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Scroll down to view medical protocols for common medical problems in West Africa.


  1. (1)Diarrhea Protocol

  2. (2)Phagogenic Ulcer Protocol

  3. (3)Vaginal Infection Protocol

DIARRHEA

3 TYPES ACUTE 9 LESS THAN 14 DAYS), CHRONIC (OVER 14 DAYS), DYSENTERY (10% OF DIARRHEA CASES, 20% OF THE DEATHS, 50% OF TIME ITS SHIGHELLA

A COMMON PROBLEM IN CLINIC, AND IN THE WORLD

2ND LEADING KILLER OF CHILDREN UNDER 5

15% OF CHILDREN UNDER 5 DEATHS WORLDWIDE ARE CAUSED BY DIARRHEA

2 MILLION DEATHS ANNUALLY

1.5 BILLION EPISODES OF ACUTE DIARRHEA WORLDWIDE YEARLY

WORSE IN AFRICA THAN IN HAITI

MORE SERIOUS IN MALNOURISHED PEOPLE

ONE OF TOP 5 KILLERS OF CHILDREN UNDER 5 IN DEVELOPING COUNTRIES

DYSENTERY IS DIARRHEA WITH BLOOD IN THE STOOL

DEFINE: MORE THAN 3   LOOSE STOOLS IN A DAY

STRESS: MOST DIARRHEA CAN BE TREATED IN THE HOME, BY USING ORAL REHYDRATION SALTS AND ZINC SUPPLEMENTATION

STRESS: PATIENTS MUST CONSUME SMALL, FREQUENT QUANTITIES OF FOOD AND WATER. EVEN IF THE PATIENT VOMITS OR CONTINUES WITH DIARRHEA SOME NUTRITION IS GETTING IN.


CAUSES:

POOR NUTRITION

UNCLEAN WATER

THE PATHOGENS: THESE ARE TRANSMITTED VIA THE FECAL-ORAL ROUTE, THE SAME PATHOGENS CAN CAUSE ACUTE/CHRONIC PERSISTENT OR DYSENTERY.

VIRUS ROTOVIRUS THIS IS THE MOST COMMON CAUSE, THIS TYPE USUALLY HAS VOMITING WITH IT. PARENTS OFTEN STOP THE REHYDRATION SOLUTION BECAUSE THE CHILD VOMITS. STRESS TO THE CAREGIVER TO KEEP GIVING ORS.

BACTERIAL INFECTION, SHIGELLA/ SALMONELLA (USUALLY FEVER), E.COLI/ VIBRIO CHOLERA

DEATHS PER YEAR BY BACTERIAL PATHOGEN

V.CHOLERAE 100K-120K

E.COLI       300K-500K

SALMONELLA (TYPHOID FEVER)     600K

SHIGELLA               1 MILLION

PARASITES AMOEBIASIS/ GIARDIA 

   -PATIENTS ARE USUALLY CRAMPY, LITTLE OR NO FEVER

   -USUALLY BLOOD OR MUCOUS IN DIARRHEA

   -YELLOW. FROTHY DIARRHEA IS GIARDIA

   -TREAT WITH METRONIDAZOLE GIARDIA 2GMS ONE DOSE

                                                            AMOEBIASIS 25-50 MG/KG/DAY DIVIDED DOSE TID x5-10DAYS

NON-INTESTINAL INFX. EAR, TONSILS, MEASLES, UTI

MALARIA (USUALLY FALCIPARUM)

Whipworm (prolapsed rectum) CAN CAUSE DIARRHEA

FOOD POISONING

DIGESTIVE DISORDERS

BABIES TRYING NEW TYPES OF FOOD/WEENING

FOOD ALLERGIES

SIDE EFFECTS OF MEDICINES

INGESTION OF LAXATIVE, CERTAIN PLANTS, POISONS

POOR DIET/ UNRIPE FRUIT, GREASY FOOD

TYPHOID FEVER (DECREASED PULSE, INCREASING FEVER, VERY SICK)

AIDS (USUALLY LONG LASTING DIARRHEA, THIS MAY BE THE FIRST SIGN OF HIV/AIDS)



