The document provides treatment guidelines for several sexually transmitted infections (STIs):
- Chancroid is diagnosed based on painful genital ulcers and lymphadenopathy. It is treated with azithromycin, ceftriaxone, ciprofloxacin, or erythromycin.
- Herpes is typically treated with acyclovir, valacyclovir, or famciclovir for suppressive or episodic therapy. Pregnant women may take acyclovir or valacyclovir.
- Syphilis treatment depends on stage, and involves benzathine penicillin for most cases.
1. Bacterial vaginosis (BV) is a common cause of vaginal discharge in women of reproductive age, caused by a shift in vaginal bacteria from predominantly lactobacillus to other bacteria like Gardnerella vaginalis and anaerobes.
2. BV is diagnosed using tests like Amsel's criteria or Gram stain of vaginal discharge showing clue cells and reduced lactobacilli. Treatment includes oral or topical metronidazole or clindamycin.
3. BV in pregnancy is associated with preterm birth and other obstetric complications. Screening and treatment is recommended for symptomatic pregnant women and those at high risk of preterm labor. Oral metron
Bacterial Vaginosis (BV) is a common cause of abnormal vaginal discharge characterized by a depletion of normal Lactobacillus bacteria and overgrowth of anaerobic bacteria. It is associated with a fishy-smelling discharge and increased risk of pregnancy complications and HIV transmission. BV is diagnosed based on clinical signs and a pH above 4.5. Treatment involves oral or topical antibiotics like metronidazole or clindamycin. Prevention focuses on screening women and restoring normal vaginal acidity to prevent recurrence.
1. Candida albicans causes the majority of fungal infections, accounting for 80-90% of cases, while Candida glabrata is the second most common cause, accounting for 5-15% of cases.
2. The prevalence of non-albicans Candida species, particularly C. glabrata and C. tropicalis, has been increasing in recent years, especially in recurrent cases. These species are more resistant to antifungal treatments.
3. Treatment for uncomplicated Candida vaginitis typically involves topical or short-course oral antifungal azole therapy for 1-7 days. More severe or recurrent cases may require longer treatment courses or maintenance therapy.
Chlamydia trachomatis is the most common bacterial sexually transmitted infection worldwide. It is often asymptomatic but can cause serious complications if left untreated, especially in women. Diagnosis is via nucleic acid amplification tests of urine, swabs, or other samples. Recommended treatments include azithromycin or doxycycline antibiotics. All newborns should receive topical ocular treatment to prevent chlamydial eye infections.
1. Bacterial vaginosis is a common cause of vaginal discharge in women of reproductive age, caused by a shift in vaginal bacteria from predominantly lactobacillus to other bacteria like Gardnerella vaginalis and anaerobes.
2. It is diagnosed based on clinical criteria like increased vaginal pH, presence of clue cells on microscopy, or a positive amine test. Treatment involves oral or topical antibiotics like metronidazole or clindamycin.
3. Bacterial vaginosis in pregnancy is associated with risks like preterm labor, so pregnant women are often screened and treated, especially those at high risk of preterm labor. Oral metronidazole is the
This document discusses Group B Streptococcus (GBS) prevention of early-onset disease in newborns. It covers that 10-30% of pregnant women asymptomatically carry GBS. GBS is the leading cause of neonatal bacterial sepsis in the US and most frequent cause of neonatal infection in the UK. The document outlines recommendations for intrapartum GBS prophylaxis based on previous infections, current pregnancy GBS test results, gestational age and other risk factors. It recommends screening all pregnant women between 35-37 weeks gestation for vaginal and rectal GBS colonization. Antibiotics such as ampicillin are recommended for GBS prophylaxis based on screening results and risk factors.
Ceftriaxone is a third-generation cephalosporin antibiotic effective against many gram-negative bacteria and some gram-positive organisms. It has a long half-life allowing once daily dosing. Ceftriaxone is used to treat osteomyelitis, gonorrhea, and other infections. It penetrates bone and cerebrospinal fluid well. Potential side effects include allergic reactions, diarrhea, and gallstones in children. Dosing is typically 1-2 g intravenously or intramuscularly once daily for several weeks depending on the infection.
1. Bacterial vaginosis (BV) is a common cause of vaginal discharge in women of reproductive age, caused by a shift in vaginal bacteria from predominantly lactobacillus to other bacteria like Gardnerella vaginalis and anaerobes.
2. BV is diagnosed using tests like Amsel's criteria or Gram stain of vaginal discharge showing clue cells and reduced lactobacilli. Treatment includes oral or topical metronidazole or clindamycin.
3. BV in pregnancy is associated with preterm birth and other obstetric complications. Screening and treatment is recommended for symptomatic pregnant women and those at high risk of preterm labor. Oral metron
Bacterial Vaginosis (BV) is a common cause of abnormal vaginal discharge characterized by a depletion of normal Lactobacillus bacteria and overgrowth of anaerobic bacteria. It is associated with a fishy-smelling discharge and increased risk of pregnancy complications and HIV transmission. BV is diagnosed based on clinical signs and a pH above 4.5. Treatment involves oral or topical antibiotics like metronidazole or clindamycin. Prevention focuses on screening women and restoring normal vaginal acidity to prevent recurrence.
1. Candida albicans causes the majority of fungal infections, accounting for 80-90% of cases, while Candida glabrata is the second most common cause, accounting for 5-15% of cases.
2. The prevalence of non-albicans Candida species, particularly C. glabrata and C. tropicalis, has been increasing in recent years, especially in recurrent cases. These species are more resistant to antifungal treatments.
3. Treatment for uncomplicated Candida vaginitis typically involves topical or short-course oral antifungal azole therapy for 1-7 days. More severe or recurrent cases may require longer treatment courses or maintenance therapy.
Chlamydia trachomatis is the most common bacterial sexually transmitted infection worldwide. It is often asymptomatic but can cause serious complications if left untreated, especially in women. Diagnosis is via nucleic acid amplification tests of urine, swabs, or other samples. Recommended treatments include azithromycin or doxycycline antibiotics. All newborns should receive topical ocular treatment to prevent chlamydial eye infections.
1. Bacterial vaginosis is a common cause of vaginal discharge in women of reproductive age, caused by a shift in vaginal bacteria from predominantly lactobacillus to other bacteria like Gardnerella vaginalis and anaerobes.
2. It is diagnosed based on clinical criteria like increased vaginal pH, presence of clue cells on microscopy, or a positive amine test. Treatment involves oral or topical antibiotics like metronidazole or clindamycin.
3. Bacterial vaginosis in pregnancy is associated with risks like preterm labor, so pregnant women are often screened and treated, especially those at high risk of preterm labor. Oral metronidazole is the
This document discusses Group B Streptococcus (GBS) prevention of early-onset disease in newborns. It covers that 10-30% of pregnant women asymptomatically carry GBS. GBS is the leading cause of neonatal bacterial sepsis in the US and most frequent cause of neonatal infection in the UK. The document outlines recommendations for intrapartum GBS prophylaxis based on previous infections, current pregnancy GBS test results, gestational age and other risk factors. It recommends screening all pregnant women between 35-37 weeks gestation for vaginal and rectal GBS colonization. Antibiotics such as ampicillin are recommended for GBS prophylaxis based on screening results and risk factors.
Ceftriaxone is a third-generation cephalosporin antibiotic effective against many gram-negative bacteria and some gram-positive organisms. It has a long half-life allowing once daily dosing. Ceftriaxone is used to treat osteomyelitis, gonorrhea, and other infections. It penetrates bone and cerebrospinal fluid well. Potential side effects include allergic reactions, diarrhea, and gallstones in children. Dosing is typically 1-2 g intravenously or intramuscularly once daily for several weeks depending on the infection.
