Publications
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Richardson D, Goldmeier D, BASHH Special Interest Group for Sexual Dysfunction, 2006, Recommendations for the management of retarded ejaculation: BASHH Special Interest Group for Sexual Dysfunction., Int J STD AIDS, Vol: 17, Pages: 7-13, ISSN: 0956-4624
We present the British Association of Sexual Health and HIV (BASHH) special interest group in sexual dysfunction recommendations for the management of retarded ejaculation. The recommendations outline the physiology, prevalence, definitions, aetiological factors and patient assessment for this sexual problem. We suggest treatment strategies, recommendations for management and an auditable outcome.
Richardson D, Goldmeier D, Green J, et al., 2006, Recommendations for the management of premature ejaculation: BASHH Special Interest Group for Sexual Dysfunction., Int J STD AIDS, Vol: 17, Pages: 1-6, ISSN: 0956-4624
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.
Richardson D, Green J, Ritcheson A, et al., 2005, A review of controlled trials in the pharmacological treatment of premature ejaculation., Int J STD AIDS, Vol: 16, Pages: 651-658, ISSN: 0956-4624
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.
Richardson D, Goldmeier D, 2005, Pharmacological treatment for premature ejaculation., Int J STD AIDS, Vol: 16, Pages: 709-711, ISSN: 0956-4624
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.
Hamill M, Goldmeier D, 2005, Patients support innovative models of care in recurrent genital herpes clinics: results from a patient satisfaction study., Int J STD AIDS, Vol: 16, Pages: 615-617, ISSN: 0956-4624
Genital herpes is one of the most common sexually transmitted infections and is characterized by recurrent, painful, ulcerative lesions. Severe psychosocial disturbance has been described in a variety of settings and there are well-documented associations with poor self-esteem, centred around contagion and stigma. Recurrent genital herpes (RGH) is traditionally managed by doctors in the genitourinary medicine clinic setting; we wanted to evaluate patient's opinions on alternative models of care. We performed a questionnaire of patients attending our RGH clinic to ascertain patients' opinions and preferences. Seventy four percent of patients expressed a wish to see the same health-care professional at follow-up visits and 62% supported the idea of a nurse-led clinic. One-third found the concept of group sessions acceptable. Regarding GP follow-up management and prescribing, there was a split response with almost equal numbers accepting and rejecting this proposition (42 versus 45%). Seventy-six percent of patients thought that RGH had important psychological impact on their lives and 58% found the prospect of psychological referral acceptable.
Goldmeier D, Richardson D, 2005, Romantic love and sexually transmitted infection acquisition: hypothesis and review., Int J STD AIDS, Vol: 16, Pages: 585-587, ISSN: 0956-4624
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.
Goldmeier D, Madden P, Lacey C, et al., 2005, Complementary therapy and genital warts, SEXUALLY TRANSMITTED INFECTIONS, Vol: 81, Pages: 360-360, ISSN: 1368-4973
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Richardson D, Goldmeier D, 2005, Premature ejaculation--does country of origin tell us anything about etiology?, J Sex Med, Vol: 2, Pages: 508-512, ISSN: 1743-6095
INTRODUCTION: Premature ejaculation is a common sexual problem. The etiology of this condition is unclear. It has been suggested that some racial groups may be more at risk than others. We had a clinical impression that in our unit in London, UK, there was a preponderance of men from Islamic and Asian backgrounds. AIM: We therefore undertook a retrospective analysis of our clinic population over an eighteen-month period. METHODS: A total of 123 patients were identified with a clinical diagnosis of PE based on the DSM-IV and UK national guidelines. MAIN OUTCOME MEASURE: Demographic and clinical data were collected retrospectively: parameters of patients seen in the previous 18 months were identified, including self-identified ethnicity and age. Patient-defined ethnicity was compared with the ethnicity of self-referring patients attending our general sexual health services (outpatients), and also with local population census data. RESULTS: A total of 60% of patients were from Islamic or Asian backgrounds but 12% and 11% came from those racial groups in local population census data and our general clinic population respectively (P<0.001). CONCLUSIONS: It thus appears that there is a preponderance of men from Islamic and Asian backgrounds presenting to our unit with premature ejaculation. The reasons for this are unclear. Possible mechanisms include psychosocial, familial, or genetic influences.
