ABSTRACT
Purpose - to draw attention to an infection that was little known, but has now become a global problem for society;to familiarize readers with the peculiarities of the 2022 monkeypox outbreak and to increase the level of alertness of doctors to this disease. Monkeypox is a global problem because the disease is spreading rapidly, covering 111 countries. Three cases were diagnosed in Ukraine. It is predominantly a self-limited infection, but there are severe and deadly complications. The lethality of this disease ranges from 0% to 11%. The course of the disease is more severe in children and people with reduced immunity. Vertical transmission of the virus from mother to child is possible, resulting in congenital monkeypox. Monkeypox is a zoonotic disease and its natural reservoir is not exactly known, but rodents are most likely to act. In most cases, person-to-person transmission of the virus occurs through close skin to skin contact, often during sexual intercourse. At the beginning of the outbreak 98% of cases of disease were was diagnosed in homo- and bisexuals. Airborne transmission is also possible. Infection is possible through close contact with infectious skin lesions. Clinically, the initial period resembles influenza, but lymphadenopathy is characteristic, which is considered a pathognomonic symptom of mpox. The rash is similar to that of chickenpox, but with more prevalent location on palms and soles than in chickenpox. In the presence of a vesicular rash in a patient, it is necessary to exclude monkeypox. PCR diagnostics of the virus in samples of vesicles or crusts has the greatest diagnostic value. Hygienic skin care is important. Antiviral drugs (tecovirimat, brincidofovir) are recommended only in severe cases. To reduce the spread of infection, international rules apply as for other infections, such as COVID-19. The monkeypox virus vaccine is recommended primarily for groups at risk of infection, including medical personnel who may come into contact with the patient or samples for laboratory testing. Being aware for this infection, following international health regulations, it is possible to prevent the further spread of monkeypox.Copyright © 2023 Tomsk State University. All rights reserved.
ABSTRACT
Androgen insensitivity syndrome has a wide spectrum of presentations. It results from a mutation in androgen receptor (AR) gene. It ranges from mild androgen insensitivity syndrome (MAIS) which is the mildest form to complete androgen insensitivity syndrome (CAIS). In case of MAIS, the abnormality that can be observed appears to be male infertility and sexual difficulties including premature ejaculation and erectile dysfunction. In this case report, we discuss a case of MAIS in a 37-year-old male who presented with infertility, premature ejaculation, and secondary erectile dysfunction.Copyright © 2023, Ibn Sina Trust. All rights reserved.
ABSTRACT
Background: Sexual health is an important component of general health. Objective(s): To evaluate sexual function and sexual quality of life (SQOL) in women during the COVID-19 pandemic. Method(s): This descriptive, cross-sectional study was conducted in Turkey. Data were collected via a Visual Analog Scale (VAS), Female Sexual Function Index (FSFI), and Sexual Quality of Life-Female (SQOL-F) questionnaire. Result(s): The mean FSFI score was 26.91+/-5.62, and 39.1% of the women had an FSFI score of 26.55 or lower. The mean SQOL-F score was 79.08+/-20.90. FSFI score was significantly associated with employment status (beta=-0.661), partner education (beta=1.698), sexual compatibility between partners (beta=0.518), sexual satisfaction (beta=0.230), fatigue level (beta=-0.120), and frequen-cy of sexual intercourse (beta=0.160). In addition, SQOL-F score was significantly associated with sexual desire (beta=2.625), satisfaction (beta=1.338), pain or discomfort (beta=1.274), age (beta=-0.356), sexual compatibility between partners (beta=1.984), and fatigue level (beta=-0.981) (p<0.05). Conclusion(s): Less than half of the women participating in this study had sexual dysfunction, and overall SQOL was moderate to high. These results were associated with some descriptive characteristics of the women and were similar to those reported in pre-pandemic studies conducted in Turkey.Copyright © The Authors.
