Podcasts about Trichomoniasis

New treatments for Prader-Willi Syndrome and hemophilia; FDA fast tracks a chlamydia vaccine candidate; over-the-counter test cleared for identifying chlamydia, gonorrhea and trichomoniasis; semaglutide improves walking ability in patients with peripheral artery disease; and Imfinzi combo therapy approved for MIBC.    

We review Sexually Transmitted Infections and pertinent updates in diagnosis and management. Hosts: Avir Mitra, MD Brian Gilberti, MD https://media.blubrry.com/coreem/content.blubrry.com/coreem/Sexually_Transmitted_Infections_2_0.mp3 Download Leave a Comment Tags: gynecology, Infectious Diseases, Urology Show Notes Table of Contents (1:49) Chlamydia  (3:31) Gonorrhea (4:50) PID (6:14) Syphilis (8:08) Neurosyphilis  (9:13) Tertiary Syphilis (10:06) Trichomoniasis  (11:13) Herpes (12:49) HIV (14:10) PEP (15:13) Mycoplasma Genitalium  (18:00) Take Home Points Chlamydia: Prevalence: Most common STI. High percentage of asymptomatic cases (40% to 96%). Presentation: Urethritis, cervicitis, pelvic inflammatory disease (PID), prostatitis, proctitis, pharyngitis, arthritis. Importance of considering extra-genital sit...

Today we provide you with an update on the sexually transmitted infection: Trichomonas vaginalis, a protozoan which infects the vagina, urethra and paraurethral glands. It is an uncommon cause of vaginal discharge and penile urethritis and can persist for a long time if left untreated. Up to 50% of people with vaginal infections and especially people with urethral infections remain asymptomatic. Persistent trichomonas infection has been associated with facilitating the transmission of human immunodeficiency virus (HIV) and adverse poor reproductive health outcomes. Dr Christina Munzy, Professor in Infectious Diseases at University of Alabama, Birmingham, USA, will present on published clinical trial data on novel treatment against trichomoniasis. Relevant publications: Van Gerwen OT, Aaron KJ, Schroeder J, et al. Spontaneous resolution of Trichomonas vaginalis infection in men. Sexually Transmitted Infections. Published Online First: 27 June 2024. Muzny CA, Van Gerwen OT, Kaufman G, Chavoustie S. Efficacy of single-dose oral secnidazole for the treatment of trichomoniasis in women co-infected with trichomoniasis and bacterial vaginosis: a post hoc subgroup analysis of phase 3 clinical trial data. BMJ Open. 2023;13:e072071 Kissinger PJ, Gaydos CA, Seña AC, McClelland RS, Soper, Secor WE, Legendre D, Workowski KA, Muzny CA, Diagnosis and Management of Trichomonas vaginalis: Summary of Evidence Reviewed for the 2021 Centers for Disease Control and Prevention Sexually Transmitted Infections Treatment Guidelines, Clinical Infectious Diseases, Clinical Infectious Diseases, Volume 74, Issue Supplement_2, 15 April 2022 Howe K and Kissinger PJ. Single-dose compared with multidose metronidazole for the treatment of trichomoniasis in women: a meta-analysis. Sex Transm Dis 2017; 44: 29–34. Kissinger P, Muzny CA, Mena LA, et al. Single-dose versus 7- day-dose metronidazole for the treatment of trichomoniasis in women: an open-label, randomised controlled trial. Lancet Infect Dis 2018; 18: 1251–1259. Sherrard J, Pitt R, Hobbs KR, Maynard M, Cochrane E, Wilson J, Tipple C. British Association for Sexual Health and HIV (BASHH) United Kingdom national guideline on the management of Trichomonas vaginalis 2021. Int J STD AIDS. 2022 Jul;33(8):740-750. STI Guidelines Australia - Trichomoniasis Host: Dr Fabiola Martin, STI BMJ Podcast editor, a Sexual Health, HIV and HTLV Specialist, Canberra & University of Queensland, Brisbane, Australia Guest: Dr Christina Munzy, Professor in Infectious Diseases at University of Alabama, Birmingham, USA

Trichomoniasis is the most prevalent nonviral sexually transmitted infection (STI) in the United States and is more prevalent than chlamydia and gonorrhea combined. In the US, the southern states share a disproportionate burden of infection, with rates up to 14%. Infection with Trichomonas vaginalis increases risk of human immunodeficiency virus (HIV) acquisition and is associated with adverse perinatal outcomes, including preterm birth, low birth weight, and preterm premature rupture of membranes. Although 80% of infections are asymptomatic, there are no national recommendations for trichomoniasis screening in women who are HIV-negative (including pregnant women who are HIV-negative), except for incarcerated women, where screening is recommended. Plus, there is also perpetual controversy surrounding whether asymptomatic trich should be treated in pregnancy or not. Why is that? Shouldn't we always treat STIs in pregnancy? The data is a bit confusing for asymptomatic trichomoniasis. We'll review the data in this episode and we will end with some practical advice for treatment of trich in pregnancy.