Ciprofloxacin is a broad-spectrum fluoroquinolone antibiotic that is highly effective against both gram-positive and gram-negative bacteria. It was the first quinolone developed that could be administered orally to treat serious infections. A new extended release formulation, CiproMega, was developed to provide the benefits of once daily dosing for improved patient compliance compared to the previous twice daily dosing. Clinical trials demonstrated CiproMega was as effective as, and in some cases more effective than, the previous twice daily dosing regimen with fewer side effects.
Bacterial vaginosis (BV) is the
name of a condition in women where the normal balance of bacteria in
the vagina is disrupted and replaced by an overgrowth of certain
bacteria. It is sometimes accompanied by discharge, odor, pain,
itching, or burning.
This document discusses infection as a cause of preterm birth (PTB). It notes that local or systemic infection is a major cause, especially of early PTB between 26-34 weeks of gestation. Screening and treatment of infection-related conditions like bacterial vaginosis (BV) in early pregnancy may help prevent PTB. While some antibiotic studies show a reduction in PTB, results are conflicting. Overall, antibiotics should be considered for women found to have abnormal vaginal microflora early in pregnancy, targeting organisms associated with PTB such as those causing BV. Treatment choice and timing may depend on individual factors.
There are around 150 Candida species but C. albicans causes 80-90% of infections. C. glabrata is the second most common cause, accounting for 5-15% of cases. Infections can be uncomplicated, involving mild symptoms, or complicated, with recurrent or severe infections often associated with underlying conditions like diabetes. Treatment depends on the severity but usually involves topical or oral antifungals for uncomplicated cases and longer courses or maintenance therapy for complicated cases. Non-albicans species often require different treatments.
This document discusses various obstetric ultrasound indications and techniques. It covers:
1. Cervical length measurement and cerclage indications such as history of preterm labor or second trimester loss and cervical length <25mm.
2. Placenta praevia grading and indications for c-section if placenta is <2cm from internal os in third trimester.
3. Doppler ultrasound of the umbilical artery and middle cerebral artery for assessing fetal wellbeing and growth restriction. Abnormal Doppler indices suggest compromised fetal status.
4. Other assessments including biophysical profile, amniotic fluid volume, and techniques for conditions like preterm premature rupture of membranes.
Bovine brucellosis is caused primarily by Brucella abortus and occasionally by B. melitensis or B. suis. It is a widespread global disease characterized by abortion, retained placenta, and orchitis/epididymitis in cattle. Diagnosis involves isolating Brucella from aborted fetal tissues or secretions. The disease poses a serious risk to human health and appropriate safety precautions must be followed when handling infected materials. Vaccines used for prevention must meet standards for safety and efficacy.
This document discusses fungal vulvovaginal infections, including candidiasis (yeast infection). It covers the vaginal environment and factors that can lead to infection. Candida albicans is noted as the most common cause of vulvovaginal candidiasis (VVC). Symptoms, diagnosis, classification as uncomplicated or complicated VVC, and treatment recommendations including topical and oral antifungal agents are summarized. Recurrent and severe VVC require longer treatment courses and consideration of maintenance therapy.
This document discusses antibiotics, including their definitions, mechanisms of action, contraindications, drug interactions, and a study on antibiotic dispensing in Egyptian community pharmacies. The study aimed to describe antibiotic use patterns in Egypt. It found that the majority of antibiotics were dispensed without being checked by a pharmacist. Common reasons for dispensing included respiratory and urinary tract infections. Penicillins and cephalosporins were most commonly dispensed both with and without prescriptions. The high use and misuse of antibiotics in Egypt risks increasing antibiotic resistance.
Current evidence for management of Refractory Endometrium Aboubakr Elnashar
This document discusses current evidence and management approaches for refractory endometrium. It defines refractory endometrium as an endometrial thickness unable to reach the threshold for embryo implantation. It reviews prevalence, assessment methods including ultrasound measurements of endometrial thickness and pattern, and potential causes such as inflammation, iatrogenic factors, and congenital anomalies. Treatment approaches discussed include hysteroscopic procedures, hormonal manipulation with estrogen and HCG, improving endometrial perfusion with medications, and new modalities, but it concludes that evidence is limited for any specific validated treatment.
This document discusses antibiotic prophylaxis and treatment for infections during pregnancy and childbirth. It recommends antibiotics like cefazolin before and antibiotics like nitrofurantoin or cephalexil after Caesarean sections to prevent infections. It also recommends treating all urinary tract infections during pregnancy as they can cause pyelonephritis or preterm delivery. Common antibiotics recommended for treating UTIs during pregnancy include amoxicillin, cefadroxil, and cephalexin. The duration of treatment depends on whether it is an asymptomatic infection, acute cystitis, or pyelonephritis.
Cephalosporins are a class of β-lactam antibiotics originally derived from the fungus Acremonium. They are divided into generations based on their spectrum of activity. First generation cephalosporins such as cephazolin are effective against gram-positive and gram-negative bacteria. Second generation cephalosporins like cefuroxime have increased activity against Haemophilus influenzae and are used to treat respiratory tract infections. Third generation cephalosporins demonstrate better activity against gram-negative bacteria compared to prior generations and some like ceftriaxone have activity against Neisseria meningitidis making them useful for treating bacterial meningitis. Fourth generation cephalospor
β-lactam antibiotics like cephalosporins contain a β-lactam ring that allows them to inactivate bacterial cell wall enzymes and inhibit cell wall synthesis. Cephalosporins are classified into generations based on their antimicrobial spectrum, with later generations having greater gram-negative coverage. First-generation cephalosporins are alternatives to penicillin for skin infections while third-generation cephalosporins have activity against pneumonia-causing S. pneumoniae and are also effective against many gram-negative bacteria.
The document discusses several methods for diagnosing bacterial vaginosis:
1. pH of discharge - an elevated pH supports but does not confirm the diagnosis. A low pH rules it out.
2. The whiff test detects a fishy odor when potassium hydroxide is added, which is highly specific.
3. A wet film exam looks for clue cells which is the most sensitive single test but requires an experienced interpreter.
4. A Gram stain examines the bacteria present and can use scoring systems to determine diagnosis. It is highly sensitive and specific.
Cephalosporins are a class of beta-lactam antibiotics that are bactericidal and inhibit cell wall synthesis. They are classified into four generations based on their spectrum of activity and resistance to beta-lactamases. First generation cephalosporins are narrow spectrum and sensitive to beta-lactamases. Second generation have intermediate spectrum and sensitivity. Third generation are broad spectrum and highly resistant. Fourth generation are also broad spectrum and highly resistant. Cephalosporins vary in their ability to cross the blood brain barrier and are excreted primarily through renal or biliary pathways. They are used to treat a variety of bacterial infections.
This document provides an overview of cephalosporins, a class of beta-lactam antibiotics. It describes their classification into four generations based on their spectrum of activity and other properties. Key points include: Cephalosporins are derived from the fungus Cephalosporium and are bactericidal by inhibiting bacterial cell wall synthesis. Their classification is based on their spectrum of activity, with later generations having increased activity against gram-negative bacteria. Common examples from each generation like cefazolin, cefuroxime, cefotaxime, and cefepime are described along with their indications, dosages, and adverse effects.
1. Medical abortion methods include mifepristone with misoprostol up to 56 days gestation, or misoprostol alone up to 12 weeks gestation.
