STDs can be transmitted during pregnancy and pose risks. Common STDs include chlamydia, gonorrhea, herpes, HPV, and syphilis. It is important to test for STDs during pregnancy, counsel partners, and treat both mother and partners to prevent complications like preterm birth, stillbirth, congenital infections, and infertility. Proper use of condoms and abstaining from sex during outbreaks can help prevent transmission.
Sexually transmitted disease in pregnancyDR MUKESH SAH
An STI during pregnancy can pose serious health risks for you and your baby. As a result, screening for STIs , such as human immunodeficiency virus (HIV), hepatitis B, chlamydia and syphilis, generally takes place at the first prenatal visit for all pregnant women.
Sexually transmitted disease in pregnancyDR MUKESH SAH
An STI during pregnancy can pose serious health risks for you and your baby. As a result, screening for STIs , such as human immunodeficiency virus (HIV), hepatitis B, chlamydia and syphilis, generally takes place at the first prenatal visit for all pregnant women.
Cord prolapse is a frightening and life-threatening event that occurs in labor. Rapid identification and immediate appropriate response may well save the life of a neonate. Therefore, clinicians should be knowledgeable in its recognition and management.
Hydatidiform Mole (HM) is a rare mass or growth that forms inside the uterus at the beginning of a pregnancy. It is a type of gestational trophoblastic disease (GTD).
When a normal sperm cell fertilizes one of these oocytes, the resulting embryo has only one set of chromosomes. Because the embryo has no genes from the mother, the pregnancy cannot develop normally, resulting in a hydatidiform mole.
Prelabour Rupture of Membrane (PROM) by Sunil Kumar Dahasunil kumar daha
Please find the power point on Prelabour Rupture of Membrane (PROM). I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Rh Incompatibility in Pregnancy. Rh incompatibility occurs when a pregnant woman whose blood type is Rh-negative is exposed to Rh-positive blood from her fetus, leading to the mother's development of Rh antibodies
it contains a presentation on injuries that occur during baby birth
summary:
Maternal injuries following childbirth process are quite common.
VULVA
PERINEUM
RISK FACTORS FOR THIRD DEGREE PERINEL TEAR
REPAIR OF COMPLETE PERINEAL TEAR
VAGINA
CERVIX
PELVIC HEMATOMA
DIAGNOSIS OF RUPTURE UTERUS
When fetal head is delivered, but shoulders are stuck and cannot be delivered it is known as shoulder dystocia.
The anterior shoulder becomes trapped behind on the symphysis pubis, whilst the posterior shoulder may be in the hollow of the sacrum or high above the sacral promontory.
Cord prolapse is a frightening and life-threatening event that occurs in labor. Rapid identification and immediate appropriate response may well save the life of a neonate. Therefore, clinicians should be knowledgeable in its recognition and management.
Hydatidiform Mole (HM) is a rare mass or growth that forms inside the uterus at the beginning of a pregnancy. It is a type of gestational trophoblastic disease (GTD).
When a normal sperm cell fertilizes one of these oocytes, the resulting embryo has only one set of chromosomes. Because the embryo has no genes from the mother, the pregnancy cannot develop normally, resulting in a hydatidiform mole.
Prelabour Rupture of Membrane (PROM) by Sunil Kumar Dahasunil kumar daha
Please find the power point on Prelabour Rupture of Membrane (PROM). I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Rh Incompatibility in Pregnancy. Rh incompatibility occurs when a pregnant woman whose blood type is Rh-negative is exposed to Rh-positive blood from her fetus, leading to the mother's development of Rh antibodies
it contains a presentation on injuries that occur during baby birth
summary:
Maternal injuries following childbirth process are quite common.
VULVA
PERINEUM
RISK FACTORS FOR THIRD DEGREE PERINEL TEAR
REPAIR OF COMPLETE PERINEAL TEAR
VAGINA
CERVIX
PELVIC HEMATOMA
DIAGNOSIS OF RUPTURE UTERUS
When fetal head is delivered, but shoulders are stuck and cannot be delivered it is known as shoulder dystocia.
The anterior shoulder becomes trapped behind on the symphysis pubis, whilst the posterior shoulder may be in the hollow of the sacrum or high above the sacral promontory.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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3. RISK FACTORS FOR STIS
1. Multiple partners (two or more in the last year).
2. Recent partner change (in past 3mths).
3. Non-use of barrier protection.
4. STI in partner.
5. Other STI.
6. Younger age (particularly aged ≤ 25yrs).
ABOUBAKR ELNASHAR
4. HISTORY
• Symptoms:
lumps, bumps, ulcers, rash
itching, IMB or PCB
Low abdominal pain, dyspareunia
sudden/distinct change in discharge.