It's been a little while, but for good reason: we're back with a HUGE, sprawling 4 record show with some old favorites and perhaps some new ones for all ye Terminators. Today, we're split roughly in half between black metal and grind. Side one: Gridlink returns from their long absence with an exquisite record of technical and melodic grind, while fiendish upstarts Trichomoniasis horrify with a bloated slab of grinding gorenoise. Side two: returning veterans Sielunvihollinen presents a new record of confounding but exciting black/heavy metal while Ynkleudherhenavogyon enters the arena with brackish but subtle storming pagan black metal. 0:00:00 - Intro 0:01:09 - Gridlink - Coronet Juniper (Willowtip Records) 0:41:07 - Sielunvihollinen - Helvetinkone (Hammer of Hate) 1:19:08 - Interlude - Ashbury - “The Warning” fr. Endless Skies (Ashbury Music, 1983) 1:23:05 - Trichomoniasis - Makeshift Crematoria (New Standard Elite) 2:00:48 - Ynkleudherhenavogyon - Honan Bleydh II (BC - Inverse Solar Reqvriem / tape - Analög Ragnarök / LP - Urtod Void / CD - Dark Adversary) 2:44:29 - Outro - Forest - “The Flames and The Ash before Horizons Opened Wide,” fr. Forest (Independent, 1996) Terminus links: Terminus on Youtube Terminus on Patreon Terminus on Instagram Terminus on Facebook thetrueterminus@gmail.com

Trichomoniasis has been found in every continent and climate without showing any significant seasonal variability. According to the CDC, trichomoniasis is estimated to be the most prevalent nonviral STI worldwide, affecting approximately 2.6 million persons in the United States. Conditions shown to be associated with T vaginalis infection include: Increased risk of HIV acquisition and transmission, increased prevalence of other sexually transmitted infections, adverse outcomes of pregnancy (eg, preterm delivery, preterm prelabor ROM), pelvic inflammatory disease, and infertility. Nonetheless, despite this potential morbidity, T. Vaginalis remains a non-reportable communicable illness. Why is that? In this episode we will summarize the data and look into the CDC's rationale for that decision.

This week's episode is sponsored by Better Help.Your favorite aunties Bridget Kelly and Mandii B are joined by a fan favorite and recurring friends with benefits Antoinette for some Grown, Honest, and Slightly Toxic conversations. (33:00) In the Grown Segment the ladies talk about: (34:00) Trichomoniasis, a very common STD that many people mistake for for a yeast infectionLittle Caesars founder Mike Ilitch paid Rosa Parks rent for 10 years The history behind the formation of some prominent HBCU'SThe rich Black history in Oklahoma (50:00) Ja Morant's suspension (43:00) Honest Segment Philadelphia highschool Principal withholding graduation diplomas for dancing on stage. What does policing Black joy look like? (1:03:00) Slightly Toxic Segment (TRIGGER WARNING) YK Osiris and Sukihana and the larger conversation it has amplified about assault and harassment against women.Bi-racial debate is not monolithic: Amber Rose Vs. Joseline Hernandez (1:46:00) Freshly Squeezed: New Music Doja Cat- Attention August 08- BruisesVictoria Monet- On My Mama —----------------LINKS:

Dr. Caoimhe Hartley, GP

In this second part of STI chit chat I discuss the other 4 most popular STIs found around the United States; HPV, hepatitis B, Syphilis, and Trichomoniasis plus Pubic Lice/Crabs, because why not? January is cervical cancer awareness month, so this episode comes at a great time for you to make sure your paps are up to date & go get it done if you're due!*Note: Mississippi Rug Burn = syphilis. It has only been speculated that Hitler had syphilis, there is no proof but based on medical professionals investigating his later life, it is believed his symptoms mimicked that of neurosyphilis. Also speculated that a Jewish prostitute was the one who gave it to him... she's the real MVP.

Dr. John Toney, Professor of Medicine at the USF Morsani College of Medicine, presents this STI treatment refresher updated for 2022-2023. Dr. Toney begins by reviewing the new changes to the latest 2021 STI guidelines (updated from 2015). He next discusses Chlamydia and Neisseria, Chancroid and LGV. Next, he discusses syphilis. Topics discussed related to syphilis includes differentiating primary, secondary, and latent disease, diagnostic testing and treatment. Dr. Toney closes by discussing genital Herpes and Trichomoniasis.

