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 following criteria for PID: cervical motion tenderness, uterine tenderness, or adnexal tenderness.
Women with suspected PID can be treated as either outpatients or inpatients.
Treat urethritis promptly, while test results are pending.
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
Usual initial evaluation
Chlamydia trachomatis pyuria Neisseria gonorrhoeae
Demonstration of urethral discharge or
Mycoplasma genitalium complications
Urethral Gram's stain to confirm urethritis, detect gram-negative diplococci
Test for N. gonorrhoeae, C.
Adolescents who become pregnant prior to
completion of their education typically face
expulsion from school, and those who give
birth often are not readmitted. In many African
societies for example, once a young woman
has given birth she is regarded as an adult, a
role that is generally perceived as
incompatible with continued formal educa-
tion. In the event that a young woman is
forced to abandon her education due to early
pregnancy, she likely faces curtailment of her
social, intellectual and economic develop-
Each mental health professional’s life offers a personal opportunity to diminish the sense of
bafflement about how health, suffering, and recovery processes work. Over decades of
work in a mental health field, many of us develop the sense that we better understand
some aspects of psychology and psychopathology. Those who devote themselves to one
subject in a scholarly research fashion seem to have a slightly greater potential to remove
some of the mystery for themselves and others in a particular subject area.
Pathways that control erection and detumescence. A. Erection is mediated by cholinergic parasympathetic pathways, and nonadrenergic,
noncholinergic (NANC) pathways, which release nitric oxide (NO). Endothelial cells also release NO, which induces vascular smooth-muscle cell relaxation, allowing enhanced blood flow, and leading to erection. Detumescence is mediated by sympathetic pathways that release norepinephrine and stimulate α-adrenergic pathways, leading to contraction of vascular smooth-muscle cells. Endothelin, released from endothelial cells, also induces contraction.
Chapter 124. Sexually Transmitted Infections: Overview and Clinical Approach (Part 21)
Although gonorrhea is now substantially less common than chlamydial infection in industrialized countries, screening tests for N. gonorrhoeae are still appropriate for women and teenage girls attending STD clinics and for sexually active teens and young women from areas of high gonorrhea prevalence. Multiplex NAATs that combine screening for N. gonorrhoeae and C. trachomatis in a single low-cost assay now facilitate the prevention and control of both infections in populations at high risk.
The study provides information on key reproductive and sexual health indicators in young women
and men age 15-24 in 38 developing countries. The data come from Demographic and Health Surveys
(DHS) and AIDS Indicator Surveys (AIS) conducted between 2001 and 2005. Indicators are selected for
the following key areas: background characteristics; adolescent pregnancy; contraception; sexual activity;
and HIV/AIDS-related knowledge, attitudes, and behaviors. Additional analysis examines the association
of various individual and household characteristics with the key indicators.
The neighborhoods and communities that adolescents live in may also influence their
reproductive health behaviors. Numerous studies show that adolescents living in disadvantaged
communities with high poverty rates and low levels of socioeconomic status have a greater risk
of early sexual initiation and a greater risk of adolescent pregnancy and childbearing (Brewster,
Billy, & Grady, 1993; Hogan & Kitagawa, 1985; Sucoff & Upchurch, 1998). Alternately, living
in a community with higher socioeconomic status is associated with a reduced risk of risky
as mentioned, sexual and reproductive health is a
unique sub-sector, due to its close association with
important and sensitive socio-cultural factors and
gender roles which define and prescribe appropriate
opportunities and avenues of action. the field is
uniquely sensitive and therefore must involve explicit
exploration across all areas of activity of some critical
cross cutting issues – among them gender, adolescent
health, sexually transmitted infections and HIV/AIDs.