ABOUBAKR ELNASHAR
5. • Past history of
STIs/GUM clinic attendance/last HIV –ve test.
• All sexual partners in past 12mths.
• Risk factors for blood-borne viruses:
• patient or partner from area of high HIV prevalence
• IV drug use
ABOUBAKR ELNASHAR
6. TESTING FOR SEXUALLY TRANSMITTED
INFECTIONS—INCUBATION PERIOD
• Tests should be done at the time of presentation.
• Incubation period
before tests for STIs become positive can give
false negative after a single episode of sex.
for bacterial STIs this is 10–14 days
for HIV and syphilis it may be up to 3mths.
ABOUBAKR ELNASHAR
7. 1. GONORRHOEA
Epidemiology
• Neisseria gonorrhoeae:
intracellular Gram –ve diplococcus.
• Fourth most common STI in the UK.
• > 35% of strains are resistant to ciprofloxacin
70% to tetracyclines.
ABOUBAKR ELNASHAR
9. Symptoms
Usually asymptomatic,
often diagnosed when screening on contact tracing
Can present with
vaginal discharge,
low abdominal pain,
IMB or PCB.
ABOUBAKR ELNASHAR
11. Diagnosis
Endocervical or vulvovaginal
swab with NAAT.
Urethral, pharyngeal, and
rectal swabs if contact with
gonorrhoea.
If diagnosed on NAAT, culture
for sensitivity testing should be
taken from all sites prior to
antibiotic treatment.
ABOUBAKR ELNASHAR
12. A nucleic acid test (NAT) or nucleic acid amplification
test (NAAT)
a technique utilized to detect a particular nucleic acid, virus,
or bacteria which acts as a pathogen in blood. tissue, urine,
etc.
The NAT system differs from other tests in that it detects
genetic materials rather than antigens or antibodies.
Detection of genetic materials allows
1. an early diagnosis of a disease because the detection
of antigens requires time for antigens to appear in the
bloodstream
2. Since the amount of a certain genetic material is usually
very small, NAT includes an amplification step of the
genetic material.
There are several ways of amplification
including polymerase chain reaction (PCR), strand
displacement assay (SDA), or transcription mediated
assay (TMA).[
ABOUBAKR ELNASHAR
13. Complications of gonococcus infection
• PID (~10% of infections result in PID).
• Bartholin’s or Skene’s abscess.
• Disseminated gonorrhoea may cause:
• fever
• pustular rash
• migratory polyarthralgia
• septic arthritis.
• Tubal infertility.
• Risk of ectopic pregnancy.
ABOUBAKR ELNASHAR
14. Treatment
• Ceftriaxone
500mg IM stat, plus azithromycin 1g PO stat.
• Spectinomycin 2g IM, plus
azithromycin 1g PO stat (if severe penicillin allergy).
• Contact tracing and treatment of partners.
• The same antibiotics are recommended for treating
gonorrhoea in pregnancy.
ABOUBAKR ELNASHAR
15. Implications in pregnancy
• Gonorrhoea associated with:
• preterm rupture of membranes and premature
delivery
• chorioamnionitis.
• The risks to the baby are of ophthalmia neonatarum
(40–50%).
ABOUBAKR ELNASHAR
16. 2. SYPHILIS
Epidemiology
• Treponema pallidum —spirochaete.
• Relatively rare STI in the UK; however, a 12-fold rise
1997–2007.
• Doubling of congenital syphilis from 1999–2007.
• Nearly 3000 cases were diagnosed in 2010 in the
UK.
ABOUBAKR ELNASHAR
17. Symptoms
Primary syphilis
• 10–90 days postinfection.
• Painless, genital ulcer (chancre)—may pass
unnoticed on the cervix.
• Inguinal lymphadenopathy.
ABOUBAKR ELNASHAR
18. Secondary syphilis
• Occurs within the first 2yrs of infection.
• Generalized polymorphic rash affecting palms
and soles.
• Generalized lymphadenopathy.
• Genital condyloma lata.
• Anterior uveitis.
ABOUBAKR ELNASHAR
19. Tertiary syphilis
• P resents in up to 40% of people infected for at least
2yrs, but may take 40+yrs to develop.
