DOCSLIB.ORG

Quebec's Medical Protocol

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Quebec's Medical Protocol No 628001 Initiating diagnostic measures and pharmacological treatment in a female with unusual vaginal discharge Developed in collaboration with an advisory committee consisting of Québec clinicians and experts. Validated by the Comité d’excellence clinique en ordonnances nationales of the Institut national d’excellence en santé et en services sociaux (INESSS). CLINICAL SITUATION OR TARGET POPULATION Symptomatic female: ► A sexually active female with unusual vaginal discharge with or without pre- or postmenstrual spotting or postcoital bleeding. Asymptomatic sexual partner (male or female)1: ► An asymptomatic individual identified as a sexual partner of a female with laboratory-documented Trichomonas vaginalis vaginitis. CONTRAINDICATIONS TO THE APPLICATION OF THIS PROTOCOL ► < 14 years of age; ► Pregnancy, breastfeeding; 2 ► Immunocompromised state ; ► Abnormal uterine bleeding, if: • Menopause; • Bleeding that has persisted for 6 months or longer; • History of gynecological cancer; ► The presence of a contraindication to the use of a recommended drug, with no appropriate alternative; ► Four or more episodes of bacterial vaginosis in the past 12 months (each as evaluated by a physician or a nurse); ► Four or more episodes of vulvovaginal candidiasis in the past 12 months (each as evaluated by a physician or a nurse). INSTRUCTIONS 1. PRECAUTIONS For a victim of sexual assault, also follow the recommendations in the Guide d’intervention médicosociale. 1 For asymptomatic individuals identified as sexual partners of a female who has been treated pharmacologically for a syndrome consistent with cervicitis, refer to the Protocole national pour le traitement d’une infection à Chlamydia trachomatis ou à Neisseria gonorrhoeae chez une personne asymptomatique. 2 Examples of possible causes of an immunocompromised state (see Appendix V of the Guide québécois de dépistage des ITSS): congenital immune deficiency, leukemia, lymphoma, multiple myeloma, nonhematologic cancer, acquired immune deficiency (such as during HIV infection), hemodialysis, and the use of immunosuppressants. INESSS | Quebec’s medical protocol – Unusual vaginal discharge 1 2. HEALTH STATUS ASSESSMENT 2.1. Presence of signs and symptoms Look for and characterize the following: ► Unusual vaginal discharge; ► Pre- or postmenstrual spotting; ► Postcoital bleeding. Look for the following: ► Signs and symptoms of a sexually transmitted and blood-borne infection (STBBI) at other sites of exposure. ► Signs and symptoms of a complicated infection (e.g., lower abdominal pain, deep dyspareunia, joint involvement or a deterioration in overall health with fever). 2.2. Medical history ► Pregnancy; ► Voluntary termination of pregnancy (VTP) or an invasive gynecological procedure; ► Date of last menstruation; ► Barrier method of contraception; ► Date and results of last STBBI screening test; ► STBBI history; ► History of bacterial vaginosis or vulvovaginal candidiasis (previous number of episodes, confirmed or not by a physician, nurse or laboratory tests). 2.3. Medication history ► Medication use; ► Drug allergies; ► Use of antibiotics in the past month; ► Hormonal contraception, a levonorgestrel intrauterine system (IUS), a copper intrauterine device, emergency oral contraception. 2.4. STBBI risk factors Inquire about STBBI risk factors and assess the indications for STBBI screening. Consult the tool ITSS à rechercher selon les facteurs de risque décelés. 2.5. Pelvic inflammatory disease risk factors Look for risk factors for pelvic inflammatory disease (PID): ► Having undergone a VTP or an invasive gynecological procedure (e.g., an endometrial biopsy, a hysteroscopy, hysterosonography or hysterosalpingography) in the past month. ► A levonorgestrel IUS or a copper intrauterine device installed in the past month. ► A history of at least one episode of C. trachomatis or N. gonorrhoeae infection in the past year. ► Previous history of PID. INESSS | Quebec’s medical protocol – Unusual vaginal discharge 2 3. PHYSICAL EXAMINATION 3.1. Overall health and vital signs Take temperature, if warranted. 