This episode covers trichomoniasis.Written notes can be found at https://zerotofinals.com/obgyn/gum/trichomoniasis/ or in the genitourinary medicine section of the Zero to Finals obstetrics and gynaecology book.The audio in the episode was expertly edited by Harry Watchman.

The fourth installment in our series on trichomoniasis (“trich”) infections focuses on the psychosocial impact of trich. In our conversation with Ina Park, MD, we explore common questions that emerge following a trich diagnosis including how long may one have had the infection before it was detected, what partners need to know in terms of testing and treatment, and how patients and health professionals alike can become empowered to discuss sexual health including testing for STIs like trich. Dr. Park is Associate Professor, Family Community Medicine, University of California at San Francisco School of Medicine. Dr. Park's website: https://www.inapark.net/ Finding the Right Health Care Provider: https://www.ashasexualhealth.org/your-healthcare-provider/ Trichomoniasis - Fast Facts: https://www.ashasexualhealth.org/trichomoniasis/ Taking a Sexual History for Health Care Providers: https://www.ashasexualhealth.org/healthcare-providers/

Trichomoniasis, most commonly known as Trich, is a devastating disease affecting cattle.

STIs Part 1: Candidasis, Trichomoniasis, and Bacterial Vaginosis The Centers for Disease Control and Prevention just updated guidelines for sexually transmitted infections (previously sexually transmitted diseases) for everything but HIV. In this multi-part series, host Geoff Wall will break down what's new and what's changing in practice.  The GameChanger Maintenace treatment for recurrent vulvovaginal candidiasis is marginally effective. The standard of care in the treatment of trichomoniasis is now metronidazole for seven days. Current data do not suggest routine treatment of male partners of women with bacterial vaginosis.  Show Segments 00:00 – Introductions 01:20 – STI Guidelines 02:20 – Vaginal Candidiasis  11:12 – Trichomoniasis  19:23 – Bacterial Vaginosis  26:06 – Closing Remarks  Host Geoff Wall, PharmD., BCPS, FCCP, CGP Professor of Pharmacy Practice, Drake University Internal Medicine/Critical Care, UnityPoint Health All relevant financial relationships have been mitigated. References and Resources CDC Sexually Transmitted Infections Treatment Guidelines, 2021Redeem your CPE or CME.CPE (Pharmacists)  CME (Physicians)Get a membership & earn CE for GameChangers Podcast episodes (30 mins/episode)Join for CPE Credit Join for CME Credit CE Information Learning Objectives Describe the new recommendations for treatment of candidiasisDiscuss changes in duration of therapy for treatment of trichomoniasisIdentify treatment options for bacterial vaginosis0.05 CEU/0.5 Hr UAN: 0107-0000-22-222-H01-P Initial release date: 05/23/2022 Expiration date: 05/23/2023 Additional CPE and CME details can be found here. 

Trichomoniasis (“trich”) is the most common non-viral sexually transmitted infection globally, affecting all demographics but with a disproportionate impact on women and marginalized communities. We're chatting in this episode with Denise Linton, DNS, RN, FNP, FAANP about the systemic reasons behind the high rates of trich and other STIs in under-served populations and what we can do to promote health equity among those most in need. Questions or feedback about this episode? Drop us a line at info@ashasexualhealth.org.

With roughly two million cases in the U.S., trichomoniasis ("trich") is the most common STI you've never heard of. Most cases don't have obvious symptoms but undetected trich can make it more like to contract or transmit other STIs (like HIV) and the infection is linked to pre-term delivery and low-birth weight babies. Today we chat with Dr. Bobbie Van Der Pol, a professor in the schools of medicine and public health with the University of Alabama, Birmingham where she's a scientist with the UAB Center for Women's Reproductive Health. Dr. Van Der Pol is also president of the International Society for STD Research. Resources: ASHA's Trichomoniasis Information Page: https://www.ashasexualhealth.org/trichomoniasis/ Ten Questions to Ask Your Provider about Sexual Health: https://www.ashasexualhealth.org/your-healthcare-provider/

