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Sexual health: Men and women
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.
Saliva may be a vehicle for gonorrhoea transmission.
15 Dec 2016
Almost half of men who have sex with men (MSM) with positive cultures for gonorrhoea from the pharnyx also had positive saliva samples, in a study from Australia, suggesting that saliva may act as a vehicle for transmission of the infection.
Lidocaine spray reduces pain during IUD insertion
23 May 2016
Women treated with a 10% lidocaine spray during IUD insertion suffered significantly less pain than those treated with a placebo spray in a randomised, double-blind, placebo-controlled trial of 200 women.
Does vasectomy affect sexual function?
28 Apr 2016
Vasectomy does not appear to be associated with reduced sexual activity, a large study from the United States has found. The study authors used the National Survey of Family Growth (NSFG) dataset comprising 7,643 women and 4,928 men.
Recreational use of drugs to enhance sexual performance
21 Mar 2016
Findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3) have revealed that a substantial minority of people in Britain have used medication recreationally to enhance sexual performance.
Is mine a normal size doctor?
22 Dec 2015
Healthcare professionals may be asked by men nervous about their penis size whether they are normal. However, we are not able to offer much in terms of reassurance because there is very little information about the normal distribution of penis length based on objective measurements on a large enough number of men to make it representative. This systematic review aimed to produce a nomogram which shows the normal distribution of penis measurements.
Shortfalls in primary care management of HIV
25 Nov 2015
A case notes review from general practices in inner London has shown that there is still room for improvement in the management of patients with HIV, particularly in the coding of ART, prescribing of drugs with potential interactions and timely diagnosis. A total of 31 out of 44 (70.5%) GP surgeries in Hackney took part in the study. Representatives from each practice performed a retrospective case notes review.
How well do GPs manage STIs?
21 Oct 2015
General practice makes an important contribution to the diagnosis and management of chlamydia and gonorrhoea infections in England, a population-based study has found. However, although most patients diagnosed with chlamydia were managed appropriately, many patients with gonorrhoea were treated with antimicrobials that are no longer recommended.
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
|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.
|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.
|Managing lower urinary tract symptoms in men
25 Apr 2016
Up to 90% of men aged 50 to 80 may suffer from troublesome 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]
|Managing epididymo-orchitis in general practice
25 Apr 2013
Epididymitis and orchitis normally co-exist with isolated epididymitis being more common than an isolated orchitis. Sexually transmitted infection is the most common cause in younger men and urinary tract pathogens are the more common culprits in older men. The most common pathogens in the under 35s are N. gonorrhoeae and C. trachomatis and E. coli is the most common cause of acute epididymitis in the over 35s. Acute testicular torsion is the most important differential diagnosis of acute testicular pain especially in younger men. If there is any suspicion of testicular torsion, the patient should be referred to secondary care immediately as surgery is required within four to six hours.
|Advances in the treatment of metastatic prostate cancer
25 Apr 2013
Prostate cancer is the most common cancer in men in the UK. It accounts for nearly a quarter of all male cancer diagnoses and is the second most common cause of male cancer death. Most patients present with localised disease, but there are still many who present with metastatic disease. Medical castration using LHRH analogues has become the gold standard in managing both locally advanced prostate cancer, in combination with radiotherapy, and metastatic disease. Eventually most men with advanced prostate cancer become resistant to androgen deprivation therapy. This is called castrate refractory prostate cancer, and is associated with a poor prognosis. There is now hope for patients who progress after chemotherapy with the emergence of several new agents that have been shown to benefit patients. [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.