3.2. Inspection of external genitalia Inspection of the vulva, urethra and perianal region. Look for the following: erythema, edema, fissures, excoriations, or ulcerous, vesicular, erosive, pustular or verrucous lesions. 3.3. Speculum examination Inspection of the cervix and vaginal walls. Describe the unusual vaginal discharge (consult the Comparative table of features consistent with cervicitis, bacterial vaginosis, vulvovaginal candidiasis or trichomoniasis, in Section 5). Look for the following: unusual vaginal discharge, inflammatory appearance of the vaginal walls and cervix, a purulent or mucopurulent endocervical exudate, endocervical bleeding (brittle cervix) or petechiae on the genital mucosa (strawberry cervix). 3.4. Bimanual examination Examination of the uterus and adnexal structures. A bimanual examination is indicated if: ► Pre- or postmenstrual spotting or postcoital bleeding; ► PID risk factors; ► A purulent or mucopurulent endocervical exudate; ► Endocervical bleeding upon swabbing (brittle cervix). Look for the following: lower abdominal tenderness, adnexal tenderness (unilateral or bilateral) or cervical motion tenderness, masses or other structural abnormalities. 4. INVESTIGATION 4.1. Specimens and microbiological tests If unusual vaginal discharge consistent with bacterial vaginosis, vulvovaginal candidiasis or trichomoniasis: ► If a process is in place to provide supervision of the examens de biologie médicale délocalisés (EBMD), obtain a vaginal secretion specimen for a pH measurement and a potassium hydroxide (KOH) amine odour test at the point service3. ► Obtain a vaginal secretion specimen for the appropriate microbiological tests3. If a purulent or mucopurulent endocervical exudate: ► Obtain a vaginal or endocervical specimen to screen for C. trachomatis and N. gonorrhoeae by nucleic acid amplification testing (NAAT) and an endocervical specimen for an N. gonorrhoeae culture. If signs or symptoms of pharyngeal or rectal infection: ► Obtain a pharyngeal or rectal specimen (depending on the location of the symptoms) to screen for C. trachomatis and N. gonorrhoeae by NAAT and an N. gonorrhoeae culture specimen. 3 As per the recommendations in the laboratory procedures at the facility concerned. INESSS | Quebec’s medical protocol – Unusual vaginal discharge 3 In the case of sexual practices implying pharyngeal or rectal exposure with no signs or symptoms at these sites: ► Consult the tool Prélèvements et analyses recommandés en fonction de l’infection recherchée chez les personnes asymptomatiques (dépistage). If risk factors for C. trachomatis or N. gonorrhoeae infection: ► Obtain a vaginal or endocervical specimen to screen for C. trachomatis and N. gonorrhoeae by NAAT and an endocervical specimen for an N. gonorrhoeae culture. If risk factors for other STBBIs: ► Determine the STBBIs to screen for in accordance with the tool ITSS à rechercher selon les facteurs de risque décelés. ► Obtain the specimen or specimens to screen for the other STBBIs to be checked for according to the tool Prélèvements et analyses recommandés en fonction de l’infection recherchée chez les personnes asymptomatiques (dépistage). If there is a possibility that the patient is pregnant or if she experiences pre- or postmenstrual spotting or postcoital bleeding: ► Do a urine pregnancy test. 4.2. Details concerning specimens Regardless of type of specimen, it is important to consult the laboratory at the facility concerned for details on the tests used locally (e.g., suitable specimen collection sites, the types of specimens accepted, the applicable