2. Surgical abortion methods include menstrual regulation up to 14 days after a missed period, vacuum aspiration up to 12 weeks, and dilation and evacuation or curettage up to 10 weeks.
3. Later term abortions between 13-15 weeks may use cervical preparation with mifepristone or misoprostol before dilation and evacuation, and between 16-20 weeks involve intrauterine installation of hypertonic saline.
This document discusses cephalosporins, a class of beta-lactam antibiotics similar to penicillins. It covers the classifications of first, second, third, and fourth generation cephalosporins and describes their mechanisms of action, spectra of activity, pharmacokinetics, uses, and adverse effects. The key points are:
- Cephalosporins act by inhibiting cell wall synthesis and are bactericidal. They are ineffective against certain bacteria like MRSA.
- Classifications are based on spectra of activity, with later generations having broader spectra. Uses include respiratory, skin, urinary infections and surgical prophylaxis.
- They are excreted renally and have varying protein binding
This document provides an overview of recurrent miscarriage, including its definition, causes, evaluation, and treatment. It discusses possible causes like anatomic, endocrine, infectious, and genetic factors. Evaluation involves assessing history, physical exam, pelvic ultrasound, thyroid function, infections, antiphospholipid antibodies, and thrombophilias. Treatment targets identified causes and includes surgical correction of anomalies, treating hypothyroidism, infections like brucellosis, antiphospholipid syndrome with aspirin and heparin, inherited thrombophilias with heparin, and genetic counseling. Progesterone, lifestyle modifications, and hCG have uncertain benefits for unexplained recurrent miscarriage.
This document summarizes the 2015 CDC treatment guidelines for common sexually transmitted diseases. It lists the recommended medications, dosages, and alternative treatments for diseases including bacterial vaginosis, chlamydia, gonorrhea, herpes, trichomoniasis, and others. For each disease, the recommended first-line treatment is provided, as well as alternative options if the first treatment fails or cannot be tolerated. Guidance is given for treating both adults and special populations like pregnant women, infants, and children.
Gynecology genital disease and treatment Dr. Ahmadi.pdfTayebehHeidari1
This document discusses the classification, diagnosis, and treatment of various gynecological conditions including vulvovaginal candidiasis, bacterial vaginosis, trichomonas vaginitis, inflammatory vaginitis, cervicitis, pelvic inflammatory disease, genital ulcer disease, syphilis, genital warts, and human immunodeficiency virus. It provides guidelines on differential diagnosis and treatment regimens for these conditions using various topical creams, oral medications, and in some cases intravenous antibiotics or surgery.
Global Medical Cures™ | Sexually Transmitted Diseases (CDC Treatment Guidelines)Global Medical Cures™
Global Medical Cures™ | Sexually Transmitted Diseases (CDC Treatment Guidelines)
DISCLAIMER-
Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
Ciprofloxacin is a broad-spectrum fluoroquinolone antibiotic that is highly effective against both gram-positive and gram-negative bacteria. It was the first quinolone developed that could be administered orally to treat serious infections. A new extended release formulation, CiproMega, was developed to provide the benefits of once daily dosing for improved patient compliance compared to the previous twice daily dosing. Clinical trials demonstrated CiproMega was as effective as, and in some cases more effective than, the previous twice daily dosing regimen with fewer side effects.
Bacterial vaginosis (BV) is the
name of a condition in women where the normal balance of bacteria in
the vagina is disrupted and replaced by an overgrowth of certain
bacteria. It is sometimes accompanied by discharge, odor, pain,
itching, or burning.
This document discusses infection as a cause of preterm birth (PTB). It notes that local or systemic infection is a major cause, especially of early PTB between 26-34 weeks of gestation. Screening and treatment of infection-related conditions like bacterial vaginosis (BV) in early pregnancy may help prevent PTB. While some antibiotic studies show a reduction in PTB, results are conflicting. Overall, antibiotics should be considered for women found to have abnormal vaginal microflora early in pregnancy, targeting organisms associated with PTB such as those causing BV. Treatment choice and timing may depend on individual factors.
There are around 150 Candida species but C. albicans causes 80-90% of infections. C. glabrata is the second most common cause, accounting for 5-15% of cases. Infections can be uncomplicated, involving mild symptoms, or complicated, with recurrent or severe infections often associated with underlying conditions like diabetes. Treatment depends on the severity but usually involves topical or oral antifungals for uncomplicated cases and longer courses or maintenance therapy for complicated cases. Non-albicans species often require different treatments.
This document discusses various obstetric ultrasound indications and techniques. It covers:
1. Cervical length measurement and cerclage indications such as history of preterm labor or second trimester loss and cervical length <25mm.
2. Placenta praevia grading and indications for c-section if placenta is <2cm from internal os in third trimester.
3. Doppler ultrasound of the umbilical artery and middle cerebral artery for assessing fetal wellbeing and growth restriction. Abnormal Doppler indices suggest compromised fetal status.
4. Other assessments including biophysical profile, amniotic fluid volume, and techniques for conditions like preterm premature rupture of membranes.
Bovine brucellosis is caused primarily by Brucella abortus and occasionally by B. melitensis or B. suis. It is a widespread global disease characterized by abortion, retained placenta, and orchitis/epididymitis in cattle. Diagnosis involves isolating Brucella from aborted fetal tissues or secretions. The disease poses a serious risk to human health and appropriate safety precautions must be followed when handling infected materials. Vaccines used for prevention must meet standards for safety and efficacy.
This document discusses fungal vulvovaginal infections, including candidiasis (yeast infection). It covers the vaginal environment and factors that can lead to infection. Candida albicans is noted as the most common cause of vulvovaginal candidiasis (VVC). Symptoms, diagnosis, classification as uncomplicated or complicated VVC, and treatment recommendations including topical and oral antifungal agents are summarized. Recurrent and severe VVC require longer treatment courses and consideration of maintenance therapy.
This document discusses antibiotics, including their definitions, mechanisms of action, contraindications, drug interactions, and a study on antibiotic dispensing in Egyptian community pharmacies. The study aimed to describe antibiotic use patterns in Egypt. It found that the majority of antibiotics were dispensed without being checked by a pharmacist. Common reasons for dispensing included respiratory and urinary tract infections. Penicillins and cephalosporins were most commonly dispensed both with and without prescriptions. The high use and misuse of antibiotics in Egypt risks increasing antibiotic resistance.
Current evidence for management of Refractory Endometrium Aboubakr Elnashar
This document discusses current evidence and management approaches for refractory endometrium. It defines refractory endometrium as an endometrial thickness unable to reach the threshold for embryo implantation. It reviews prevalence, assessment methods including ultrasound measurements of endometrial thickness and pattern, and potential causes such as inflammation, iatrogenic factors, and congenital anomalies. Treatment approaches discussed include hysteroscopic procedures, hormonal manipulation with estrogen and HCG, improving endometrial perfusion with medications, and new modalities, but it concludes that evidence is limited for any specific validated treatment.
This document discusses antibiotic prophylaxis and treatment for infections during pregnancy and childbirth. It recommends antibiotics like cefazolin before and antibiotics like nitrofurantoin or cephalexil after Caesarean sections to prevent infections. It also recommends treating all urinary tract infections during pregnancy as they can cause pyelonephritis or preterm delivery. Common antibiotics recommended for treating UTIs during pregnancy include amoxicillin, cefadroxil, and cephalexin. The duration of treatment depends on whether it is an asymptomatic infection, acute cystitis, or pyelonephritis.