ABSTRACT
INTRODUCTION AND OBJECTIVE: Robotic assisted radical prostatectomy (RARP) is an invaluable whole gland treatment for intermediate, high-risk prostate cancer (PCa). However, a non-negligible proportion of these patients still harbour urinary incontinence and erectile disfunction after surgery. To assess the efficacy of our rehabilitation program in these patients. METHOD(S): A two arm, retrospective study on patients who underwent a RARP at a single institution in two pre-specified time intervals, namely March-July 2019 (study group) and March-July 2020 (control group), was conducted. Patients in the study group underwent a specific rehabilitation program, consisting of counseling with a prostate case-manager, an urologist and a physiotherapist, therefore starting pelvic floor muscle training (PFMT) at least 1-month before RARP. Due to the Covid-19 pandemic restrictions, this structured program was not delivered to the control group. The primary endpoint was the assessment functional outcomes at 30 days, 3 and 6 months after surgery. Continence recovery was defined as no use of pad, while erectile function (EF) recovery was defined as erection sufficient for an intercourse. Secondary endpoints included the following: surgical waiting time (SWT;period from prostate biopsy to surgery), biochemical recurrence (BCR) and/or imaging evidence of progression. RESULT(S): We included 249 patients, 136 (54.6%) in the study group and 113 (45.4%) in the control group. At 30 days after RARP, 49 (36.0%) patients in the study group were completely continent, and 6 (4.4%) had preserved EF as compared to 8 (7.1%) and 0 (0%) in the control group (p<0.001 and p=0.072 respectively). At 3 months, 131 (96.3%) were continent and 30 (22.1%) patients had recovery of EF in the study group, compared with 77 (68.14%) and 9 (8.0%) in the control group (p<0.001). Finally, at 6 months, 134 (98.5%) were continent and 50 (36.8%) had erection sufficient for intercourse in the study group, as compared with 96 (85.0%) and 19 (16.8%) in the control group (p<0.001). Median SWT was 2.9 (2.5-3.1) in 2019 and 5.8 (5.0-7.0) in 2020, (p<0.001). Median follow-up was 42 months (43-44) in the study group vs 32 (31-32) in the control group. No significant differences were observed in the proportion of patients experiencing BCR or imaging disease progression (8.1% vs 2.7%, p>=0.05). CONCLUSION(S): Our rehabilitation program is an valuable tool to enhance functional outcomes in patients undergoing RARP. Further prospective studies are still needed to confirm our results.
ABSTRACT
Due to the risk of infection with the SARS-CoV-2 virus, as well as due to limited opportunities for intimate and sexual contact, primarily among singles and couples who live separately, there arises an increased interest in various forms of sexual interaction mediated by technology, including sexting. Previous research on this topic were mostly conducted on convenient samples and focused on the first phases of the isolation measures. This research relies on the assumption that consensual sexting can serve young people as a kind of substitute for real intimate contact during a period marked by restrictions due to the pandemic, given that young people less often live with intimate partners, have a more pronounced desire for sexual exploration, and more often have short-term relationships. The first goal of this research is to understand whether the partner relationship plays a role in the connection between the self-assessed change in the need for sexual relations and the frequency of sexting during the pandemic. The second goal is to analyze the role of the change in the need for sexual relations in the connection between the frequency of sexting and the number of sexual partners since the beginning of the pandemic. The data was collected at the beginning of February 2021 on a random sample of young people aged 18 to 25 (N=607), selected from a national Internet panel. The analysis was conducted on a sub-sample of singles and couples living separately (N=500). By controlling the socio-demographic, psycho-social and sexual characteristics of the respondents, the assumed moderating roles of the partner relationship and changes in the need for sexual relationships were not determined in the analyzes of the frequency of sexting. The obtained results do not support the assumption that sexting was a substitute for real intimate contact during the period of the coronavirus pandemic. © 2022, Croatian Sociological Association. All rights reserved.
ABSTRACT
Disease outbreaks can severely disrupt the global tourism sector. New approaches for preventing infectious diseases from emerging and spreading are urgently needed to secure the prosperity of the tourism industry. This conceptual article proposes a comprehensive framework of interrelationships between tourism and emerging infectious disease. The conceptual framework highlights the pathways in which the tourism industry itself can potentially contribute to the emergence and spread of infectious diseases, including tourism-induced land changes, sourcing meat from intensive animal farms, global movement and close proximity of people, and high-risk sexual activities. Based on the interrelationships, the framework proposes tangible managerial action recommendations for tourism businesses and policy makers to contribute to the prevention of future disease outbreaks. This paper concludes with a research agenda on how scholars can support tourism practitioners and governments in reducing the likelihood of future epidemics and pandemics.
