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Dysuria in Children

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101. Urological Infections

Guidelines on Paediatric Urology. In: EAU Guidelines, edition presented at the annual EAU Congress Barcelona 2019. ISBN 978-94-92671-04-2. 2. Blok, B., et al. EAU Guidelines on Neuro-urology. In: EAU Guidelines, edition presented at the annual EAU Congress Barcelona 2019. ISBN 978-94-92671-04-2. 3. Guyatt, G.H., et al. What is “quality of evidence” and why is it important to clinicians? BMJ, 2008. 336: 995. 4. Phillips B, et al. Oxford Centre for Evidence-based Medicine Levels of Evidence. Updated (...) . Immunoactive prophylaxis of recurrent urinary tract infections: a meta-analysis. Int J Antimicrob Agents, 2009. 33: 111. 128. Bauer, H.W., et al. A long-term, multicenter, double-blind study of an Escherichia coli extract (OM-89) in female patients with recurrent urinary tract infections. Eur Urol, 2005. 47: 542. 129. Schwenger, E.M., et al. Probiotics for preventing urinary tract infections in adults and children. Cochrane Database Syst Rev, 2015: CD008772. 130. Kontiokari, T., et al. Randomised trial

2019 European Association of Urology

103. Diagnosis and Management of Hymenal Variants

of thin hymenaltissuewithadarkorbluishhuecausedbythehematocolposbehindit.Otherfindingsthatmaybepresent include an abdominal mass, urinary retention, dysuria, constipation, and dyschezia. On evaluation, the goal is to differentiateanimperforatehymenfromotherobstructinganatomicetiologies,suchaslabialadhesions,urogenital sinus, transverse vaginal septum, or distal vaginal atresia. Surgical intervention is necessary only in symptomatic prepubertal patients. After confirmation of the diagnosis, surgical (...) ,dysuria,constipation,anddyschezia. Microperforateor Septate Hymen It is important to note that a microperforate hymen or septate hymen may not present as an obstruction. Often there will be menstrual efflux; however, depending on the degree of perforation or efflux, there may be retained menstrual blood with malodorous discharge, particularly withamicroperforatehymen.Mostoften,thepatientwith a microperforate or septate hymen will present when she has difficulty placing tampons, has a retained tampon

2019 American College of Obstetricians and Gynecologists

104. British Association for Sexual Health and HIV national guideline for the management of vulvovaginal candidiasis

the various international terminology used for VVC but resulted in a large number of citations (1412). • The article titles and abstracts of all 1412 citations were reviewed for relevance. Citations clearly from animal studies, non-patient based studies, single case reports, studies in children, and those on subjects not relevant to the diagnosis or management of VVC were excluded on first review. • The titles and abstracts of the remaining citations (800) were reviewed by at least two members

2019 British Association for Sexual Health and HIV

106. 34m with fever, headache and myalgias

with a UTI and prescribed doxycycline. But he discontinues this after four days as his symptoms remained unchanged. Of note, the patient denied any dysuria, urgency, abdominal pain, or flank pain at the time of this diagnosis. Two days later, he has an episode of epistaxis while blowing his nose and presents to the same outside ER for evaluation. At that point, he is found to have multiple lab abnormalities, prompting his transfer to for further care. The patient is a sanitation worker in NYC. He stays (...) in an apartment in Brooklyn during the week and travels to Long Island on the weekends to be with his wife and children. He denies any travel outside of NY. He smokes one pack per day and drinks a 6-pack of beer on weekends. Shira Based on the history so far, take a few minutes to organize your thoughts and we’ll meet back up after the break! ♫ Musical Interlude ♫ Shira Welcome back! I sat down with my friend and mentor Dr. Stephanie Sherman, an academic hospitalist at Baylor College of Medicine in Houston