DEHYDRATION IS THE USUAL CAUSE OF DEATH

STAGES OF DEHYDRATION, ALL PATIENTS WHO PRESENT TO CLINIC SHOULD BE STAGED

SEVERE

DEHYDRATION

TWO OF THE FOLLOWING SIGNS:

-LETHARGIC/ UNCONCIOUS

-SUNKEN EYES

-NOT ABLE TO DRINK/ DRINKING POORLY

-SKIN PINCH GOES BACK VERY SLOWLY

MAY ALSO HAVE:

-ANURIA

-HYPOTENSIVE

-WEAK PULSE

-COOL EXTREMITIES

-SIGNS/SYMPTOMS OF HYPOVOLEMIC SHOCK

-LOSS OF 8-10% BODY WEIGHT, >10% DEATH

SOME DEHYDRATION

TWO OF THE FOLLOWING SIGNS:

-RESTLESS/ IRRITABLE

-SUNKEN EYES

-DRINKS EAGERLY/ THIRSTY

-SKIN PINCH GOES BACK SLOWLY

-DRY MUCOUS MEMBRANES

-LOSS OF 5% OF BODY WEIGHT

NO DEHYDRATION

NOT ENOUGH SIGNS LISTED ABOVE  TO CLASSIFY




ASSESSING THE PATIENT

DURATION OF THE DIARRHEA

IS BLOOD PRESENT

PAIN WITH DEFECATION

FEVER

STAGE DEHYDRATION

GENERAL CONDITION: LETHARGIC, RESTLESS, AND IRRITABLE

REACTION TO A DRINK BEING OFFERED EAGER/ NONE

SKIN ELASTICITY


PREVENTION/ EDUCATION

CLEAN SAFE/ FILTERED WATER

LATRINES

AVOID MALNUTRITION

GOOD HYGIENE

PROTECT FOOD

BREAST FEED

AVOID UNNECESSARY MEDICINES

LATE WEANING, PROGRESS SLOWLY BE VERY CAREFUL WITH THE CLEANLINESS OF THE FOOD OFFERED


TREATMENT:

IS BASED ON THE MECHANISM OF DIARRHEA NOT THE CAUSATIVE AGENT USUALLY

NO MEDICINE NEEDED FOR MOST CASES

RISK IS DEHYDRATION AND MALNUTRITION


HOW TO MAKE REHYDRATION SOLUTION

-USE 1 LITER OF CLEAN WATER, MIX ½ TEASPOON OF SALT AND 8 LEVEL TEASPOONS OF SUGAR, ADD SOME KOOL AID MIX FOR COLOR, PALATABILITY, DISPENSE THIS IN A SMALL ZIPLOCK BAG. TELL THE CAREGIVER TO ADD FRUIT JUICE, COCONUT WATER OR MASHED RIPE BANANA FOR POTASSIUM.SIP THIS CONTINUOUSLY EVERY 5 MINUTES.

ORS MUST NEVER BE SWEET! GIVE ENOUGH SO THAT THE CHILD PASSES PALE YELLOW URINE.STORE UNUSED BES/ORS OUT OF DIRECT SUNLIGHT

REHYDRATION DRINK SMALL SIPS CONTINUOUSLY

SMALL QUANTITIES OF FOOD OFTEN EVEN IF DIARRHEA CONTINUES. CHILDREN ESPECIALLY NEED 30% MORE CALORIES AND 100% MORE PROTEIN WHEN THEY HAVE ACTIVE DIARRHEA AND DURING THE RECOVERY STAGE.

SUPPLEMENT WITH ZINC FOR 10 DAYS

ANTIBIOTICS, ONLY IF DYSENTARY, CHOLERA, SERIOUS INFECTIONS ELSEWHERE IN THE BODY

CIPRO IS DRUG OF CHOICE FOR SHIGHELLA

AVOID ANTI-DIARRHEA MEDS LIKE KAOLIN AND PECTIN; THESE ARE ADSORBATES AND ARE NOT EFFECTIVE.  NEVER USE ANTIMOTILITY DRUGS, (LOPERAMIDE) THESE DECREASE G.I. MOTILITY AND ARE DANGEROUS BECAUSE THEY PREVENT THE INFECTED MATERIAL FROM COMING OUT.