ABSTRACT
This dissertation explores queer individuals' participation within hookup culture, the goals and motivations of those taking part in queer hookup encounters, and the ways queer individuals make sense of their hookup experiences. I analyze data from 24 semi-structured qualitative in-person and online interviews to examine LGBTQ+-identified individuals' experiences with queer hookup encounters. This dissertation offers several major contributions to the scholarship of LGBTQ+ hookup experiences. First, I find that participants talk about three discrete levels of intimacy: noncommittal hookups, "catching feelings," and third, "real relationships" or emotional connections. Second, both men and women define hookups as noncommittal sexual encounters, but in practice many are worried about or have already caught feelings. Men and women were also similar in viewing LGBTQ+ hookups as distinct from heterosexual hookups. For example, most participants note that it is more difficult for them to find hookup partners on campus. Third, I also find gender differences among by LGBTQ+ participants. Most men did not talk about forging romantic relationship out of their hookups, whereas women are more likely to discuss moving from hookup encounters to relationships. Men also talk about their partners' physical aesthetics, whereas women are more likely to value an emotional connection and are less likely to discuss their partners' physical attributes. Finally, women are more likely to discuss difficulty in knowing how and when to initiate hookups with other women. The second part of this dissertation focuses on participants' experience with hookups during the COVID-19 pandemic. Few have yet to explore LGBTQ+ hookup culture through a pandemic-focused lens. I examine how the COVID-19 pandemic has restructured dating and hookup experiences among LGBTQ+-identified college students. I find that sexual minority college students have begun to shift the type of connections they make on dating and hookup apps. These connections are less centered on sexual encounters and now focus on building relationships online that may not lead to a hookup or sexual experience. These findings suggest that dating apps have become a way for individuals to form social connections as opposed to merely a vehicle for organizing hookup encounters. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
ABSTRACT
Introduction & Objectives: Robotic assisted radical prostatectomy (RARP) is an invaluable whole gland treatment for intermediate, high-risk prostate cancer (PCa). However, a non-negligible proportion of these patients still harbour urinary incontinence and erectile disfunction after surgery. To assess the efficacy of our rehabilitation program among patient with intermediate, high-risk PCa underwent RARP. Material(s) and Method(s): A two arm, retrospective study on patients who underwent a RARP at a single institution in two time intervals, namely March-July 2019 (study group) and March-July 2020 (control group), was conducted. Patients in the study group underwent a specific rehabilitation program, consisting of counseling with a prostate case-manager, an urologist and a physiotherapist, therefore starting pelvic floor muscle training (PFMT) at least 1-month before RARP. Due to the Covid-19 pandemic restrictions, this structured program was not delivered to the control group. The primary endpoint was the assessment functional outcomes at 30 days, 3 and 6 months after surgery. Continence recovery was defined as no use of pad, while erectile function (EF) recovery was defined as erection sufficient for an intercourse. Secondary endpoints included the following: surgical waiting time (SWT), defined as period from prostate biopsy to surgery and oncological outcomes, defined as biochemical recurrence (BCR) and/or imaging evidence of progression. Result(s): We included 249 patients, 136 (54.6%) in the study group and 113 (45.4%) in the control group. No significant differences in baseline characteristics, clinical and pathological features were observed between the two groups. At 30 days after RARP, 49 (36.0%) patients in the study group were completely continent, and 6 (4.4%) had preserved EF as compared to 8 (7.1%) and 0 (0%) in the control group (p <0.001 and p=0.072 respectively). At 3 months, 131 (96.3%) were fully continent and 30 (22.1%) patients had full recovery of EF in the study group, compared with 77 (68.14%) and 9 (8.0%) in the control group (p <0.001). Finally, at 6 months, 134 (98.5%) were continent and 50 (36.8%) had erection sufficient for intercourse in the study group, as compared with 96 (85.0%) and 19 (16.8%) in the control group (p <0.001). Median SWT was 2.9 (2.5-3.1) in 2019 and 5.8 (5.0-7.0) in 2020, (p<0.001). Median follow-up was 42 months (43-44) in the study group vs 32 (31-32) in the control group. No significant differences were observed in the proportion of patients experiencing BCR or disease progression between the two groups (8.1% vs 2.7%, p>=0.05). Conclusion(s): Our rehabilitation program appears to be a valuable tool to enhance functional outcomes in patients undergoing RARP. Further prospective studies on larger populations are still needed to confirm our results.Copyright © 2023 European Association of Urology. Published by Elsevier B.V. All rights reserved.
