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Dysuria in Children

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101. Gonorrhoea

arthralgia, tenosynovitis, or septic arthritis. In men, if left untreated, complications include epididymitis, infertility and prostatitis. In women, complications include pelvic inflammatory disease (PID). Gonorrhoea in pregnancy is associated with spontaneous abortion and other complications. A diagnosis of gonorrhoea may be suspected on the basis of history, symptoms, and examination. In men, symptoms (such as urethral discharge and dysuria) usually develop 2–5 days after exposure. Examination (...) commonly reveals a mucopurulent or purulent urethral discharge, and less commonly epididymal tenderness or swelling. Uncomplicated urogenital infection is asymptomatic in up to 50% of women. Where present, symptoms (such as dysuria and increased or altered vaginal discharge) usually develop within 10 days. No abnormal findings are usually present on examination. Ideally, all people with suspected gonorrhoea should be referred to a genito-urinary (GUM) clinic or other local specialist sexual health

2019 NICE Clinical Knowledge Summaries

102. Pyelonephritis - acute

in pregnancy. Emphysematous pyelonephritis. Acute pyelonephritis should be diagnosed by taking a detailed medical history and conducting a physical examination. Acute pyelonephritis should be suspected in people with signs or symptoms of a urinary tract infection (for example, dysuria, frequency, urgency) accompanied by any new signs or symptoms of pyelonephritis (including fever, nausea, vomiting, or flank pain). A midstream or catheter specimen of urine should be sent for culture and sensitivity. A urine (...) acute pyelonephritis in people with signs or symptoms of a urinary tract infection (for example, dysuria, frequency, urgency) accompanied by any of pyelonephritis (including fever, nausea, vomiting, or flank pain). For information on the signs and symptoms of UTI, see the CKS topics on , and . In all people suspected of having acute pyelonephritis, arrange collection of a mid-steam urine (MSU) or catheter specimen of urine (CSU), to determine the infecting micro-organism. Obtain a urine sample

2019 NICE Clinical Knowledge Summaries

103. Urinary tract infection (lower) - women

infecting organisms. Co-morbidities such as immunosuppression. Complications of lower UTI include pyelonephritis, impaired renal function, urosepsis and in pregnancy pre-term delivery and low-birthweight. Clinical features of lower UTI include dysuria, frequency, urgency, change in urine appearance, nocturia and suprapubic discomfort. Typical features may be absent (in particular in those with underlying cognitive impairment) — UTI may present with delirium and reduced functional ability. Urinary (...) Diagnosis of UTI (lower) - women When to suspect UTI When should I suspect lower urinary tract infection? Suspect urinary tract infection (UTI) in a woman presenting with typical features of UTI (in the absence of vaginal discharge or irritation) such as : Dysuria — discomfort, pain, burning, tingling or stinging associated with urination. Frequency — passing urine more often than usual. Urgency — a strong desire to empty the bladder, which may lead to urinary incontinence. Changes in urine appearance

2019 NICE Clinical Knowledge Summaries

104. Child maltreatment - recognition and management

, hitting, throwing, burning, or suffocating. Sexual abuse involves forcing or tempting a child to take part in sexual activities. Emotional abuse includes conveying to children/young people that they are worthless, unloved, or a burden. Neglect includes the persistent failure to meet the child’s basic physical and/or psychological needs. Fabricated or induced illness involves the misrepresentation of the child as ill by the caregiver by fabricating or inducing symptoms. Healthcare professionals should (...) , children's social care should be contacted to discuss the need for a referral. If the child is thought to be in immediate danger, the police should be informed. If hospital admission is needed, the admitting paediatrician should be made aware of any safeguarding concerns. If maltreatment is considered one possible explanation for a report or clinical feature: Other alerting features of child maltreatment should be sought. Information should be obtained from other agencies and colleagues

2019 NICE Clinical Knowledge Summaries

105. Pelvic inflammatory disease

, acute bowel infection, or diverticular disease. See the CKS topics on and for more information. Complications of an ovarian cyst, such as rupture, torsion, or haemorrhage — symptoms are often of sudden onset. Urinary tract infection — often associated with dysuria and/or urinary frequency. See the CKS topic on for more information. Mittelschmerz pain. Functional pain (that is of unknown physical origin) — there may be other longstanding symptoms. Basis for recommendation Basis for recommendation

