Sexually Transmitted Infections: Updates From the 2021 CDC Guidelines.

Sexually transmitted infection (STI) rates are increasing for most nationally notifiable disease categories in the United States. The 2021 Centers for Disease Control and Prevention STI guidelines provide several updated, evidence-based testing and treatment recommendations. The recommended treatment for gonorrhea is ceftriaxone monotherapy given intramuscularly, with dosing based on the patient's body weight. For chlamydia, doxycycline is the preferred treatment. A test-of-cure is recommended for all cases of pharyngeal gonorrhea and for rectal chlamydia if treated with azithromycin. Vaginal trichomoniasis should be treated with a seven-day regimen of metronidazole. Treatment of pelvic inflammatory disease routinely includes metronidazole with doxycycline and an increased dosage of ceftriaxone. Syphilis of less than one year's duration should be treated with a single dose of intramuscular penicillin G benzathine, 2.4 million units. Syphilis of more than one year's or unknown duration should be treated with three consecutive weekly doses of intramuscular penicillin G benzathine, 2.4 million units each. A thorough evaluation for otic, ophthalmic, and neurologic symptoms is essential for anyone with syphilis because these complications can occur at any stage and require 10 to 14 days of treatment with intravenous aqueous crystalline penicillin G. Family physicians can reduce STI rates by taking a thorough sexual history, especially in teens and young adults, ordering screening tests and treatment based on the updated Centers for Disease Control and Prevention STI guidelines, and collaborating with public health departments for disease reporting and partner services.

The Use of Intracranial Vessel Wall Magnetic Resonance Imaging to Detect a Presumptive Syphilitic Brain Aneurysm.

ABSTRACT: Syphilitic intracranial aneurysm is a rare presentation of meningovascular syphilis in developed countries. In this case report, we discuss the utilization of the intracranial vessel wall magnetic resonance imaging in the management of a patient with a rare fusiform brain aneurysm, positive syphilis serologies, and inconclusive cerebrospinal fluid findings.

Menopause.

The menopausal transition is a time when many physical and psychological changes are occurring for women. Women may experience irregular menses, vasomotor symptoms, sleep disruption, mood disorders as well as genitourinary symptoms. Despite irregular menstrual cycles, some women can still conceive. It is important to understand what is within normal physiologic changes and what may represent pathologic changes and how to further evaluate this. There are many options available to manage menopausal symptoms when they are impacting quality of life.

Contraceptive care best practices.

These 5 practice-changing initiatives can help reduce the number of unwanted pregnancies and allow women to take more control of their reproductive health.

Adolescent pregnancy and contraception.

7% of US teen women became pregnant in 2008, totaling 750,000 pregnancies nationwide. For women ages 15 to 19, 82% of pregnancies are unintended. Adolescents have a disproportionate risk of medical complications in pregnancy. Furthermore, adolescent parents and their infants both tend to suffer poor psychosocial outcomes. Preventing unintended and adolescent pregnancies are key public health objectives for Healthy People 2020. Screening for sexual activity and pregnancy risk should be a routine part of all adolescent visits. Proven reductions in unintended pregnancy in teens are attained by providing access to contraception at no cost and promoting the most-effective methods.

Screening and prevention of sexually transmitted infections.

Sexually transmitted infections (STIs) are common and costly, in part because they are asymptomatic and result in serious complications. Primary care clinicians can easily diagnose and effectively treat most STIs. Clinicians should screen patients for STIs based on high-risk behaviors, and consult with local public health officials to adapt national screening guidelines to local epidemiology. Clinical encounters involving STI screening are opportunities to counsel patients on risk behaviors, and vaccinate against human papillomavirus and hepatitis B. Electronic health records and mobile phone apps show promise for improving the clinical care of STIs.

Cardiovascular disease in women: contraceptive issues and nonvalvular cardiovascular disease.

Several reproductive issues affect cardiovascular risk in women. Polycystic ovary syndrome is common and may include menstrual irregularities, hirsutism, and metabolic symptoms. Patients with this syndrome have an increased risk of impaired glucose tolerance and dyslipidemia. Hysterectomy is a common gynecologic surgery that may affect estrogen levels in women. There are conflicting data on the cardiovascular risk associated with estrogen use in women after a hysterectomy. Human papillomavirus is a newly identified risk factor for cardiovascular disease (CVD), but the mechanism and effect are still unknown. Contraceptives are the most commonly used prescription drugs among women in the United States. The absolute risk of CVD in young women is low; therefore, the threefold increase in risk that is associated with contraceptives is still low. Estrogen is thought to be the primary concern related to the increased cardiovascular risk associated with combined oral contraceptives. Contraceptive pills also may affect insulin, lipid, and blood pressure levels.

Reproductive health care of adolescent women.

Reproductive health care of adolescent women is focused on prevention of disease. Adolescents are at higher risk for pelvic inflammatory disease than adult women; therefore, screening regularly for sexually transmitted infections is important. Immunization for human papillomavirus is the primary means of cervical cancer prevention because new guidelines recommend not initiating Papanicolaou smears until the age of 21. Contraception for adolescents is a challenge, and clinicians should focus on long-acting, reversible contraception in this group. The treatment of pelvic pain and menstrual disorders in adolescent women is distinct from adult women and is related to differing prevalence of conditions. Lastly, this article discusses the importance of confidential care when treating adolescent women.

Emergency contraception: an underutilized resource.

This emergency contraception update and telephone triage guide can help ensure that your patients get the help they need, when they need it.

Family planning training in US family medicine residencies.

BACKGROUND AND OBJECTIVES: Family planning is among the most common services family physicians provide. Evidence that family doctors are not offering the broadest range of these services prompted this study of family planning training in family medicine residency programs. METHODS: This study was a cross-sectional survey of program directors and chief residents at US family medicine residencies accredited by the Accreditation Council for Graduate Medical Education (ACGME). The survey was adapted from the instrument used by Steinauer et al in 1995. RESULTS: Didactic and clinical training in most contraception methods is common, but large gaps remain, especially with regard to implant, diaphragm, tubal ligation, and vasectomy. Didactic or clinical training in pregnancy options counseling is available in most programs; however, it should be universal to comply with ACGME requirements. Despite an even split in attitudes toward abortion within family medicine, training remains uncommon. CONCLUSIONS: Family medicine residency programs are not offering training in the broadest range of family planning methods, and abortion training is uncommon. To address these gaps, family medicine educators need to work to increase training in all methods of contraception, including newer and procedural methods, and consider strategies for offering abortion training to interested residents.

Contraception in Wisconsin: a review.

The Contraceptive Equality Mandate took effect in Wisconsin on January 1, 2010. This mandate from the Wisconsin Office of the Commissioner of Insurance requires all insurance companies in the state of Wisconsin to cover all types of contraception, making Wisconsin the 28th state to do so. This article reviews the literature related to several types of contraception including Implanon (a newly available implantable contraception), drospirenone-containing oral contraceptive pills, and intrauterine devices. We also review evidence regarding depot medroxyprogesterone acetate and bone mineral density, and new cycling regimens for oral contraceptive pills.