Research Interests:
Syphilis has become less common in Europe in the last decade, but has once again become a major problem in the USA, and remains so in many developing countries. Several treponemal genes have now been cloned and expressed in Escherichia... more
Syphilis has become less common in Europe in the last decade, but has once again become a major problem in the USA, and remains so in many developing countries. Several treponemal genes have now been cloned and expressed in Escherichia coli, allowing study of treponemal proteins. The importance of cell mediated immunity in syphilis has been demonstrated in animal models. A diagnosis of syphilis is usually confirmed by dark-field microscopy or serological tests. Seroconversion may be delayed in HIV infected individuals. A positive reaginic test in cerebrospinal fluid (CSF) has a high specificity but low sensitivity in the diagnosis of neurosyphilis. Indeed, virulent treponemes can be identified in CSF samples which have negative reaginic tests, normal cell counts and protein levels. In the CSF, the FTA-Abs test has a high sensitivity but low specificity for neurosyphilis. Penicillin remains the treatment of choice for all stages of syphilis, although it penetrates the blood brain bar...
Research Interests: Immunology, Medical Microbiology, Medicine, Syphilis, Humans, and 14 moreAnimals, Clinical Sciences, Treponema, Anti-Bacterial Agents, Adult, Public health systems and services research, Rabbits, Sexually Transmitted Disease, Penicillin, Neurosyphilis, lactams, Guinea pigs, HIV infections, and Penicillins
Research Interests:
Research Interests:
Until recently, PCR had been used to detect but not quantify Treponema pallidum. To understand infection kinetics of this uncultivable organism, a real-time PCR assay was developed to quantify 47 kDa membrane lipoprotein gene DNA... more
Until recently, PCR had been used to detect but not quantify Treponema pallidum. To understand infection kinetics of this uncultivable organism, a real-time PCR assay was developed to quantify 47 kDa membrane lipoprotein gene DNA (tpp47). Assay specificity was determined against DNA from humans, skin organisms and sexually transmitted pathogens. tpp47 DNA (Nichols strain) was used to construct a standard curve for T pallidum quantification. Blood and ulcer samples were obtained from 99 patients being investigated or screened for syphilis and tpp47 was quantified. The assay was specific, not cross-reactive with other organisms tested and sensitive, with a detection limit of a single copy of tpp47 DNA. For ulcer samples, the assay was 100% sensitive and 97.14% specific. Sensitivity fell to 34.1% for blood samples but specificity remained high (100%). tpp47 DNA was more commonly detected, and at a higher copy number, in blood of patients with secondary infection (sensitivity 57....
Research Interests: Medical Microbiology, Medicine, HIV, Syphilis, Prospective studies, and 15 moreHumans, Female, Sexually transmitted infections, Male, Polymerase Chain Reaction, Clinical Sciences, Treponema, Adult, Public health systems and services research, Lipoproteins, Sensitivity and Specificity, Cross Sectional Studies, Sexually Transmitted Disease, Early Diagnosis, and HIV infections
Research Interests:
Research Interests: Endocrinology, Medical Microbiology, Adolescent, Medicine, Adipose tissue, and 15 moreHumans, Internal Medicine, Sexually transmitted infections, Male, Clinical Sciences, Middle Aged, Adult, Aromatase Inhibitor, Lipodystrophy, Libido, Aromatase Activity, Androstenedione, fibroblasts, aromatase, and HIV infections
Research Interests: Sexual Dysfunction, Heterosexuality, Family Medicine, Medical Microbiology, Medicine, and 13 moreErectile dysfunction, London, Humans, Sexual Medicine, Female, Sexually transmitted infections, Male, Clinical Sciences, Prevalence, Middle Aged, Adult, Public health systems and services research, and attitude to health
Research Interests:
Research Interests:
Research Interests: Personality Assessment, Medical Microbiology, Adolescent, Medicine, Social Class, and 15 moreCounseling, Humans, Female, Sexually transmitted infections, Male, Psychosocial, Recurrence, Clinical Sciences, Psychological distress, General Health Questionnaire, Adult, Genital Herpes, Eysenck Personality Questionnaire, Herpes Simplex Virus, and antiviral agent