MORE DANGEROUS CASES:

-DIARRHEA MORE THAN 4 DAYS WITH NO IMPROVEMENT, 1 DAY ON A SMALL CHILD

-DEHYDRATION AND WORSENING (SEE NOTES ON DEHYDRATION)

-IF VOMITING CONTINUES MORE THAN 3 DAYS AFTER STARTING REHYDRATION SOLUTION

-A PATIENT WITH SEIZURES OR EDEMA IN THE FEET/FACE

-IF THE PERSON WAS VERY SICK/ MALNOURISHED BEFORE THE DIARRHEA BEGAN

-SIGNIFICANT BLOOD IN THE STOOL

RICE WATER/ VOLUMINOUS DIARRHEA



CHOLERAVibrio cholerae IS A GRAM (-) STRAIGHT OR CURVED ROD WITH A SINGLE POLAR FLAGELLA. IT IS NON INVASIVE AND USES AN ENTEROTOXIN, “THE MODEL”

TRANSMITTED VIA WATER AND FOOD

CLINICAL PICTURE

SUDDEN MASSIVE DIARRHEA, GALLONS, WITH FLAKES OF MUCOUS AND EPITHELIAL CELL SO IT RESEMBLES RICE WATER

THE MOST RAPID FATAL DISEASE KNOWN, IN EXTREME CASES THE PATIENT CAN BE HYPOTENSIVE IN 1 HOUR AND DEAD IN 2-3 HOURS.

IN NORMAL CASES FROM THE FIRST LOOSE STOOL TO SHOCK IN 4-12 HOURS TO DEAD IN 18 HOURS

BUT:

UP TO 80% OF CASES CAN BE SUCCESSFULLY TREATED WITH ORAL REHYDRATION

IT CAN BE CONTROLLED BY PROVIDING SAFE WATER AND PROPER SANITATION

75% OF PEOPLE AFFECTED HAVE NO SYMPTOMS

TREATMENT IS RAPID PO/ IV FLUID REPLACEMENT

“BY THIS SIMPLE TREATMENT REGIME, PATIENTS ON THE VERGE OF DEATH SEEM TO BE MIRACULOUSLY CURED AND THE MORTALITY RATE CAN BE REDUCED TEN FOLD”

THERE IS NO VALUE TO ANTIBIOTIC TREATMENT ALTHOUGH TETRACYCLINES AND CIPROFLOXACIN MAY SHORTEN THE DURATION OF THE ILLNESS.

PANDEMIC - WORLDWIDE

EPIDEMIC – IN A REGION

ENDEMIC- NORMALLY PRESENT IN A REGION

IN HAITI AS OF NOVEMBER 2010 THERE WERE 16,000 CASES IN PORT AU PRINCE AND 95 DEATHS. CROIX DES BOUQUETTES WAS AFFECTED. THIS IS THE NEAREST TOWN TO OUR VILLAGE, LAMOTHE. CHOLERA HAS AFFECTED THE RURAL AREAS MORE.

AS OF FEBRUARY 2011 SINCE THE OUTBREAK IN OCTOBER 2010 231,070 CASES AND 4,549 DEATHS. MORTALITY RATES NOW AT 2%. THEY WERE AS HIGH AS 9%. MORTALITY RATE SHOULD BE BELOW 1%.

