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The provision of the sexually transmitted disease clinic service in the regional health authorities of England and Wales has been compared by relating the opening hours of clinics to the size of the population served. Relatively low levels of service were provided in the West Midlands and South-west Thames regions and high levels in the North-east and North-west Thames regions. When the service in the Greater London area health authorities was examined in relation to both resident and day-time populations, provision was relatively high in both instances, particularly in certain central London areas. Valid conclusions, however, about the equality of the service in different areas can only be drawn if the needs of the population for that service are known.

The current methods of treating and reporting non-specific genital infection (NSGI) are described. The most commonly used drug was tetracycline in one or other form. Epidemiological treatment was widely used, particularly for female sexual contacts. There was considerable variation in the reporting criteria for the quarterly returns. The establishment of acceptable and uniform criteria for notification of NSGI is discussed.

The current methods used in the diagnosis of gonorrhoea are reported. The sites sampled in symptomatic patients who were not gonorrhoea contacts and those sampled in symptomless contacts are described. Urethral specimens were taken routinely from all male heterosexual and active homosexual patients with a urethral discharge but in only 81% and 82% respectively of these patients if they were symptomless gonorrhoea contacts. Not all consultants would repeat investigations (smear and/or cultures) in gonorrhoea contacts if the initial ones were negative; heterosexual male and active homosexual patients were less likely to be seen again. Smears and cultures were performed routinely on women in 97% of clinics, but for men this was so in only 81% of clinics. The wider use of cultures for men, the policy with regard to the taking of urethral specimens from asymptomatic male heterosexual and active homosexual patients who are gonorrhoea contacts, and the number of diagnostic investigations required are discussed.

Recent trends for gonorrhea and pelvic inflammatory disease in England and Wales are presented using routinely available data. The drawbacks of these data are examined, and a study is described which has attempted to rectify some of these inadequacies. The study attempted to identify patients with and without symptoms of gonorrhea, trichomoniasis, and candidiasis, living in a defined population. In addition, a calculation has been made of the number of cases of PID treated on an ambulatory basis in clinics for sexually transmitted disease in England and Wales.

The current methods of treatment and reporting are described. The most common form of treatment for gonorrhoea in men and women was a single dose of oral ampicillin, usually 2 g. In proportionately more of the clinics treating women, treatment was given over several days. The wide use of ampicillin represents a marked change in treatment practice during the last decade. Procaine penicillin was the most commonly used parenteral preparation. The two dosages used most often for men were 1.2 and 2.4 megaunits. In women the commonest regimen was 2.4 megaunits and again there was a tendency for treatment to be given over several days. Epidemiology treatment was used widely and in one-third of clinics this occurred without confirmation that the patient was a true contact. Consultants used varying diagnoses on the quarterly returns for patients treated epidemiologically in whom the smears and/or cultures were negative. Most clinics classified these cases as 'other conditions requiring treatment' (D2) but as many as 19% of clinics designated these cases as being 'true' gonorrhoea. It is suggested that this results in an overestimate of the number of cases of 'real' gonorrhoea treated in England and Wales.

A study was carried out to quantify and describe patients seen in sexually transmitted diseases clinics in England and Wales during 1978. Nine per cent of male patients were homosexual and 58% of female patients were under 25 years compared with only 42% of heterosexual men. Homosexual men had a higher mean number of cases per patient during the year than heterosexual men or women, largely because thay were more likely to have multiple episodes of disease. Female patients also had a higher mean number of cases than heterosexual men, because they often had several concurrent infections. There were 100,000 fewer patients than cases (322,000 compared with 432,000); 41% were seen in clinics in London. These findings show that current statistics for STDs are inadequate. Some quantification and categorisation of patients treated would be useful in analysing the trends in the incidences of the STDs.

Data previously collected on the facilities and diagnostic criteria used in clinics for sexually transmitted diseases in England and Wales were reanalysed to established how different consultant policies affected the management of individual cases. Several discrepancies were found between conclusions based on percentages of clinics and those based on numbers of cases. Full-time facilities for contact tracing were available to more cases than previously suggested and rectal sampling in women was more widespread. Laboratory facilities were limited and cultural facilities lacking in small clinics, which thus affected only a small number of cases. Previous indications that diagnostic criteria were fairly standardised in the diagnosis of non-specific urethritis were found to be invalid. Variation in the management of individual cases was found to lead to inconsistencies in the notification of STDs to the Department of Health and Social Security.

A study of diagnostic patterns in patients attending sexually transmitted disease clinics in England and Wales during 1978 showed that homosexuals contributed 10% of all male cases but 15% of gonococcal infections. In heterosexual and homosexual men only 6% of disease episodes included more than one positive diagnosis compared with 16% in women. One or more diseases occurred concurrently in over 30% of cases of gonorrhoea, trichomoniasis, candidosis, genital herpes, and genital warts in women. Men with multiple episodes of disease contributed a disproportionate number of gonococcal infections but were less likely to have candidosis or genital herpes than patients with only one disease episode. Thus, counting cases treated appears to be an inadequate way of measuring the problems caused by STDS. To enable more rapid identification of the diseases which are the most difficult to control, STD statistics should include the sexual orientation of male patients and differentiate between genuine "new" attenders at clinics and those previously seen.

The current methods of diagnosis for non-specific genital infection (NSGI) in clinics in England and Wales are described. In most clinics (92%) microscopical findings were used by consultants to establish the diagnosis of non-specific urethritis (NSU) in male patients. However, the microscopical criteria that they used in reaching a diagnosis varied between clinics. The most commonly applied criterion was that of less than five leucocytes per high power field. NSGI in female patients and non-specific proctitis in passive homosexuals were recognised as distincy in 60% of clinics and the latter in 57%. Among those who recognised these conditions the diagnostic criteria varied. The establishment of acceptable and uniform criteria for diagnosis are discussed.