2019 NICE Clinical Knowledge Summaries

107. Chlamydia - uncomplicated genital

, purulent vaginal discharge, mucopurulent cervical discharge, deep dyspareunia, dysuria, pelvic pain and tenderness, inflamed or friable cervix. In men: dysuria, urethral discharge, urethral discomfort. Samples are taken by the following methods: In women: endocervical or vulvovaginal swab, or first-void urine sample. In men: first-void urine sample or urethral swab. Treatment should be initiated promptly in all people who test positive for chlamydia, or have symptoms or signs strongly suggestive (...) or intermenstrual bleeding. Purulent vaginal discharge. Mucopurulent cervical discharge. Deep dyspareunia. Dysuria. Pelvic pain and tenderness. Cervical motion tenderness. Inflamed or friable cervix (which may bleed on contact). Suspect chlamydia in sexually active men with: Dysuria. Mucoid or mucopurulent urethral discharge. Urethral discomfort/urethritis. Epididymo-orchitis. Reactive arthritis. Symptoms of rectal chlamydia include anal discharge and anorectal discomfort, although rectal infection is usually

2019 NICE Clinical Knowledge Summaries

108. Neutropenic sepsis

the right topic? Have I got the right topic? From age 1 month onwards. This CKS topic is largely based on the National Institute for Health and Care Excellence (NICE) clinical guideline Neutropenic sepsis: prevention and management of neutropenic sepsis in cancer patients [ ]. This CKS topic covers when to suspect and refer cases of suspected neutropenic sepsis in children over one month of age and adults in primary care. This CKS topic does not cover the recognition and referral of pregnant (...) , and notes that epidemiology data from non-specialised centres is lacking [ ]. The European Society for Medical Oncology (ESMO) guidelines state that febrile neutropenia is observed in about 8 cases per 1000 people receiving cancer chemotherapy [ ]. A prospective observational study of febrile episodes during chemotherapy-induced neutropenia in children with cancer or after haemopoietic stem cell transplantation (n = 1792 neutropenic periods) found a rate of 0.76 episodes of febrile neutropenia per 30

2019 NICE Clinical Knowledge Summaries

109. Scrotal pain and swelling

of a testicular or epididymal appendage. Testicular cancer. Squamous cell carcinoma of the scrotum. Indirect inguinal hernia. Epididymo-orchitis (including epididymitis and orchitis). Haematocele. Epididymal cyst/spermatocele. Varicocele. Hydrocele. Some boys or men may present having discovered the normal epididymis for the first time. Other causes of scrotal swelling include: Sebaceous cyst. Generalized oedema. Idiopathic scrotal oedema (mainly in children). Syphilitic gumma of the testis (round, hard (...) of lymphatic vessels (Milroy's disease). [ ; ; ] Testicular torsion Testicular torsion Testicular torsion is torsion of the spermatic cord. Torsion occurs in boys of any age, can occur in the first year of life, but most commonly in those aged 12–18 years, with peak incidence between 13–16 years. In older children and adults, testicular torsion is usually intravaginal (twisting of the cord within the tunica vaginalis). Annual incidence in the US is 1 per 4,000 males younger than 25 years of age. In 2013/14

2019 NICE Clinical Knowledge Summaries

110. Opioid dependence

, in particular, seems to promote thrombosis. Venous and arterial thrombosis can result from poor injecting technique, especially in people injecting into the groin. Poor nutrition and dental disease — people who have a history of substance use problems are more likely to have poorer oral and dental health, and may suffer from poor nutrition. Social problems, including: Crime — it is estimated that half of all recorded crime is drug related. Imprisonment. Effect on partner and children including child (...) : Supply of needles and syringes; sharing habits; knowledge of how to inject safely; correct disposal of used equipment; knowledge of HIV and hepatitis A, B, and C; issues of transmission and safer sex. For drug-misusing parents or other adults with dependent children, obtain information on the children and any drug-related risks to which they may be exposed. Medical history — current or previous physical complications of drug use such as infection with blood-borne viruses or continuing related risky

2019 NICE Clinical Knowledge Summaries

111. Sepsis

of severe illness or death, and appropriately. Ask the person/carers about: Any recent fever or rigors. Any symptoms suggesting specific infection, such as dysuria or productive cough. Clinical features suggesting dehydration, such as reduced urine output in the past 18 hours. Any altered behaviour, mental state, or cognition, such as not responding normally to social cues or waking only with prolonged stimulation, or new irritability (in children); new-onset confusion (in adults). See the CKS topic (...) recovery, and sources of information and support. Assessing and managing any complications following sepsis, such as anxiety and/or post-traumatic stress disorder; persistent fatigue; or chronic pain. Have I got the right topic? Have I got the right topic? From age 1 month onwards. This CKS topic covers when to suspect and refer cases of suspected sepsis in children over one month of age and adults in primary care. This CKS topic does not cover the detailed diagnosis or specialist management of sepsis

