tailieunhanh - Chapter 124. Sexually Transmitted Infections: Overview and Clinical Approach (Part 4)

Risk assessment is followed by clinical assessment (elicitation of information on specific current symptoms and signs of STDs). Confirmatory diagnostic tests (for persons with symptoms or signs) or screening tests (for those without symptoms or signs) may involve microscopic examination, culture, antigen detection tests, genetic probe or amplification tests, or serology. Initial syndrome-based treatment should cover the most likely causes. For certain syndromes, results of rapid tests can narrow the spectrum of this initial therapy (., wet mount of vaginal fluid for women with vaginal discharge, Gram's stain of urethral discharge for men with urethral discharge, rapid plasma reagin. | Chapter 124. Sexually Transmitted Infections Overview and Clinical Approach Part 4 Risk assessment is followed by clinical assessment elicitation of information on specific current symptoms and signs of STDs . Confirmatory diagnostic tests for persons with symptoms or signs or screening tests for those without symptoms or signs may involve microscopic examination culture antigen detection tests genetic probe or amplification tests or serology. Initial syndrome-based treatment should cover the most likely causes. For certain syndromes results of rapid tests can narrow the spectrum of this initial therapy . wet mount of vaginal fluid for women with vaginal discharge Gram s stain of urethral discharge for men with urethral discharge rapid plasma reagin test for genital ulcer . After the institution of treatment STD management proceeds to the 4 C s of prevention and control contact tracing see Prevention and Control of STIs below ensuring compliance with therapy and counseling on risk reduction including condom promotion and provision. Urethritis in Men Urethritis in men produces urethral discharge dysuria or both usually without frequency of urination. Causes include Neisseria gonorrhoeae C. trachomatis Mycoplasma genitalium Ureaplasma urealyticum Trichomonas vaginalis HSV and perhaps adenovirus. Until recently C. trachomatis caused 30-40 of cases of nongonococcal urethritis NGU however the proportion of cases due to this organism may have declined in some populations served by effective chlamydial-control programs and older men with urethritis appear less likely to have chlamydial infection. HSV and T. vaginalis each cause a small proportion of NGU cases in the United States. Recently multiple studies have consistently implicated M. genitalium as a probable cause of many Chlamydia-negative cases. Fewer studies than in the past have implicated Ureaplasma the ureaplasmas have been differentiated into U. urealyticum and U. parvum and a few studies suggest that U. .