Don’t forget local epidemiology and guidance …BMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c1976 (Published 13 April 2010) Cite this as: BMJ 2010;340:c1976
- 1A1 Department of Genitourinary Medicine and HIV, Southampton Community Healthcare, Southampton SO14 0YG
- 2A2 University of Birmingham
- 3A3 University of Southampton
Presentation to general practice may be the only opportunity to manage some men who have sex with men,1 but such patients should be managed in primary care only after attempts to encourage attendance at genitourinary medicine clinics have failed. Such management should also be informed by local epidemiology and current testing guidance.
For example, the prevalence of gonorrhoea in men is about the same in Australia and the United Kingdom (46/100 000), but men who have sex with men account for one third of UK cases (4524/13 627 in 2006). Wong and Fairley do not advise that a urethral swab be taken for gonorrhoea but the British Association for Sexual Health and HIV (BASHH) continues to recommend sampling all mucosal surfaces, including the urethra, in symptomatic males.2 3
Wong and Fairley also do not advise testing for hepatitis, in accordance with Australian guidelines but contrary to UK guidelines.4 5 They advise that human papillomavirus vaccination should be considered in men who have sex with men, depending on the chance of previous infection, but this is not currently endorsed or funded by the NHS.
General practitioners need to be aware that guidance frequently changes in response to local epidemiology and policy and should also feel comfortable in seeking the opinion of specialists in genitourinary medicine.
Cite this as: BMJ 2010;340:c1976
Competing interests: None declared.