Có 51+ tài liệu thuộc chủ đề "Harrisons Internal Medicine"
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Table 124-4 summarizes the steps in management of sexually active men with urethral discharge and/or dysuria.. Table 124-4 Management of Urethral Discharge in Men. Demonstration of urethral discharge or pyuria. Urethral Gram's stain to confirm urethritis, detect gram-negative diplococci. Initial Treatment for Patient and Partners. plus Treat chlamydial infection:. Cefpodoxime, 400 mg PO. Cefixime, 400 mg. Management of Recurrence. Confirm...
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Acute epididymitis, almost always unilateral, produces pain, swelling, and tenderness of the epididymis, with or without symptoms or signs of urethritis. This condition must be differentiated from testicular torsion, tumor, and trauma.. Torsion, a surgical emergency, usually occurs in the second or third decade of life and produces a sudden onset of pain, elevation of the testicle within the scrotal...
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Vulvovaginal Infections. Abnormal Vaginal Discharge. If directly questioned about vaginal discharge during routine health checkups, many women acknowledge having nonspecific symptoms of vaginal discharge that do not correlate with objective signs of inflammation or with actual infection. However, unsolicited reporting of abnormal vaginal discharge does suggest bacterial vaginosis or trichomoniasis. Specifically, an abnormally increased amount or an abnormal odor of...
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Symptoms or signs of abnormal vaginal discharge should prompt testing of vaginal fluid for pH, for a fishy odor when mixed with 10% KOH, and for certain microscopic features when mixed with saline (motile trichomonads and/or "clue cells") and with 10% KOH (pseudohyphae or hyphae indicative of vulvovaginal candidiasis). Additional objective laboratory tests useful for establishing the cause of abnormal...
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Bacterial Vaginosis. An interesting observation is that new genital HPV infection in young women is associated with increased subsequent risk of developing bacterial vaginosis. The use of broad-range polymerase chain reaction (PCR) amplification of 16S rDNA in vaginal fluid, with subsequent identification of specific bacterial species by various methods, has documented an even greater and unexpected bacterial diversity, including several...
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Bacterial Vaginosis: Treatment. The standard dosage of metronidazole for the treatment of bacterial vaginosis is 500 mg PO twice daily for 7 days. metronidazole with a suppository containing 500 mg of metronidazole plus nystatin (the latter not marketed in the United States) showed significantly higher rates of recurrent bacterial vaginosis with the 37.5-mg regimen. Treatment of male partners with metronidazole...
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Other Causes of Vaginal Discharge or Vaginitis. In the ulcerative vaginitis associated with staphylococcal toxic shock syndrome, Staphylococcus aureus should be promptly identified in vaginal fluid by Gram's stain and by culture. In desquamative inflammatory vaginitis, smears of vaginal fluid reveal neutrophils, massive vaginal epithelial-cell exfoliation with increased numbers of parabasal cells, and gram-positive cocci. Additional causes of vaginitis and...
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Gram's stain of cervical mucus, showing a strand of cervical mucus. This picture is typical of mucopurulent cervicitis. Note that leukocytes are not seen in areas of the slide containing vaginal epithelial cells, adjacent to the mucus strands.. Mucopurulent Cervicitis: Treatment. Although the above criteria for MPC are neither highly specific nor highly predictive of gonococcal or chlamydial infection in...
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Pleuritic upper abdominal pain and tenderness (usually localized to the right upper quadrant) develop in 3–10% of women with acute PID. Symptoms of perihepatitis arise during or after the onset of symptoms of PID and may overshadow lower abdominal symptoms, thereby leading to a mistaken diagnosis of cholecystitis. In perhaps 5% of cases of acute salpingitis, early laparoscopy reveals perihepatic...
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Overview and Clinical Approach. Pelvic Inflammatory Disease: Treatment. The 2006 CDC guidelines recommend initiation of empirical treatment for PID in sexually active young women and other women at risk for PID if they are experiencing pelvic or lower abdominal pain, if no other cause for the pain can be identified, and if pelvic examination reveals one or more of the...
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For hospitalized patients, the following two parenteral regimens have given nearly identical results in a multicenter randomized trial:. Doxycycline (100 mg twice daily, given IV or PO) plus cefotetan (2.0 g IV every 12 h) or cefoxitin (2.0 g IV every 6 h).. Administration of these drugs should be continued by the IV route for at least 48 h after...