2019 NICE Clinical Knowledge Summaries

112. Fever in under 5s: assessment and initial management

-and- conditions#notice-of-rights). Page 17 of 401.2.3.8 Consider urinary tract infection in a child aged 3 months or older with fever and 1 or more of the following [7] : vomiting poor feeding lethargy irritability abdominal pain or tenderness urinary frequency or dysuria. [new 2013] [new 2013] 1.2.3.9 Consider septic arthritis/osteomyelitis in children with fever and any of the following signs: swelling of a limb or joint not using an extremity non-weight bearing. [2007] [2007] 1.2.3.10 Consider Kawasaki (...) Contents Overview 5 Who is it for? 5 Introduction 6 Patient-centred care 8 Key priorities for implementation 9 Thermometers and the detection of fever 9 Clinical assessment of the child with fever 9 Management by remote assessment 9 Management by the non-paediatric practitioner 10 Management by the paediatric specialist 10 Antipyretic interventions 10 1 Recommendations 12 1.1 Thermometers and the detection of fever 12 1.2 Clinical assessment of children with fever 13 1.3 Management by remote assessment

2013 National Institute for Health and Clinical Excellence - Clinical Guidelines

113. Dietary interventions for preventing complications in idiopathic hypercalciuria. (PubMed)

life stages; people with the condition are prone to developing oxalate and calcium phosphate kidney stones. In some cases, crystallised calcium can be deposited in the renal interstitium, causing increased calcium levels in the kidneys. In children, idiopathic hypercalciuria can cause a range of comorbidities including recurrent macroscopic or microscopic haematuria, frequency dysuria syndrome, urinary tract infections and abdominal and lumbar pain. Various dietary interventions have been described (...) that aim to decrease urinary calcium levels or urinary crystallisation.Our objectives were to assess the efficacy, effectiveness and safety of dietary interventions for preventing complications in idiopathic hypercalciuria (urolithiasis and osteopenia) in adults and children, and to assess the benefits of dietary interventions in decreasing urological symptomatology in children with idiopathic hypercalciuria.We searched the Cochrane Renal Group's Specialised Register (23 April 2013) through contact

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2014 Cochrane

114. Late Effects of Treatment for Childhood Cancer (PDQ®): Health Professional Version

for Childhood Cancer During the past five decades, dramatic progress has been made in the development of curative therapy for pediatric malignancies. Long-term survival into adulthood is the expectation for more than 80% of children with access to contemporary therapies for pediatric malignancies.[ , ] The therapy responsible for this survival can also produce adverse long-term health-related outcomes, referred to as late effects , which manifest months to years after completion of cancer treatment (...) to Support Survivor Care Risk-based screening The need for long-term follow-up for childhood cancer survivors is supported by the American Society of Pediatric Hematology/Oncology, the International Society of Pediatric Oncology, the American Academy of Pediatrics, the Children’s Oncology Group (COG), and the Institute of Medicine. A risk-based medical follow-up is recommended, which includes a systematic plan for lifelong screening, surveillance, and prevention that incorporates risk estimates based

2018 PDQ - NCI's Comprehensive Cancer Database

115. New Zealand Guideline for the Management of Gonorrhoea

Partner notification 39 Management of sexual partners/contacts 39 Management of gonorrhoea in children 40 Testing for N. gonorrhoeae in prepubertal children 40 When should N. gonorrhoeae testing be undertaken in prepubertal children? 41 Which specimens should be taken, and which tests should be requested? 41 Additional testing 42 Gonorrhoea typing 42 NAAT 42 Management of gonorrhoea in prepubertal children (excluding neonates) 42 For uncomplicated anogenital and pharyngeal gonorrhoea (not in neonates (...) . For more detailed discussion, see ‘Laboratory testing for N. gonorrhoeae’, page 21, and the following text. Version 2014-09-1 0 28 New Zealand Guideline for the Management of Gonorrhoea The following should be noted: ? The recommendations in this section apply to male, female, and sex- and gender-minority adults postpuberty in New Zealand. ? For prepubertal sampling, see ‘Management of gonorrhoea in children’, page 40. ? For testing of adults where recent sexual assault is a consideration, please