Episode Notes Episode summary Guest info and links The host Margaret Killjoy can be found on twitter @magpiekilljoy or instagram at @margaretkilljoy. This show is published by Strangers in A Tangled Wilderness. We can be found at Tangled Wilderness You can support the show on Patreon. Referenced Texts: > Fitzpatrick's Dermatology, 9e > Taylor and Kelly's Dermatology for Skin of Color, 2e > Sanford Guide To Anti-Microbials > UpToDate: > UpToDate – Evidence-based Clinical Decision Support | Wolters Kluwer > Where there is no Doctor:Books and Resources - Hesperian Health GuidesHesperian Health Guides > CDC > American Academy of Orthopedic Surgeons > Transcript Max on Taking Care of Medical Needs Margaret 00:15 Hello, and welcome to Live Like The Wold Is Dying, your podcast for what feels like the end times. I'm your host Margaret killjoy. I use she or they pronouns. And this week I'm talking to another medical practitioner. I'm talking to a nurse practitioner named Max, who is going to talk about how to access medical care when medical care doesn't want to give you access to medical care. And we'll be talking about the different ways that people source medications, and we'll be talking about the different diagnostic tools and kind of talk about what you can do to learn how to be your own doctor. Yeah, I hope you enjoy it. This podcast as a proud member of the Channel Zero network of anarchists podcasts. And here's a jingle from another show on the network. Ba-da-da-dah-dah-da. Channel Zero Jingle Margaret 02:18 Okay, so if you could introduce yourself with your name, your pronouns, and then I guess a little bit of your background as relates to the kind of stuff we're going to be talking about today. Max 02:27 Sure, my name is Max, I use he/him pronouns. I'm a medical provider, technically, I'm a nurse practitioner with a degree in family health care. I've been working in health care for about 15 years on the, on the East Coast, first doing primary care and working with LGBTQ+ folks, and now mostly doing HIV care in an infectious diseases environment. Margaret 02:56 Okay, so the reason I wanted to have you on the show is I wanted to talk about, I guess you could say like DIY allopathic health care, or maybe rather like accessing allopathic medical care without access to the allopathic medical system. And, I was wondering if you could kind of give a brief introduction to that, and also explain what allopathy is, for anyone who's listening who's not familiar with that term? Max 03:21 Sure. Allopathic is the word I think I'm going to use to describe the medical world I work in, I think about it, like how people talk about Western medicine. But I feel like there are so many different contributions to what we think of as Western medicine, from all over the world historically, and currently that it seems kind of like a dumb term. And I sort of reached out to some friends of mine who are in other kinds of health care, outside of this sort of what we think of as like this health care model and was like, "What's the best terminology?" and they're like, "Oh, "allopathic", that's what you should use," you know, and so I think, "all right, that's what I'm going to use for this." And for me, I think a lot about expertise, right? Like someone could learn to work on a bicycle outside of ever having to learn necessarily in a shop or in a school. And they could learn to work on their bicycle super super well, and they could learn to start working on other people's bicycles. And they could go on the internet and they could diagnose problems with bicycles and they could you know, become the person who lives next door who's really really good at fixing everybody's bicycles. And ultimately with experience that person can be an expert in bicycles right? That's that's something we allow people and there's something about allopathic medicine that just doesn't allow for that expertise outside of really rigid model, outside of schooling outside...it it police's its borders. So like, if you want to go and look something up about your own health care on the internet, the things that you find are are terrible, even the things that are supposed to be reliable, like something like Medscape or something like that, you know, it's like every, "Oh, you have a sore throat," you look up sore throat, and it gives you every possible thing that could ever possibly have ever caused a sore throat, including some kind of cancer, right Margaret 05:16 Yeah like if you look up, yeah. Max 05:17 Yeah. And if you...but if you look up how to fix a flat, there's not disclaimers about "Oh, you might cut off your tongue while fixing a flat, or run yourself over, or wear a helmet." You know, it's this...it's like, matter of fact, you're allowed to access the information. And I think that there's...it's a big problem when it comes to health care. And... Margaret 05:29 Well everyone has bicycles, but only some people have bodies. Max 05:42 No, no one has bodies. No one... Margaret 05:44 Yeah. But everyone has a bicycle. So it makes sense. Max 05:47 Everyone has a bicycle. Yeah. Margaret 05:49 Yeah. Sorry, I cut you off. Please continue. Max 05:51 No, it's fine. Makes total sense. I, I, I also think too, about a lot of the, you know, I think one of the things I think about in your show is that idea of like, you know, the prepper, and the fallout shelter, or like the little green anarchists like how that's not necessarily like a sustainable model in the, in the tradition, like, because we need each other, right. And I think one of the things that we need about each other is that we need all of each other. And I think this idea of being able to just go and live on the mountaintop and survive on your own is deeply ablest and assumes a lot about bodies and what bodies need and what people need to keep their bodies healthy. Margaret 06:29 Yeah, and