doi:10.1111/jog.13831 J. Obstet. Gynaecol. Res. 2019 Guidelines for office gynecology in Japan: Japan Society of Obstetrics and Gynecology (JSOG) and Japan Association of Obstetricians and Gynecologists (JAOG) 2017 edition Ryuji Kawaguchi1 , Koji Matsumoto2, Shigeo Akira3, Ken Ishitani4, Kazuhiro Iwasaku5, Yutaka Ueda6, Ryugo Okagaki7, Hiroya Okano8, Toshimichi Oki9, Kaori Koga10, Michiko Kido11, Takumi Kurabayashi12, Yasushi Kuribayashi13,YuichiSato14, Kaori Shiina15, Yasushi Takai16, Satoshi Tanimura17, Osamu Chaki18, Masakazu Terauchi19, Yukiharu Todo20, Yasuyuki Noguchi21, Sayaka Nose-Ogura22, Tsukasa Baba23,AkiraHirasawa24, Takuma Fujii25,TsuneoFujii26, Tetsuo Maruyama27, Etsuko Miyagi28, Kaoru Yanagida29, Osamu Yoshino30, Mitsutoshi Iwashita31, Tsugio Maeda32, Takashi Minegishi33 and Hiroshi Kobayashi1 1Department of Obstetrics and Gynecology, Nara Medical University, Kashihara, 2Department of Obstetrics and Gynecology, Showa University School of Medicine, 3Department of Obstetrics and Gynecology, Nippon Medical School, 4Department of Obstetrics and Gynecology, Kitasato University Kitasato Institute Hospital, 8Iidabashi Ladies Clinic, 10Department of Obstetrics and Gynecology, The University of Tokyo, 11Department of Obstetrics and Gynecology, Japanese Red Cross Medical Center, 13Center for Reproductive Medicine and Endoscopy, Sugiyama Clinic Marunouchi, 19Department of Women’s Health, Tokyo Medical and Dental University, 22Japan Institute of Sports Sciences, 27Department of Obstetrics and Gynecology, Keio University School of Medicine, 31Department of Obstetrics and Gynecology, Kyorin University School of Medicine, Tokyo, 5Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine, School of Nursing, 23Department of Obstetrics and Gynecology, Kyoto University Graduate School of Medicine, Kyoto, 6Departments of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, 7Department of Obstetrics and Gynecology, Faculty of Medicine, Saitama Medical University, Saitama, 9Department of Reproductive Health Nursing, School of Health Science, Faculty of Medicine, Kagoshima University, Kagoshima, 12Department of Obstetrics and Gynecology, Niigata City General Hospital, Niigata, 14Department of Obstetrics and Gynecology, Tatedebari Sato Hospital, Takasaki, 15Udagawa Gynecological Clinic, Chiba, 16Department of Obstetrics and Gynecology, Saitama Medical Center/Saitama Medical University, Kawagoe, 17Department of Obstetrics and Gynecology, Toyama Central Prefectural Hospital, 30Department of Obstetrics and Gynecology, University of Toyama, Toyama, 18Department of Obstetrics and Gynecology, Yokohama Rosai Hospital, 28Department of Obstetrics and Gynecology, Yokohama City University Hospital, Yokohama, 20Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, Sapporo, 21Department of Obstetrics and Gynecology, Aichi Medical University School of Medicine, Nagakute, 24Department of Clinical Genomic Medicine. Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, 25Department of Obstetrics and Gynecology, School of Medicine, Fujita Health University, Toyoake, 26Fujii Ladies’ Clinic, Hiroshima, 29Center for IVF and Infertility, International University of Health and Welfare Hospital, Nasushiobara, 32Maeda Clinic, Yaizu and 33Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, Maebashi, Japan Abstract Six years after the first edition of The Guideline for Gynecological Practice, which was jointly edited by The Japan Society of Obstetrics and Gynecology and The Japan Association of Obstetricians and Gynecologists, the third revised edition was published in 2017. The 2017 Guidelines includes 10 additional clinical questions (CQ), which brings the total to 95 CQ (12 on infectious disease, 28 on oncology and benign tumors, 27 on Received: August 7 2018. Accepted: September 15 2018. Correspondence: Dr Ryuji Kawaguchi, Department of Obstetrics and Gynecology, Nara Medical University, 840 Shijo-cho, Kashihara 634-8522, Japan. Email: [email protected] © 2019 Japan Society of Obstetrics and Gynecology 1 http://guide.medlive.cn/ R. Kawaguchi et al. endocrinology and infertility and 28 on healthcare for women). Currently a consensus has been reached on the Guidelines and therefore the objective of this report is to present the general policies regarding diagnos- tic and treatment methods used in standard gynecological outpatient care that are considered appropriate. At the end of each answer, the corresponding recommendation level (A, B, C) is indicated. Key words: gynecologic oncology, gynecology, infections, reproductive endocrinology and infertility, urogynecology. Introduction least 80% of the Committee that prepared these guide- lines. Recommendation levels are