During the conflict and civil war in the 1980s and 1990s, particularly between 1992 and
1995, armed factions turned the traditional norms of honor and shame into weapons of
war, engaging in rape and sexual assault against women of opposing groups as an ultimate
means of dishonoring entire communities and reducing people's capacities to resist military
advances.2 In response, concerns about women's security led to the imposition of ever
stricter interpretations of what constitutes socially acceptable behavior, supported by the
most conservative reading of the holy scriptures.
Including urinary issues in the gynecologic evaluation is helpful. Urinary
tract infections (UTIs) are one of the most common reasons to seek medical
care and are sometimes triggered by sexual activity. Urinary incontinence is
an increasingly recognized health problem (see Chapter 10).
Finally, because domestic violence is common (2), screening for current or
previous physical, emotional, or sexual abuse is an important part of the pa-
tient’s history and in some states is mandatory.
P ain is an inevitable part of the human experience. We are born frail
and vulnerable, and maturation does little to change our condition. Re-
gardless of age, we have practically no natural protection from attacks by
predators or even from the environment in harsh weather conditions.
What keeps us safe is our intelligence and the ability to come up with
methods to protect our soft skin, easily broken bones, and vulnerable vi-
tal organs. In fact, we humans live in mortal fear of even the slightest
wound, and we have devised elaborate mechanisms to protect ourselves.
EU enlargement, the CAP reform, changing consumer demands and globalization have also
impacted negatively on the agricultural sector (Rudmann, 2008), with the scale of support
provided to farmers drastically reduced (Alsos, Carter, Ljunggren & Welter, 2011). A
gradual decline in income from traditional farming activities has forced many farming
businesses to diversify in order to remain viable. Diversification requires farmers to combine
other, typically non-agricultural activities with their core farm business.
There were no patients in whom water intoxication developed or who needed
transfusions perioperatively. Bladder neck contracture, which developed three to four
months postoperatively, was the most frequent complication (49 cases, 32.7%). Other
complications included pubic osteitis (2 cases), bladder tamponade (2 case), acute
epididymitis (3 case), pulmonary embolism (1 case), and rectourethral fistula (1 case).
Erectile function was preserved after the first operation in 26 (60.5%) of the evaluated 38
sexually active patients.
An understanding of the patient’s current and past sexual activity aids in
assessment of sexually transmitted disease risk and contraceptive needs. The
physician should strive to avoid assumptions about a patient’s sexuality. One
way is to ask, “Are you sexually active with men, women, or both?” Similarly,
inquiring whether the patient is interested in contraception rather than as-
suming a patient is only choosing between birth control methods will lead to
a more productive interaction. Current and prior expression of sexual identity
In all regions, knowledge of any method of contraception is high among young women and nearly
universal among young men. However, knowledge of multiple methods is lower among young women
and men in sub-Saharan Africa than their counterparts in other regions. Current use of modern
contraception among married youth is lowest in sub-Saharan Africa. Overall, although sexually active,
unmarried young women are more likely to use modern contraceptive methods, they also have higher
levels of unmet need for contraception compared to currently married young women.
Several sexuality education programs have been evaluated, and many include a combination of
abstinence messages for sexually inexperienced teens and messages about contraceptive use for
sexually experienced teens. Slightly more than half of these programs show some positive
impacts on reproductive health outcomes for at least some populations (Aarons et al., 2000;
Eisen, Zellman & McAlister, 1990; Kirby, 2001; Thomas et al., 1992).
A complete medical history is perhaps the single most important part of the evaluation of the patient with unexplained jaundice. Important considerations include the use of or exposure to any chemical or medication, either physicianprescribed, over-the-counter, complementary or alternative medicines such as herbal and vitamin preparations, or other drugs such as anabolic steroids. The patient should be carefully questioned about possible parenteral exposures, including transfusions, IV and intranasal drug use, tattoos, and sexual activity. ...
Chapter 124. Sexually Transmitted Infections: Overview and Clinical Approach (Part 12)
Gram's stain of cervical mucus, showing a strand of cervical mucus
containing many polymorphonuclear leukocytes. 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.