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Prolapse, Urogynecology & Infections

Question
28 out of 30
 

Wife of truck driver came with complain of profuse vaginal discharge since 2 days. Syndromic management: (AIIMS MAY 2012)



A Azithromycin + metronidazole + fluconazole

B Azithromycin

C Fluconazole

D Metroniazole + Fluconazole

Ans. A
Azithromycin + metronidazole + fluconazole

1. Etiological diagnosis of STIs is problematic for health care providers in many settings.

2. It places constraints on their time and resources, increases costs and reduces access to treatment.

3. In addition, the sensitivity and specificity of commercially available tests can vary significantly Many health care facilities in developing countries lack the equipment and trained personnel required for etiological diagnosis of STIs.

4. To overcome this problem, a syndrome-based approach to the management of STI patients has been developed and promoted in a large number of countries in the developing worlD.

5. The syndromic management approach is based on the identification of consistent groups of symptoms and easily recognized signs (syndromes), and the provision of treatment that will deal with the majority of, or the most serious, organisms responsible for producing a syndrome.

6. A complaint of abnormal vaginal discharge (in terms of quantity, colour or odour) is most commonly a result of a vaginal infection.

7. It may in rare cases be caused by mucopurulent STI-related cervicitis.

8. T. vaginalis, C. albicans and bacterial vaginosis (BV) are the commonest causes of vaginal infection.

9. N. gonorrhoeae and C. trachomatis cause cervical infection.

10. The symptom of abnormal vaginal discharge is highly indicative of vaginal infection, but poorly predictive for cervical infection.

11. Thus, all women presenting with vaginal discharge should receive treatment for trichomoniasis and BV.

12. Knowledge of the local prevalence of gonococcal and/or chlamydia in women presenting with vaginal discharge is important when making the decision to treat for cervical infection.

13. The higher the prevalence, the stronger the justification for treatment.

14. Women with a positive risk assessment have a higher likelihood of cervical infection than those who are risk negative. Women with vaginal discharge and a positive risk assessment should, therefore, also be offered treatment for gonococcal and chlamydia cervicitis additionally.

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