Health Effects of Oral Contraceptive Use

(Great Britain—British Journal of General Practice, October 1998, p. 1657.) A long-term study of oral contraceptive use in patients attending British general practices provides reassuring information about the health consequences of these medications. Over 23,000 women attending 1,400 general practices were enrolled in the study in 1968 and 1969. Women who had ever used oral contraceptives had an increased risk of cerebrovascular disease, pulmonary embolism and venous thromboembolism, but the risks were concentrated in smokers and women who used preparations containing 50 μg of estrogen or more. The risk also appeared limited to women younger than 35 years of age, and no evidence indicated that prolonged use posed a greater risk than using contraceptives for short periods. The risk of ovarian and endometrial cancer was significantly reduced in women who used oral contraceptives. The risk of several malignancies, including breast cancer, and diseases such as diabetes, multiple sclerosis, inflammatory bowel disease, rheumatoid arthritis and liver disease, did not differ significantly between users and nonusers of oral contraceptives. The authors conclude that modern oral contraceptive agents are not associated with an increase in the net risk of serious disease.

Etiology and Management of Cystitis

(Great Britain—The Practitioner, October 1998, p. 698.) The lifetime prevalence of cystitis is approximately 20 percent in women and 0.5 percent in men. Predisposing factors for cystitis include abnormalities of the urinary tract (particularly those that facilitate retrograde spread of organisms up the urethra), pregnancy, advanced age, diabetes mellitus, use of immunosuppressive drugs and any instrumentation, surgery or insertion of foreign material into the urinary tract. Over 80 percent of cases of cystitis are caused by Escherichia coli, with the remainder of cases attributed to enterococci (particularly Streptococcus faecalis), Staphylococcus saprophyticus, various yeasts, and species of Klebsiella, Proteus and Pseudomonas. The six key symptoms are urinary frequency, urgency, dysuria, nocturia, hematuria and voiding dysfunction, but other common complaints include incontinence, fever, chills and nausea. If the diagnosis is supported by dipstick findings, treatment should be started immediately using the “best guess” antibiotic, usually trimethoprim or amoxicillin, for one to three days. Further investigations and more aggressive treatment are indicated in women who have persistent symptoms after initial treatment and in men with cystitis.

Good News About Depressive Illness

(Great Britain—British Journal of General Practice, October 1998, p. 1643.) A recent Dutch study highlighted differences in the prognosis of patients with depression treated in primary care compared with patients referred to psychiatric services. Ten-year follow-up of 222 patients meeting criteria for depressive illness indicated that only 18 percent required referral during the initial episode, including 5 percent who were hospitalized. Ten suicide attempts were recorded, of which two were successful. More than 60 percent of the patients had no recurrence of depressive symptoms during the 10 years of observation. Only 12 percent of the patients experienced more than three episodes of depression, and 3 percent reported six or more episodes during the 10-year study period. The index episode lasted a mean of 103 days (range: 14 to 1,266 days), but in 11 patients the first episode lasted more than one year. The total mortality rate for depressed patients did not differ significantly from that of the control population.

Skin Conditions Caused by Corynebacteria

(Great Britain—The Practitioner, October 1998, p. 692.) Although most skin infections are caused by staphylococci or streptococci, erythrasma, pitted keratolysis and trichomycosis axillaris are attributed to corynebacteria. Erythrasma occurs mainly in obese elderly or diabetic patients and is characterized by red or brown scaling patches in the skinfolds, especially the groin, axillae or webs of the feet. The diagnosis may be confirmed by pink-orange fluorescence under Wood's lamp and may be treated by vigorous washing followed by topical application of erythromycin or clindamycin. Oral erythromycin may be required for the treatment of extensive or resistant cases of erythrasma. Both pitted keratolysis and tricomycosis axillaris are associated with excessive sweating (hyperhidrosis) and respond to the same topical antibiotic treatments as erythrasma. In pitted keratolysis, pitted lesions on the soles of the feet may coalesce to form superficial erosions. Patients may complain of local itching, burning or discomfort in addition to the cosmetic problem and an unpleasant smell to the feet. In trichomycosis axillaris, large colonies of bacteria form waxy nodules coating the axillary hair.