Abstract
Sirs: I concur with the C Sonnex report and sentiment regarding ‘Destigmatizing genitourinary (GU) medicine and sexually transmitted infections in the UK’. 1 The document reminds me of the address that Dr W Harris gave, as the out-going president of the then Medical Society for the Study of Venereal Diseases, on areas of extending the sphere of GU medicine as a medical discipline. He projected a sketch of three circles representing dermatology, urology and gynaecology; with the three circles meeting within the central sphere of GU medicine. Many patients who present at GU medicine clinics have conditions of the lower GU tract and/or genital skin that have been unravelled by a sexual encounter of concern.
The GU medicine service in Stafford has provided care for sexual dysfunction, vulvoscopy, penoscopy and colposcopy over the past 17 years, which have transformed local public perception about the ‘GU medicine’ service. It has got rid of the old stigma of ‘the clap clinic’. Culture is difficult to change in a small semi-rural area, with a small town with a population of 70,000 inhabitants, and surrounding satellite towns and villages. The outcome of culture change, for the GU medicine service's perception between clients, is fulfilling for the staff and rewarding to patients. Fifteen years ago, managers said that ‘they walk into the GU medicine department with a brown folder under their arm, to indicate that they are coming for a business visit, rather than a clinical assessment’. Now, we have hospital staff turning up to the clinic in their work uniform to undertake GU medicine clinical care. The de-stigmatization of our services has improved attendance, which has grown beyond similar clinics, serving comparable populations.
The specialty had been subdivided by the HIV demand, interest and pharmaceutical sponsorships. This reflected on the subspecialized services in teaching centres, which continuously lost interest and services for female/male genital dermatology, sexual dysfunctions and colposcopy. This has gradually reflected on the GU medicine subspecialist training, which consequently limited the provision for gaining expertise in these subspecialized services. The current specialist GU medicine training programme gives very limited scope for subspecialized interests. 2
The current medicopolitical atmosphere supports primary care units. Most of the GU medicine attendees are of primary care nature, irrespective of where the unit is geographically located (i.e. whether hospital-based or community-based). The ‘payment by result’ system has provided our clinics with ample opportunity to enhance services, with financial returns to the department that enable it to improve the overall patient's care.
Our ability to see male and female patients is unique, between specialties caring for patients with lower urogenital problems (e.g. gynaecologists or urologists). Male genital dermatological conditions receive far less attention than their female counterparts (i.e. the scope of vulval clinics with no similar men's genital skin clinics).
Medicine has never been a one condition field. A senior medical colleague once described GU medicine, sarcastically, as ‘a specialty of two diseases and one treatment’ (i.e. syphilis, gonorrhoea and penicillin). This is far from subspecialized services targeting conditions of women and men presenting with a wide range of GU problems, some of which are sexually transmitted infections.
I believe that the way forward is to revive subspecialty services in teaching centres, or their allied hospitals that have the clinical expertise; to promote the interest, knowledge, practice and art of GU medicine; and enhance the expertise of our trainees and future colleagues.