Clinical Review Recent advances

Sexually transmitted infections

BMJ 1998; 317 doi: https://doi.org/10.1136/bmj.317.7151.129 (Published 11 July 1998) Cite this as: BMJ 1998;317:129
  1. Chris Carne (christopher.carne@msexc.addenbrookes.anglox.nhs.uk), consultant
  1. Department of Genitourinary Medicine, Addenbrooke's Hospital, Cambridge CB2 2QQ
  • Accepted 16 April 1998

Sexually transmitted infections are an important cause of morbidity and mortality throughout the world. Over 300 000 cases of sexually transmitted infection were diagnosed in genitourinary medicine clinics in England in 1996.1 Among these infections, the commonest were genital warts (over 50 000 first attacks), non-specific genital infection (over 50 000 cases), proved chlamydial infection (over 30 000 cases), genital herpes (about 15 000 first attacks), and gonorrhoea (over 10 000 cases).

Methods

In selecting material for this article, I used the current publications section of the journal Sexually Transmitted Infections (formerly Genitourinary Medicine) and searched Medline under the following headings: Chlamydia trachomatis, human papillomavirus, genital herpes, famciclovir, and valaciclovir.

Epidemiological changes

Rates of infection with gonorrhoea in England had been declining rapidly, even before the government launched its Health of the Nation initiative in 1992.2 Unfortunately, soon after the target (a fall in gonorrhoea rates of at least 20% by 1995) had been reached, the trend was reversed: diagnoses of gonorrhoea in genitourinary medicine clinics rose by 20% between 1995 and 1996.1 Over the same period, diagnoses of genital infection with C trachomatis rose by 11% and those of genital warts by 5%.1 Among homosexual men, there was a steady increase in the incidence of genital warts between 1990 and 1995, while there was no clear trend in the incidence of gonorrhoea (fig 1).

Recent advances

  • Amplification assays, such as the ligase chain reaction, have excellent sensitivity and specificity

  • A third class of anti-retroviral drug is now available—the non-nucleoside reverse transcriptase inhibitors, such as nevirapine

  • Valaciclovir and famciclovir offer more convenient dosage regimens than aciclovir

  • A single dose regimen of azithromycin has a place in treating Chlamydia trachomatis, especially where compliance may be a problem

  • Viral load assays for HIV are the best way of predicting disease …

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