CME : Your SA Journal of CPD - Volume 22, Issue 2, 2004
Volume 22, Issue 2, 2004
Author M. MoodleySource: CME : Your SA Journal of CPD 22, pp 63 –65 (2004)More Less
Cervical cancer remains a major health problem worldwide, particularly in the developing world The age at which screening should be started is controversial. <br>However, evidence from several different analyses suggests that it should start before the age of 25 years. <br>Women with HIV infection should be screened at a younger age since data on the age incidence of invasive cervical cancer show that it occurs at a younger age in these women. <br>Screening should take place every 3 - 5 years. <br>For the GP the Pap smear still remains the most practical method of cervical cancer screening.
Author S.R. RamphalSource: CME : Your SA Journal of CPD 22, pp 66 –70 (2004)More Less
Dysuria is defined as pain, burning or discomfort on urination. <br>It is commonly accompanied by frequency or urgency. <br>Pain at the start of urination suggests urethral pathology, while pain at the end of urination suggests bladder origin. <br>Haematuria is common with UTI. and is unlikely to occur with other potential causes. <br>Pyuria is the most sensitive laboratory indicator for UTI. <br>A positive nitrite test is suggestive of UTI, but a negative test does not rule out the diagnosis. <br>Other conditions which present with dysuria are cystitis, acute and subclinical pyelonephritis, urethritis, vaginitis, genital herpes, interstitial cystitis, urethral diverticulum and burning vulvar syndrome.
Author A.A. HoosenSource: CME : Your SA Journal of CPD 22, pp 72 –78 (2004)More Less
Vaginal discharges are a common problem in adult women. <br>The discharges may be physiological or pathological. <br>The common pathological causes are due to infection occurring in the cervix (cervicitis) or in the vagina (vaginitis and vaginosis). <br>The common causes of endocervicitis are the sexually transmitted pathogens of <I>Neisseria gonorrhoeae</I> and <I>Chlamydia trachomatis</I>. <br>The important causes of vaginal infection are trichomoniasis due to <I>Trichomonas vaginalis</I>, candidiasis due to <I>Candida albicans</I> and bacterial vaginosis due to proliferation of endogenous vaginal flora of <I>Gardnerella vaginalis</I>, anaerobes and <I>Mycoplasma hominis</I>. <br>Bedside tests of pH determination, whiff test and wet smear microscopy can easily diagnose vaginal infection. <br>Laboratory tests are required to confirm the causes of endocervicitis or mucopurulent cervicitis (MPC). <br>Syndromic management of vaginal discharge attempts to treat both cervical and vaginal causes. <br>Syndromic management is widely acclaimed for use in developing communities as it covers the common causes of infection at the point of first contact.
Author J.S. BagrateeSource: CME : Your SA Journal of CPD 22, pp 79 –82 (2004)More Less
The major cause of abnormal uterine bleeding is dysfunctional uterine bleeding (DUB). <br>In sexually active women presenting with menstrual aberrations, pregnancy complications must be excluded. <br>Simple explanation and reassurance should be given to adolescents with DUB regarding the functional and anatomical normality of the genital tract. <br>Breakthrough bleeding and spotting occur in 25% of women during the first 3 months of the oral contraceptive pill, but improves with ongoing use. <br>The progestogen-only pill should be taken at the same time every day as a variability of 2 - 3 hours can cause menstrual disturbances. <br>Endometrial cancer and hyperplasia are the two most important conditions that need to be excluded in perimenopausal women with abnormal uterine bleeding and a normal cervical smear. <br>Tranexamic acid and prostaglandin synthetase inhibitors reduce menstrual loss by 35 - 55%. <br>Hysteroscopy and biopsy is preferable to dilatation and curretage (D & C) as the latter is a blind procedure that samples less than 50% of the endometrium in 60% of patients and misses up to 10% of endometrial pathology and 15% of endometrial cancers.
Source: CME : Your SA Journal of CPD 22, pp 83 –86 (2004)More Less