specimen collection conditions, storage and transport). INESSS | Quebec’s medical protocol – Unusual vaginal discharge 4 5. COMPARATIVE TABLE OF FEATURES CONSISTENT WITH CERVICITIS, BACTERIAL VAGINOSIS, VULVOVAGINAL CANDIDIASIS OR TRICHOMONIASIS C. TRACHOMATIS VULVOVAGINAL AND BACTERIAL VAGINOSIS TRICHOMONIASIS CANDIDIAISIS* N. GONORRHOEAE Clinical manifestations (none of these infections necessarily presents by all the clinical manifestations listed) Adherent, Vaginal Thick, curd-like Frothy appearance Purulent homogeneous, fluid discharge Whitish to yellowish Yellowish to greenish Whitish to greyish Malodorous: fishy Odour Nonspecific Nonspecific Malodorous smell Itching None None or slight Moderate to severe Moderate to severe Purulent or mucopurulent endocervical exudate Erythema, edema, fissures, excoriations Petichiae on the Pre- or genital epithelium postmenstrual Associated Other Not applicable (strawberry cervix) spotting, postcoital symptoms (pain, bleeding superficial Superficial dyspareunia, dyspareunia, dysuria Endocervical external dysuria) bleeding upon swabbing (brittle cervix epithelium) Clinical criteria Vaginal pH Not applicable Vaginal pH > 4.5 Vaginal pH ≤ 4.5 Vaginal pH > 4.5 Amine odour Not applicable Yes No No (with KOH) Laboratory criteria Nugent’s score ≥ 7‡: Yeast present on wet C. trachomatis vaginal flora consistent Presence of Result mount or Gram with bacterial T. vaginalis N. gonorrhoeae staining vaginosis * Predisposing factor: recent use of antibiotics. ‡ Nugent’s score ≥ 7 or another microbiological test result consistent with bacterial vaginosis. INESSS | Quebec’s medical protocol – Unusual vaginal discharge 5 6. THERAPEUTIC APPROACH IN THE PRESENCE OF A PURULENT OR MUCOPURULENT ENDOCERVICAL EXUDATE SUGGESTIVE OF CERVICITIS 6.1. Treatment indication If there is a purulent or mucopurulent endocervical exudate,
Load more

Recommended publications
  • How to Evaluate Vaginal Bleeding and Discharge
    How to Evaluate Vaginal Bleeding and Discharge Is the bleeding normal or abnormal? When does vaginal discharge reflect something as innocuous as irritation caused by a new soap? And when does it signal something more serious? The authors’ discussion of eight actual patient presentations will help you through the next differential diagnosis for a woman with vulvovaginal complaints. By Vincent Ball, MD, MAJ, USA, Diane Devita, MD, FACEP, LTC, USA, and Warren Johnson, MD, CPT, USA bnormal vaginal bleeding or discharge is typically due to either inadequate levels of estrogen one of the most common reasons women or a persistent corpus luteum. Structural causes of come to the emergency department.1,2 bleeding include leiomyomas, endometrial polyps, or Because the possible underlying causes malignancy. Infectious etiologies include pelvic in- Aare diverse, the patient’s age, key historical factors, flammatory disease (PID). Additionally, a variety of and a directed physical examination are instrumental bleeding dyscrasias involving platelet or clotting fac- in deciding on diagnosis and treatment. This article tors can complicate the normal menstrual period. Iat- will review some common case presentations of rogenic causes of vaginal bleeding include hormone nonpregnant female patients with abnormal vaginal replacement therapy, steroid hormone contraception, bleeding, inflammation, or discharge. and contraceptive intrauterine devices.3-5 Anovulatory bleeding is common in perimenar- ABNORMAL VAGINAL BLEEDING chal girls as a result of an immature hypothalamic- To ensure appropriate patient management, “Is she pituitary axis and in perimenopausal women due to pregnant?” should be the first question addressed, declining levels of estrogen. During reproductive since some vulvovaginal signs and symptoms will years, dysfunctional uterine differ in significance and urgency depending on the bleeding (DUB) is the most >>FAST TRACK<< answer.