Cephalosporins are a class of β-lactam antibiotics originally derived from the fungus Acremonium. They are divided into generations based on their spectrum of activity. First generation cephalosporins such as cephazolin are effective against gram-positive and gram-negative bacteria. Second generation cephalosporins like cefuroxime have increased activity against Haemophilus influenzae and are used to treat respiratory tract infections. Third generation cephalosporins demonstrate better activity against gram-negative bacteria compared to prior generations and some like ceftriaxone have activity against Neisseria meningitidis making them useful for treating bacterial meningitis. Fourth generation cephalospor
β-lactam antibiotics like cephalosporins contain a β-lactam ring that allows them to inactivate bacterial cell wall enzymes and inhibit cell wall synthesis. Cephalosporins are classified into generations based on their antimicrobial spectrum, with later generations having greater gram-negative coverage. First-generation cephalosporins are alternatives to penicillin for skin infections while third-generation cephalosporins have activity against pneumonia-causing S. pneumoniae and are also effective against many gram-negative bacteria.
The document discusses several methods for diagnosing bacterial vaginosis:
1. pH of discharge - an elevated pH supports but does not confirm the diagnosis. A low pH rules it out.
2. The whiff test detects a fishy odor when potassium hydroxide is added, which is highly specific.
3. A wet film exam looks for clue cells which is the most sensitive single test but requires an experienced interpreter.
4. A Gram stain examines the bacteria present and can use scoring systems to determine diagnosis. It is highly sensitive and specific.
Cephalosporins are a class of beta-lactam antibiotics that are bactericidal and inhibit cell wall synthesis. They are classified into four generations based on their spectrum of activity and resistance to beta-lactamases. First generation cephalosporins are narrow spectrum and sensitive to beta-lactamases. Second generation have intermediate spectrum and sensitivity. Third generation are broad spectrum and highly resistant. Fourth generation are also broad spectrum and highly resistant. Cephalosporins vary in their ability to cross the blood brain barrier and are excreted primarily through renal or biliary pathways. They are used to treat a variety of bacterial infections.
This document provides an overview of cephalosporins, a class of beta-lactam antibiotics. It describes their classification into four generations based on their spectrum of activity and other properties. Key points include: Cephalosporins are derived from the fungus Cephalosporium and are bactericidal by inhibiting bacterial cell wall synthesis. Their classification is based on their spectrum of activity, with later generations having increased activity against gram-negative bacteria. Common examples from each generation like cefazolin, cefuroxime, cefotaxime, and cefepime are described along with their indications, dosages, and adverse effects.
1. Medical abortion methods include mifepristone with misoprostol up to 56 days gestation, or misoprostol alone up to 12 weeks gestation.
2. Surgical abortion methods include menstrual regulation up to 14 days after a missed period, vacuum aspiration up to 12 weeks, and dilation and evacuation or curettage up to 10 weeks.
3. Later term abortions between 13-15 weeks may use cervical preparation with mifepristone or misoprostol before dilation and evacuation, and between 16-20 weeks involve intrauterine installation of hypertonic saline.
This document discusses cephalosporins, a class of beta-lactam antibiotics similar to penicillins. It covers the classifications of first, second, third, and fourth generation cephalosporins and describes their mechanisms of action, spectra of activity, pharmacokinetics, uses, and adverse effects. The key points are:
- Cephalosporins act by inhibiting cell wall synthesis and are bactericidal. They are ineffective against certain bacteria like MRSA.
- Classifications are based on spectra of activity, with later generations having broader spectra. Uses include respiratory, skin, urinary infections and surgical prophylaxis.
- They are excreted renally and have varying protein binding
This document provides an overview of recurrent miscarriage, including its definition, causes, evaluation, and treatment. It discusses possible causes like anatomic, endocrine, infectious, and genetic factors. Evaluation involves assessing history, physical exam, pelvic ultrasound, thyroid function, infections, antiphospholipid antibodies, and thrombophilias. Treatment targets identified causes and includes surgical correction of anomalies, treating hypothyroidism, infections like brucellosis, antiphospholipid syndrome with aspirin and heparin, inherited thrombophilias with heparin, and genetic counseling. Progesterone, lifestyle modifications, and hCG have uncertain benefits for unexplained recurrent miscarriage.
This document summarizes the 2015 CDC treatment guidelines for common sexually transmitted diseases. It lists the recommended medications, dosages, and alternative treatments for diseases including bacterial vaginosis, chlamydia, gonorrhea, herpes, trichomoniasis, and others. For each disease, the recommended first-line treatment is provided, as well as alternative options if the first treatment fails or cannot be tolerated. Guidance is given for treating both adults and special populations like pregnant women, infants, and children.
Gynecology genital disease and treatment Dr. Ahmadi.pdfTayebehHeidari1
This document discusses the classification, diagnosis, and treatment of various gynecological conditions including vulvovaginal candidiasis, bacterial vaginosis, trichomonas vaginitis, inflammatory vaginitis, cervicitis, pelvic inflammatory disease, genital ulcer disease, syphilis, genital warts, and human immunodeficiency virus. It provides guidelines on differential diagnosis and treatment regimens for these conditions using various topical creams, oral medications, and in some cases intravenous antibiotics or surgery.
Global Medical Cures™ | Sexually Transmitted Diseases (CDC Treatment Guidelines)Global Medical Cures™
Global Medical Cures™ | Sexually Transmitted Diseases (CDC Treatment Guidelines)
DISCLAIMER-
Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
Chlamydia is an infection with Chlamydia bacteria. it is a sexually transmitted bacterium. When an infection is present, the bacteria can be present in the cervix, urethra, vagina, and rectum of an infected person, It can also live in the throat.
this bacteria lives inside cells, Infect columnar epithelial cells that can results in the death of the cells.
I will also be explaining about prevention, treatments and medicines (for women, men, pregnant women and kids )
The document summarizes the June 2015 update to the 2010 CDC Guidelines for Treatment of Sexually Transmitted Diseases. It provides clinical guidance on recommended treatment regimens for various STDs, including bacterial vaginosis, chlamydial infections, gonococcal infections, pelvic inflammatory disease, syphilis, and trichomoniasis. The regimens are listed by disease with dosage, administration route, and alternative options. Partner management is an important component of STD treatment.
This document provides guidance on diagnosing and treating infections during pregnancy and the postpartum period. It discusses abnormal vaginal discharge, sexually transmitted infections like candidiasis, gonorrhea, chlamydia and trichomoniasis. It also addresses genital warts, ulcers, syphilis, urinary tract infections, acute pyelonephritis, and malaria. For each condition, it describes signs and symptoms, recommended testing, and treatment guidelines. It emphasizes treating sexually transmitted infections syndromically and the importance of notifying partners for examination and treatment.
A B C of URINARY TRACT INFECTION, Dr. Sharda Jain Lifecare Centre Lifecare Centre
Urinary Tract Infection
Overview
Understanding Urinary Tract Infection
How Big is theProblem
What is UTI
Why UTI is more Common in Woman
Pathogenesis
Classification
Risk Factors
Causative Organisms
Clinical Manifestation
Diagnosis
SINGLE DOSE treatment of URINARY TRACT INFECTION in women, Dr Sharda jain , ...Lifecare Centre
SINGLE DOSE treatment of URINARY TRACT INFECTION in women
Urinary Tract Infection (UTI)
UTI is the 2nd most common infectious presentation in community practices
The document provides information on various clinical diseases seen at Qods Polyclinic including vaginitis, herpes, HPV, granuloma inguinale, chancroid, condyloma acuminata, chlamydia, gonorrhea, lymphogranuloma venereum, and their treatments. It discusses symptoms, stages of lesions, diagnostic methods like gram stain, and recommended medications for each condition such as acyclovir, azithromycin, doxycycline, and ceftriaxone. Imaging findings and management options for ovarian cysts are also summarized. The document concludes with an overview of overactive bladder and its psychological effects.
