Wisdom Antony. A Colour Atlas of Sexually Transmitted Diseases

Wolf Medical Publications, 1992. — 300 p. — ISBN: 0-7234-1592-7.Since the first edition of this Atlas was published 15 years ago, under the title of A Color Atlas of Venereology, there have been many changes, some minor and some major. Even the accepted title of the specialty has changed to genitourinary medicine partly to diminish the pejorative associations of the former title, venereology, but also to reflect the changing patterns of morbidity of relevant conditions within the community.In this edition, I have added a section on HIV/AIDS which is necessarily brief. Many patients presenting with this condition are first diagnosed in genitourinary medical clinics, and much of the subsequent care as outpatients will likely be managed in these departments. I have considerably changed the section on non-gonococcal infections, mainly because facilities for the identification of chlamydial infections are now widespread, allowing more rational management of the condition. New investigative techniques such as colposcopy are included. I have also added many new pictures, both in the new sections and to improve existing ones.Undoubtedly the major change in genitourinary practice has been the emergence of HIV/AIDS. This severely disabling disease with its high mortality was first recognized in the USA in 1981 and is still too new for the natural history to have been clearly defined, but it is probably the most important medical matter to arise in the second half of the twentieth century. Initially, in developed countries the disease was found almost exclusively in male homosexuals or the recipients of blood products or transfusions: now it is clear that heterosexual transmission does occur and this is likely to be the main method of spread of infection in the future. At the time of writing no effective therapy is available: treatment at present consists of palliation, both physical and psychological. Of prime importance is the establishment of effective cooperation between healthcare facilities, social services, local authority services, and voluntary organizations to help individuals affected by HIV, who have to cope with both their illness and public prejudice. It is already evident that HIV-associated problems can ramify even into the (apparently) most unlikely areas of everyday life.Two other areas in the specialty are also causing concern because of the greatly increased frequency of occurrence, and are covered in this new edition: these are genital warts and pelvic inflammatory disease. Genital wart (HPV) infections are associated with cervical intraepithelial neoplasia and carcinoma of the cervix, which have been found much more frequently in recent years, especially in younger women. The number of cases of the pelvic inflammatory disease has markedly increased, both in genitourinary and gynecological practice. There has also been an increase in the number of infertile couples who, on investigation, often show signs of previous clinically silent tubal infection in the female, which is known frequency to be caused by microorganisms that are transmitted sexually. This suggests that we must ensure that screening methods (cervical cytology in HPV, and microbiology in sexually active people not in a stable relationship) are freely available and that the public is educated to make use of the resources.The importance of health education in genitourinary practice has never been in doubt: the recent advent of HIV has emphasized this point. The only practical way at present to reduce transmission of the virus (and other microorganisms) is for individuals to adopt a low-risk lifestyle. My impression is that this message has been received and acted upon by the male homosexual community (as shown by the reduced incidence of sexually transmitted diseases in male homosexuals observed in both the UK and the USA) but there is little evidence as yet that the heterosexual community (particularly those most at risk) have changed their habits. Finally, I would like to repeat the final words of the introduction to the first edition "Treatment...must include sympathetic understanding and reassurance of the patient, who is so often acutely anxious about his or her condition". All my experience of the past 15 years, and especially since the appearance of HIV, underlines that conclusion.