it doesn't take into account that like even able-bodied people aren't always perpetually able-bodied, you know, like, speaking as someone who currently lives alone on a mountaintop...you know, I think about it a lot, right? Like, I'm like, if I fall on the ice, my dog isn't going for help. You know, and like, I could probably only do what I do with access to a cell phone. You know, like, realistically, I mean, sure people successfully live alone for long periods of time, without access to any of that, but people also unsuccessfully live alone without access to other people, too. So I agree with you. I am....Yeah, we do need each other even even, even when you choose to be mostly isolated, which actually come any kind of crisis. I'm not making this about me, I just got really self conscious thinking about the mountain top thing. You know, come any kind of crisis, I immediately don't want to be alone anymore. Like, be...living alone only make sense in the context of the entire, like, social infrastructure that we have set up, you know? Max 07:34 Oh, for sure. Oh, for sure. And it's like, as soon as you get a little bit hurt, and you're laying on the ground, and you're like, "Why did I do that thing that I just did that got me a little bit hurt?" you're like, "Will I be hurt forever. Will anybody findfind my corpse. Margaret 07:51 Okay, so, so and then. So, you're someone who does have access to a lot of the, you know, traditional allopathic medical world, right. And and what you're saying is that it's something that people can become more competent as individuals, whether they're, like specializing, or whether they're just like Jack-of-all-trades-ing their, you know, their health care. What does that...what does that look like? What are good places to start, either in the current context, or in a, you know, a crisis context in which we might be detached from social infrastructure? Like, what what should people learn? Max 08:28 I'm definitely not in the working in any kind of realm of right now, like, emergency, right? So this definitely isn't the like, 'how to, you know, stop somebody from bleeding and excessively' or... Margaret 08:41 We have that episode, actually, so. Max 08:43 Exactly, yeah. No, I've listened to it. And it was great. Um, but it's sort of more like, how do we access these things, so that so that people can become experts outside of a traditional model, right? And so I think about things like, like, sort of big three big things as like reliable sources, right? Where can you look up information and actually get information without being told that you're gonna, that you have cancer when you just have a sore throat, right. And, and then you have access to diagnostic tools, and things that help make diagnostics, and things that help sort of lay it out. And then because that's something that you...we use all the time. And then the final thing I think about is, and also in in that realm of tools, is medications, right? Like how do we get medicine? You know, like this, like medicine in pill form, medicine in injectable form, like how do we get those things outside of a doctor model? And then the final thing is just like, what makes someone an expert is experience. But so the big things I'm going to talk about, like are like what I'd like to talk about, I guess is sources, and tools. Tools, and in the sense of tools I think, you know, diagnostics, manuals and things like that, but diagnostic tools and, and medicines. Okay, so Margaret 10:09 This is exciting, I want to know these things, and then I'm going to ask you about fish antibiotics afterwards. Max 10:13 And then in the very most fundamental level, I think that everyone in the whole world who...should have a little index card that they keep on their person that says, you know, their name and emergency contact, what they're allergic to, if they have any medical conditions, if they take any medications, you know. It...or make, you know, or make that if you live with someone who's older, if you live with someone who's house bound, if you live with someone who's particularly vulnerable, help them do that, make them for that for them, and just have that on hand. Because that just simplifies every process. Margaret 10:50 I, I really liked that idea. And then like maybe people who have access to whoever in your neighborhood has a lamination machine, you know, make laminated cards for everyone. No, that makes sense. It's one of the questions I get the most, you know, because the traditional, as you kind of mentioned, the traditional prepper space is very ableist, and very focused on people who are not marginalized by society. And, and so a lot of people are like, well, you know, "I need a thyroid pill every day, or I'll die," or, you know, or "I don't want to go off antidepressants, I'd rather die," or, you know, whatever these things are. And I don't usually have good solid answers. So that was actually why when you reached out, I was so excited to talk to you. So I guess, do you want to start with sources? What are good sources, obviously, WebMD and Wikipedia, but... Max 11:41 I have a ton as they do about ways of sort of amassing medication, so we'll get to that. Margaret 11:46 Okay, cool. Yeah, yeah. Max 11:47 So, sources was like the first thing. If you can get health insurance right now. And I mean that in like...there are sometimes ways to get it. Like if you can access a lower income clinic, or you know, someone who's a social worker, or does case management, they can help you often get, like state assistance health insurance. And like if you're super sick, and you have a complex issue that would might involve...like, if you have a broken bone, or you worried that you might have legit pneumonia, you can absolutely always give fake information at an emergency room. Just be savvy about it... Margaret 12:24 Right, and