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests: Psychiatry, Addiction, Medical Microbiology, Medicine, Mood, and 14 moreHumans, Female, Cognitive Therapy, Sexually transmitted infections, Male, Sexual Behavior, Clinical Sciences, Mood Disorders, Sexual Addiction, Public health systems and services research, Dysfunctional Family, Ambulatory Care, Medical History Taking, and Referral and consultation
Research Interests: Risk Taking, Public Health, Health Policy, Medicine, Erectile dysfunction, and 13 moreHumans, Sex Education, Sexual Medicine, Female, Male, Sexual Behavior, Psychological Intervention, The, Sexually Transmitted Diseases, Primary Prevention, Psychology and Cognitive Sciences, Medical and Health Sciences, and HIV infections
Sexual difficulties are common in people attending genitourinary (GU) medicine/HIV services and many would like professional help. Here, we report the results of the BASHH Special Interest Group in Sexual Dysfunction (SD) survey on the... more
Sexual difficulties are common in people attending genitourinary (GU) medicine/HIV services and many would like professional help. Here, we report the results of the BASHH Special Interest Group in Sexual Dysfunction (SD) survey on the level and type of SD service provision within UK GU medicine services in 2007. Many clinicians expressed an interest in SD, however, only 25% of GU medicine clinics provide a designated SD service. Marked regional variation in the level of service provision was highlighted. Lack of resources and other pressures on GU medicine services, notably 48-h access, are barriers to SD service development. In spite of these constraints, we argue that GU medicine clinics are a highly appropriate place to treat SD.
Research Interests:
We present the British Association for Sexual Health and HIV (BASHH) Special Interest Group for Sexual Dysfunction recommendations for the management of vaginismus. The recommendations outline the history, prevalence, aetiological... more
We present the British Association for Sexual Health and HIV (BASHH) Special Interest Group for Sexual Dysfunction recommendations for the management of vaginismus. The recommendations outline the history, prevalence, aetiological factors, patient assessment and management for this sexual problem. Treatment strategies are discussed along with general recommendations and auditable outcomes.
Research Interests:
We present the British Association for Sexual Health and HIV (BASHH), Special Interest Group for Sexual Dysfunction updated recommendations for the management of premature ejaculation. The recommendations outline the physiology,... more
We present the British Association for Sexual Health and HIV (BASHH), Special Interest Group for Sexual Dysfunction updated recommendations for the management of premature ejaculation. The recommendations outline the physiology, prevalence, definitions, aetiological factors and patient assessment for this common sexual problem. Behavioural, local and systemic pharmacological treatments are discussed along with general recommendations and auditable outcomes.
Research Interests:
The training programme for specialist registrars in genitourinary medicine (GU) lists sexual dysfunction (SD) as ‘beyond essential, core curriculum’ despite many GU medicine clinics offering this service. A cross-sectional study was... more
The training programme for specialist registrars in genitourinary medicine (GU) lists sexual dysfunction (SD) as ‘beyond essential, core curriculum’ despite many GU medicine clinics offering this service. A cross-sectional study was performed of all trainees on the British Association for Sexual Health and HIV mailing list. Data collected included frequency of clinics attended and involvement, any training and interest in future training. A total of 39/76 (51%) responses were received. In total, 20/39 (51%) work in departments with no SD clinic provision, and 12/39 have had some training in SD. In routine GU medicine consultation, 85% trainees are consulted regarding SD at least monthly. In all, 19/39 (49%) work in areas with weekly SD clinics; however, only three trainees were involved. Thirty-four out of 39 (87%) expressed interest in training and 31/39 (79%) respondents would like to see SD training added to the SpR curriculum. Fifty-one percent of juniors work in units without S...