ABSTRACT
Harmful alcohol use and sexually transmitted infections (STIs) are significant public health concerns for college students. Because alcohol use and condomless sex often co-occur in this population, alcohol-associated condomless sex has been identified as a target for behavioral interventions. Existing theoretical frameworks have not garnered sufficient empirical support to serve as the foundation for interventions. The primary goal of the current study was to use a mixed-methods approach to develop a novel model of college student alcohol-associated condomless sex that combines elements from well-established health behavior theories. In Aim 1, multilevel structural regression models were estimated to predict condomless vaginal intercourse in a sample of sexually-active college student drinkers (N = 57). An Exploratory Aiminvestigated the extent to which the model estimated in Aim 1 fit sexual activity occurring prior to the COVID-19 pandemic (N = 128). Aim 2 consisted of in-depth-interviews with a sub-sample of participants (n = 18) to gather perceptions about the role of alcohol in sexual activity and identify additional constructs pertaining to college student condom use. Quantitative results demonstrated the best-fitting model explained a significant proportion of variance in condomless vaginal intercourse at the between- and within-person level. Themes derived from the in-depth-interviews identified supplemental components of condom use decision-making. Findings from both aims were synthesized to construct a preliminary combined model of alcohol-associated condomless sex. This model can be refined in future work and ultimately serve as the theoreticalfoundation from which to develop a combination alcohol-STI prevention-intervention tailored to college students. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
ABSTRACT
Hookup culture is frequently branded as promoting female empowerment, yet many detrimental effects of hooking up have been documented for women. The present study investigates the lived experience of college women in hookup culture through a phenomenological research method, paying special attention to their experiences of empowerment and/or disempowerment. An intersectional feminist lens is utilized to include how college women's experiences with power are also shaped by multiple identities in addition to gender, such as race and sexual orientation. Additionally, this dissertation explores how the coronavirus pandemic has impacted hookup culture. Six diverse college women were interviewed, their interviews coded for themes. The seven overarching themes participants spoke about were: women as sexual objects, consent in hookup culture, communication in hookup culture, the social effects of hookup culture, the emotional effects of hookup culture, the role of the pandemic on hookup culture, and their experiences of power and identity in hookup culture. This study concludes that hookup culture is not always as advertised, with significant disempowering aspects that women are sometimes silenced from voicing. A continued power imbalance between men and women may shape the way college students interact sexually. Implications for psychotherapy, program development, and future research are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
ABSTRACT
Background: The sex ratio at birth (male live births divided by total live births) may be a sentinel health indicator. Stressful events reduce this ratio 3-5 months later by increasing male fetal loss. This ratio can also change 9 months after major population events that are linked to an increase or decrease in the frequency of sexual intercourse at the population level, with the ratio either rising or falling respectively after the event. We postulated that the COVID-19 pandemic may have affected the ratio in England and Wales. Methods: Publicly available, monthly live birth data for England and Wales was obtained from the Office for National Statistics up to December 2020. Using time series analysis, the sex ratio at birth for 2020 (global COVID-19 onset) was predicted using data from 2012-2019. Observed and predicted values were compared. Results: From 2012-2020 there were 3,133,915 male and 2,974,115 female live births (ratio 0.5131). Three months after COVID-19 was declared pandemic (March 2020), there was a significant fall in the sex ratio at birth to 0.5100 in June 2020 which was below the 95% prediction interval of 0.5102-0.5179. Nine months after the pandemic declaration, (December 2020), there was a significant rise to 0.5171 (95% prediction interval 0.5085-0.5162). However, December 2020 had the lowest number of live births of any month from 2012-2020. Conclusions: Given that June 2020 falls within the crucial window when population stressors are known to affect the sex ratio at birth, these findings imply that the start of the COVID-19 pandemic caused population stress with notable effects on those who were already pregnant by causing a disproportionate loss of male fetuses. The finding of a higher sex ratio at birth in December 2020, i.e., 9 months after COVID-19 was declared a pandemic, could have resulted from the lockdown restrictions that initially spurred more sexual activity in a subset of the population in March 2020.