2019 Clinical Correlations

107. United Kingdom National Guideline for the Management of Pelvic Inflammatory Disease (2019 Interim Update)

PID guideline V4 page 7 • urinary tract infection – often associated with dysuria and/or urinary frequency • irritable bowel syndrome – disturbance in bowel habit and persistence of symptoms over a prolonged time period are common. Acute bowel infection or diverticular disease can also cause lower abdominal pain usually in association with other gastrointestinal symptoms. • functional pain (pain of unknown aetiology) – may be associated with longstanding symptoms Management It is likely (...) - Cognitive - Mobility - Other impairment There are no data to suggest any link between this condition and disability status, although people with mental health problems are at disproportionate risk of STIs in general None identified although use of clinical tests in guideline may improve diagnostic accuracy in non verbalising patients Dept of Health Low PID guideline V4 page 20 Age - Older people - Children and young people - Young adults Young woman are disproportionately at greater risk

2019 British Association for Sexual Health and HIV

108. British Association for Sexual Health and HIV national guideline for the management of infection with Neisseria gonorrhoeae

of gonorrhoea in people aged 16 years and older. For individuals under the age of 16 years please see the BASHH guideline on STI and Related Conditions in Children and Young People. The guidelines are primarily aimed at level 3 sexual health services within the United Kingdom (UK) although the principles of the recommendations could be adopted at all levels. EDITORIAL INDEPENDENCE This guideline was commissioned and edited by the Clinical Effectiveness Group (CEG) of the British Association for Sexual (...) , on the site of infection. Co-existing infections and conditions such as Chlamydia trachomatis, Trichomonas vaginalis, Mycoplasma genitalium, Candida albicans and bacterial vaginosis, are not uncommon and these should be considered as a possible cause for an individual’s symptoms. 2.1 Penile urethral infection Symptoms occur in over 90% of individuals, with discharge and/or dysuria appearing two to five days following exposure. A mucopurulent urethral discharge is often present on examination. Rarely

2019 British Association for Sexual Health and HIV

109. The Irish Maternity Early Warning System (IMEWS) National Clinical Guideline

National Perinatal Epidemiology Centre NSP National Service Plan NWIHP National Women and Infants Health Programme ONMSD Office of the Nursing and Midwifery Services Director PEWS Paediatric Early Warning System QC-M Quality Care-Metrics QI Quality Improvement SAFE Situation Awareness for Everyone SMM Severe Maternal Morbidity TYC Test Your Care WHO World Health Organization9 | A National Clinical Guideline | Irish Maternity Early Warning System V2 1 National Clinical Guideline recommendations 1.1 (...) and the National Women and Infants Health Programme. Membership nominations were sought from a variety of clinical and non-clinical backgrounds to represent stakeholders within the maternity services. GDG members included those involved in obstetrics, midwifery, anaesthetics, neonatology, clinical risk, quality assurance, Clinical Indemnity Scheme, education, the National Women and Infants Programme and two representatives of maternity service users (Table 1). Table 1: Members of the Childbirth GDG Name Job

2019 HIQA Guidelines

110. Sepsis: How should I assess a person with suspected sepsis?

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 on for more information. Any sudden change or deterioration in functional ability. Possible for sepsis (...) , including co-morbidities and drug treatments. Possible risk factors for antibiotic resistance, such as recent or previous antibiotic therapy, previous hospital admissions, and residency in a care home, for example. Immunization status (particularly in infants and young children). Examine the person to assess for: General appearance, level of consciousness and cognition. Cognitive assessment should include recognition of new-onset confusion, disorientation, and/or agitation. See the CKS topic

2019 NICE Clinical Knowledge Summaries

111. Recurrent Uncomplicated Urinary Tract Infections in Women

imaging, cystoscopy, or other further investigation for bacterial reservoirs. The definitions used in this guideline can be found in Table 1. Copyright © 2019 American Urological Association Education and Research, Inc.® Recurrent Uncomplicated Urinary Tract Infection TABLE 1: Guideline Definitions Term Definition Acute bacterial cystitis A culture-proven infection of the urinary tract with a bacterial pathogen associated with acute-onset symptoms such as dysuria in conjunction with variable degrees (...) prevention of UTI in operative or procedural settings. Symptoms In UTI, acute-onset symptoms attributable to the urinary tract typically include dysuria in conjunction with variable degrees of increased urinary urgency and frequency, hematuria, and new or worsening incontinence. Dysuria is central in the diagnosis of UTI; other symptoms of frequency, urgency, suprapubic pain, and hematuria are variably present. Acute-onset dysuria is a highly specific symptom, with more than 90% accuracy for UTI in young

