SEARCH
Practitioner CPD prompts to action
Immediate CPD prompts
These templates*, associated with all articles, prompt drafting of personal learning, reflection and planning.
Save your record into your personal development folder on your device or cloud storage system.
*Adobe fillable PDFs. Adobe reader needed for iPad
Case report submission
Your case report would need to be around 1,500 words long, include a brief review of the literature to put the case in context, and be fully referenced in the Vancouver style.
Submissions for consideration should be sent to:
[email protected]
Comment or question
If you, or your peer group, would like to comment on an article or have a question for the authors, write to:
Sexual health: Men and women
Patients at risk of STIs not attending sexual health services
25 Jul 2018
More than 80% of women and nearly 90% of men who reported having unsafe sex in the past year did not consult sexual health services, findings from the third National Sexual Attitudes and Lifestyles (Natsal 3) study have shown.
Exploring the barriers to fitting IUCDs in primary care
25 Jun 2018
A general practice study has revealed a reluctance among GPs and practice nurses to fit intrauterine contraceptive devices (IUCDs). An online survey was sent to 69 practices in the south east of England and 208 individuals responded. More than two-thirds of the respondents were GPs and nearly a third were nurses. When asked about statements relating to potential barriers to providing or recommending IUCDs, respondents who were not trained to fit IUCDs were more likely to identify with more barriers than those who had been trained.
Composition of vaginal microbiota may increase risk of chlamydia infection
22 May 2018
Lactobacillus iners-dominated vaginal microbiota was associated with increased susceptibility to Chlamydia trachomatis infection in women, in a Dutch nested case-control study.
|Self-taken swabs can detect bacterial vaginosis and candidiasis
23 Jan 2018
Lower vaginal swabs taken by patients are as reliable as high vaginal swabs taken by clinicians for the detection of vulvovaginal candidiasis or bacterial vaginosis, a UK study has shown.
Dyspareunia in women associated with physical and mental health conditions
23 Nov 2017
The third National Survey of Sexual Attitudes and Lifestyles in Britain (Natsal-3) has found a strong association between women reporting painful sex and poor physical health and depressive symptoms.
Chlamydia and HIV testing for young people in primary care
22 Jun 2017
Young men and women would be happy to be offered chlamydia screening, contraception and HIV tests from GPs, a UK study has shown.
GP vs clinic care for people living with HIV
22 Mar 2017
Around 60% of people living with HIV would choose GP care in preference to an HIV clinic, a UK study has found.
Exploring risk-taking behaviour for STIs in middle age
22 Feb 2017
Sexually transmitted infection (STI) rates are increasing in the over 45 age group. However, feelings of guilt, embarrassment about age and stigma attached to STIs may deter middle-aged people from consulting sexual health services, a UK study has found.
Special Interest: Men's health
Articles on Men's health appear with direct links to the current evidence base by pre-defined search requests. Immediate access to the relevant evidence base allows readers instant access to browse new evidence and so update and deepen their reading and reflection around the article. Resources include:
- Results of pre-defined search requests made to PubMed
- The US National Cancer Institute's database of peer-reviewed, regularly updated evidence-based summaries on cancer in men
- Results of pre-defined search requests made to 'NHS Evidence'
Symposium articles
|Identifying and managing men with early prostate cancer
23 Apr 2018
Prostate cancer is the most common cancer in men in the UK. Men have a 1 in 8 lifetime risk of being diagnosed with the disease. Factors associated with an increased risk of prostate cancer include: age > 50 years, black ethnicity, a first-degree relative with prostate cancer, and obesity. Patients may present with erectile dysfunction or lower urinary tract symptoms such as frequency, hesitancy, nocturia, or haematuria.
|Managing acute and chronic urinary retention in men
23 Apr 2018
Urinary retention is the most common urological emergency and more than 95% of cases occur in men. Acute urinary retention (AUR) is defined as the sudden inability to pass any urine voluntarily associated with a painful, palpable or percussable bladder. In chronic urinary retention (CUR) there is a non-painful bladder, which remains palpable or percussable after the man has passed urine, with a post-void residual volume > 300 ml. In acute on chronic urinary retention no urine can be voluntarily passed but the condition is relatively painless and the residual volume on catheterisation is > 1.5 litres.
|Diagnosing and managing androgen deficiency in men
24 Apr 2017
Androgens play a crucial role in bone, muscle and fat metabolism, erythropoiesis and cognitive health. In men aged 40-79 years the incidence of biochemical deficiency and symptomatic hypogonadism is 2.1-5.7%. Decreased libido or reduced frequency and quality of erections, fatigue, irritability, infertility or a diminished feeling of wellbeing may be presenting complaints. However, a significant proportion of men with androgen deficiency will be identified when they present for unrelated concerns.
|Diagnosing testicular lumps in primary care
24 Apr 2017
Although the incidence of testicular cancer has increased over the past few decades, testicular tumours are still rare and many GPs will only see one or two new diagnoses in their career. When examining scrotal swellings, the key question is whether the lump is intra- or extra-testicular, as palpable intra-testicular lesions are highly likely (around 90%) to be malignant, whereas those lying outside the testis are usually benign.
|Managing lower urinary tract symptoms in men
25 Apr 2016
Up to 90% of men aged 50 to 80 may suffer from troublesome lower urinary tract symptoms (LUTS). A thorough urological history is essential to inform management. It is important to determine whether men have storage or voiding LUTS or both. Based on history, examination and investigation findings an individualised management plan should be formulated.