2011 ASSOCIATED PRESS.

PHAGOGENIC /TROPICAL ULCER TREATMENT PROTOCOLS

INFX WITH BACTEROIDES FUSIFORMIS, AN ANAEROBIC FUSIFORM BACTERIA AND  BORRELIA VINCENTI AN AEROBIC BACTERIA

1.CIPRO 10 DAYS OR UNTIL NO S/S OF INFX, ESPECIALLY ODOR

2.COMPRESSION

3.GENTAMYCIN CREAM QD

4.TOTAL CONTACT CASTING  DECREASE ADDITIONAL WOUND TRAUMA- TCC, CAM WALKER, UNNA BOOT, POSTERIOR SPLINT, CRUTCHES

5.PROTEIN RICH DIET/VIT C SUPPLEMENTATION/ ? ANABOLIC STEROIDS

6.PREDNISONE

7.REGRANEX

8.APPLIGRAF

9.LASIX  CONTROL EDEMA/ PERI WOND, WATCH DEHYDRATION / DIURETIC/ UNNA BOOT

11. MAXIMIZE/ ENHANCE SYSTEMIC CONDITIONS

12. WATCH FOR MALIGNANT TRANSFORMATION ESPECIALLY IN CHRONIC CASES MARJOLINS ULCER.

13. MAINTAIN A CLEAN/ NON INFECTED BASE

14.MOIST WOUND BED

VAGINAL INFECTIONS


MOST COMMON WOMEN’S HEALTH PROBLEM


BOTH STD (TRICHIMONIASIS) AND NON-STD (CANDIDIASIS)


BACTERIAL VAGINOSIS (BV) SEXUALLY OR NON-SEXUALLY TRANSMITTED


SYMPTOMS: DISCHARGE, IRRITATION, ITCH,  SHOULD NOT  BE A CLINICAL DIAGNOSIS ONLY. MUST USE  WHIFF TEST, PH TEST.


DYSURIA, (PAIN ON URINATION) IS EXTERNAL. IT OCCURS WHEN URINE  TOUCHES THE VULVA. INTERNAL PAIN IS  URETHRITIS/CYSTITIS


SPECIFICALLY IN HAITI  FROM MELLON ET. AL. INT CONF AIDS 1996

IN WOMEN WITH VAGINAL DISCHARGE AS A CHIEF COMPLAINT 30% HAD Trichimonas vaginalis,  24% HAD Candida albicans, 23% HAD Chlamydia, 20% HAD BACTERIAL VAGINOSIS


TAKING THE HISTORY

ASK DISCHARGE COLOR, QUANTITY, ODOR

PELVIC PAIN, PALPATE LOWER ABDOMEN

PAIN WITH SEXUAL INTERCOURSE

PAIN WITH URINATION DEEP/ SUPERFICIAL


PHYSICAL EXAM

WHIFF TEST/KOH PREP   USE A SWAB TO OBTAIN VAGINAL DISCHARGE, PLACE THIS ON A SLIDE, ADD A DROP OR TWO OF 10% KOH. A POSITIVE TEST WILL HAVE A “FISHY” ODOR


LITMUS/PH TEST DIP THE TEST STRIP IN THE VAGINAL SECRETIONS AND COMPARE THE COLOR TO THE STANDARDS. THIS TEST IS INACCURATE IF THE PATIENT IS MENSTRUATING, HAS DOUCHED OR USED A SPRAY OR HAS HAD INTERCOURSE RECENTLY. USE THE SAME SOURCE OF LIGHT FOR ALL TESTS, SUNLIGHT AND FLOURESCENT LIGHTING IS NOT GOOD, USE AMBIENT OR INCANDESCENT LIGHT. TEST STRIPS MUST NOT BE EXPOSED  TO HIGH HEAT AND LIGHT



BACTERIAL VAGINOSIS  (BV)


CAUSE, GRAM (-) GARDNERELLA VAGINALIS, MYCOPLASMA HOMINIS


UNPLEASANT ODOR, WHITE, GRAY, MILKY DISCHARGE, ODOR WORSENS DRAMATICALLY AFTER SEX DUE TO PH CHANGES, 40% MAY HAVE NO SYMPTOMS


ASSOCIATED WITH

PID- INFERTILITY

ENDOMETRITIS

CERVICITIS

LOW BIRTH- WEIGHT BABY


STD OR NONSTD


MOST COMMON CAUSE VAGINITIS IN WOMEN OF CHILD-BEARING AGE

ASSOCIATED WITH

MULTIPLE SEX PARTNERS

NEW SEX PARTNER

DOUCHING

STRESS

LACK OF LACTOBACILLI- HEALTHY BACTERIA

NO NEED TO TREAT THE MALE PARTNER(S) UNLESS THEY HAVE THE DISEASE OR ARE UN-CIRCUMCISED.