Subject(s)
COVID-19 , Sex Ratio , Pregnancy , Infant, Newborn , Humans , Male , Female , Wales/epidemiology , Pandemics , COVID-19/epidemiology , Communicable Disease Control , England/epidemiologyABSTRACT
The psychodynamic therapist is both aware of and open to phenomena arising in their relationship with the patient. This paper compares two different phenomena and expands on how processing these phenomena aids the therapeutic pair: Bion's container-contained relationship and Jung's concept of the collective unconscious, which could be thought of as containing the therapeutic relationship. The two concepts will be described and elucidated using a clinical example of a therapist's dream from the collective unconscious following sudden termination in therapy. This supports a synthesis of the two concepts in a developmental context and within the wider scholarship of both thinkers. Finally, their relationships to embodied processes will be explored. Copyright © 2022 BPF and John Wiley & Sons Ltd.
ABSTRACT
BACKGROUND: Following increased rates of domestic abuse/violence (DAV) reporting during the pandemic, London's online sexually transmitted infection (STI) testing service (Sexual Health London, SHL) introduced routine DAV enquiry and directed survivors to supportive online information. SHL evaluated this adaptation. METHOD: SHL's database identified the first individuals that ordered a test-kit between 17.8.21-28.2.22 and triggered questions disclosing DAV. SHL clinicians only contacted these individuals if positive/abnormal STI results required communicating. Within these interactions DAV was opportunistically discussed and further counselling/support offered. RESULTS: 3846/231460 (1.7%) service users triggered DAV question(s). The first 202 individuals were: median age 28 yrs (18-73 yrs); 66% (134/202) female; 72% (145/202) heterosexual; 75% (152/202) UK born. 27% (55/202) reported physical/emotional abuse, 81% (164/202) coercive control, and 22% (45/202) sexual abuse. 26% (52/202) had never visited a clinic. Telephonic discussion occurred with 10% (20/202) individuals: 10/20 accepted counselling/signposting; 2/20 referred to independent DAV advocate, 6/20 stated historic abuse, 2/20 mistakenly triggered, 2/10 declined support or disengaged. Of 29% (58/202) individuals that ordered another e-kit, 38% disclosed ongoing DAV and 9% sexual assault. CONCLUSION: 1.7% e-service users reported DAV. Telephonic DAV discussion was accepted by 80% individuals contacted. Despite providing online support 38% experienced ongoing/escalating abuse. Further engagement and support for DAV survivors using e-services is required.
Subject(s)
Coronavirus Infections , Coronavirus , Domestic Violence , Sexual Health , Sexually Transmitted Diseases , Humans , Female , Adult , Pandemics , Sexually Transmitted Diseases/diagnosis , Sexually Transmitted Diseases/epidemiology , Physical AbuseABSTRACT
Harmful alcohol use and sexually transmitted infections (STIs) are significant public health concerns for college students. Because alcohol use and condomless sex often co-occur in this population, alcohol-associated condomless sex has been identified as a target for behavioral interventions. Existing theoretical frameworks have not garnered sufficient empirical support to serve as the foundation for interventions. The primary goal of the current study was to use a mixed-methods approach to develop a novel model of college student alcohol-associated condomless sex that combines elements from well-established health behavior theories. In Aim 1, multilevel structural regression models were estimated to predict condomless vaginal intercourse in a sample of sexually-active college student drinkers (N = 57). An Exploratory Aiminvestigated the extent to which the model estimated in Aim 1 fit sexual activity occurring prior to the COVID-19 pandemic (N = 128). Aim 2 consisted of in-depth-interviews with a sub-sample of participants (n = 18) to gather perceptions about the role of alcohol in sexual activity and identify additional constructs pertaining to college student condom use. Quantitative results demonstrated the best-fitting model explained a significant proportion of variance in condomless vaginal intercourse at the between- and within-person level. Themes derived from the in-depth-interviews identified supplemental components of condom use decision-making. Findings from both aims were synthesized to construct a preliminary combined model of alcohol-associated condomless sex. This model can be refined in future work and ultimately serve as the theoreticalfoundation from which to develop a combination alcohol-STI prevention-intervention tailored to college students. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
ABSTRACT