|The role of PSA in detection and management of prostate cancer
25 Apr 2016
The prostate specific antigen (PSA) test clearly provides the opportunity for clinically relevant prostate cancer to be detected at a stage when treatment options are greater and outcomes may be improved. In addition, a raised PSA may often indicate benign prostatic enlargement, and this may provide an opportunity for treatment of this condition before complications develop. However, in some patients the PSA test may lead to investigations which can identify clinically insignificant cancers which would not have become evident in a man’s lifetime.
|Careful assessment key in managing prostatitis
23 Apr 2015
Prostatitis is a common condition estimated to affect up to 30% of men in their lifetime, it is most prevalent in men aged between 35 and 50. Prostatitis is subclassified into: acute bacterial prostatitis, chronic bacterial prostatitis, chronic pelvic pain and asymptomatic inflammatory prostatitis. Clinical assessment includes a thorough history and examination. A digital rectal examination should be performed after a midstream urine sample has been collected for urine dipstick, microscopy and culture. The prostate should be checked for nodules.
|New developments in metastatic prostate cancer therapy
23 Apr 2015
Advanced prostate cancer remains an incurable and lethal disease. Innovation continues to provide new hope for patients with advanced disease, with improved survival while maintaining quality of life. As patients live longer with increasing treatment options, education of all healthcare professionals involved in their care is crucial in ensuring holistic care for this complex disease.
|GPs have key role in managing men with testicular cancer
22 Apr 2014
Testicular cancer accounts for 1% of all malignancies in males. However, it is the most frequently occurring solid tumour in men between the ages of 15 and 34 years. Testicular tumours have excellent cure rates, even in those with metastases, as they are extremely sensitive to chemotherapy and radiotherapy. Early diagnosis is, however, very important as treatment is more successful and less intensive, and long-term health consequences can be minimised. [With external links to current evidence and summaries]
|Optimising the management of early prostate cancer
22 Apr 2014
A suspicion of a diagnosis of prostate cancer is usually based on either induration or nodularity of the prostate on digital rectal examination or, more commonly, a rise in serum prostate specific antigen (PSA) level. The usual cut-off point for PSA is taken as 4 ng/ml, but in men below 65 a value of more than 2.5 ng/ml should raise suspicion. The Gleason grading of any cancer identified is an important part of the decision-making process concerning the need for active treatment, as opposed to surveillance alone. Gleason pattern 6 cancers are regarded as low risk, Gleason 7 intermediate risk and 8-10 high risk. [With external links to the current evidence base]
Urology: men and women
Fracture admissions higher in men on ADT
23 Jun 2016
Androgen deprivation therapy (ADT) in men with prostate cancer is associated with a small but significant increase in fracture risk, a UK study has shown. Using the Hospital Episodes Statistics database for 2004-2008, the authors identified 8,902 men with prostate cancer who had been admitted to hospital with a fracture. Of these, 3,372 (37.8%) had been treated with ADT and 5,530 (62.2%) had not. There were 228,852 admissions in the background population.
|What are the benefits of testosterone treatment in older men?
28 Apr 2016
Testosterone therapy in men 65 and over with low testosterone levels produced moderate improvements in sexual function and some improvement in mood but had no effect on vitality or walking. All men enrolled were randomised to either testosterone gel or a placebo gel for one year.
Chemotherapy with hormone therapy boosts survival in advanced prostate cancer
21 Mar 2016
The addition of docetaxel at the time of hormone therapy initiation for advanced prostate cancer improved overall survival by 10 months, in a large randomised controlled trial. The STAMPEDE study commenced in 2005, and has recruited men with metastatic, high-risk localised or node-positive prostate cancer who were newly diagnosed or had high-risk recurrence following previous local therapy. STAMPEDE utilises a multi-arm approach to test whether addition of other agents at the time of hormone therapy initiation improves overall survival.
Can NSAIDs reduce the need for antibiotics in UTI in women?
25 Jan 2016
Although initial treatment of urinary tract infection (UTI) with ibuprofen reduced the use of antibiotics, women had a greater symptom burden and a higher risk of pyelonephritis than those treated with antibiotics from the outset, a primary care study from Germany has found.
Prostate specific alpha blockers increase risk of falls
25 Nov 2015
The newer prostate-specific alpha blockers produce a small but significant increase in the risk of falls in older men with lower urinary tract symptoms (LUTS), a study from Canada has shown. The alpha blocker cohort consisted of 147,084 men aged 66 years and over, starting a selective alpha blocker (84% tamsulosin). An equal cohort of matched men, not taking alpha blockers was created on a 1:1 basis. The primary outcome measures were falls and fractures 90 days after initiation of therapy. Secondary outcomes were major osteoporotic fractures, hip fractures, hypotension and head trauma.
Editorials
|Should men who have sex with men be screened for hepatitis C?
21 Feb 2013
Reports of acute HCV infection in HIV-positive men who have sex with men (MSM) have emerged where sexual exposure was the only risk factor. In a systematic review, HIV-positive MSM had approximately four times the risk of acquiring acute HCV infection compared with HIV-negative MSM. The data suggest it would be reasonable to consider routine screening for HCV in HIV-positive MSM.
Do 5-ARIs have a role in preventing BPH?
21 Aug 2012
Treating asymptomatic older men with 5-alpha reductase inhibitors may reduce their risk of developing benign prostatic hyperplasia (BPH). However, the case for prophylactic use of these drugs is still unproven. Dr Jonathan Rees, GPwSI Urology, Bristol, considers the implications of new data from the long-running Prostate Cancer Prevention Trial.