    [Show full text]
  • OBGYN-Study-Guide-1.Pdf
    OBSTETRICS PREGNANCY Physiology of Pregnancy: • CO input increases 30-50% (max 20-24 weeks) (mostly due to increase in stroke volume) • SVR anD arterial bp Decreases (likely due to increase in progesterone) o decrease in systolic blood pressure of 5 to 10 mm Hg and in diastolic blood pressure of 10 to 15 mm Hg that nadirs at week 24. • Increase tiDal volume 30-40% and total lung capacity decrease by 5% due to diaphragm • IncreaseD reD blooD cell mass • GI: nausea – due to elevations in estrogen, progesterone, hCG (resolve by 14-16 weeks) • Stomach – prolonged gastric emptying times and decreased GE sphincter tone à reflux • Kidneys increase in size anD ureters dilate during pregnancy à increaseD pyelonephritis • GFR increases by 50% in early pregnancy anD is maintaineD, RAAS increases = increase alDosterone, but no increaseD soDium bc GFR is also increaseD • RBC volume increases by 20-30%, plasma volume increases by 50% à decreased crit (dilutional anemia) • Labor can cause WBC to rise over 20 million • Pregnancy = hypercoagulable state (increase in fibrinogen anD factors VII-X); clotting and bleeding times do not change • Pregnancy = hyperestrogenic state • hCG double 48 hours during early pregnancy and reach peak at 10-12 weeks, decline to reach stead stage after week 15 • placenta produces hCG which maintains corpus luteum in early pregnancy • corpus luteum produces progesterone which maintains enDometrium • increaseD prolactin during pregnancy • elevation in T3 and T4, slight Decrease in TSH early on, but overall euthyroiD state • linea nigra, perineum, anD face skin (melasma) changes • increase carpal tunnel (median nerve compression) • increased caloric need 300cal/day during pregnancy and 500 during breastfeeding • shoulD gain 20-30 lb • increaseD caloric requirements: protein, iron, folate, calcium, other vitamins anD minerals Testing: In a patient with irregular menstrual cycles or unknown date of last menstruation, the last Date of intercourse shoulD be useD as the marker for repeating a urine pregnancy test.
    [Show full text]
  • Pretest Obstetrics and Gynecology
    Obstetrics and Gynecology PreTestTM Self-Assessment and Review Notice Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy are required. The authors and the publisher of this work have checked with sources believed to be reliable in their efforts to provide information that is complete and generally in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical sciences, neither the authors nor the publisher nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete, and they disclaim all responsibility for any errors or omissions or for the results obtained from use of the information contained in this work. Readers are encouraged to confirm the information contained herein with other sources. For example and in particular, readers are advised to check the prod- uct information sheet included in the package of each drug they plan to administer to be certain that the information contained in this work is accurate and that changes have not been made in the recommended dose or in the contraindications for administration. This recommendation is of particular importance in connection with new or infrequently used drugs. Obstetrics and Gynecology PreTestTM Self-Assessment and Review Twelfth Edition Karen M. Schneider, MD Associate Professor Department of Obstetrics, Gynecology, and Reproductive Sciences University of Texas Houston Medical School Houston, Texas Stephen K. Patrick, MD Residency Program Director Obstetrics and Gynecology The Methodist Health System Dallas Dallas, Texas New York Chicago San Francisco Lisbon London Madrid Mexico City Milan New Delhi San Juan Seoul Singapore Sydney Toronto Copyright © 2009 by The McGraw-Hill Companies, Inc.
    [Show full text]
  • Vaginitis and Sexually Transmitted Diseases
    VAGINITIS AND SEXUALLY TRANSMITTED DISEASES Joel T. Katz, MD* Sexually transmitted diseases (STDs) are among the most in which R0 is the average number of secondary cases gener- common causes of infectious illness in the world. The Unite d ated by each primary infection in a population (i.e., the States leads industrialized nations in the occurrence of STDs, reproductive number), b is the average probability of trans- and after a slight trend downward in the 1990s, there has mission with each sexual partnership, c is the average been an upswing in STDs in the past decade, especially number of sexual partnerships formed per unit of time, and among teenagers. Currently, the annual rate of AIDS diag- D is the mean duration of infection.8 For diseases in which noses reported among males aged 15 to 19 years has nearly each case generates an average of one additional case, R0 doubled in the past 10 years, and rates for gonorrhea and equals 1 and the prevalence remains stable; values less than syphilis have also risen in this population.1 In many deve l- 1 and greater than 1 are associated with a declining or rising oping nations, STDs (excluding HIV infection) are the prevalence, respectively. second greatest cause of disability-adjusted years of life Although each of the terms in this equation is complex, lost,2 and highly prevalent bacterial and viral STDs may the simplification that the equation offers can explain a great facilitate HIV transmission.3 deal about the distribution of different STDs in a population Of the more than 30 sexually transmitted pathogens and provides a framework for conceptualizing STD epide- that are currently recognized, eight have been identified miology.