not necessarily The Guidelines for Gynecological Practice 2017 is the based on evidence level. Their implications are as fol- third edition. It is the product of revisions that were lows: Level A indicates that implementation is included every 3 years since the publication of the strongly recommended, Level B indicates that imple- first edition in 2011. The 2017 Guidelines was jointly mentation is recommended and Level C indicates that edited and published by The Japan Society of Obstet- implementation or other action is to be considered. rics and Gynecology and The Japan Association of Some answers contain recommended tests and/or Obstetricians and Gynecologists. The Guidelines are treatments that may be difficult for some facilities to intended for use by physicians routinely involved in provide. In such cases, it is to be understood that the gynecological outpatient care. Our fundamental pol- guidelines imply that gynecologists are to ‘consult icy regarding its creation was to examine papers pub- with facilities that are able to provide the services and lished in Japan and overseas by July 2016 and identify refer and transfer patients to such facilities’. A specific and recommend testing procedures and treatment example of such a case would be ‘In cases in which methods determined to be practically applicable in at your own medical facility is incapable of providing a least 80% of the regions of the world and that had treatment, consultation with and referral to a facility benefits that greatly outweighed any potential risks that is capable of providing the treatment is A: known at the time they were published. strongly recommended, B: recommended, C: should The 2017 edition contains 95 clinical questions be considered’. (CQ). These include 10 new CQ that were added in response to needs that arose since the previous edi- tion (microwave endometrial ablation, familial cancer, Contents amenorrhea due to weight loss, care of female ath- letes, congenital uterine malformation, ovulation Chapter A. Infectious disease (CQ101–CQ112) induction methods, fertility preservation in patients Chapter B. Oncology and benign tumors (CQ201– with malignant tumors, violence and abuse by part- CQ228) ners, lifestyle-related diseases and female lower uri- Chapter C. Endocrinology and Infertility (CQ301– nary tract symptoms). In addition to Clinical CQ327) Questions and Answers, the original edition of The Chapter D. Healthcare for women (CQ401–CQ428) Guidelines for Gynecological Practice in Japan 2017 also contained key words, descriptions of implications A. Infectious disease and a reference section. These have all been omitted from this report due to space limitations. CQ101 How do we diagnose and treat chlamydial cervicitis? Answer Implications of ‘A’, ‘B’ and ‘C’ 1. Diagnose by testing for the presence of chlamydia recommendation levels in cervical swab specimens using nucleic acid amplification methods (e.g. PCR, SDA, TMA). (A) The recommendation levels are the result of compre- 2. Test for gonococcus simultaneously using nucleic hensive consideration of factors such as clinical effec- acid amplification methods. (B) tiveness, evidence, prevalence and medical economics 3. Treat with macrolide or quinolone oral antibi- and have been determined based on a consensus of at otics. (A) 2 © 2019 Japan Society of Obstetrics and Gynecology http://guide.medlive.cn/ Guidelines office gynecology in Japan 4. Determine the treatment outcome at 3 weeks after Answer the conclusion of drug administration. (B) 1. Clinical symptoms and presentation are usually 5. Recommend that the patient’s partner(s) be tested sufficient for diagnosis. Biopsy and pathological and treated. (B) evaluation can be performed when necessary. (B) 2. Treat with topical creams containing 5% imiqui- CQ102 mod. (B) How do we diagnose and treat gonococcus infection? 3. Surgical therapy involving direct excision, cryo- Answer therapy, electrocauterization and laser vaporiza- 1. Diagnose genital infection by testing for pathogens tion. (C) in cervical swab specimens using nuclei acid amplification methods or isolation culture. (A) CQ105 2. In cases in which pharyngeal gonococcal infection How do we screen for sexually transmitted infections is suspected, collect a pharyngeal specimen and (set testing)? test using the aforementioned methods. (C) Answer 3. Test for chlamydia simultaneously using nucleic 1. Test for the following four diseases: Genital chla- acid amplification methods. (B) mydia infection (cervical canal), gonococcal infec- 4. Treat with single administration of ceftriaxone tion (cervical canal), syphilis (blood) and HIV (intravenous injection) or spectinomycin (intramus- infection