2014 New Zealand Sexual Health Society

116. Bacterial vaginosis

— characterized by a fishy-smelling, yellow/green frothy discharge that may be associated with itching, soreness, and dysuria. See the CKS topic on for more information. Chlamydia — can cause vaginal discharge and dysuria and does not usually present with itch. See the CKS topic on for more information. Gonorrhoea — rarely presents with itch and is associated with pain and a purulent cervical discharge. See the CKS topic on for more information. Genital herpes — may present with redness, itch, and ulceration

2018 NICE Clinical Knowledge Summaries

117. Balanitis

be suspected if there is: Penile soreness and itch, odour, and possible dysuria, difficulty passing urine, and/or dyspareunia. Redness and swelling of the glans penis (and often the foreskin) with exudate; tightening of the foreskin or meatal stenosis; phimosis. Assessment of a person with suspected balanitis should include: Asking about hygiene practices; exposure to potential irritants, allergens and new drugs; trauma, skin conditions, sexual history, and history of immunosuppression. Examining (...) with pain and burning (irritant) or itch (allergic contact dermatitis) with a persistent or recurrent red, scaly rash on the glans penis with localized swelling. Allergic contact dermatitis requires prior sensitization to chemicals such as preservatives, and is uncommon in children. See the CKS topic on for more information. Seborrhoeic dermatitis — this may present with mild itch or redness, with typical scaly lesions elsewhere on the body, such as the nasolabial folds, scalp, ears, eyebrows. See

2018 NICE Clinical Knowledge Summaries

118. Trichomoniasis

pain, dysuria, and dyspareunia. Of men with trichomoniasis, 15–50% are asymptomatic and usually present as sexual partners of infected women. The commonest symptoms are urethral discharge and/or dysuria. Other clinical features include balanitis, urethral irritation, and increased urinary frequency. The diagnosis of trichomoniasis should ideally be confirmed by a sexual health specialist. If referral is declined or not possible, the person can be tested in primary care, but results may (...) thin and scanty to profuse and thick. The classic discharge is frothy and yellow-green, and occurs in 10-30% of infected women. For other causes of vaginal discharge, see the CKS topic on . Other symptoms include: Vulval itch/vulvovaginal soreness. Offensive odour. Lower abdominal pain and dysuria. Dyspareunia. Inflammation of the vulva and vagina, or more rarely a strawberry appearance of the cervix (cervicitis) may be observed on pelvic examination. No abnormalities are found on pelvic

2018 NICE Clinical Knowledge Summaries

119. Chilblains

in children, pregnant or breastfeeding women. If no underlying cause can be identified and there are no contraindications, consider prescribing modified-release nifedipine 20-60mg daily (off-label indication). Titrate slowly up to a maximum dose of 60 mg daily depending on response and tolerability. Monitor the person's blood pressure as nifedipine may be associated with hypotension. Discontinue treatment if not tolerated or response is inadequate. Continue treatment until the lesions have healed (...) , or for the rest of the cold season if prophylaxis is indicated. Seek specialist advice if nifedipine is unsuitable or not tolerated. Do not prescribe nifedipine to children under the age of 18 years or pregnant or breastfeeding women. Advise continuation of self-care and preventative measures in addition to drug treatment. Basis for recommendations Basis for recommendation The recommendations on the management of chilblains are based on the clinical guideline Perniosis (syn. Chilblains) [ ] and expert opinion

2018 NICE Clinical Knowledge Summaries

120. Complicated urinary tract infections: ceftolozane/tazobactam

such as people with complicated lower urinary tract infection, older people or people with moderate renal impairment. Ceftolozane/tazobactam has not been studied in people with severe neutropenia, or those who are immunocompromised or who have severe renal impairment. It is not indicated for use in children (summary of product characteristics). Ceftolozane/tazobactam is administered by IV infusion. Resource implications Resource implications A vial of ceftolozane/tazobactam costs £67.03 excluding VAT (MIMS (...) to be complicated in people with increased susceptibility, Complicated urinary tract infections: ceftolozane/tazobactam (ESNM74) © NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 3 of 27for example children or older people; people with functional or structural abnormalities of the genitourinary tract or people who are immunocompromised, so that the infection will likely be severe (Frassetto 2015). Complicated urinary tract

2016 National Institute for Health and Clinical Excellence - Advice

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