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Mathematical models for infectious diseases are of lim ited use in providing practical help to health professionals. In this paper we discuss computer models developed jointly by operational research mathematicians and clinicians to meet this need. W e use the term 'operational modelling' to describe this pragm atic approach. The models can aid decision-making at a resource planning level and can also be used by clinicians to monitor and im prove patient care. The models incorporate uncertainty and variability and are therefore mathematically complex, but are easy to use and provide a great deal of useful information about morbidity and resource use. [ABSTRACT FROM AUTHOR]

An audit of triage was conducted between June and September 2003 in a district general hospital genitourinary medicine department to evaluate the appropriateness of triage criteria to identify those who require urgent intervention. We selected gonorrhoea (B1), chlamydia (C4a), gential herpes (C10a/b) and epidemiological treatment of contacts of B1 or C4a (C4e/B4) as conditions requiring urgent intervention. Eighty-eight percent met one or more of the criteria and were offered urgent appointments and 69% who did not meet the criteria were offered routine appointments. The incidences of B1, C4a, C10a/b and C4e/B4 were 26.5%, 21.2%, 16.8% and 8% respectively in the urgent group compared with corresponding incidences of 4.4% and 16.2% respectively in the routine group. No cases of C10a/b or C4e/B4 were seen in the latter group. Although triage criteria did not identify asymptomatic infections, efficient contact tracing will improve detection of asymptomatic carriers of infections and should be encouraged. The outcome of the audit informed modifications to the criteria and reinforced the need for staff training in triage. In the United Kingdom, genitourinary medicine must be urgently prioritized and invested in, to improve access to all who need to be seen within 48 h of contacting the service. [ABSTRACT FROM AUTHOR]

Kaposi's sarcoma (KS) has a higher incidence in some parts of Africa than anywhere else in the world. Recent studies in western homosexual men with AIDS-KS suggest that KS may be caused by a putative sexually transmissible agent. Our analytical review of studies on KS in Africa before and during the AIDS era reveals a disparate epidemiological picture. Its occurrence in sexually inexperienced children; overwhelming male preponderance in an almost exclusively heterosexual population; rarity of concordant couples in areas of very high incidence; sequestration of high incidence to Eastern and Central Africa; and regional variations in incidence even in high-incidence countries are all difficult to reconcile with a conventional sexually transmissible aetiology. There is a need for prospective studies specifically designed to test the hypothesis in Africa. Also, we recommend that studies pursuing the aetiology of KS in western countries be linked with studies in high incidence areas in Africa. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "How is gonorrhea treated in genitourinary medicine clinics in Great Britain," by J. D. C. Ross and R. Maw that was published in an issue.