What do senior genitourinary medicine physicians think of the future of the speciality? A national survey

Genitourinary Medicine (GUM) is a specialty that has undergone significant change over the past decade. Multiple factors have contributed to this including changes in service models and commissioning landscapes, health service leadership, medical education and changes in the spectrum of our clinical work. The Joint Specialist Committee for GUM at the Royal College of Physicians (RCP) conducted a national survey in December 2019 – January 2020 to understand the changing scope of work for GUM consultants. The survey indicated an increase in clinical complexity alongside a decline in registrar recruitment, staff shortages and service fragmentation. Funding cuts have impacted many services and the majority of consultants feel a return to an NHS commissioning model would be preferable. Despite the many challenges, GUM physicians consider the specialty ‘unique, dynamic, friendly and open-minded’. It is clear that senior doctors value the wider clinical, academic and educational opportunities within the specialty.

Osteolytic lesions as the sole presenting feature of secondary syphilis

We present the case of a 48-year-old man with a background of well-controlled HIV who presented with bony pain in multiple regions and raised inflammatory markers. After an investigative process, the patient was newly diagnosed with secondary syphilis. Bony pain, secondary to osteolytic lesions and demonstrated on plain radiography, CT and nuclear medicine imaging, was the sole presenting feature. The patient was successfully treated with penicillin G and his symptoms improved. Rheumatologists are often tasked with diagnosing the cause of a patient’s pain. However, in this case, a multidisciplinary approach was needed and the contribution of a specialist in Genitourinary Medicine/HIV was required to help diagnose this rare cause of bony pain.

Gynaecology and genitourinary medicine

Gynaecological practices are changing constantly, with more emphasis on management in primary care, conservative, rather than surgical, management of conditions, and an increase in sub-specialization such as gynaecological oncology and urogynaecology. This chapter contains 29 questions that encompass all of the important areas of this subject, with detailed explanations. Unique to this series, questions are rated by difficulty and are cross-referenced to the eleventh edition of Oxford Handbook of Clinical Specialties to track revision progress and revise effectively.

Sexually transmitted infections in primary care

Sexually transmitted infections (STIs) have often been managed in genitourinary medicine clinics. However, with increasing rates of STIs, more patients are now presenting to primary care services. It can be a sensitive subject for patients, who may be embarrassed to attend. A non-judgemental approach and knowledge about STIs are important in easing patients’ anxieties. This article provides an overview of the most common STIs in the UK, including presenting features and primary care investigation and management.

The Imperial Makings of Medical Work: Peter Johnstone Freyer and the Practice of Genitourinary Medicine in Britain and the Raj, c. 1875–1921

This article establishes the social history that connected British imperialism, the medical profession, and the meaning of its work through the career of a prominent Irish surgeon, Peter Johnstone Freyer, between 1875 and 1921. Although the social history of professions has been of frequent interest among contributors to this journal, their readings have maintained particularly “structural” accounts of what provides professions with their power and authority. From this perspective, professions are made and maintained by formal education, the strength of the associations between their members, and how they practice their knowledge. In recent years, however, such accounts have been called into question by scholars who seek to emphasize the “imaginative” qualities of professions, that is, the active processes by which they situate their ethics, values, and institutions in relation to particular cultures external to the formal structures of the profession itself. This is the premise from which I work in order to demonstrate the ways in which the social and cultural contexts provided by British imperialism shaped the meaning of Freyer’s practice in genitourinary medicine, both in India and metropolitan London. As a result, I augment pre-existing accounts of this medical specialty, which have been written in line with structural accounts of the social history of professions.

Genitourinary medicine and Hiv

This chapter outlines the basic science and theory of GUM medicine and HIV required for MRCP Part 1, before addressing the clinical aspects of GUM medicine and HIV for MRCP Part 2. To ensure effective revision, material is presented in short sections with bullet lists, tables, and boxes to highlight key facts.

Specific genitourinary situations

This chapter summarizes clinical features, causes, diagnosis, and management of different groups of presentations or situations that need to be managed in genitourinary medicine or sexual health settings. Algorithms are provided for the different topics covered. The topics are listed at the beginning of the chapter.