• Neurosyphilis: tabes dorsalis and dementia.
• Cardiovascular syphilis: commonly affecting the
aortic root.
• Gummata: infl ammatory plaques or nodules.
ABOUBAKR ELNASHAR
20. Diagnosis
• Specific treponemal enzyme immunoassay (EIA) for
screening (IgG + IgM).
• 1 ° lesion smear may show spirochaetes on dark
field microscopy.
• Quantitative cardiolipin (non-treponemal) tests, i.e.
rapid plasma reagin (RPR)/VDRL are useful in
assessing need for and response to treatment.
ABOUBAKR ELNASHAR
21. Treatment
• Depends on penicillin allergy:
• benzathine benzylpenicillin 2.4 MU single dose IM
(used in pregnancy)
• doxycycline 100mg bd PO for 14 days
(contraindicated in pregnancy),
• erythromycin 500mg qds PO for 14 days (used in
pregnancy).
• Treatment courses are longer in tertiary syphilis.
• Contact tracing (potentially over several years).
ABOUBAKR ELNASHAR
23. 1. HERPES SIMPLEX
Epidemiology
• DNA virus—herpes simplex
type 1 (orolabial/genital) and
type 2 (genital only).
• Third most common STI in England in 2010.
ABOUBAKR ELNASHAR
24. Symptoms
Primary HSV infection
usually the most severe
often results in:
• Prodrome
(tingling/itching of skin in affected area).
• Flu-like illness +/– inguinal lymphadenopathy.
• Vulvitis and pain
(may cause urinary retention).
• Small, characteristic vesicles on the vulva
can be atypical with fissures, erosions, erythema of skin.ABOUBAKR ELNASHAR
27. Recurrent attacks
result from reactivation of latent virus in the
sacral ganglia
normally shorter and less severe.
can be triggered by:
• Stress.
• Sexual intercourse.
• Menstruation.
ABOUBAKR ELNASHAR
28. Complications of HSV infection (usually of primary
infection)
• Meningitis.
• Sacral radiculopathy:
urinary retention and constipation.
• Transverse myelitis.
• Disseminated infection.
ABOUBAKR ELNASHAR
29. Diagnosis
• Usually from appearance of the typical rash.
• PCR testing of vesicular fluid
(most sensitive—gold standard).
• Culture of vesicular fluid.
• Serum antibody tests
of no use for diagnosing primary herpes.
ABOUBAKR ELNASHAR
33. Neonatal risks
Transmission rate from vaginal delivery
during primary maternal infection may be as
high as 50%,
during recurrent attack (<5%) relatively uncommon
Neonatal herpes appears during first 2wks of life.
• 25% limited to eyes and mouth only.
• 75% widely disseminated, of which:
70% will die
many of the survivors will have long-term
problems including mental retardation.
ABOUBAKR ELNASHAR
34. Treatment
• No cure for genital herpes.
• Symptomatic relief with
• simple analgesia,
• saline bathing, and
• topical anaesthetic.
• Oral aciclovir
200mg 5x day for 5 days or similar
double dose/length if immunosuppressed.
Topical aciclovir is not beneficial.
ABOUBAKR ELNASHAR
35. Aciclovir
decrease severity and duration of the primary
attack if given within 5 days of onset of symptoms.
If labour is within 6w of primary infection:
CS
provided the membranes have not been ruptured for
>4h.
With active vesicles from a recurrent attack, the risk
of surgery must be carefully weighed against the very
small risk of neonatal infection.
ABOUBAKR ELNASHAR
37. 2. HUMAN PAPILLOMAVIRUS
Epidemiology
• DNA virus, many subtypes.
• Subtypes 6 and 11:genital warts (condylomata
acuminata).
• Subtypes 16 and 18: CIN and cervical neoplasia.
• Commonest viral STI in England.
• 25% of people presenting with warts have other
concurrent STIs.
ABOUBAKR ELNASHAR
38. Symptoms
Majority asymptomatic.
Painless lumps anywhere in the genitoanal area.
Perianal warts are common in the absence of anal
intercourse.
ABOUBAKR ELNASHAR
40. A filamentous genital
wart is present in the
urethra
Cauliflower-like
condyloma acuminata
are seen on the
perineum, adjacent
posterior fourchette,
and right lower labia
majora. ABOUBAKR ELNASHAR
41. Perianal condyloma
acuminata are present, but
their morphology is smoother.