Introduction: General lockdown due to the outbreak of Corona virus is a major change in people's lives. Some mental health professionals consider it as a traumatic event with potentially serious psychiatric repercussions, especially on married couples. Objective(s): Determine the consequences of the lockdown on married couples. Method(s): An online survey conducted on social media during Mai 2020. Result(s): A total of 223 married persons filled our survey with 86,1% females. Marriage was traditional in 17%, through mutual friends and acquaintances in 0,4% and after a love story in 84,3%. Families were not consenting to the marriage in 5,4% and 28,7% of participants did not consider that they knew their partner enough prior to marriage. The mean duration of marriage was 2 years and 10 months. Having children was reported in 77,1%. Before the general lockdown, 1,79% described their relationship as "bad" compared to 5,82% during;sharing house chores raised from 56,44% to 68,44%. And taking care of children by both parents during the lockdown raised also from 55% to 67,22%. Frequency of sexual intercourse was the same in 57,4% and lower in 23,8%. The lockdown was an opportunity to discover new things in their partner for 28,4% and 19,7% did not consider the lockdown as a chance to spend more time with their partner. Conclusion(s): The lockdown gave us a chance to study the impact of the absence of social life on married couples.
ABSTRACT
Introduction: The COVID-19 pandemic and subsequent public health response resulted in unprecedented changes to society, including recommendations for social and physical distancing. Sexual dysfunction is best understood within a biopsychosocial framework, and it is reasonable to predict that biological, psychological, and social aspects of the COVID-19 pandemic may impact sexual function, particularly in a patient population actively planning pregnancy. Objective: The aim of this study was to understand the impact of the COVID19 pandemic - including COVID-19 infection, COVID-19 vaccination, and psychosocial conditions of the pandemic - on the sexual function of women receiving fertility care. Methods: Eligible patients aged 18 or older were identified using ICD codes related to female infertility and fertility testing and invited to complete an online survey regarding COVID-19 infection and vaccination status, fertility planning, and the impact of pandemic conditions on sexual function. Participants were recruited from a large academic-based fertility center and received care between April 2020 and April 2021. χ2 was used for between-group comparisons. Results: Of the 738 eligible patients, 197 participants completed the survey. Seventy-four (37.5%) participants had been pregnant within the past year and 168 (85.3%) participants had attempted to conceive in the past year. Forty-four (22.3%) participants reported prior COVID-19 infection, with 29 confirmed diagnoses and 15 suspected diagnoses. Further, 107 (54.2%) participants had been vaccinated against COVID-19, 35 (17.8%) were planning on being vaccinated, and 52 (26.4%) were not planning on being vaccinated. Participants declining vaccination cited concerns with health, fertility, pregnancy, breastfeeding, and a lack of vaccine safety data as common reasons for declining. Most (n = 180;91.4%) participants were sexually active at the time of survey, but only 25 (12.7%) reported their sex life was improved as a result of the pandemic;this did not differ in patients with or without a prior COVID-19 infection (15.9% vs. 11.8%, P=NS). These participants cited having more time with their partner, working from home, fewer outside stressors and social obligations, improved relationship dynamics and emotional bonding, and shared feelings about pandemic-related policies as reasons for improved sexual function. Of the 44 participants who had experienced COVID-19 infection, the majority (52.3%) expressed interest in returning to sexual activity within two weeks of infection. An additional 20.5% reported interest in sexual activity between two and four weeks after infection. Most (81.8%) stated that they were “not at all” or “not really” concerned about infecting their partner through intimacy or intercourse and 70.5% stated that their interest in sex was “not at all” or “not really” affected by their COVID-19 infection. Finally, 68.2% of participants reported that their ability to enjoy sex was “not at all” or “not really” affected by their COVID-19 infection. Conclusions: The majority of participants in this study did not experience improved sexual function during the pandemic, but those who did may offer insight into psychosocial and environmental factors that contribute to sexual function. The majority of participants who experienced COVID-19 infection did not report significant disruption to their sexual function as a result of their infection.