Ciprofloxacin 500mg film coated tablets smpc- taj pharmaceuticalsTaj Pharma
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This document discusses pre-labour rupture of membranes (PROM), specifically defining it as rupture of membranes before the onset of labour. It describes the typical incidence rates of term and preterm PROM. The document then outlines the clinical diagnosis and assessment process, including examination findings and additional tests that can be used. Expectant and active management strategies are described for term and preterm PROM cases. Complications associated with PROM are also summarized.
Brucellosis is an enzootic infection (i.e. endemic in animal) caused by Gram-negative bacilli.
Infected animals may excrete Brucella spp, in their milk for prolonged periods and human infection is acquired by ingesting contaminated dairy products (especially unpasteurised milk), uncooked meat or offal.
Animal urine, faeces, vaginal discharge and uterine products may transmit infection through abraded skin or via splashes and aerosols to the respiratory tract and conjunctiva.
Brucellosis is an enzootic infection (i.e. endemic in animal) caused by Gram-negative bacilli.
Infected animals may excrete Brucella spp, in their milk for prolonged periods and human infection is acquired by ingesting contaminated dairy products (especially unpasteurised milk), uncooked meat or offal.
Animal urine, faeces, vaginal discharge and uterine products may transmit infection through abraded skin or via splashes and aerosols to the respiratory tract and conjunctiva.
Brucellosis is an enzootic infection (i.e. endemic in animal) caused by Gram-negative bacilli.
Infected animals may excrete Brucella spp, in their milk for prolonged periods and human infection is acquired by ingesting contaminated dairy products (especially unpasteurised milk), uncooked meat or offal.
Animal urine, faeces, vaginal discharge and uterine products may transmit infection through abraded skin or via splashes and aerosols to the respiratory tract and conjunctiva.
Brucellosis is an enzootic infection (i.e. endemic in animal) caused by Gram-negative bacilli.
Infected animals may excrete Brucella spp, in their milk for prolonged periods and human infection is acquired by ingesting contaminated dairy products (especially unpasteurised milk), uncooked meat or offal.
Animal urine, faeces, vaginal discharge and uterine products may transmit infection through abraded skin or via splashes and aerosols to the respiratory tract and conjunctiva.
Brucellosis is an enzootic infection (i.e. endemic in animal) caused by Gram-negative bacilli.
Infected animals may excrete Brucella spp, in their milk for prolonged periods and human infection is acquired by ingesting contaminated dairy products (especially unpasteurised milk), uncooked meat or offal.
Animal urine, faeces, vaginal discharge and uterine products may transmit infection through abraded skin or via splashes and aerosols to the respiratory tract and conjunctiva.
This case study describes a 21-year-old male patient presenting with fever, chills, vomiting, and epigastric pain for several days. Laboratory tests found malaria parasites and anemia. The patient was diagnosed with malaria and prescribed Ceftriaxone, Artemether/Lumefantrine, Omeprazole, Metoclopramide, Acetaminophen, and Vitamin B Complex to treat the infection, symptoms, and anemia. Malaria is caused by Plasmodium parasites transmitted by mosquitoes and has both benign and malignant forms treatable with drugs like chloroquine, quinine, and artemisinin combinations.
HIV AND OPPORTUNISTIC INFECTIONS IN HIV.pptxdrsriram2001
Definition
Opportunistic infections (Ols) are infections that occur more often or are more severe in people with weakened immune systems (people living with HIV) than in people with healthy immune systems.
This document provides information on acyclovir, an antiviral medication. It discusses acyclovir's class and structure, pharmacokinetics, mechanism of action in inhibiting viral DNA synthesis, uses for treating herpes viruses and varicella zoster virus, dosage recommendations for adults and pediatrics with considerations for renal impairment and immunocompromised patients, common side effects involving gastrointestinal, renal and nervous systems, and major drug interactions to avoid combining acyclovir with cidofovir, sirolimus, tacrolimus or tizanidine due to risk of kidney damage.
This document provides an overview of urinary tract infections (UTIs) in children from a surgeon's perspective. Some key points:
- UTIs are common in infants and children, especially girls under 5 years old. Boys are more commonly affected in the first year of life.
- Evaluation of a child with UTI includes a physical exam, urine culture, and consideration of imaging like ultrasound based on factors like age, symptoms, recurrence.
- Common causes of UTIs include anatomical abnormalities like vesicoureteral reflux, posterior urethral valves, or ureteroceles.
- Treatment involves antibiotics tailored to culture results. Children with recurrent UTIs or anatomical issues may
This document discusses pelvic inflammatory disease (PID), including risk factors, pathogenesis, clinical manifestations, diagnosis, treatment, prevention, and sequelae. Some key points:
- PID is commonly caused by bacteria like Neisseria gonorrhoeae and Chlamydia trachomatis. It occurs via an ascending infection from the cervix to the endometrium, fallopian tubes, and ovaries.
- Symptoms range from mild to severe, including uterine or adnexal tenderness. Diagnosis involves minimum criteria of uterine or adnexal tenderness plus additional criteria like abnormal discharge or positive STI tests.
- Treatment involves antibiotics to cover common causative agents. Oral
This document discusses vaginal discharge and its causes. It describes two main types of vaginal discharge: physiological discharge which results from normal hormonal changes, and pathological discharge which can be caused by infections like bacterial vaginosis, candidiasis, trichomoniasis, gonorrhea, and chlamydia. It provides details on the signs, symptoms, diagnosis, and treatment of these infections. It also discusses proper techniques for obtaining vaginal swabs for testing and the importance of screening and treatment for preventing complications.
The World Health Organization (WHO) defined «healthy ageing»
as the process of developing and maintaining the functional ability
that enables wellbeing in older age.
Functional ability is referred to as the ability to:
- meet their basic needs,
- learn, grow and make decisions,
- be mobile,
- build and maintain relationships, and
- contribute to society
WHO describes this functional ability as being formed by interactions between intrinsic capacity and environmental characteristics.
The intrinsic capacity includes the mental and physical capacities of a person.
The environmental characteristics are related to home, community and society as a whole.
Management of menopausal symptoms for breast cancer survivorsTevfik Yoldemir
This document summarizes management strategies for menopausal symptoms in breast cancer survivors. It discusses pharmacological options like clonidine, oxybutynin, antidepressants, black cohosh, and phytoestrogens. It also covers mind-body practices like cognitive behavioral therapy and hypnosis. Non-hormonal treatments for vulvo-vaginal symptoms are discussed, as well as short-term low-dose local estrogen therapy. Management of menopausal symptoms requires a personalized approach balancing symptom relief with safety.
The document discusses several studies related to endometriosis and IVF outcomes. It provides summaries of studies that examined:
- Live birth rates, clinical pregnancy rates, number of oocytes retrieved, and miscarriage rates for patients with endometriosis undergoing IVF compared to controls.
- IVF outcomes based on the severity of endometriosis compared to controls.
- Outcomes of fresh versus frozen embryo transfers.
- The risk of embryonic aneuploidy in patients with endometriosis.
- Treatment guidelines from ESHRE on the use of IVF and surgery for infertility associated with endometriosis.
