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  1. Richard J C Gilson (rgilson@gum.ucl.ac.uk), senior lecturera,
  2. Adrian Mindel, professorb
  1. a Department of Sexually Transmitted Diseases, Royal Free and University College Medical School, University College London, London WC1E 6AU,
  2. b Sexually Transmitted Infections Research Centre, Westmead Hospital, Westmead, NSW 2145, Australia
  1. Correspondence to: R J C Gilson
  • Accepted 19 February 2001

See also Editorial by Catchpole

Rates of sexually transmitted diseases are increasing, particularly in people aged between 15 and 25. How best to tackle this increase is unresolved, although several tests have recently been developed that are providing new opportunities for screening, early detection, and prevention of sexually transmitted infections and their complications, particularly for Chlamydia trachomatis, herpes simplex virus, and human papillomavirus. Already these tests are being used in research studies, but their introduction into clinical practice raises complex issues. This articles describes the tests that are now available for the major sexually transmitted infections and discusses the important issues they raise in the management of those diseases.

Methods

We selected topics for inclusion by reviewing specialist journals and conference abstracts from 1998 to 2000. We chose areas that were the subject of most research reports and that are having a direct impact on patient care. We performed a search of Medline for the same period, based on keywords related to these topics. Earlier references were among those quoted in the publications retrieved by the systematic search. We have not considered advances in HIV disease and its management.

Surveillance data

In the United Kingdom most cases of sexually transmitted infections are treated at genitourinary medicine clinics. Surveillance data from these clinics show that their workload is steadily increasing (fig 1). There has been a noticeable increase in the number of cases of bacterial infections, particularly chlamydia and gonorrhoea since 1995.1

Chlamydia

Chlamydia trachomatis is the most commonly diagnosed bacterial sexually transmitted infection in the developed world and a leading cause of pelvic inflammatory disease.2 In 1999, 56 855 patients with uncomplicated chlamydial infection were seen at UK clinics dealing with genitourinary medicine, an increase of 61% since 1996.1 Given the potential for morbidity from ectopic pregnancy and tubal infertility …

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