ABSTRACT
Introduction: Telemedicine utilization has grown exponentially since the start of the COVID-19 pandemic. Virtual encounters provided a safe platform to continue patient care while mitigating the spread of COVID-19. However, we present a case that highlights the limitations and challenges of telemedicine, especially amongst sexually active teenagers. Case Description: A 15-year-old female presented to the ED with worsening abdominal pain and new onset bilious emesis. Six weeks earlier, she developed diarrhea and abdominal pain which was diagnosed as C. diff colitis. During this time, she had 10 virtual encounters between her pediatrician and GI team. Antibiotics were completed for C. diff with partial improvement, but were restarted after symptoms returned. She also reported vaginal discharge that was treated empirically with antifungals. Given the onset of bilious emesis and acute worsening abdominal pain, she was directed to the ED. She tested positive for COVID-19 and computed tomography of the abdomen/pelvis showed a partial small bowel obstruction (SBO). The first HEADSS exam during this illness was done on admission;she initially denied recent sexual activity. However, when expectations around confidentiality were clarified, she disclosed sexual intercourse ten weeks ago. Chlamydia trachomatis testing was positive and diagnostic laparoscopy for her SBO revealed diffuse adhesive disease consistent with pelvic inflammatory disease (PID) and Fitz-Hugh-Curtis syndrome. Adhesions were successfully lysed, she was started on appropriate antibiotics, her abdominal pain resolved and she was discharged home. Discussion: Telemedicine allows patients access to their physicians with the click of a button. It can prevent delays in diagnosis that would otherwise occur due to the inability to come into the clinic or hospital. However, managing patients through telemedicine can be challenging;this case highlights some of the difficulties. Firstly, there is no physical exam to aid diagnosis. It can also be difficult to discuss sensitive issues over video. Even during inperson visits, confidentiality remains an important yet challenging component for adolescents. With the added component of telemedicine and more family members at home, teen privacy may be at risk and needs to be confirmed during every encounter. Despite the ease, telemedicine must be carefully utilized to ensure adequate adolescent sexual healthcare and confidentiality. Conclusion: This case illustrates a rare presentation of SBO caused by PID in an adolescent female and should remind clinicians to approach abdominal pain in a sexually active adolescent with a broad differential. Moreover, the increased utilization of telemedicine during the COVID-19 pandemic creates opportunities for patient care, though comes with its imperfections. As telemedicine is here to stay, pediatricians must recognize these current limitations to avoid delays in diagnosis and care. (Figure Presented).
ABSTRACT
CASE: A 24-year-old male without past medical history aside from high-risk sexual activity (multiple female sexual partners complicated by a distant history of chlamydia) however with frequent negative testing (recent negative HIV, syphilis RPR, and urinary gonorrhea/chlamydia RNA tests) and consistent condom use presents to an urgent care visit for 1 week history of sore throat with difficulty swallowing. The symptoms presented gradually with reported lymph node swelling of upper neck without associated cough, congestion, or fever. He denies sick contacts however there is high local transmission of COVID-19. Exam shows bilateral tonsillar swelling with right-sided white exudate and midline uvula;bilateral tender anterior cervical lymphadenopathy is present. COVID-19 PCR and Strep antigen/culture tests are negative. Patient is advised to treat symptomatically with ibuprofen and saltwater gargles for a likely viral upper respiratory tract infection. Symptoms persist without improvement;he presents again 1 week later. He now reveals that prior to this sore throat he had receptive oral intercourse with a female partner of unknown sexual history. Exam is unchanged. Repeat COVID-19 PCR test is negative. Monospot and HIV RNA tests are negative but gonorrhea RNA pharyngeal swab results positive. Patient is given IM ceftriaxone and symptoms resolve;patient tests negative on repeat swab 10 days later. IMPACT/DISCUSSION: This case demonstrates the difficulty in expeditious diagnosis of gonococcal pharyngitis without high index of suspicion. Spread primarily through receptive oral intercourse, most oropharyngeal infections with N. gonorrhoeae are asymptomatic, although symptoms shared with other common upper respiratory infections like sore throat, exudate, and cervical lymphadenopathy as well as fever may occur. Management is a single 500mg IM injection of ceftriaxone, notification of relevant partners, as well as a test of cure 7-14 days after initial treatment due to challenges of effective treatment when at this site. Expeditious diagnosis and eradication are important as pharyngeal gonococcal infections can contribute to high level of gonococcal transmission, uneradicated gonococcal infection could disseminate, and the pharynx is thought to be where horizontal transfer of gonococcal antimicrobial resistance genes commonly occurs. Given the increasing prevalence of gonococcal infections nationally and increasing rates of antimicrobial-resistant gonococcal infections, which were estimated to be 550,000 infections in 2019 and increasing when studied from 2000-2017 as per the CDC's 2019 Antibiotic Resistance Threats Report, this concern becomes increasingly urgent with time. CONCLUSION: -A high index of suspicion is required for expeditious diagnosis of gonococcal pharyngitis -A test of cure is recommended after treatment given the challenge of eradication at the pharynx -Eradication is important to decrease gonorrhea transmission and horizontal transfer of antimicrobial resistance genes.