Keratinized flat warts are
present in the junction
between the introitus and
the perineum. Keratin
produces the strikingly white
appearance.
ABOUBAKR ELNASHAR
43. Micropapillations are normal single-
filament projections on the inner
labia minora that can often be
confused with genital warts. The
single filament of each projection
differentiates this normal finding
from HPV induced genital warts.
ABOUBAKR ELNASHAR
44. Diagnosis
Usually identified by clinical appearance.
Non-wart HPV infection often diagnosed by
characteristic appearance on cervical cytology
or
colposcopy (whitening on topical application of
acetic acid).
ABOUBAKR ELNASHAR
46. Complications
HPV 16 and 18 associated with high-grade CIN
and cervical neoplasia.
Smoking and immunosuppression both affect viral
clearance thereby increasing the risk.
ABOUBAKR ELNASHAR
47. Treatment for genital warts
Removal of the visible wart.
High rate of recurrence due to the latent virus in
the surrounding epithelial cells.
1. Clinic treatment
• Cryotherapy.
• Trichloroacetic acid.
• Electrosurgery/scissors excision/curettage/laser.
ABOUBAKR ELNASHAR
48. 2. Home treatment
both contraindicated if pregnancy risk
Podophyllotoxin cream or solution:
this is self-applied
must be used for about 4–6wks.
• Imiquimod cream:
a self-applied immune response modifier.
It may need to be used for up to 16wks.
ABOUBAKR ELNASHAR
49. Management of Sex Partners
Persons should inform current partner(s) about
having genital warts because the types of HPV that
cause warts can be passed on to partners.
Partners should receive counseling messages that
partners might already have HPV despite no visible
signs of warts, so HPV testing of sex partners of
persons with genital warts is not recommended.
Partner(s) might benefit from a physical examination
to detect genital warts and tests for other STDs.
No recommendations can be made regarding
informing future sex partners about a diagnosis of
genital warts because the duration of viral persistence
after warts have resolved is unknown.
ABOUBAKR ELNASHAR
50. Implications in pregnancy
Genital warts tend to grow rapidly in pregnancy
usually regress after delivery.
Very rarely, babies exposed perinatally may
develop laryngeal or genital warts.
Not an indication for CS.
CS is indicated for
women with anogenital warts if the pelvic outlet
is obstructed or
vag delivery would result in excessive bleeding.
ABOUBAKR ELNASHAR
51. Routine vaccination
From 2008 the DH has recommended HPV
vaccination for all girls aged 12–13.
Initially the selected vaccine was active against
HPV 16 and 18
in 2012 was changed to include HPV 6 and 11 as
well.
ABOUBAKR ELNASHAR
52. 3. HBV
Sexual transmision
Primary mode of transmission in US
by saliva, vaginal secretions, and semen.
Hepatitis B transmitted by direct contact with
blood
semen, vaginal fluids and other body fluids.
So It is STD
Fortunately there HBV vaccine
(Bacq & Lee, UpToDate, 2015)
ABOUBAKR ELNASHAR
53. Sex partners of HBsAg-positive persons
CDC2015
use methods condoms to protect themselves from
sexual exposure to infectious body fluids (e.g., semen
and vaginal secretions)
unless they have been demonstrated to be
immune after vaccination (anti-HBs >10 mIU/mL)
or
previously infected (anti-HBc positive).
ABOUBAKR
ELNASHAR
54. 1. CHLAMYDIA
Epidemiology
• Chlamydia trachomatis: obligate intracellular parasite.
• Commonest bacterial STI in the UK.
• An important cause of tubal infertility.
Symptoms
Dysuria
vaginal discharge, or
irregular bleeding (IMB or PCB)
70% of cases are asymptomatic.
ABOUBAKR ELNASHAR
55. Complications of Chlamydia infection
• Pelvic inflammatory disease
(10–40% of infections result in PID).
• Perihepatitis (Fitz–Hugh–Curtis syndrome).
• Reiter’s syndrome (more common in men):
• arthritis
• urethritis
• conjunctivitis.
• Tubal infertility.
• Risk of ectopic pregnancy.ABOUBAKR ELNASHAR
56. Diagnosis
Vulvovaginal (which can be self-taken) or
endocervical swab for nucleic acid amplification
test (NAAT).
Requires specific medium.