Goldmeier D, Madden P, McKenna M, et al., 2005, Treatment of category III A prostatitis with zafirlukast: A randomized controlled feasibility study, INTERNATIONAL JOURNAL OF STD & AIDS, Vol: 16, Pages: 196-200, ISSN: 0956-4624
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- Citations: 23
Seivewright H, Salkovskis P, Green J, et al., 2004, Prevalence and service implications of health anxiety in genitourinary medicine clinics, INTERNATIONAL JOURNAL OF STD & AIDS, Vol: 15, Pages: 519-522, ISSN: 0956-4624
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- Citations: 39
Goldmeier D, Malik F, Phillips R, et al., 2004, Cost implications of sexual dysfunction: the female picture., Int J Impot Res, Vol: 16, Pages: 130-134, ISSN: 0955-9930
This study examined the clinical workload, outcome and direct costs of managing women with sexual dysfunction in an NHS clinic in the UK. A retrospective analysis of a 3-month period showed that of 47 referrals to the clinic, 38 undertook treatment. The therapists' assessments suggested that over 80% of patients improved on treatment. The average cost per patient was pound 472 (compared to pound 335 per annum for erectile dysfunction, which included physician's and drug costs). The average cost by type of practitioner was pound 278 (psychologist), pound 322 (physician), pound 532 (physician and psychologist) and pound 597 (sex therapist). Patients required between 1 and 51 treatment sessions, which were mainly restricted to psychological therapy. Female sexual dysfunction (FSD) represents a significant economic burden to the NHS. Further research on the potential role and cost effectiveness of pharmacological agents for FSD is warranted.
Lamba H, Goldmeier D, Mackie NE, et al., 2004, Antiretroviral therapy is associated with sexual dysfunction and with increased serum oestradiol levels in men., Int J STD AIDS, Vol: 15, Pages: 234-237, ISSN: 0956-4624
Our objective was to determine the relationship between highly active antiretroviral therapy (HAART), serum total oestradiol and sexual dysfunction in HIV-infected men. Sexual difficulties were recorded prospectively in a cohort of HIV-negative (or unknown status) gay/bisexual men (MSM) and a cohort of HIV-infected men. The HIV-infected men were divided into those on and not on HAART and by sexuality. Serum total oestradiol and testosterone levels were evaluated where possible. One hundred HIV-negative MSM and 73 HIV-infected men (88% MSM) were analysed. Low libido and erectile dysfunction (ED) were reported in the control group in 2% and 10% respectively. This compared to a prevalence of 26% for both problems in HIV-infected MSM not taking HAART. In those MSM on HAART reduced libido was noted in 48% and ED in 25%. In the group of men taking HAART the mean oestradiol level was 228 pmol/L and was significantly above normal limits. Low libido and ED are more commonly reported in HIV-infected men compared to gay men of negative or unknown status. HAART is associated with a higher prevalence of lack of sexual desire and raised serum oestradiol levels.
Sundararajan L, Polkey M, Goldmeier D, et al., 2003, Referrals from a sexual dysfunction clinic for OSA - The value of an Epworth score, Winter Meeting of the British Thoracic-Society, Publisher: B M J PUBLISHING GROUP, Pages: 81-81, ISSN: 0040-6376
Goldmeier D, Guallar C, 2003, Syphilis: an update., Clin Med (Lond), Vol: 3, Pages: 209-211, ISSN: 1470-2118
Goldmeier D, Lamba H, 2002, Prolonged erections produced by dihydrocodeine and sildenafil., BMJ, Vol: 324
Goldmeier D, Scullard G, Kapembwa M, et al., 2002, Does increased aromatase activity in adipose fibroblasts cause low sexual desire in patients with HIV lipodystrophy?, Sex Transm Infect, Vol: 78, Pages: 64-66, ISSN: 1368-4973
There is evidence from our own unit and other workers that many patients who have lipodystrophy on HAART given for HIV disease also have raised oestrogen levels and complain of low sexual desire. This hypothesis paper discusses a possible pathological mechanism for these changes--an increase in the number of fibroblasts and macrophages present in lipoatrophic areas that could convert testosterone to oestrogen by intracellular aromatisation. This process is known to be enhanced by increased levels of tumour necrosis factor, interleukin 6 (IL-6), and hydroxycorticosteroids present in many patients with HIV lipodystrophy. Treatment options are discussed, including aromatase inhibitors and testosterone.
Green J, Christmas P, Goldmeier D, et al., 2001, A review of physical and psychological factors in vulvar vestibulitis syndrome., Int J STD AIDS, Vol: 12, Pages: 705-709, ISSN: 0956-4624
This review is based on a MEDLINE search of all papers on vulvar vestibulitis syndrome (VVS) published 1995-2000. The causation, natural history and prevalence of VVS are unknown. There is no convincing evidence that VVS is the result of an infection or of an allergy. It has been proposed that it is an atypical pain syndrome but there is currently no clear evidence that this is so. The usual diagnostic criteria used in VVS are of doubtful discriminative value. Findings from biopsies of women with VVS are inconsistent. While there is some evidence to suggest that women with VVS attending clinics differ psychologically from normal controls, it is not clear whether these differences reflect the effects of VVS, are the result of patient selection or influence the development of the disease. Several treatments, including biofeedback, psychosexual treatment and surgery have been reported to be successful in some patients but there is a lack of proper placebo-controlled trials on which to base estimates of efficacy. There is a vital need for further, high-quality, research in this area.