Pelvic anatomy in relation with pelvic organ prolapseTevfik Yoldemir
The document discusses pelvic organ prolapse from an anatomical perspective. It describes the layers of fascia and muscles that provide support to the pelvic organs. Damage to the fascia can result in cystocele, rectocele, or uterine prolapse as the pelvic organs lose support and protrude into the vaginal canal. The document outlines the components of the pelvic floor according to the Integral Theory and how dysfunction, such as stress urinary incontinence, can result from weakness or damage in specific areas. Assessment tools like the Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire are also mentioned for evaluating patients.
Certain viruses can be transmitted from mother to fetus during pregnancy and cause fetal or neonatal damage. These include cytomegalovirus, rubella virus, varicella zoster virus, herpes simplex virus, and parvovirus B19. Cytomegalovirus is the most common cause, with an estimated 1% of newborns infected worldwide. Severe damage from cytomegalovirus, such as cytomegalic inclusion disease, occurs in about 1 in 5,000 to 1 in 20,000 births. Transmission is more likely when a mother has a primary infection compared to a recurrent infection. Clinical manifestations in the newborn are also more common following primary maternal infection.
This document discusses different types of energy modalities used in surgery including monopolar, bipolar, ultrasonic, and plasma kinetic technologies. Monopolar energy uses an active electrode at the surgical site and a return electrode elsewhere on the patient's body, allowing for tissue cutting, coagulation, and desiccation. Bipolar energy passes between two close electrodes, minimizing collateral damage. Advanced bipolar technologies like Ligasure, Plasma Kinetic Gyrus, and Enseal can additionally seal and transect tissue. Ultrasonic devices use high frequency vibrations to denature proteins for coagulation and mechanical cutting. The effects of different energies on tissue are described, noting temperatures at which protein denaturation and
This document discusses techniques for diagnosing endometriosis, including magnetic resonance imaging (MRI) and transvaginal ultrasound (TVS). It provides details on MRI protocols, including patient preparation, positioning, and rectal opacification. It also outlines four basic steps for a TVS exam when evaluating for deep infiltrating endometriosis: 1) evaluating the uterus and adnexa; 2) assessing for soft markers like tenderness and ovarian mobility; 3) using the "sliding sign" to assess the pouch of Douglas; and 4) searching for endometriosis nodules. The document also discusses agreement between observers for diagnosing deep infiltrating endometriosis using TVS in different pelvic
This document summarizes research on the effects of alternative hormonal treatments, including bazedoxifene, on various tissues in humans. It discusses preclinical and clinical data on the effects of ospemifene, tamoxifen, raloxifene, and bazedoxifene on the endometrium, vagina, breast, and bone. It then summarizes results from several clinical trials, known as the SMART trials, that evaluated the efficacy and safety of a combination of conjugated estrogens and bazedoxifene for vasomotor symptoms, quality of life, vaginal health, and bone mineral density and fracture risk reduction.
1. The document discusses premature ovarian insufficiency (POI), including delays in diagnosis contributing to low bone density. For every month of delayed diagnosis, spine bone mineral density decreases by 0.026.
2. POI can manifest as delayed puberty, primary or secondary amenorrhea, or irregular periods. Genetic factors are responsible for some cases, with mutations in meiotic and DNA repair genes linked to syndromic and non-syndromic POI.
3. Treatment of POI involves hormone replacement therapy to mimic normal estrogen and progesterone levels. Estrogen therapy should begin at age 12-13 and be gradually increased over 2-3 years. Progestogen is later added for endometrial protection
This document discusses menopause and osteoporosis, including clinical risk factors for osteoporosis, indications for bone mineral density testing, hip fractures and biochemical markers of bone turnover. It also addresses calcium content of food, pharmacologic agents for osteoporosis, changes in lumbar spine and total hip bone mineral density, vertebral and non-vertebral fractures, and risks and benefits of hormone replacement therapy, including its effects on cardiovascular disease, cancer risks, and risks of breast and endometrial cancer. Contact information is provided for further questions.
This document discusses tests that should be performed before various forms of contraception including IUD insertion, implant insertion, DMPA initiation, OCP use, and POP initiation. It also mentions that follow-up is important and that PID can sometimes be found in IUD users. The document is authored by Tevfik Yoldemir MD BSc MA and provides his contact information and links to additional information on contraception.
This document contains a summary of topics related to early pregnancy complications and abortion. It lists bleeding in early pregnancy, ectopic pregnancy, risk factors and algorithms for diagnosis, methotrexate protocol, molar pregnancy symptoms and management, and habitual abortion as sections within the document. Contact information is provided for Dr. Tevfik Yoldemir as the author along with links to additional resources on these medical topics.
This document discusses menstrual cycle disorders and their causes and treatment. It defines menorrhagia as heavy menses in ovulatory women, and metrorrhagia as irregular bleeding during an ovulatory cycle. Common causes of abnormal uterine bleeding (AUB) include uterine fibroids, endometrial polyps, and adenomyosis. Evaluation of AUB may involve a saline-infused sonogram. Medical treatments aim to regulate hormone levels and bleeding patterns through contraceptives and cyclic progestin-only regimens.
This document discusses chronic pelvic pain and associated disorders. It covers chronic pelvic pain disorders, different physical examination positions, diagnostic tests, endometriosis, and provides contact information for questions. The document appears to be notes from a presentation or article on evaluating and diagnosing chronic pelvic pain and conditions that may cause it such as endometriosis.
This document summarizes research on endometriosis beyond late reproductive age. It discusses findings that endometriosis persists and can recur even after menopause. Studies show endometriosis symptoms continue across all age groups and surgical recurrence rates remain high. Hormone replacement therapy after menopause may increase risk of endometriosis recurrence and malignant transformation. Emerging treatments for endometriosis that are discussed include GnRH antagonists, aromatase inhibitors, and other drug classes targeting factors like angiogenesis and inflammation.
This document summarizes several studies on the impact of fibroids on fertility and in vitro fertilization (IVF) outcomes. It discusses factors like sample size calculations, reliability and validity of research data, and potential confounding factors in sham surgery trials. It then summarizes multiple studies that found no significant impact or decreased live birth rates with intramural fibroids not distorting the uterine cavity compared to controls without fibroids undergoing IVF. The document provides an expert review of the evidence on fibroids and fertility.
1. The document discusses fertility options for women over age 40, what is realistic and not realistic. It provides data from studies on pregnancy rates by age and discusses strategies like tailored stimulation protocols, embryo selection techniques, and oocyte accumulation.
2. Case studies are presented of women over 40 concerned about their fertility. The document recommends counseling based on AMH, AFC, prior response and discussing tailored protocols, cumulative success rates, and alternative options.
3. Strategies discussed include minimal or double stimulation protocols, embryo banking, oocyte donation, and new selection techniques, but individualized assessment is important due to variability.
- Maternal nutrition and environmental exposures during pregnancy can impact the fetal epigenome through DNA methylation, histone modifications, and microRNAs. This can increase the risk of health issues like metabolic syndrome later in life.
- Certain phytochemicals from foods like epigallocatechin gallate, resveratrol, genistein, and curcumin may beneficially influence the fetal epigenome by regulating enzymes involved in epigenetic modifications.
- Adequate intake of nutrients like vitamins, minerals, and phytochemicals during pregnancy and lactation may help protect the offspring by modulating the fetal epigenome.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
1. 20.06.2018
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Sexually transmitted diseases
Tevfik Yoldemir MD BSc MA
www.yoldemir.com
Chancroid
• The combination of a painful genital ulcer and tender
suppurative inguinal adenopathy suggests the diagnosis of
chancroid
1) the patient has one or more painful genital ulcers;
2) the clinical presentation, appearance of genital ulcers and, if
present, regional lymphadenopathy are typical for chancroid;
3) the patient has no evidence of T. pallidum infection by
darkfield examination of ulcer exudate or by a serologic test for
syphilis performed at least 7 days after onset of ulcers; and
4) an HSV PCR test or HSV culture performed on the ulcer
exudate is negative
Chancroid
Recommended Regimens
Azithromycin 1 g orally in a single dose
OR
Ceftriaxone 250 mg IM in a single dose
OR
Ciprofloxacin 500 mg orally twice a day for 3 days
OR
Erythromycin base 500 mg orally three times a day for 7 days
Herpes
• Painful multiple vesicular or ulcerative lesions typically associated
with HSV are absent in many infected persons.
