposcopy and GD group following the BASHH Spring meeting in New York in 2008. It was recognised that colposcopy was declining in genitourinary medicine (GUM) practice, and interest was increasing in the management of genital skin conditions, in which the colposcope could be used as a tool. Use of the colposcope for high-resolution anoscopy saw the colposcopy component being dropped , as the Human Papilloma Virus (HPV) Specialist Group were more appropriately placed to develop its use, but we continue to work closely together, having run joint BASHH scientific sessions over the recent years. The name of the SIG was changed to GD SIG in November 2013. The SIG aims to provide continuing medical education and thus improve quality of patient care. Further development of the group and redefining of its remit have seen some of the original members continuing in new roles, and fresh faces providing new impetus and support, which saw us revisit the trainee survey …

Syphilis on the face in primary care: a rare sign of an increasingly common problem

Syphilis in the UK continues to rise, particularly among men who have sex with men. In 2014, there was a 46% increase in syphilis in this risk group.1 Syphilis is a major problem in some parts of the world including Eastern Europe and is also seen in heterosexual men and women. Syphilis has also been diagnosed in white British individuals with no obvious risk factors. Two rapidly emerging social phenomena are likely to be helping the transmission of sexually transmitted infections (STIs) including syphilis. First, dating apps such as Tinder and Grindr are facilitating meeting more sexual partners.2 Second, the use of recreational drugs for enhanced sexual pleasure, known as chemsex, is associated with increased risk-taking behaviour.3 This article describes an unusual case of primary syphilis presenting with tongue and facial sores, and encourages primary care practitioners to consider testing for STIs including syphilis in individuals with oropharyngeal lesions. Box 1. ### Facts about syphilis