    [Show full text]
  • Laboratory Diagnosis of Sexually Transmitted Infections, Including Human Immunodeficiency Virus
    Laboratory diagnosis of sexually transmitted infections, including human immunodeficiency virus human immunodeficiency including Laboratory transmitted infections, diagnosis of sexually Laboratory diagnosis of sexually transmitted infections, including human immunodeficiency virus Editor-in-Chief Magnus Unemo Editors Ronald Ballard, Catherine Ison, David Lewis, Francis Ndowa, Rosanna Peeling For more information, please contact: Department of Reproductive Health and Research World Health Organization Avenue Appia 20, CH-1211 Geneva 27, Switzerland ISBN 978 92 4 150584 0 Fax: +41 22 791 4171 E-mail: [email protected] www.who.int/reproductivehealth 7892419 505840 WHO_STI-HIV_lab_manual_cover_final_spread_revised.indd 1 02/07/2013 14:45 Laboratory diagnosis of sexually transmitted infections, including human immunodeficiency virus Editor-in-Chief Magnus Unemo Editors Ronald Ballard Catherine Ison David Lewis Francis Ndowa Rosanna Peeling WHO Library Cataloguing-in-Publication Data Laboratory diagnosis of sexually transmitted infections, including human immunodeficiency virus / edited by Magnus Unemo … [et al]. 1.Sexually transmitted diseases – diagnosis. 2.HIV infections – diagnosis. 3.Diagnostic techniques and procedures. 4.Laboratories. I.Unemo, Magnus. II.Ballard, Ronald. III.Ison, Catherine. IV.Lewis, David. V.Ndowa, Francis. VI.Peeling, Rosanna. VII.World Health Organization. ISBN 978 92 4 150584 0 (NLM classification: WC 503.1) © World Health Organization 2013 All rights reserved. Publications of the World Health Organization are available on the WHO web site (www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: [email protected]). Requests for permission to reproduce or translate WHO publications – whether for sale or for non-commercial distribution – should be addressed to WHO Press through the WHO web site (www.who.int/about/licensing/copyright_form/en/index.html).
    [Show full text]
  • Diagnostic Value of Vaginal Discharge, Wet Mount and Vaginal
    DGGG Review 355 Diagnostic Value of Vaginal Discharge, Wet Mount and Vaginal pH – An Update on the Basics of Gynecologic Infectiology Was Fluor, Nativpräparat und pH-Wert verraten – Ein Update zu den Grundlagen der gynäkologischen Infektiologie Authors W. Frobenius1, C. Bogdan 2 Affiliations 1 Frauenklinik, Universitätsklinikum Erlangen, Erlangen 2 Mikrobiologisches Institut, Universitätsklinikum Erlangen, Erlangen Key words Abstract Zusammenfassung l" bacterial vaginosis ! ! l" vulvovaginal candidiasis The majority of uncomplicated vulvovaginal com- Die überwiegende Zahl unkomplizierter vulvo- l" trichomoniasis plaints (e.g. bacterial vaginosis, vulvovaginal can- vaginaler Beschwerden (z.B. bakterielle Vaginose, l" pelvic inflammatory disease didiasis, trichomoniasis) can be detected with un- Vulvovaginalkandidose, Trichomoniasis) lässt sich l" vaginal pH complicated basic infectiological tests and can durch eine einfache, infektiologische Basisunter- Schlüsselwörter usually be treated effectively without requiring suchung abklären und ohne weitergehende Diag- l" bakterielle Vaginose further diagnostic procedures. Tests include mea- nostik meist auch effektiv behandeln. Zu dieser l" Vulvovaginalkandidose surement of vaginal pH, preparation and assess- Untersuchung gehören die Messung des vagina- l" Trichomoniasis ment of wet mount slides prepared from vaginal len pH-Wertes, die Anfertigung und Beurteilung l" Pelvic inflammatory Disease l" vaginaler pH‑Wert or cervical discharge, and the correct clinical and eines Nativpräparats aus vaginalem bzw. zervi- microbiological classification of findings. In Ger- kalem Fluor sowie die korrekte Einordnung der many, at least in recent years, this has not been erhobenen Befunde in das klinische Bild und den sufficiently taught or practiced. As new regula- mikrobiologischen Kontext. Zumindest in tions on specialist gynecologic training in Ger- Deutschland wird dies seit Jahren zu wenig ge- Deutschsprachige many are currently being drawn up, this overview lehrt und praktiziert.