obviously only do this.... Max 12:25 And if you have to get hospitalised... Margaret 12:27 Oh no, obviously, we're talking about fiction in this particular context, as we would never advocate for you to break the law, but yeah. Max 12:31 Yeah, absolutely fiction. Yeah, absolutely fiction and in... Margaret 12:33 In a post apocalyptic society that looks exactly like our current society. This is what you could tell. Max 12:37 Yeah, that's what we're, that's what we're talking about. And the only way to talk, you know, and in said society too, if you end up in a in a hospitalized situation, and you're what they consider to be indigent. They know they can't get blood from a stone. So they'll often sort of retroactively sign people up for medical coverage to cover that. This is all of course, assuming that someone is documented so I don't want to, I don't want to assume that. So that's on the baseline. But, so things that you could do diagnostic wise, right, we can learn and people can learn how to do physical exams. But I'm a big fan of, of, of some sources that people can access, there's this book called "Where There Is No Doctor", and everyone and their mother should ownthis book. You can get free PDFs of it, and tons and tons of languages, tons and tons and tons and tons of languages. And it is an incredibly useful thing. People should just get it for each other for like birthday presents, you know, and it pretty much shows you how to like diagnose and treat a wide variety of illnesses, even with explicit medication instruction. And it's just, it's just a really, really, really, really useful tool. There's also this thing, this online thing that most healthcare people have access to called "Up To Date." And if you know anyone in healthcare, and you know, in an in an in an alternate reality, where people can share things like you know, logins and things like that, you know, someone who might be willing to share that, you can use Up To Date to diagnose and treat everything. And what it is, is it's, it's, it's staffed by medical people who create, you know, pages about different illnesses, about different things that you might encounter, and gives you all the most quote unquote, "up to date" well referenced literature about whatever it is, you know, and they kind of grade like, "Okay, we give this a Grade A, we give this a Grade B" in terms of like, okay, this is a good intervention or not. And you it's, it's, I look at it all day long, and I've been doing healthcare for a long time. Another possible thing that one could do if one was in like a collective of people was you could all go in on it have an Up To Date. Margaret 15:06 How much does it cost? Or do you need to provide like medical license? Or? Max 15:09 I've not had to, to sign up for it? I mean, and I think it's, I think it's very worth it. But I think it's also like one of those kinds of things like, you know, a lot of subscription services where somebody's got login. And there's no way to sort of misuse it, you know. Margaret 15:29 it just, it drives me crazy how like, this exists, and that we can't access it. Like, I mean, obviously, some people can. And that's, that's wonderful. And I'm sure there's reasons or whatever, but it's just, it's very frustrating the idea that, like, we're all stuck with WebMD, you know, whereas like, actual doctors are able to like...it's not that they just magically know, all this information, you know, I mean, I've been going to a friend of mine for years as like my primary medical provider, basically. As soon as he started going to med school, you know, he just started answering everyone's medical questions for the community that he was in. And, you know, yeah, he spends all of his day like reading and stuff like that, and keeping up to date...it is a very clever name...about all this stuff. And it's amazing how much it changes. I don't know. I don't know, I sorry, I just got really frustrated, think about how that that exists, and I can't immediately access it, and I'm stuck, like, using things telling me I'll die of cancer. Max 16:30 And it's, it's...that's kind of one of the things I mean, like what else? What else? Where else? Is it so difficult maybe to to access, actual legitimate, you know, resources, if you have a friend, like who's in health care, and they're associated with a university or like a major hospital system, there are also sometimes these biomedical libraries online? Well, of course, there are there are biomedical libraries online, sorry. And, you know, you can look up to the very most current research on things papers wise, you know, and that's a fantastic, fantastic resource. If you know anybody with a login, who's...or is...who is a medical student, or even just a student period, most of them have an online acc... online access to really, really good current research. And ways of guiding care. And so that's another great tool. So you can actually be doing, you know, very, very current, you know, well documented smart health care for people, because they're these things exist. These these documents, these research papers, exist, we just, it's the access, right? It's, it's the access like 100%. Let's see.... Margaret 17:56 I mean, it's, it's ivory tower shit, it's like, it's the same as like, whenever I'm trying to research history. There's all kinds of papers written by historians, and they're all locked up behind these academic paywalls. And I basically have to like bug my friends in the academy being like, "Hey, can you pull this paper?" Or like, write the author's directly and be like, "Hey, you're the only person who's written about the blue spectacles worn by the nihilists in 1860s. Russia, can you tell me why they were blue? Can you just give me the paper?" You know, and I don't know. Sorry, as an aside, it just irritates me. I don't like this ivory tower thing. Max 