January 25th, 2010
Epididymitis is a sexually transmitted infection in men. Most of the sexually transmitted epididymitis are acute and generally affect only on one side. Epididymitis causes pain, tenderness (pain on pressure to that part), swelling of epididymis and these symptoms may or may not be accompanied by signs and symptoms of urethritis (infection/inflammation of urethra).
What are the causative organisms of acute sexually transmitted epididymitis?
Most commonly the causative organisms of acute sexually transmitted epididymitis is Clamydia trachomatis and less commonly due to N. gonorrhea, especially in case of males below 35 years of age and sexually active.
Other conditions which should be differentiated from acute epididymitis are torsion of testis, trauma or due to tumor. In torsion of testis, which is a surgical emergency there is sudden onset of pain, the testicle is located in the scrotal sac, there is rotation of the epididymis from a posterior to an anterior position. In torsion of testis on Doppler study there is absence of blood flow to the testis. If symptoms do not subside after complete treatment with appropriate antibiotics, it suggests tumor or a granulomatous disease like tuberculosis. In trauma there is history of trauma.
Treatment of epididymitis:
The treatment of choice for acute epididymitis is ceftriaxone 250 mgs single dose intramuscularly followed by doxycycline 100 mg orally two times a day for next 10 days. This regime cures acute epididymitis due to Clamydia trachomatis as well as due to N. gonorrhea. Previously fluoroquinolones like ciprofloxacin were used, but at present not recommended due to emergence of resistance against fluoroquinolones. Levofloxacin is used sometimes if the causative organism of epididymitis is found to be Enterobacteriaceae, but it is not useful if epididymitis is due to other organisms.
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January 24th, 2010
Contact lenses are mainly used for corrective (correction of refractive errors of the eye like myopia, astigmatism, hypermetropia and presbyopia) purpose. Generally contact lenses are used for correction of myopia or short sightedness, hypermetropia or long sightedness, astigmatism (a condition where light rays are not focused on retina), and presbyopia (inability to adjust the eyes to focus on far and near objects quickly). Many individuals, especially younger generation do not want to use glasses for correcting refractive errors of the eye and prefer to use contact lens instead.
Contact lenses can be soft lens or hard lens. There are several advantages and disadvantages of using either type of contact lens (hard as well as soft lens). The advantages of using soft contact lens are the comfort of use and lesser chances of injury to the eye due to softness of the lens. The advantages of hard contact lenses are the cheaper price and longer lasting qualities of hard lens.
One of the major disadvantages of using contact lens over glasses is the chance of infection and injury to the eyes, especially if not used with proper caution with aseptic precaution and care. To overcome this common problem of contact lens, nowadays disposable contact lenses are available and very popular. Disposable soft lenses as well as disposable hard lenses is available. The disposable contact lens can reduce the incidence of infection drastically and use of disposable soft lens can cut down the incidence of injury to the eye due to use of contact lens.
Soft contact lenses are also used for therapeutic purpose e.g. use of soft contact lens to protect injured eye or cornea from constant rubbing of the cornea due to blinking, which allow the injured cornea to heal properly and faster. Contact lenses are also developed to deliver drugs in certain conditions.
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January 19th, 2010
Urethritis in men is caused by many different types of organisms and ideal treatment would be to identify the infecting organism and treat it with specific antibiotics highly effective in treating such infection. But it may not be possible in every cases of urethritis. In practice after diagnosing a case of urethritis in men, initially Gram’s staining is done, if it reveals gonococci, treatment for gonococci is done and if it does not reveal gonococci than treatment for NGU (nongonococcal urethritis) is done.
Treatment of gonococci infection:
Gonococci infection is treated with cephalosporin antibiotics. Among cephalosporin antibiotics ceftriaxone (125 mg intramuscularly single dose), cefpodoxime (400 mg orally single dose) or cefixime (400 mg orally single dose) can be used.
If no diagnostic test is available or performed in a patient with urethritis, than treatment regimen should be single-dose regimen for gonorrhea (as above) plus azithromycin (1 gram orally as single dose) or doxycycline (100 mg twice a day for 7 days) for treatment of clamidial infection (C. tracomatis) which occurs frequently in patients suffering from urethritis due to gonococci.
If gonococci are not demonstrated by Gram’s staining, it should be treated as NGU (nongonococcal urethritis) like azithromycin (1 g orally in a single dose) or doxycycline (100 mg orally 2 times a day for 7 days).
How to treat recurrent cases of urethritis?
Recurrent cases of urethritis should be treated with the same regimen as before if they did not comply with the earlier treatment or if they are reexposed to same infection. If the patient was treated appropriately previously, than an intraurethral swab specimen and a first-voided morning urine sample should be tested (culture of the swabs and antibiotic sensitivity done). If compliance to the initial treatment can be confirmed and reexposure excluded (in persistent cases) the treatment should include metronidazole or tinidazole (2 gram orally in a single dose) plus azithromycin (1 gram orally in a single dose).
N.B.- The sexual partner/partners (should be tested for gonorrhea and chlamydial infection) also should be treated with the same regimen as given to the male urethritis patient.
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