DIAGNOSIS – YOU MUST HAVE 3 CRITERIA

THIN DISCHARGE

PH GREATER THAN 4.5

VAGINAL DISCHARGE + 10% KOH LIBERATES “FISHY” ODOR


TREATMENT

DO NOT DOUCHE

NOTHING TO MASK ODOR

GIVE METRONIDAZOLE OR CLINDAMYCIN





YEAST INFECTION- CANDIDA ALBICANS,VULVOVAGINAL CANDIDIASIS



THICK CURD LIKE DISCHARGE, INTENSE ITCHING AFFECTS VULVA AND LABIA, PAINFUL INTERCOURSE, NOT CONSIDERED AN STD BUT 12-15% MEN CAN GET IT AFTER SEX WITH AN INFECTED WOMAN.

COMPLICATIONS ARE RARE


CAUSES/ RISK FACTORS: ANTIBIOTIC USE, PREGNANCY, OBESITY, DIABETES, ORAL CONTRACEPTIVES, STEROIDS, MOISTURE, POOR HYGEINE, TIGHT UNDERWEAR, UNDERWEAR THAT IS NOT COTTON, HORMONAL CHANGES (PREGNANCY, OVULATION,OC USE,MENOPAUSE),YOUNG AGE AT FIRST INTERCOURSE, INTERCOURSE MORE THAN FOUR TIMES PER MONTH


TREATMENT: FIRST LINE TREATMENT IS TOPICAL ANTIFUNGALS. CLOTRIMAZOLE, MICONAZOLE,  NYSTATIN TOPICAL, FLUCONAZOLE ORAL


PREVENTION:

KEEP DRY

WIPE FROM FRONT TO REAR AFTER USING THE TOILET

WEAR LOOSE COTTON UNDERWEAR

GET OUT OF WET CLOTHES QUICKLY

AVOID DEODORANTS EVEN THOSE IN TAMPONS

DO NOT DOUCHE BECAUSE:

                    -ALTERS NORMAL VAGINAL FLORA

                    - REMOVES PROTECTIVE COMPONENTS

                    - PROMOTES ASCENSION OF ORGANISMS FROM LOWER TO

                       UPPER EPRODUCTIVE TRACT

                                 

DO NOT USE FEMININE HYGEINE PRODUCTS

REGULAR BATHING




TRICHIMONIASIS  T. vaginalis


CAUSED BY PARASITE.FLAGELLATED PROTOZOAN, ITCHY, BURNING, PAINFUL URINATION, FROTHY, GREEN, CREAMY DISCHARGE, VERY MALODOROUS. TRICHIMONAS IS ASSOCIATED WITH AND MAY BE A VECTOR FOR OTHER VENERAL DISEASES.


20-50% OF WOMEN MAY BE ASYMPTOMATIC


RISK FACTORS

PREGNANCY

ORAL CONTRACEPTIVES

USE OF IUD

CIGARETTE SMOKING

MULTIPLE SEXUAL PARTNERS


EASILY  SPREADS  TO URETHRA- CAUSES DYSURIA, FREQUENCY AND URGENCY


RARELY CAUSES SYMPTOMS IN MEN SO WOMEN GET REINFECTED FROM UNTREATED MALE SEXUAL PARTNERS, SO TREAT ALL SEXUAL PARTNERS


TREATMENT IS METRONIDAZOLE


CHART 1 DIAGNOSTIC CRITERION


DIAGNOSTIC CRITERIA

NORMAL

BV

TRICHOMONAS

YEAST

VAGINAL PH

3.8-4.2

GREATER 4.5

4.5

LESS THAN 4.5

DISCHARGE

WHITE, THIN

MILKY, THIN, WHITE, GRAY

YELLOW, GREEN, FROTHY

WHITE, CURDY, COTTAGE CHEESE

“WHIFF” TEST

ABSENT

FISHY

FISHY

ABSENT



THE FOLLOWING THREE CHARTS ARE TAKEN FROM THE JOURNAL OF THE AMERICAN FAMILY PHYSICIAN SEPTEMBER 1, 2000, EGAN AND LIPSKY


CHART 2 VAGINITIS EVALUATION ALGORITIM




CHART 3 Treatments of the Most Common Causes of Vaginitis


Treatment regimens



Bacterial vaginosis



Vulvovaginal candidiasis



Trichomoniasis




Acute regimens


Metronidazole (Flagyl), 500 mg orally twice daily for seven days*
Clindamycin phosphate vaginal cream 2 percent (Cleocin Vaginal), one full applicator (5 g) intravaginally each night for 7 days* (Note that oil-based cream may weaken condoms and diaphragms.)
Metronidazole gel 0.75 percent (Metrogel-Vaginal), one full applicator (5 g) intravaginally twice daily for 5 days*