• Cell culture and PCR are the preferred HSV tests for persons who
seek medical treatment for genital ulcers or other mucocutaneous
lesions.
Recommended Regimens
Acyclovir 400 mg orally three times a day for 7–10 days
OR
Acyclovir 200 mg orally five times a day for 7–10 days
OR
Valacyclovir 1 g orally twice a day for 7–10 days
OR
Famciclovir 250 mg orally three times a day for 7–10 days
Suppressivetherapyfor recurrentgenital
herpes
Recommended Regimens
Acyclovir 400 mg orally twice a day
OR
Valacyclovir 500 mg orally once a day*
OR
Valacyclovir 1 g orally once a day
OR
Famiciclovir 250 mg orally twice a day
Episodictherapyforrecurrentgenital herpes
Recommended Regimens
Acyclovir 400 mg orally three times a day for 5 days
OR
Acyclovir 800 mg orally twice a day for 5 days
OR
Acyclovir 800 mg orally three times a day for 2 days
OR
Valacyclovir 500 mg orally twice a day for 3 days
OR
Valacyclovir 1 g orally once a day for 5 days
OR
Famciclovir 125 mg orally twice daily for 5 days
OR
Famciclovir 1 gram orally twice daily for 1 day
OR
Famciclovir 500 mg once, followed by 250 mg twice daily for 2 days
2. 20.06.2018
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Suppressivetherapyof a pregnantwomen
Recommended regimenfor suppressive therapy of pregnant
women with recurrent genital herpes *
Acyclovir 400 mg orally three times a day
OR
Valacyclovir 500 mg orally twice a day
* Treatment recommended starting at 36 weeks of gestation
GranulomaInguinale(Donovanosis)
• Painless, slowly progressive ulcerative lesions on the genitals or
perineum without regional lymphadenopathy; subcutaneous
granulomas (pseudobuboes) also might occur.
• The lesions are highly vascular (i.e., beefy red appearance) and
bleed.
• Extragenitalinfection can occur with extension of infection to
the pelvis, or it can disseminate to intra-abdominal organs,
bones, or the mouth.
• The lesions also can develop secondary bacterial infection and
can coexist with other sexually transmitted pathogens.
• Diagnosis requires visualization of dark-staining Donovan
bodies on tissue crush preparation or biopsy.
RecommendedRegimen
Azithromycin 1 g orally once per week or 500 mg daily for at least 3
weeks and until all lesions have completely healed
Alternative Regimens
Doxycycline 100 mg orally twice a day for at least 3 weeks and until all
lesions have completely healed
OR
Ciprofloxacin 750 mg orally twice a day for at least 3 weeks and until all
lesions have completely healed
OR
Erythromycin base 500 mg orally four times a day for at least 3 weeks
and until all lesions have completely healed
OR
Trimethoprim-sulfamethoxazole one double-strength (160 mg/800 mg)
tablet orally twice a day for at least 3 weeks and until all lesions have
completely healed
LymphogranulomaVenereum
• tender inguinal and/or femoral lymphadenopathy that is
typicallyunilateral.
• A self-limited genital ulcer or papule sometimes occurs at the
site of inculation.
• Genital lesions, rectal specimens, and lymph node specimens
(i.e., lesion swab or bubo aspirate) can be tested for C.
trachomatis by culture, direct immunofluorescence, or nucleic
acid detection
• Chlamydia serology (complement fixation titers ≥1:64 or
microimmunofluorescencetiters >1:256) might support the
diagnosis of LGV
Recommended Regimen
Doxycycline 100 mg orally twice a day for 21 days
Alternative Regimen
Erythromycin base 500 mg orally four times a day for 21 days
Syphilis
• Persons who have syphilis might seek treatment for signs or
symptoms of primary syphilis infection (i.e., ulcers or chancre
at the infection site),
• secondary syphilis (i.e., manifestations that include, but are not
limited to, skin rash, mucocutaneous lesions, and
lymphadenopathy), or
• tertiary syphilis (i.e., cardiac, gummatous lesions, tabes
dorsalis, and general paresis).
• Darkfield examinations and tests to detect T. pallidum directly
from lesion exudate or tissue are the definitive methods for
diagnosing early syphilis.
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Recommended Regimen for Adults*
Benzathine penicillin G 2.4 million units IM in a single dose
Recommended Regimens for Adults*
Early Latent Syphilis
Benzathine penicillin G 2.4 million units IM in a single dose
Late Latent Syphilis or Latent Syphilis of Unknown Duration
Benzathine penicillin G 7.2 million units total, administered as 3
doses of 2.4 million units IM each at 1-week intervals
Recommended Regimen for Infants and Children
Benzathine penicillin G 50,000 units/kg IM, up to the adult dose of
2.4 million units in a single dose
Recommended Regimens for Infants and Children
Early Latent Syphilis
Benzathine penicillin G 50,000 units/kg IM, up to the adult dose of
2.4 million units in a single dose
Late Latent Syphilis
Benzathine penicillin G 50,000 units/kg IM, up to the adult dose of
2.4 million units, administered as 3 doses at 1-week intervals (total
150,000 units/kg up to the adult total dose of 7.2 million units)
ChlamydialInfections
• C. trachomatis urogenital infection can be diagnosed in women
by testing first-catch urine or collecting swab specimens from
the endocervix or vagina.
• Diagnosis of C. trachomatis urethral infection in men can be
made by testing a urethral swab or first-catch urine specimen.
Recommended Regimens
Azithromycin 1 g orally in a single dose
OR
Doxycycline 100 mg orally twice a day for 7 days
Alternative Regimens
Erythromycin base 500 mg orally four times a day for 7 days
OR
Erythromycin ethylsuccinate 800 mg orally four times a day for
7 days
OR
Levofloxacin 500 mg orally once daily for 7 days
OR
Ofloxacin 300 mg orally twice a day for 7 days
Pregnancy
Recommended Regimens
Azithromycin 1 g orally in a single dose
Alternative Regimens
Amoxicillin 500 mg orally three times a day for 7 days
OR
Erythromycin base 500 mg orally four times a day for 7 days
OR
Erythromycin base 250 mg orally four times a day for 14 days
OR
Erythromycin ethylsuccinate 800 mg orally four times a day for 7 days
OR
Erythromycin ethylsuccinate 400 mg orally four times a day for 14 days
GonococcalInfections
• Culture and NAAT are available for the detection of
genitourinary infection with N. gonorrhoeae (394); culture
requires endocervical (women) or urethral (men) swab
specimens
• Detection of infection using Gram stain of endocervical,
pharyngeal, and rectal specimens also is insufficient and is not
recommended. MB/GV stain of urethral secretions is an
alternative point-of-care diagnostic test with performance
characteristics similar to Gram stain.
• Presumed gonococcal infection is established by documenting
the presence of WBC containing intracellular purple diplococci
in MB/GV smears.