2019 American Urological Association

113. Trichomonas

dysuria, urethral irritation or discharge. Complications • Usually no complications. • In pregnancy, trichomoniasis has been associated with low birth weight, premature rupture of membranes, and preterm delivery. However, it is unclear whether treatment of asymptomatic infection in pregnancy reduces these outcomes. • Increased risk of post-surgical and post-partum infections are also associated with concurrent trichomoniasis. • Mother to child transmission during delivery is possible, but usually has (...) Asymptomatic male contacts: • Full sexual health check (see Sexual Health Check guideline www.nzshs.org/guidelines) including first void urine (first 30ml), preferably =1 hour after last void for trichomoniasis testing by NAAT if available locally • Treat empirically for trichomoniasis • Male contacts with dysuria or discharge (see Urethritis in Males guideline www.nzshs.org/guidelines) Symptomatic male contacts: • See Urethritis in Men guideline www.nzshs.org/guidelines TEST IF: • Female with vaginal

2017 New Zealand Sexual Health Society

114. Gonorrhoea

check in females • Pre-termination of pregnancy (TOP) • Pre-intrauterine device (IUD) insertion • Routine sexual health check in man who has sex with other men (MSM) • Signs or symptoms suggestive of gonorrhoea – Females: Vaginal discharge/dysuria/lower abdominal pain/abnormal bleeding/anal pain or discharge – Males: Urethral discharge/dysuria/testicular pain or swelling/anal pain or discharge Note: Most laboratories are automatically performing multiplex NAAT testing for chlamydia & gonorrhoea (...) to be symptomatic than females with endocervical infection. Symptoms and signs are non-specific. Females • Often asymptomatic, but may complain of vaginal discharge, dysuria,lower abdominal pain, abnormal bleeding, anal pain or discharge. • There may be signs of purulent urethral discharge, mucopurulent cervicitis with easily induced bleeding and/or signs of PID. Males • Males with urethral infection are usually symptomatic with discharge and dysuria (see Urethritis guideline www.nzshs.org/guidelines

2017 New Zealand Sexual Health Society

115. Sexually Transmitted Infections

are present, as friction may delay healing. • Oral to genital transmission of HSV-1 is very common through oral sex. This can happen when ‘cold sores’ are not causing symptoms. • Genital herpes does not affect your fertility or stop you having children. Vaginal delivery is usual for most women with a history of genital herpes. • Genital herpes does not stop you having sex. • Anybody with genital herpes, whether they get symptoms or have never had symptoms, may shed the virus from time to time (...) status unknown and risk factors present e.g. Maori, Pasifika, areas of high endemicity, IDU or incarceration www.hepatitisfoundation.org.nz/ Symptomatic Examination is required for clinical assessment if symptomatic of vaginal discharge, dysuria, lower abdominal pain, abnormal bleeding, anal pain or discharge, or a contact of gonorrhoea: • Examine the inguinal nodes, vulval and perianal skin, vestibule and introitus. • Vulvovaginal NAAT swab for chlamydia & gonorrhoea testing prior to speculum

2017 New Zealand Sexual Health Society

116. Balanitis: How should I assess suspected balanitis?

Balanitis: How should I assess suspected balanitis? Assessment | Diagnosis | Balanitis | CKS | NICE Search CKS… Menu Assessment Balanitis: How should I assess suspected balanitis? Last revised in October 2018 How should I assess suspected balanitis? Assess for clinical features which may suggest specific of balanitis. Ask about: and their onset and duration, including dysuria, pain, itch, bleeding, splitting, dyspareunia, sexual dysfunction, urethral discharge or exudate. Additional symptoms (...) such as joint problems or eye involvement (may suggest Reiter's syndrome or infection). Hygiene practices, for example, how often nappies are changed in children, or how often the penis is cleaned. Exposure to potential irritants or allergens, such as soaps, bubble bath, detergents, or creams; latex condoms or lubricants. Exposure to new drugs (may suggest a drug eruption) and any over-the-counter treatments tried. Trauma, for example from 'foreskin fiddling' in children; or during sexual intercourse