Goldmeier D, 2001, Female low sexual desire and sexually transmitted infections., Sex Transm Infect, Vol: 77, Pages: 293-294, ISSN: 1368-4973
Goldmeier D, Judd A, Schroeder K, 2000, Prevalence of sexual dysfunction in new heterosexual attenders at a central London genitourinary medicine clinic in 1998, SEXUALLY TRANSMITTED INFECTIONS, Vol: 76, Pages: 208-209, ISSN: 1368-4973
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- Citations: 33
Goldmeier D, 2000, Sexual dysfunction in genitourinary medicine clinics., Int J STD AIDS, Vol: 11, Pages: 191-192, ISSN: 0956-4624
Goldmeier D, 1998, Genital herpes: Heisenberg revisited., Sex Transm Infect, Vol: 74, Pages: 219-220, ISSN: 1368-4973
In the confirmation of recurrences of genital herpes, patient defined disease reactivation and virological data hold the scientific high ground. The influence of the psyche on recurrence rates and perception of recurrences has been largely neglected and marginalised up to the present, possibly because research work in that area has been and continues to be of poor calibre. However, neglected psychological variables may render otherwise relevant clinical trials uninterpretable. Psychological aspects of counselling before testing for serum herpes simplex type 2 antibodies are also discussed.
Keane FE, Carter P, Goldmeier D, et al., 1997, The provision of psychosexual services by genitourinary medicine physicians in the United Kingdom., Int J STD AIDS, Vol: 8, Pages: 402-404, ISSN: 0956-4624
A postal questionnaire survey, enquiring about the provision of psychosexual services, was sent to each GUM clinic in the UK. Of the 246 questionnaires distributed, replies were received from 166 directors responsible for 171 (69.5%) clinics. Of the 140 (84%) who supported the provision of a sexual dysfunction service, 59 (42%) currently provided such a service. Doctors and psychologists were the health care professionals most commonly involved in sexual dysfunction services for patients who were referred both internally and from external sources such as general practice and diabetic clinics. Patients with a variety of dysfunctions were being treated with a broad range of therapies, a reflection probably of the multidisciplinary nature of the team providing the service. However, it appears that junior doctors are not being trained in this field at present.
Goldmeier D, Keane FE, Carter P, et al., 1997, Prevalence of sexual dysfunction in heterosexual patients attending a central London genitourinary medicine clinic., Int J STD AIDS, Vol: 8, Pages: 303-306, ISSN: 0956-4624
Our objective was to determine the prevalence of sexual dysfunction among new heterosexual attendees at a central London genitourinary medicine (GUM) clinic. We carried out a cross-sectional study in which patients completed a self-administered questionnaire-the Golombok-Rust Inventory of Sexual Satisfaction (GRISS) and participated in a brief interview during which additional information was sought regarding the patient's sexual history. An overall transformed score of >5 on the GRISS was defined as indicative of overall sexual dysfunction and a score of >5 on any of the subscales as indicative of a specific sexual dysfunction. Twenty-five (24%) men and 10 (9%) women had a GRISS score in keeping with overall sexual dysfunction, the prevalence being significantly lower in women (P=0.01, chi2=6.56, 1df). Sixty-three men (59%) and 63 (60%) women produced scores indicative of significant abnormality on at least one subscale, including, in men: erectile dysfunction 20 (19%), premature ejaculation 23 (22%), and in women: vaginismus 26 (25%) and anorgasmia 23 (22%). Neither an abnormal overall or subscale score on the GRISS was associated with a current STD on KC60 diagnosis or a history of sexual assault for either men or women. There is a substantial prevalence of sexual dysfunction in new heterosexual attendees at our clinic, the service implications of which need to be addressed.