    [Show full text]
  • June 2007 Volume 1, Number 8
    jucmcov_0607ideas:final 5/21/07 3:50 PM Page 1 ™ JUNE 2007 VOLUME 1, NUMBER 8 THE JOURNAL OF URGENT CARE MEDICINE® www.jucm.com | The Official Publication of the Urgent Care Association of America IN THIS ISSUE FEATURES 11 Management of Patients Presenting with Symptoms of Vulvovaginitis 19 Bouncebacks: The Case of an 18-Year-Old Male with Hand Pain 30 UCAOA Benchmarking Survey: Addressing the Data Drought DEPARTMENTS 23 Abstracts in Urgent Care 25 Insights in Images: Clinical Challenge 33 Coding Q & A 34 Health Law 35 Occupational Medicine 40 Developing Data PUBLICATION BRAVEHEART A ciprodex:Layout 1 5/17/07 12:30 PM Page 1 HOW CAN YOU MISS? Achieve Proven Otitis Externa Cures with the #1 Otic Drop Among ENTs and Pediatricians.1,2 Based on 2 clinical trials, CIPRODEX® Otic demonstrated clinical cures in 87% and 94% of per protocol evaluable acute otitis externa (AOE) patients. And, among culture positive patients, clinical cures were 86% and 92% per protocol for CIPRODEX® Otic.1 Licensed to Alcon, Inc. by Bayer HealthCare AG. CIPRODEX is a registered trademark of Bayer AG, licensed to Alcon, Inc. by Bayer AG. Please see adjacent page for prescribing information. ©2007 Alcon, Inc. 5/07 CDX07505JA CIPRODEX® Otic is indicated in patients 6 months and older for acute otitis externa due to Staphylococcus aureus and Pseudomonas aeruginosa. CIPRODEX® Otic is contraindicated in patients with a history of hypersensitivity to ciprofl oxacin, to other quinolones, or to any of the components in this medication. Use of this product is contraindicated in viral infections of the external canal including herpes simplex infections.
