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Infection and sexual health
Published in David M. Luesley, Mark D. Kilby, Obstetrics & Gynaecology, 2016
If a woman is at low risk of STI and has no other concerning symptoms/history it is reasonable to examine and also test the vaginal pH. If the pH is >4.5 and the symptoms fit with BV, then she can be treated as such. If the symptoms are of candida and the clinical picture fits, then she can be treated with oral or topical antifungals. A high vaginal swab is not necessary unless there are recurrent or worrying symptoms or failure of therapy.
Effect of intravaginal gentian violet for acute vaginal candidiasis treated with a single dose oral fluconazole: a randomised controlled trial
Published in Journal of Obstetrics and Gynaecology, 2022
Chenchit Chayachinda, Manopchai Thamkhantho, Popchai Ngamsakulrungroj, Charussri Leeyaphan, Orwan Tulyaprawat
After signing the informed consent, the participants were asked to be in lithotomy position for high vaginal swab and GV application. The swab was immediately spread on the Sabouraud agar plates which were sent to the laboratory centre within four hours. The participants who were assigned in FLU + GV group stay around one-minute longer in lithotomy for GV. The application technique was calibrated by using a 10 mL syringe containing 1 mL of GV; applying the speculum into vagina; inserting the syringe to around one cm in front of cervix; pushing the syringe piston; withdrawing the syringe; and slowly removing the speculum. Vaginal cleansing was strictly prohibited throughout the whole process of examination and specimen collection. A sanitary pad was provided to prevent staining from GV.
Time to re-evaluate the guidance on sexual infections in fertility services
Published in Human Fertility, 2021
Daisy Ogbonmwan, Jane Hussey, Madhavi Gudipati
Sampling for Chlamydia and Gonorrhoea using a PCR swab from the cervix is less sensitive than sampling from the vagina and therefore screening from the cervix is no longer recommended. Self-taken vulvo-vaginal swabs have consistently been shown to be more sensitive than healthcare taken vaginal swabs (Fifer et al., 2019; Nwokolo et al., 2016). Screening for TV in women can be cheaply and easily achieved by taking a high vaginal swab for culture (where NAAT testing is locally available this would be preferable) (Sherrard et al., 2014). Screening for MGen in women with suspected PID can be done using a vaginal swab (Soni et al., 2018). Urine is much less sensitive in women for screening STIs and is not recommended (BASHH Clinical Effectiveness Group, 2015).
Postpartum piriformis pyomyositis following vaginal delivery
Published in Journal of Obstetrics and Gynaecology, 2022
Josh Courtney McMullan, Sinead Sweeney, Mark Hoey, Gary Meenagh, Barry Patterson, David Morgan
On day 2 postpartum, she presented to the emergency department via ambulance with severe lower back pain and sciatica. The pain was unrelieved by simple analgesia, muscle relaxants or opioids and she was unable to mobilise secondary to the pain. On examination there was no discernible neurological deficit or signs indicative of Cauda Equina. Blood sampling revealed a raised Total White Cell Count (12.1 × 109 L) with associated neutrophilia and an elevated C-reactive protein (CRP) of 83 mg/L. Transvaginal ultrasound revealed an endometrial thickness of 15 mm, no adnexal masses and no tenderness on examination. A high vaginal swab taken during labour had cultured Group B Streptococcus.