18:28 It's ridiculous. It's so ridiculous. And you know, but it really, I think, probably a lot of people are only probably a couple of degrees, like, away from someone who might have one of these log-ons...logins. So I think we should just pressure the hell out of our friends and colleagues, and make sure that they you know, distribute... Margaret 18:48 Yeah. Max 18:49 equitably, equitably. The...one of the things I really use a lot is like dermatology guides. So if you have a bunch of friends and you want to go in on a little like Biomedical Library, you know, you know if you know someone who ever went to nursing school or anything like that, ask them if they have, you know, things like anatomy books and things like that. But if you can get Derm books, they're great. There's one called "Fitzpatrick's Dermatology". And it's just like the tome, and has, it has tons of color pictures, if you get an outdated one, just know that some of the recommendations in terms of things like antibiotics might be outdated, but...but what the rash is, and what it what it is, you know, is not...it hasn't changed. That book, though, has...centers I think white skin considerably. There's a book called "Taylor And Kelly's Dermatology For Skin Of Color" that's much much better in terms of, obviously, skin of color. It's very, very good book as well. The problem with both of these books is that they're not cheap. So it's totally worth finding old copies. But then again, just remembering that, you know, the "how to treat things" might have changed. Margaret 20:11 Okay, so the diagnostics are good, but the treatment... Max 20:15 Yeah, but the "what to do" has changed. Margaret 20:17 But once you diagnose it, then you can reference Up To Date or whatever to figure out a better.... Max 20:23 Absolutely. And just in terms of rashes, you know, rashes kind of can all look like each other, too. So that's that problem with rashes. Margaret 20:30 I mean, to be honest, like to just admit to everyone the main thing I've been going to medical care provider for many years, I, you know, i was a squatter, and I live in a van, I live in a cabin was was like, "Hey, what's this rash?" Max 20:43 What's this rash! Margaret 20:44 And usually the answer is shower more, and... Max 20:48 Dirt rash. Margaret 20:50 Yeah, and like, I think, ended up having to put anti-dandruff shampoo on various parts of my body at various points, and like leave it there for 10 minutes. Anyway, now that you all know more about me, then you need to...dermatology that that makes sense. Max 21:09 I love getting to tell patients to shower less that sometimes happens with eczema, Margaret 21:13 Oh, interesting. I haven't had that problem. I'm looking forward to having that problem. Max 21:24 So there's a thing called the "Sanford Guide To Anti-Microbials". They're little bitty books, if you can get a very, very up to date one, or like, like, current one. Sorry. That's a really useful thing. They're teeny. The CDC website is really, really useful when it comes to all manner of things like travel exposures, bacterial and viral illnesses, their STD stuff is great, their PrEP stuff, which is like a pre-exposure prophylaxis for HIV, their PrEP guidelines are great and super, super accessible. And that's just free and available, and you just look it up. But just instead of looking at the...look at the "For Providers", you know, always just click on "For Providers." And then I really like the American Academy of Orthopedic Surgeon website when it comes to like certain exercises for bones and joints. And then let's see, a lot of schools and universities will just have like"best practice guidelines, which are just the best ways to...like algorithms for diagnosing things. And then there's some, like online videos, there's this place I used to work....They... I used to refer a lot of my patients at this one practice to this place called Excel PT, Physical Therapy, and I love them because they have tons and tons and tons of free physical therapy videos on their website that are really really good. Like they're legitimate physical therapy exercises that people can go through and be put through. And I just really liked them because I feel like, I don't know it's not just a printout. It's...they're actually putting someone's body through the motions. They have them right up there and there's not like 50,000 disclaimers, like you're gonna...I don't know, I really I think they're super, super valuable. And I use them a lot with patients of mine who are uninsured who can't go to physical therapy. So, that's some of my...those are like my manuals, I love manuals anyways, in all manner of things. Margaret 23:37 Yeah, that's like the...sometimes people come over my house are sort of disappointed because I'm a fiction writer, and most of my shelves are just like...if I see a manual for how to do something at a used bookstore, I'll buy it. Max 23:47 Oh my gosh, totally. Every time. Margaret 23:51 I really don't see the world where I'm trapping small game. I just don't see it happening. I've been vegan for 20 some years, but... Max 23:59 I got this really good. It's like a guide. It's exactly that. I have to remember the name. I'll have to tell you later. We can cut this out of there. Margaret 24:07 Naw, we should leave that part in. Max 24:10 It's like a hunter-trapper manual. It's so good. Margaret 24:14 Good. Will we be able to put in the show notes all of the... wil you be able to send me the list and I could put this in top of the show note, so you don't have to dig through the trans, transcription to find these again. Anyone who's listening they'll be in the top of the show notes. Max 24:27 Absolutely. I will send you all of my, all of my bits and bobs. And then, I guess after after that comes to me like, diagnostic tools in terms of like physical things in like, you