ABSTRACT
Introduction Although Covid-19 mask wearing is no longer a legal requirement in England it is advised in healthcare settings and it is trust policy for patients and staff to wear one. The aim was to identify an association between choosing not to wear a facemask and the acquisition of an STI. Methods We carried out a retrospective analysis of 50 patients who attended Axess Sexual Health clinic at the Royal Liverpool University Hospital in March 2022. We specifically recorded whether they wore a facemask or not during the consultation. We then reviewed diagnosis of an STI in the last 3 months and recording of episodes of unprotected sexual intercourse (UPSI). Results Overall 48% (24) of patients did not wear a facemask during their consultation. 85% (22/26) of those presenting with a facemask had UPSI in the last 3 months compared with 83% (19/23, 1 unrecorded) of those with no mask. However, 56% (14/26) of those who wore a mask were diagnosed with an STI in the last 3 months compared with 67% (16/24) in those that chose not to wear a mask in clinic. Of the remaining 8 patients, 2 patients were treated empirically for M.Genitalium and 2 were treated for NSU. Discussion People who wear face masks may have a higher degree of health anxiety and may engage in testing more regularly. Those without facemasks may be more likely to engage in risk-taking behaviour or not disclose the full extent of their risk-taking.
ABSTRACT
Purpose/Background: Intestinal spirochetosis has been described as a rare source of colitis caused by the organism Brachyspira pilosicoli. It is more commonly associated with an immunocompromised host, such as those with HIV or post transplant. Spirochetosis can also afflict the immunocompetent host. Hypothesis/Aim: We describe in this case report the diagnosis of intestinal spirochetosis via colonoscopy in an immunocompetent host. They presented with abdominal pain and diarrhea and tested positive for COVID-19. Methods/Interventions: A 60- year old man with history of unprotected intercourse with men but a negative infectious workup for HIV, HSV, gonorrhea and chlamydia presented after multiple weeks of abdominal pain and diarrhea. He reported no recent travels and had a negative colonoscopy 9 years prior. 6 weeks prior to his appointment in the colorectal office, he was in the ER with a CT scan demonstrating diffuse colitis and pulmonary changes consistent with COVID. He tested positive for the virus, despite a lack of symptoms. He followed up in the clinic with ongoing symptoms. An infections workup for GI pathogens, including ova and parasites, C diff, was negative. A colonoscopy was ordered. Results/Outcome(s): The colonoscopy did not reveal any evidence of colitis. Random biopsies of the entirety of the colon were taken. The pathology revealed spirochetes in the mucosa. He was treated with metronidazole with complete resolution of his symptoms. Limitations: This is limited by a single reported instance of a relatively rare entity and in this particular instance associated with COVID infection. Conclusions/Discussion: Intestinal spirochetosis represents an unusual cause of abdominal pain and diarrhea in humans. It has been more commonly associated with immunocompromised host or in certain regions of the world, such as the India and portions of Asia. This instance in an otherwise immunocompetent male with asymptomatic COVID infection represents a unique case. Its symptoms, diagnosis by colonoscopy, and cure with metronidazole reflect the traditional presentation, diagnostic modality and treatment pathway.