Topical antifungal agents** (see Table 6)
Fluconazole (Diflucan), 150 mg orally one time


Metronidazole, 2 g orally in a single dose***



Alternative regimens


Metronidazole, 2 g orally in a single dose
Clindamycin (Cleocin), 300 mg orally twice daily for 7 days


Boric acid powder in size-0 gelatin capsules intravaginally once or twice daily for 2 weeks§


Metronidazole, 500 mg orally twice daily for 7 days



Pregnancy


Metronidazole, 250 mg orally three times daily for 7 days (recommended regimen)||


Only topical azole agents intravaginally for 7 to 10 days


Metronidazole, 2 g orally in a single dose (usually not recommended in first trimester)



Alternative regimens for pregnancy


Metronidazole, 2 g orally in a single dose||
Clindamycin, 300 mg orally twice daily for 7 days||
Metronidazole gel 0.75 percent, one full applicator (5 g) intravaginally twice daily for 5 days (acceptable only in women who have not had a previous premature delivery)



Recurrence¶


Retreat with an alternative regimen.


For four or more episodes of symptomatic vulvovaginal candidiasis annually: initial acute intravaginal regimen for 10 to 14 days followed immediately by maintenance regimen for at least 6 months (e.g., ketoconazole [Nizoral], 100 mg orally once daily)


Metronidazole, 2 g orally once daily for 3 to 5 days (Note that treatment of sexual partners increases cure rate.)


*--Cure rates for these regimens for bacterial vaginosis range from 74 to 85 percent.

**--Cure rates for selected topical antifungal agents (e.g., polyenes, imidazoles) range from 75 to 90 percent.

***--Cure rate for acute therapy is 90 to 95 percent. Single-dose therapy is associated with better compliance. Ensuring treatment of sexual partners will increase cure rate. Topical therapy secondary to nontherapeutic levels in the urethra and perivaginal glands should not be used. Alcohol use should be avoided during metronidazole therapy and for 24 hours after treatment.

§--Although this treatment is not included in the recommendations from the Centers for Disease Control and Prevention, a 98 percent cure rate has been reported for its use in patients who failed commonly used treatments.56

||--Lower doses of medications are recommended during pregnancy; use in first trimester should be avoided. Use of clindamycin phosphate vaginal cream is not recommended during pregnancy.

¶--All cases of recurrent vaginitis should be confirmed by culture before maintenance therapy is initiated.

.



CHART 4 Topical Antifungal Therapy for Vaginitis


Butoconazole 2 percent cream (Femstat 3, Mycelex-3), 5 g per day intravaginally for 3 days*§

Clotrimazole 1 percent cream (Mycelex-7), 5 g per day intravaginally for 7 to 14 days*§

Clotrimazole 100-mg vaginal tablet (Gyne-Lotrimen, Mycelex), one tablet per day intravaginally for 7 days*

Clotrimazole 100-mg vaginal tablet, two tablets per day intravaginally for 3 days*

Clotrimazole 500-mg vaginal tablet (Mycelex-G), one tablet intravaginally in a single application*

Miconazole 2 percent cream (Monistat 7), 5 g per day intravaginally for 7 days*§

Miconazole 200-mg vaginal suppository (Monistat 3), one suppository per day for 3 days*§

Miconazole 100-mg vaginal suppository (Monistat 7), one suppository per day for 7 days*§

Nystatin 100,000-unit vaginal tablet (Mycostatin), one tablet per day intravaginally for 14 days

Tioconazole 6.5 percent ointment (Vagistat-1), 5 g intravaginally in a single application*§

Terconazole 0.4 percent cream (Terazol 7), 5 g per day intravaginally for 7 days*

Terconazole 0.8 percent cream (Terazol 3), 5 g per day intravaginally for 3 days*

Terconazole 80-mg vaginal suppository (Terazol 3), one suppository per day for 3 days*


*--These creams and suppositories are oil-based and might weaken latex condoms and diaphragms. Additional information is available on condom product labeling.