Research Interests: Family Medicine, Medical Microbiology, Health Services Research, Medicine, Curriculum, and 11 moreHumans, Female, Male, Clinical Sciences, Great Britain, Questionnaires, Public health systems and services research, Cost Benefit Analysis, Cross Sectional Studies, Medical staff, and Delivery of Health Care
Research Interests: Sexual Dysfunction, Treatment Outcome, Medicine, Erectile dysfunction, Humans, and 14 moreFemale, Cost effectiveness, Workload, Female Sexual Dysfunction, Clinical Sciences, Great Britain, Middle Aged, Adult, Retrospective Studies, Drug Costs, IMPOTENCE, Health Care Costs, Costs and Cost Analysis, and Average cost
Research Interests: Fertility, Medicine, Human Sexuality, Humans, Reproductive health, and 15 moreFemale, Male, Androgens, Health Status, Clinical Sciences, Great Britain, Middle Aged, Benign Prostatic Hyperplasia, Risk Factors, Human Fertility, Libido, Clinical Trials as Topic, Prostatic neoplasms, Paediatrics and reproductive medicine, and Prostatic hyperplasia
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Premature ejaculation is a common sexual problem which presents to genitourinary (GU) medicine services. Five main treatment approaches have been used in clinical trials: behavioural therapy, antidepressants, phosphodiesterase-5 (PDE5)... more
Premature ejaculation is a common sexual problem which presents to genitourinary (GU) medicine services. Five main treatment approaches have been used in clinical trials: behavioural therapy, antidepressants, phosphodiesterase-5 (PDE5) inhibitors, topical anaesthetic agents and alpha-blockers. We have carried out a systematic review of published pharmacological trials. All antidepressants appeared to delay ejaculation to some extent at all doses. Anaesthetic creams appeared to be as successful in slowing ejaculation as antidepressants without systemic side-effects, although some patients did experience erectile problems or unpleasant local symptoms. Anecdotally, behavioural therapy is effective and appears to have long-lasting efficacy. There is a need for quality comparative trial of behavioural therapy, topical anaesthetic agents and antidepressants, including appropriate measures of relapse, follow-up and acceptability of continuing long-term treatment.
Research Interests:
Premature ejaculation is a common male sexual dysfunction. Treatment modalities as recommended by the British Association of Sexual Health and HIV include behavioural therapy, tricyclic antidepressants, selective serotonin reuptake... more
Premature ejaculation is a common male sexual dysfunction. Treatment modalities as recommended by the British Association of Sexual Health and HIV include behavioural therapy, tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs) and local anaesthetic creams. We audited the clinical cohort from our dedicated sexual dysfunction clinic to determine the success of prescribed treatment and co-existing prostatitis/male pelvic pain, erectile dysfunction, phosphodiesterase-5 (PDE5) inhibitor use and anxiety. The use of SSRIs was successful in the treatment of premature ejaculation with or without the use of local anaesthetic cream. Co-existing prostatitis/male pelvic pain, erectile dysfunction, PDE5 inhibitor use and anxiety were high.
Research Interests: Sexual Dysfunction, Medical Microbiology, Treatment Outcome, Medicine, Erectile dysfunction, and 14 moreAnxiety, Humans, Male, Premature Ejaculation, Clinical Sciences, Prostatitis, Public health systems and services research, Retrospective Studies, STD, Pelvic Pain, ANXIETY, Medical Audit, Serotonin Uptake Inhibitors, and Ejaculation
Rates of sexually transmitted infections (STI) in the UK continue to increase. A discrepancy between knowledge and awareness of STIs, and sexual behaviour appears to be ubiquitous throughout the world. We hypothesize that human beings are... more
Rates of sexually transmitted infections (STI) in the UK continue to increase. A discrepancy between knowledge and awareness of STIs, and sexual behaviour appears to be ubiquitous throughout the world. We hypothesize that human beings are biologically programmed to fall in love and bond in powerful relationships, which, at least in the short term, prevents them from using knowledge and cognitive strategies to prevent STI acquisition. We compare this with obsessive thoughts and compulsive behaviours seen in obsessive-compulsive disorders. We suggest how romantic love might overwhelm logical thought processes to cause a deterministic and non-logical response to have sex and thus acquire STIs. An understanding of this concept may help us humans to be more insightful and thoughtful about STI acquisition.