2018 NICE Clinical Knowledge Summaries

117. Lichen Sclerosus

), especially in children, causing constipation.(Marren 2005) Soft stools after a fiber rich diet may help. Lichen sclerosus in men and boys usually occurs on the glans penis and/or foreskin, with a predilection in the perifrenular aerea, and may cause phimosis in a previously retractable foreskin or adhesions of the foreskin to the glans causing dysuria or painful erection. Perineal involvement in men is rarely observed. Meatal stenosis may lead to problems passing urine and urinary obstruction; urethral (...) be superimposed, and these should be treated. Histological features A biopsy is not necessary in all patients in particular if the clinical picture is diagnostic. In children a vulval biopsy is not usually performed, because it may be very traumatic for the child. It should be reserved for cases with an uncertain diagnosis and thosewho fail to respond to treatments.(Neill 2010) Typical histological features of LS are orthohyperkeratosis, epidermal atrophy, basal cell degeneration, dermal hyalinisation

2018 European Dermatology Forum

118. Pentosan polysulfate sodium (Elmiron) - Interstitial Cystitis

on Paediatric requirements Not applicable Information relating to orphan market exclusivity Similarity Pursuant to Article 8 of Regulation (EC) No. 141/2000 and Article 3 of Commission Regulation (EC) No 847/2000, the applicant did not submit a critical report addressing the possible similarity with authorised orphan medicinal products because there is no authorised orphan medicinal product for a condition related to the proposed indication. Protocol Assistance The applicant received protocol Assistance (...) . Introduction The finished product is presented as hard capsules containing 100 mg of pentosan polysulfate sodium as active substance. Other ingredients of the capsule contents are microcrystalline cellulose and magnesium stearate. Ingredients of the capsule shell are gelatin and titanium dioxide (E171). The product is available in HDPE bottle with a tamper-evident PP child resistant closure and PVC/Aclar- Aluminium blisters, as described in section 6.5 of the SmPC. 2.2.2. Active Substance General

2017 European Medicines Agency - EPARs

119. Padeliporfin (Tookad) - prostate cancer / Prostatic Neoplasms

refers to: Article 8.3 of Directive 2001/83/EC - complete and independent application. The applicant indicated that padeliporfin was considered to be a new active substance. The application submitted is composed of administrative information, complete quality data, non-clinical and clinical data based on applicants’ own tests and studies and/or bibliographic literature substituting/supporting certain tests or studies. Information on Paediatric requirements Pursuant to Article 7 of Regulation (EC

2017 European Medicines Agency - EPARs

120. British Association for Sexual Health and HIV national guideline for the management of infection with Mycoplasma genitalium

malformations. Paediatr Perinat Epidemiol, 2009. 23(1): p. 18-28. 87. Briggs, G.G., Drug effects on the fetus and breast-fed infant. Clin Obstet Gynecol, 2002. 45(1): p. 6-21. 88. Horne, H.W., Jr. and R.B. Kundsin, The role of mycoplasma among 81 consecutive pregnancies: a prospective study. Int J Fertil, 1980. 25(4): p. 315-7. 89. Czeizel, A.E. and M. Rockenbauer, Teratogenic study of doxycycline. Obstet Gynecol, 1997. 89(4): p. 524-8. 90. Kelsey, J.J., et al., Presence of azithromycin breast milk (...) sexual contact and risk of reinfection) of individuals with disease caused by M. genitalium infection should be tested and/or offered epidemiological treatment (using the same antimicrobial regimen as used in the index patient). This is to reduce the risk of re-infection in the index case. 8 3. Clinical Features 3.1 Signs and symptoms in males: [3] None – the majority are asymptomatic [27] Urethral discharge Dysuria Penile irritation Urethral discomfort Urethritis (acute, persistent, recurrent

2018 British Association for Sexual Health and HIV

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