4. 20.06.2018
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Recommended Regimen
Ceftriaxone 250 mg IM in a single dose
PLUS
Azithromycin 1g orally in a single dose
Alternative Regimens
If ceftriaxone is not available:
Cefixime 400 mg orally in a single dose
PLUS
Azithromycin 1 g orally in a single dose
BacterialVaginosis
• anaerobic bacteria (e.g., Prevotella sp. and Mobiluncus sp.), G.
vaginalis, Ureaplasma, Mycoplasma, and numerous fastidious
or uncultivated anaerobes.
• Gram stain (considered the gold standard laboratory method
for diagnosing BV) is used to determine the relative
concentration of lactobacilli (i.e., long Gram-positive rods),
Gram-negative and Gram-variable rods and cocci (i.e., G.
vaginalis, Prevotella, Porphyromonas, and peptostreptococci),
and curved Gram-negative rods (i.e., Mobiluncus) characteristic
of BV.
Clinical criteria require three of the following symptoms or signs:
• homogeneous, thin, white discharge that smoothly coats the
vaginal walls;
• clue cells (e.g., vaginal epithelial cells studded with adherent
coccoobacilli) on microscopic examination;
• pH of vaginal fluid >4.5; or
• a fishy odor of vaginal discharge before or after addition of 10%
KOH (i.e., the whiff test).
RecommendedRegimens
Metronidazole 500 mg orally twice a day for 7 days
OR
Metronidazole gel 0.75%, one full applicator (5 g) intravaginally, once a day
for 5 days
OR
Clindamycin cream 2%, one full applicator (5 g) intravaginally at bedtime for
7 days
Alternative Regimens
Tinidazole 2 g orally once daily for 2 days
OR
Tinidazole 1 g orally once daily for 5 days
OR
Clindamycin 300 mg orally twice daily for 7 days
OR
Clindamycin ovules 100 mg intravaginally once at bedtime for 3 days*
Trichomoniasis
Recommended Regimen
Metronidazole 2 g orally in a single dose
OR
Tinidazole 2 g orally in a single dose
Alternative Regimen
Metronidazole 500 mg orally twice a day for 7 days
VulvovaginalCandidiasis
• Use of 10% KOH in wet preparations improves the visualization
of yeast and mycelia by disrupting cellular material that might
obscure the yeast or pseudohyphae.
• Examination of a wet mount with KOH preparation should be
performed for all women with symptoms or signs of VVC
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VulvovaginalCandidiasis
Recommended Regimens
Over-the-Counter Intravaginal Agents:
Clotrimazole 1% cream 5 g intravaginally daily for 7–14 days
OR
Clotrimazole 2% cream 5 g intravaginally daily for 3 days
OR
Miconazole 2% cream 5 g intravaginally daily for 7 days
OR
Miconazole 4% cream 5 g intravaginally daily for 3 days
OR
Miconazole 100 mg vaginal suppository, one suppository daily for 7 da
OR
Miconazole 200 mg vaginal suppository, one suppository for 3 days
OR
Miconazole 1,200 mg vaginal suppository, one suppository for 1 day
OR
Tioconazole 6.5% ointment 5 g intravaginally in a single application
• Prescription Intravaginal Agents:
• Butoconazole 2% cream (single dose bioadhesive product), 5 g
intravaginally in a single application
• OR
• Terconazole 0.4% cream 5 g intravaginally daily for 7 days
• OR
• Terconazole 0.8% cream 5 g intravaginally daily for 3 days
• OR
• Terconazole 80 mg vaginal suppository, one suppository daily for 3
days
• Oral Agent:
• Fluconazole 150 mg orally in a single dose
Pelvic InflammatoryDisease
If one or more of the following minimum clinical criteria are present on
pelvic examination:
• cervical motion tenderness or uterine tenderness or adnexal
tenderness.
One or more of the following additional criteria can be used to
enhance the specificity of the minimum clinical criteria and support a
diagnosis of PID:
• oral temperature >101°F (>38.3°C);
• abnormal cervical mucopurulent discharge or cervical friability;
• presence of abundant numbers of WBC on saline microscopy of
vaginal fluid;
• elevated erythrocyte sedimentation rate;
• elevated C-reactive protein; and
• laboratory documentation of cervical infection with N. gonorrhoeae
or C. trachomatis.
DifferentialDiagnosisfor PID
• Endometriosis
• Appendicitis & other gastro conditions
• Appendicitis is unilateral and right sided
• PID is bilateral
• Ectopic pregnancy
• Always do a pregnancy test
• Urinary tract infection or stone
• “Ovarian cysts”
• Lower genital tract infection
PID Sequelae
• Chronic Pelvic Pain (15-20 %)
• Ectopic pregnancy (6-10 fold ↑Risk)
• At least 50% of tubal pregnancies have histology
of PID
• Infertility (Tubal)
• 10 – 15% after one episode
• 20% ~ 2 episode
• >40% ~ 3 episodes
• Recurrence of acute PID at least 25%
• Male genital disease in 25%
6. 20.06.2018
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RecommendedParenteralRegimens
Cefotetan 2 g IV every 12 hours
PLUS
Doxycycline 100 mg orally or IV every 12 hours
OR
Cefoxitin 2 g IV every 6 hours
PLUS
Doxycycline 100 mg orally or IV every 12 hours
OR
Clindamycin 900 mg IV every 8 hours
PLUS
Gentamicin loading dose IV or IM (2 mg/kg), followed by a
maintenance dose (1.5 mg/kg) every 8 hours. Single daily dosing
(3–5 mg/kg) can be substituted.
AlternativeParenteralRegimen
Ampicillin/Sulbactam 3 g IV every 6 hours
PLUS
Doxycycline 100 mg orally or IV every 12 hours
RecommendedIntramuscular/OralRegimens
Ceftriaxone 250 mg IM in a single dose
PLUS
Doxycycline 100 mg orally twice a day for 14 days
WITH* or WITHOUT
Metronidazole 500 mg orally twice a day for 14 days
OR
Cefoxitin 2 g IM in a single dose and Probenecid, 1 g orally administered
concurrently in a single dose
PLUS
Doxycycline 100 mg orally twice a day for 14 days
WITH or WITHOUT
Metronidazole 500 mg orally twice a day for 14 days
OR
Other parenteral third-generation cephalosporin (e.g., ceftizoxime or cefotaxime)
PLUS
Doxycycline 100 mg orally twice a day for 14 days
WITH* or WITHOUT
Metronidazole 500 mg orally twice a day for 14 days
RecommendedRegimensfor External
AnogenitalWarts
(i.e., penis, groin, scrotum, vulva, perineum, external anus, and perianus*)
Patient-Applied:
Imiquimod 3.75% or 5% cream†
OR
Podofilox 0.5% solution or gel
OR
Sinecatechins 15% ointment†
Provider–Administered:
Cryotherapy with liquid nitrogen or cryoprobe
OR
Surgical removal either by tangential scissor excision, tangential shave
excision, curettage, laser, or electrosurgery
OR
Trichloroacetic acid (TCA) or bichloroacetic acid (BCA) 80%–90% solution
RecommendedRegimensfor Vaginal Warts
Cryotherapy with liquid nitrogen. The use of a cryoprobe in the
vagina is not recommended because of the risk for vaginal
perforation and fistula formation.
OR
Surgical removal
OR
TCA or BCA 80%–90% solution
RecommendedRegimensfor CervicalWarts
Cryotherapy with liquid nitrogen
OR
Surgical removal
OR
TCA or BCA 80%–90% solution
Management of cervical warts should include consultation with a
specialist.
For women who have exophytic cervical warts, a biopsy
evaluation to exclude high-grade SIL must be performed before
treatment is initiated