    [Show full text]
  • Bacterial Vaginosis
    sexually transmitted Infections ( STI ) Hamid Emadi M.D Professor of Infectious Diseases Tehran University of Medical Sciences Sexually Transmitted Diseases "core populations" • high rates of partner change, • multiple partners, • prostitutes and their clients, • some homosexual men, • persons involved in the use of illicit drugs, particularly crack cocaine and methamphetamine STIs, are most concentrated within "core populations" • syphilis, • gonorrhea, • HIV infection, • hepatitis B, • chancroid, Other STIs are distributed more evenly throughout societies • chlamydial infections, • genital infections with HPV, • genital herpes Urethritis in Men Urethritis in men • urethral discharge, • dysuria, without frequency of urination Major STD Syndromes and Sexually Transmitted Microbial Etiologies Syndrome Microbial Etiologies Urethritis: males Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium, Ureaplasma urealyticum Trichomonas vaginalis, HSV , Adenovirus some anaerobic bacteria, (Leptotrichia/Sneathia) Coliform bacteria Initial Treatment for Patient and Partners • In practice, if Gram’s stain does not reveal gonococci, urethritis Is treated with a regimen effective for NGU, such as azithromycin or doxycycline. • The efficacy of azithromycin for treatment of M. genitalium is rapidly declining. • Alternatives include moxifloxacin and pristinamycin, (a stretogramin antibiotic available in some countries) Initial Treatment for Patient and Partners • If gonococci are demonstrated by Gram’s stain or if no diagnostic tests ar performed, treatment should include • parenteral cephalosporin for gonorrhea plus oral azithromycin, primarily Initial Treatment for Patient and Partners Treat gonorrhea: plus Treat chlamydial infection: Ceftriaxone, Azithromycin, 250 mg IM; 1 g PO; or or Cefixime, Doxycycline, 400 mg PO 100 mg bid for 7 days Management of Recurrence • If patient was re-exposed to untreated or new partner, repeat treatment of patient and partner.
    [Show full text]
  • Screening for Gynecologic Conditions with Pelvic Examination: a Systematic Review for the U.S
    Evidence Synthesis Number 147 Screening for Gynecologic Conditions With Pelvic Examination: A Systematic Review for the U.S. Preventive Services Task Force Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 5600 Fishers Lane Rockville, MD 20857 www.ahrq.gov Contract No. HHSA-290-2012-00015-I-EPC4, Task Order No. 4 Prepared by: Kaiser Permanente Research Affiliates Evidence-based Practice Center Kaiser Permanente Center for Health Research Portland, OR Investigators: Janelle M. Guirguis-Blake, MD Jillian T. Henderson, PhD, MPH Leslie A. Perdue, MPH Evelyn P. Whitlock, MD, MPH AHRQ Publication No. 15-05220-EF-1 March 2017 This report is based on research conducted by the Kaiser Permanente Research Affiliates Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. HHSA-290-2012-00015-I-EPC4, Task Order No. 4). The findings and conclusions in this document are those of the authors, who are responsible for its contents; and do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services. The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information (i.e., in the context of available resources and circumstances presented by individual patients).
    [Show full text]
  • Vaginitis Updates
    VAGINITIS UPDATE & TREATMENT PEARLS SANDY SULIK MD MEDICAL DIRECTOR PRIMARY CARE SERVICES – ST JOSEPH’S HEALTH ST JOSEPH’S FAMILY MEDICINE RESIDENCY PROFESSOR, UPSTATE MEDICAL CENTER I HAVE NO DISCLOSURES OBJECTIVES • Review the most common causes of vaginitis and treatments for each • Discuss emerging causes of vaginitis including mycoplasma genitalium and desquamative vaginitis • Discuss treatment strategies for recurrent vaginal infections VAGINITIS • One of the most frequent reasons to visit the OB/GYN office, Family Planning services, student health and primary care offices • ACCOUNTS FOR UP TO 10 MILLION OFFICE VISITS PER YEAR • Many women never get a clear diagnosis and often have recurrent symptoms • Causes discomfort and pain, days lost from work/school, discomfort with sexual functioning and issues with self image • Often associated with other STI’s, HIV, and other infections of the female genital tract VAGINITIS • Defined as a spectrum of conditions that cause vulvovaginal symptoms: • Itching • Burning • Irritation • Abnormal Discharge • Odor • Redness • Swelling • 3 Most Common etiologies of vaginitis: Trichomonas, Bacterial vaginosis, vulvovaginal candidiasis VAGINITIS – CLINICAL PRESENTATION • Inflammatory • presence of poly-morphonuclear neutrophils (PMNS) on microscopy • with physical findings of erythema and edema • Trichomonas, candidiasis, atrophic vaginitis, Mucosal erosive diseases, desquamative inflammatory vaginitis • Non-inflammatory • absence of PMNS • no erythema, no swelling with vaginal complaints of odor or