Research Interests:
Research Interests:
Research Interests: Sexual Dysfunction, Sexual Health, Medicine, Erectile dysfunction, Humans, and 15 moreReproductive health, Female, Male, Psychological Intervention, Bacterial infections, Condom, Sexual Function, AIDS Dementia Complex, Sexually Transmitted Disease, Libido, Ejaculation, hypogonadism, Psychology and Cognitive Sciences, Medical and Health Sciences, and HIV infections
Research Interests:
Women form an increasing proportion of HIV-infected individuals in the developed world. Early data suggest that women with HIV are at particular risk of developing sexual problems. The aim of this study was to describe our anecdotal... more
Women form an increasing proportion of HIV-infected individuals in the developed world. Early data suggest that women with HIV are at particular risk of developing sexual problems. The aim of this study was to describe our anecdotal experience of HIV-infected women and to ascertain their sexual dysfunction, and also to conduct a national survey to evaluate what sexual dysfunction services are provided for women in other UK HIV centres. Retrospective analysis of clinic notes of women attending our HIV clinic and letter surveys of HIV centres in the UK were carried out. About half our cohort reported that they had sexual problems or were not satisfied with sex over the preceding 12 months. Contextual issues seemed to be the commonest cause of these problems. Sixty percent of HIV physicians in the UK rarely/never ask their female HIV patients about sexual functioning. Sexual dysfunction is probably common in HIV-infected women. Most physicians seeing women with HIV in the UK do not ask...
Research Interests: Sexual Dysfunction, Medical Microbiology, Adolescent, Medicine, Literature Review, and 12 moreHumans, Female, Female Sexual Dysfunction, Clinical Sciences, Great Britain, Middle Aged, Questionnaires, Adult, Public health systems and services research, Retrospective Studies, Ambulatory Care, and HIV infections
Research Interests:
Research Interests: Fatigue, Medicine, Humans, Sexual Medicine, Male, and 15 moreOrgasm, Etiology, Middle Aged, Spectrum, Adult, Somatoform disorders, Mental Fatigue, Syndrome, Pathological, Ejaculation, Neurologic Examination, Neuropsychological Tests, Psychology and Cognitive Sciences, Myofascial pain syndromes, and Medical and Health Sciences
Persistent genital arousal disorder is a newly recognized condition that is poorly understood. There is a paucity of research in this area and there are concerns as to the validity of the results of what little research there has been.... more
Persistent genital arousal disorder is a newly recognized condition that is poorly understood. There is a paucity of research in this area and there are concerns as to the validity of the results of what little research there has been. This article aims to draw together current literature on this topic and provide readers with guidance on the management of this condition. This includes a working definition, an exploration of possible aetiologies within the confines of current knowledge, practical advice regarding assessment, management and auditable outcomes of practice.
Research Interests:
Research Interests: Computer Science, Pain, Medicine, Anxiety, British medical history, and 13 moreHumans, Complementary Therapies, Female, Interpersonal Relations, Arousal, Public health systems and services research, BMJ, Physical examination, Vaginismus, ANXIETY, attitude to health, Medical History Taking, and Referral and consultation
The authors respond to criticisms raised by Konotey-Ahulu regarding their survey of human immunodeficiency virus (HIV) infection among patients in the UK from sub-Saharan Africa. Specifically criticized had been the failure to determine... more
The authors respond to criticisms raised by Konotey-Ahulu regarding their survey of human immunodeficiency virus (HIV) infection among patients in the UK from sub-Saharan Africa. Specifically criticized had been the failure to determine how many female respondents were prostitutes the exclusion of a large number of study subjects due to language barriers and a failure to obtain detailed information on the type of sexual practices engaged in by self-reported heterosexuals. The authors concur that questions about prostitution should have been included; however experience has indicated that prostitutes will rarely identify themselves until a trusting relationship has been developed over time. The exclusion of subjects for language reasons was a regrettable consequence of a lack of Portuguese or African-language- speaking staff. Finally the authors agree that the type of sexual activities practiced especially anoreceptive intercourse should have been documented. On the other hand the authors continue to maintain that the experiences of Belgian and Danish expatriates in Africa suggest that a heterosexually transmitted acquired immunodeficiency syndrome (AIDS) epidemic is possible in the UK in the future.