Sex and violenceBMJ 2007; 334 doi: https://doi.org/10.1136/bmj.39174.288877.3B (Published 05 April 2007) Cite this as: BMJ 2007;334:0
- Jane Smith, deputy editor
Sexually transmitted infections are tricky: prevention is always going to be difficult, especially if it involves changing behaviour, but the case of human papillomavirus suggests that preventive methods can be controversial even when they don't demand behaviour changes. Rebecca Coombes explains why a new vaccine against human papillomavirus that is designed to prevent cervical cancer is causing controversy in the US (doi: 10.1136/bmj.39164.510127.AD). The vaccine is given to preteen girls and is expensive. Some think that a mandatory universal vaccination programme undermines parental responsibility and promotes underage sex; it doesn't help that the manufacturer has been heavily promoting the vaccine.
If preventing an infection isn't easy, the next best thing is to identify cases and treat them. Identification is difficult when an infection is initially asymptomatic, so when evidence from Sweden showed that screening could control transmission of chlamydial infection and reduce morbidity of the female reproductive tract several countries started screening programmes. But, argues Nicola Low (doi: 10.1136/bmj.39154.378079.BE), the evidence that screening works isn't strong and “misinterpretation of what comprises a screening programme” has led to uncritical acceptance of chlamydial screening before benefits and harms have been evaluated. Rachel Jones and Fiona Boag also question the effectiveness of an opportunistic approach to screening, rather than a proactive one that targets an entire population (doi: 10.1136/bmj.39167.545417.80).
The third infection to dominate this week's issue is Clostridium difficile. Rates of infection are increasing in the UK, and the government has asked health authorities to set targets for reducing them. As M A Cooper and PM Hawkey explain (doi: 10.1136/bmj.39169.900475.1F), because the rates are increasing and the targets (for a percentage reduction in rates) are based on rates in 2004-5, the targets already look impossibly tough. They urge the government not to set non-negotiable targets as it did for MRSA. Indeed, John Starr argues that C difficile and MRSA should not be lumped together and treated the same (doi: 10.1136/bmj.39169.601285.80). C difficile may well be community acquired, rather than hospital acquired, and different measures are needed to prevent it. This is a classic example of where we need to understand the problem better (and design and test solutions), before leaping to a solution—and a set of targets.
If infections are at one end of the spectrum of matters that doctors deal with then domestic violence is at the other. As Lorraine Ferris says in her editorial, we know more about the epidemiology of domestic violence than how to identify, treat, and reduce it, but a recent WHO report identifies what doctors can do: have protocols, use referral systems, ensure confidentiality, and make women's safety a priority (doi: 10.1136/bmj.39168.644757.BE). That doctors too may be subject to domestic violence is illustrated by our anonymous personal view (doi: 10.1136/bmj.39170.639699.59). The writer not only describes the shock of attack but also the difference that good doctoring can make: “I sat in the consulting room of a GP 10 years my junior who documented my injuries...with kindness and a non-judgmental compassion that made me cry.”