ABOUBAKR ELNASHAR
58. Treatment
• Azithromycin 1g single dose
doxycycline 100 mg bd for 7 days—not in pregnancy
both have similar efficacy of >95%.
• Contact tracing and treatment of partners.
ABOUBAKR ELNASHAR
60. Implications in pregnancy
Association with preterm rupture of membranes
and premature delivery.
The risks to the baby are of:
• Neonatal conjunctivitis
(30% within the first 2wks).
• Neonatal pneumonia
(15% within the first 4mths).
Treat pregnant woman with
erythromycin 500mg bd for 10–14 days
73–95% effective
ABOUBAKR ELNASHAR
64. Diagnosis
Cervix
may have a ‘strawberry’ appearance from
punctate haemorrhages (2%).
wet smear:
Direct observation of the organism by normal
saline
acridine orange stained slide from the posterior
vaginal fornix
(sensitivity 40–70% cases).
Culture media
diagnose up to 80% cases.
NAATs
sensitivities and specificities approaching 100%
ABOUBAKR ELNASHAR
66. Saline wet mount of vaginal secretions in trichomonal vaginitis,
showing two T. vaginalis (arrows), leukocytes and a normal
vaginal epithelial cell
McGraw-Hill
ABOUBAKR ELNASHAR
73. Complications
may enhance HIV transmission.
Treatment
• Metronidazole: 2g orally in a single dose.
• Metronidazole: 400–500mg bd for 5–7 days.
• Partner:
Contact tracing and treatment
advised to abstain from intercourse until they
and their sex partners have been adequately
treated and any symptoms have resolved.
ABOUBAKR ELNASHAR
74. Implications in pregnancy
• Trichomonas is associated with:
• preterm delivery
• low birth weight.
• Trichomonas may be acquired perinatally, occurring
in 5% of babies born to infected mothers.
ABOUBAKR ELNASHAR
75. 3. Candidiasis (thrush)
Epidemiology
• Yeast-like fungus
90% Candida albicans,
remainder other species, e.g. C. glabrata
75% of women will experience at least one
episode
10–20% are asymptomatic chronic carriers
(increasing to 40% during pregnancy).
ABOUBAKR ELNASHAR
76. • Predisposing factors
those that alter the vaginal micro-flora and include:
• immunosuppression
• antibiotics
• pregnancy
• diabetes mellitus
• anaemia.
ABOUBAKR ELNASHAR
77. Symptoms
May be asymptomatic
usually presents with:
• Vulval itching and
soreness.
• Thick, curd-like, white
vaginal discharge.
• Dysuria.
• Superficial
dyspareunia.
ABOUBAKR ELNASHAR
79. Diagnosis
• Characteristic appearance of:
• vulval and vaginal erythema
• vulval fissuring
• typical white plaques adherent to the vaginal wall.
• Culture from HVS or LVS.
• Microscopic detection of spores and pseudohyphae
on wet slides.
ABOUBAKR ELNASHAR
83. Complications
Unlikely to cause any significant complications unless
the woman is severely immunocompromised.
ABOUBAKR ELNASHAR
84. Treatment
• As so many women are chronic carriers, candidiasis
should only be treated if it is symptomatic.
• Clotrimazole 500mg pessary +/– clotrimazole cream; or
• Fluconazole 150mg (single dose)
contraindicated in pregnancy.
Other simple measures may help to decrease
recurrent attacks, e.g.:
• Wearing cotton underwear.
• Avoiding chemical irritants, e.g. soap&bath salts.
ABOUBAKR ELNASHAR
85. Uncomplicated VVC is not usually acquired through
sexual intercourse; thus, data do not support
treatment of sex partners.
A minority of male sex partners have balanitis,
characterized by erythematous areas on the glans of
the penis in conjunction with pruritus or irritation.
These men benefit from treatment with topical
antifungal agents to relieve symptoms.
ABOUBAKR ELNASHAR
86. Implications in pregnancy
• It is very common in pregnancy with no apparent
adverse effects.
• Topical imidazoles are not systemically absorbed
and are therefore safe at all gestations.
ABOUBAKR ELNASHAR
87. You can get this lecture and 444 lectures
from:
1.My scientific page on Face book:
Aboubakr Elnashar Lectures.
https://www.facebook.com/groups/2277
44884091351/
2.Slide share web site
3. elnashar53@hotmail.com
4. My clinic, 3 Althawra St. Almansura
ABOUBAKR ELNASHAR