    [Show full text]
  • Clinical Practice Guideline for Syndromic Management of Patients with Sexually Transmitted Infections and Other Genital Tract Infections – 2013
    Revista Colombiana de Obstetricia y Ginecología Vol. 64 No. 2 • Abril-Junio 2013 • (126-177) ARTÍCULO DE REVISIÓN CLINICAL PRACTICE GUIDELINE FOR SYNDROMIC MANAGEMENT OF PATIENTS WITH SEXUALLY TRANSMITTED INFECTIONS AND OTHER GENITAL TRACT INFECTIOns – 2013. Guía de práctica clínica para el manejo sindrómico de los pacientes con infecciones de transmisión sexual y otras infecciones del tracto genital – 2013 Syndromic management of STI and other GTI guideline development group Received: 10 June 2012 – Accepted: 11 June 2013 ABSTRACT Results: The “Clinical Practice Guidelines” we Objective: To reduce practice variability in reproduced, including recommendations and the management of genital tract and sexually- supporting evidence for prevention, diagnosis and transmitted infections (GTI/STI) and provide treatment in terms of effectiveness and safety, health care practitioners caring for GTI/STI and follow-up for cervicitis, urethritis, genital patients with the most recent evidence regarding ulcers, vaginal discharge, scrotal inflammation and the effectiveness and safety of primary, secondary inguinal buboes. and tertiary prevention interventions alongside Conclusions: The guideline’s core recommendation creating indicators for tracking the implementation concerns patient management using a single dose of the guidelines and their impact on public health. and expedited patient treatment regarding sexual Materials and methods: A multidisciplinary partners whenever possible. The guidelines must development team was set up consisting of be updated in three years. professionals in health care and patient repre- Key words: Clinical practice guidelines, sexually- sentatives. Relevant clinical questions were posed and transmitted infection, reproductive tract infection, a search was made of the national and international cervicitis, urethritis, vaginal discharge, genital ulcer. guideline data-bases.
    [Show full text]
  • Manned OSCE File
    Manned OSCE File Done by: Allulu Alsulayhim, Atekah Kadi, Bayan AlMugheerah, Dania Alkelabi, Doaa Abdulfattah, Haifa alwael, Haneen alsubki, Hanin Bashaikh, Laila Mathkour, Layla AlBreacan, Leena Alwakeel, Maha Alghamdi, Munirah Aldofyan, Muneerah Alzayed, Njoud Alenezy, Noura AlShabib, Raneem Alghamdi, Rawan Alqahtani, Razan Alotaibi, Shahd Alsowaidan, Shatha Alghaihb, Wejdan Alzaid, Zaina Alkaff. Revised by: Laila Mathkour, Shrooq Alsomali References: . 436 Slides & Notes . 436 Doctor’s Notes. 435 teamwork . Books: Hacker and Moore’s, Ten Teacher Book . Teach me OBGYN . Geeky Medics Color Code: Important | Notes | Extra | Hacker and Moore’s Editing file: Here اللهم ﻻ سهل إﻻ ما جعلته سهﻻ وأنت تجعل الحزن إذا شئت سهﻻ سموا باهلل وتوكلوا عليه اﻻختبار بيكون سهل لطيف خفيف بإذن هللا، ر اغلب المعلومات يه من المحاضات النظرية فما راح تأخذ منكم وقت.. ر ر قولوا اللهم ﻻ سهل اﻻ ما جعلته سهﻻ وانت تجعل الحزن إذا شئت سهﻻ، رب اشح يل صدري ويرس يل امري واحلل عقدة من لسا ين يفقه قو يل. o OSCE exam is 15 stations. 5 Manned and 10 Unmanned “SAQs” stations. o This file contains manned stations only (history, examination, counseling and discussion). At these stations there will be an examiner and stimulated patient with you. While in SAQ there will be you and your paper only. o Don’t forget to check SAQ’s File after finishing this file. o This file references are previous cases, doctor notes, and theoretical lectures, most of cases came previously so please don’t skip any case. o For the history part: focus on the specific histories but please go through general history in case of any new station.
    [Show full text]