Filipe EM, Strauss SB, Beck EJ, et al., 1994, Sexual behaviour among London GUM clinic attenders: implications for HIV education., Int J STD AIDS, Vol: 5, Pages: 346-352, ISSN: 0956-4624
The aim of this study was to describe the sexual behaviour of a sample of genitourinary medicine (GUM) clinic attenders, 5 years after the launch of the UK government HIV media campaigns. A gender-specific and anonymous cross-sectional self-completion questionnaire was modified from the National Survey of Sexual Attitudes and Lifestyle and completed by 250 men and 250 women. The majority of the respondents were in their twenties, lived in London and were employed or students. Sixty-eight per cent of the men reported that one or more of their last 3 partners was not a regular partner. For those men whose last sexual encounter was with a new partner, 27% of heterosexuals and 33% of homosexuals reported using a condom. Fifty-one per cent of women reported one or more non-regular partners among their last 3 partners. For those women whose last sexual encounter was with a new partner, 43% of heterosexuals and 75% of bisexuals used a condom. Seventy-eight per cent of men and 75% of women had had a previous sexually transmitted disease (STD). These findings highlight the persistence of practices associated with the risk of contracting or transmitting HIV infection and which needs to be addressed in future educational campaigns. The GUM clinic population is an important population to monitor over time, either by longitudinal or serial cross-sectional studies. The results of this study provide a baseline against which to gauge the effects of future educational interventions.
Hay PE, Clarke JR, Taylor-Robinson D, et al., 1990, Detection of treponemal DNA in the CSF of patients with syphilis and HIV infection using the polymerase chain reaction., Genitourin Med, Vol: 66, Pages: 428-432, ISSN: 0266-4348
The polymerase chain reaction (PCR) was used to detect Treponema pallidum DNA in the cerebrospinal fluid (CSF) of patients with and without syphilis. The CSF from 10 of 19 patients with positive serological tests for syphilis who were being investigated for late syphilis were treponemal DNA-positive. In contrast, the CSF from only one of 30 patients with no known history of syphilis was DNA-positive. CSF from 28 HIV-positive patients was also tested. Fourteen of these patients had central nervous system (CNS) disease and seven were DNA-positive, whereas none of the 14 without CNS disease were DNA-positive. Five of the seven DNA-positive patients had a history of syphilis. Such a history in an HIV-positive patient who had CNS disease was predictive of finding treponemal DNA in the CSF. The PCR had a sensitivity of 47% and a specificity of 93% for detecting a known history of syphilis and is a potentially useful tool in treponemal diagnosis.
Hay PE, Clarke JR, Strugnell RA, et al., 1990, Use of the polymerase chain reaction to detect DNA sequences specific to pathogenic treponemes in cerebrospinal fluid., FEMS Microbiol Lett, Vol: 56, Pages: 233-238, ISSN: 0378-1097
The polymerase chain reaction was used to detect Treponema pallidum in specimens of cerebrospinal fluid (CSF), as a means of diagnosing syphilis. Segments of the TmpA and 4D genes were amplified to provide an estimated threshold sensitivity of approximately 65 organisms in 0.5 ml. A spectrum of pathogens known to cause meningitis, and several non-pathogenic treponemes were unreactive. Treponema pertenue, and only one of 30 control specimens of CSF were positive. In contrast, 10 of 19 CSFs from patients being evaluated for latent or tertiary syphilis were positive, as were 7 of 28 specimens from HIV-positive patients.
Goldmeier D, Johnson A, Byrne M, et al., 1988, Psychosocial implications of recurrent genital herpes simplex virus infection., Genitourin Med, Vol: 64, Pages: 327-330, ISSN: 0266-4348
Fifty seven patients experiencing first attacks of genital herpes simplex virus infection (HSVI) were compared with 50 patients who were concerned about frequently recurring attacks despite routine counselling and reassurance. Using the general health questionnaire this latter group was found to be more psychologically distressed and more socially naive than the first attack group, as measured by socioeconomic class and the lie score of the Eysenck personality questionnaire; otherwise the two groups were similar. Patients presenting to clinics with frequently recurring genital HSVI may therefore be especially psychologically distressed, socially naive, and disadvantaged. Managing these patients needs to include understanding these problems as well as giving advice and using antiviral agents.
Terry PM, Page ML, Goldmeier D, 1988, Are serological tests of value in diagnosing and monitoring response to treatment of syphilis in patients infected with human immunodeficiency virus?, Genitourin Med, Vol: 64, Pages: 219-222, ISSN: 0266-4348
To assess the value of serological tests in diagnosing and monitoring the response to treatment of syphilis in patients infected with the human immunodeficiency virus (HIV), case notes of eight homosexual men with a history of treated syphilis, positive reactions to serological tests for syphilis, and documented subsequent conversion to HIV seropositivity were studied. No change was noted in serological markers of syphilis after HIV infection. The case notes of one man with primary syphilis, four men with secondary syphilis, and three men with latent syphilis, of whom all were HIV seropositive, were also studied. In seven of these patients the serological responses to infection and after treatment were consistent with the experience of syphilis in HIV seronegative patients. In one man treated for secondary syphilis, and confirmed as HIV seropositive eight months after treatment, the rapid plasma reagin (RPR) test result continued to be positive at a high titre for up to 20 months after treatment.
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