CANDIDIASIS – DEFINITION

Yeasts commonly colonise the gastrointestinal tract and vagina. If their presence is associated with local irritation, the condition may be referred to as candidiasis, moniliasis or thrush. Candidiasis is the commonest cause of vaginitis. Candida albicans is the most common yeast found and most cases of candidiasis are due to this species. Other Candida species are occasionally found but are rarely pathogenic; Torulopsis glabrata is common and is sometimes associated with a mild vaginitis. Yeasts are not usually acquired as sexually transmitted infection.

Candidiasis may occur when the balance between host and yeast is disturbed by:

use of oral contraceptives;

use of antibiotics;

use of corticosteroids;

menstruation;

pregnancy;

diabetes mcllitus;

immunosuppression or immunodeficiency.

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HUMAN IMMUNODEFICIENCY VIRUS INFECTION – CLINICAL MANIFESTATIONS (OTHER GROUPS 2)

Subgroup E—Other conditions

Defined as the presence of other clinical conditions which may be attributable to HIV infection but not listed above.

Although this system allows for ready classification for epidemiological purposes, patients typically present with one of the following:

Pulmonary presentations

P carinii pneumonia is the commonest presentation of AIDS. It usually presents with fever, non-productive cough and increasing dyspnoea of several weeks duratioa

Other infections may present as pulmonary disease including CMV, cryptococcosis and mycobacterial disease (including tuberculosis and atypical mycobacteriosis).

Gastrointestinal presentations

Oral candidiasis and oral hairy leukoplakia occur commonly.

Oesophageal candidiasis is suggested by dysphagia with retrosternal pain accompanied by oral candidiasis.

Low volume diarrhoea with weight loss and malaise is a frequent presentation of early AIDS. In many cases no specific pathogen is found. HIV can infect bowel mucosa and may be the sole aetiological agent for diarrhoea in some cases.

Diarrhoea associated with an opportunistic infection such as cryptosporidiosis, isosporiasis, CMV, and MAI may be severe with dehydration and extreme weight loss. Stools should also be examined for other pathogens including Salmonella sp. Shigella sp, Giardia lamblia, Clostridium difficile, Campylobacter sp and various enteroviruses.

Herpes can cause oesophagitis, proctitis or severe ulcerative perianal lesions.

Kaposi’s sarcoma or lymphoma may present with gastrointestinal symptoms.

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SYPHILIS – ANTIBIOTIC TREATMENT

Parenteral penicillin is the drug of choice. Alternative antibiotics should only be used where there is a history of penicillin sensitivity.

Early syphilis

Aqueous procaine penicillin G 1.5 g daily intramuscularly for a minimum of 10 days;

Benzathine penicillin G 1.8 g intramuscularly in a single dose for patients unable to comply with daily injections, preferably repeated 7 days later.

Late latent syphilis

Aqueous procaine penicillin G 1.5 g daily intramuscularly for 15 days; OR

Benzathine penicillin 1.8 g intramuscularly at 7 day intervals for 3 doses for patients unable to comply with daily injections.

Benign gummatous syphilis

Aqueous procaine penicillin G 1.5 g daily intramuscularly for 21 days; OR

Benzathine penicillin G 1.8 g intramuscularly at 7 day intervals for 3 doses for patients unable to comply with daily injections. This should never be used in late syphilis unless the CSF is negative.

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GONORRHOEA – CLINICAL MANIFESTATIONS

The incubation period is usually 2 to 7 days but may be as short as 24 hours or as long as a month. In many patients infection is asymptomatic.

Classically gonococcal urethritis in males begins with urethral discomfort then dysuria and mucoid discharge followed by a yellow discharge which is at first turbid and then opaque and sufficiently profuse to stain the underclothes.

Without treatment, infection can spread to the posterior urethra causing pain, frequency, urgency and terminal haematuria. Further ascent can produce prostatitis and vesiculitis manifested by deep genital pain and tenderness on rectal palpation. Epididymitis may cause scrotal pain, tenderness and swelling which should not be confused with torsion of the testis. If gonococcal urethritis is not adequately treated, sequelae may include urethral stricture and chronic prostatitis or epididymitis.

Cervicitis is the commonest type of infection in females and is often asymptomatic. It may be associated with profuse discoloured vaginal discharge sometimes with vaginal or vulval irritation which may be misdiagnosed as a vulvovaginitis. In premcnarchal girls, gonococcal infection can cause a vulvovaginitis.

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FOREIGN OBJECTS; DRUG HISTORY

Foreign bodies in the colon and rectum are seen particularly among homosexual and bisexual men, having being introduced by the patient or his partner. The patient often presents after attempts to recover the object have failed. Urethral, vaginal or rectal foreign bodies may produce a variety of local symptoms.

Specific questions about prescribed and non-prescribed drag use should be included because:

(i)    antibiotics, whether prescribed or not, taken in the recent past to treat
infections or as prophylaxis, may modify the presentation and affect
microbiological tests;

(ii)    topical medication containing antibiotic, antiseptic or steroid may
affect the appearance of genital or cutaneous lesions;

(Hi) illicit intravenous drag use may result in infections particularly

hepatitis В and HIV; and (iv) various drags including steroids and recreational drugs (cocaine, marijuana, nitrites etc.) may alter immune function.

Any history of drag allergy should be sought and accurately recorded in a prominent place on the patient’s medical record.

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