§--Over-the-counter preparations.

Adapted from 1998 guidelines for treatment of sexually transmitted diseases. Retrieved June 19, 2000, from the World Wide Web: http://www.cdc.gov/nchstp/dstd/1998_STD_guidelines_for_the_treatment.htm.



CHLAMYDIA


IS AN STD, CAUSED BY Clostridium trachomatis


DAMAGES FEMALE REPRODUCTIVE SYSTEM. THIS RISK INCREASES WITH MULTIPLE REINFECTIONS.


90% OF WOMEN WITH CHLAMYDIA MEET TWO OF THE FOLLOWING CRITERIA

1.YOUNGER THAN 24

2.A NEW SEXUALPARTNER WITHIN THE PREVIOUS TWO MONTHS

3.MUCOUS/PUS ON THE CERVIX ( NEED SPECULUM EXAM)

4.CERVICAL BLEEDING WHEN SWABBING THE ENDOMETRIUM

5.NO FORM OF CONTRACEPTION


SYMPTOMS OCCUR WITHIN 3 WEEKS OF INFECTION ;BUT, MAY BE MILD OR ABSENT. YET CAN CAUSE SERIOUS COMPLICATIONS AND IRREVERSIBLE DAMAGE.

SYMPTOMS INCLUDE: CERVIX INFECTION

ABNORMAL DISCHARGE

BURNING WITH URINATION

MAY SPREAD TO THE RECTUM OR FALLOPIAN TUBES


IF INFECTION SPREADS TO FALLOPIAN TUBES SYMPTOMS INCLUDE

LOWER ABDOMINAL PAIN

LOW BACK PAIN

NAUSEA

FEVER

PAIN DURING INTERCOURSE

BLEEDING BETWEEN PERIODS

CAN CAUSE PELVIC INFLAMATORY DISEASE


REMEMBER BV, CANDIDA, AND TRICHIMONAS RARELY SPREAD OUT OF THE LOWER PELVIC AREA.


IF UNTREATED CAN CAUSE

CHRONIC PELVIC PAIN

INFERTILITY

POTENTIALLY FATAL ECTOPIC PREGNANCY

INCREASES RISK OF HIV INFECTION


MAY CAUSE DISCHARGE FROM THE PENIS, SO REINFECTION IS COMMON


CAN OCCUR IN THE THROAT


CAN BE PASSED FROM MOTHER TO BABY DURING VAGINAL CHILDBIRTH/ CHLAMYDIA IS LEADING CAUSE OF PNEUMONIA AND CONJUNCTIVITIS IN NEWBORNS


RISK INCREASES WITH MULTIPLE PARTNERS/  NEW SEXUAL PARTNER

TEENS AT HIGH RISK DUE TO IMMATURE ORGANS

HOMOSEXUAL SEX IS ALSO A RISK


CAN CAUSE REITERS SYNDROME, URETHRITIS, CONJUNCTIVITIS, ARTHRITIS


TREATMENT OF CHLAMYDIA


SINGLE DOSE AZITHROMYCIN OR A WEEK OF DOXYCYCLINE BID, ALL SEXUAL PARTNERS NEED TO BE TREATED



GONORRHEA


STD, CAUSED BY Neisseria gonorrheae


SPREAD BY CONTACT, CAN GO FROM MOTHER TO BABY AT DELIVERY


SYMPTOMS: MEN

SOME MEN HAVE NO SYMPTOMS

BURNING WITH URINATION

WHITE/YELLOW/GREEN DISCHARGE

PAINFUL/ SWOLLEN TESTICLES


SYMPTOMS: WOMEN

MILD TO NONE

OFTEN MIS DIAGNOSED AS A BLADDER OR VAGINAL INFECTION

PAINFUL URINATION

BLEEDING BETWEEN PERIODS

INCREASED DISCHARGE


CAN AFFECT THE ANUS/RECTUM, THROAT


HOW CAN WE PREVENT MIS-DIAGNOSIS


TREATMENT



PELVIC INFLAMATORY DISEASE



URETHRITIS/ CERVICITIS