know everybody if you you know [have a] blood pressure cuff, pulse oximeter and stethoscope. Right. But you can use...if you get a microscope and you have slides...like a decent student microscope, you can actually diagnose a fair number of things. You know, if you can, you can learn how to Gram stain so you can figure out, you know a lot about bacteria. Margaret 25:08 What kind of stuff can you successfully diagnose yourself with this kind of thing. Max 25:12 Like with a microscope, for instance? Margaret 25:14 Yeah. Margaret 25:16 You can diagnose like a yeast infection or a fungal infection. If you have a microscope and something called potassium hydroxide, you can like...Trichomoniasis is like an STD. You can absolutely see Tric, like swim on a microscope slide. Um, you can, you know, if you look at a slide and there's like loss of white blood cells, and then also like little 'cock-eyes' , sometimes you can diagnose certain kinds of STDs. And then yeah, with a microscope slide and some some pH paper, you can diagnose bacterial vaginosis, yeast infections and Trichomoniasis for sure. For sure. Margaret 26:08 That's cool. Max 26:09 And then, yeah, it's really cool actually. It's fantastic. And it's old school and, you know, people miss things. And sometimes things don't look like how they should but there's tons of information about that online Margaret 26:22 There's a question and probably, you probably can't,but a friend of mine in med school saw his own chromosomes. And I assume that's more than a microscope. Max 26:33 Yeah, no. But, you know, a student microscope is going to be kind of more like bigger, bigger cells, things swimming across, you know, little fungal things that are growing. That kind of stuff. Margaret 26:46 Okay. Max 26:48 And then if you can get access to urine dipsticks, so which you can actually buy, I think just, I mean, I even I think I looked them up on Amazon, which I shouldn't have. But I did, just to see how easy they were to get, because there are in medical offices. They just have to be kept like in the little...they have to be kept in their little container that they're in because they have to be kept dark. But, those can be used to diagnose, you know, a urinary tract infection. And if there's sort of three things, or if there's little two major things going on on them, you know, if you see something like an increase in the white blood cells that are on the little strip, and you see something called leuk leukocyte, esterase, or leuk esterase, or nitrites on there, those things pretty much are indicative of of a UTI. So if someone has recurrent UTIs, they can actually like pee on a strip and be like, you know, this is this is legit, this just this isn't just me feeling like dehydrated or having coffee, too much coffee bladder or something like that. So it's kind of really useful. Also, if someone just has a ton of glucose on there, that you know, that's like a diabetes diagnosis. So that can be really useful. Having a glucometer is really useful, which tests their blood sugar levels because it can test to see if someone, you know if someone in somebody's community is diabetic, and they get too low or too high, or just in general, if you have someone that's not faring super hot, you can check their their blood glucose levels. The problem with glucometers is they're maddeningly proprietary. So you get them and like there's strips and there's the little finger stick things and they all go with the one has the ones and so it's really obnoxious because it's not like you can super easy cobble together a little glucometer setup. Margaret 28:44 That's basically to rip off diabetic people. Max 28:47 Oh, completely. It's just all...it's the dum dum dum dum, dum dum. You know, pregnancy tests. There's home HIV tests. Now we've got COVID test. Apparently, mine's coming from the government. I just finished and I just got it back a negative rapid covid just like two seconds before this. I was feeling kind of rundown. Yeah, I was feeling kind of rundown. So I was like, I should do this before I see my kiddo tomorrow. Yeah. And then now more and more, you can just order lab work for yourself. And I think it's really useful to know what you're going into before doing something like that. And all these things I'm talking about, you know, it should be for really big like, "I think I might have an STD," you know, or like, I think, you know, there's something, something isn't right with this very specific thing. But a lot of these sort of like LabCorp and Quest Diagnostics and things you can actually just go on and order your own tests. It's not cheap, but... Margaret 29:52 I went and got a bunch from Let's Get Checked. And I'm a little bit squeamish around blood and it was like, "Oh, it's a finger prick and I can handle a finger prick." What they don't tell you is that it's a finger prick and then milk the blood out of your finger. Max 30:05 Oh, I hate that, the word milking. Margaret 30:08 Yeah, and I literally couldn't do it. I like, tried. And then I was like making someone help me. And then they were like getting really stressed out because I was kind of freaking out of them. And I couldn't do it. So I have like, a fair amount of expensive tests sitting and waiting for me to figure out how to, and then, you know, I like I talked to them, and they're like, "Oh, you just got to make sure you take a shower first, and that you're all warmed up so that you can like..." and I'm like, "I will not milk blood from my finger." So I have...my squeamishness prevents me from accessing certain amongst these tests. Max 30:48 Well, some of them, you can order yourself and actually just bring to the lab. And they'll actually do a blood draw for you. So I learned that from... Margaret 30:57 Okay, okay. Max 30:58 Yeah. But they're not always, you know, I think the cost is always kind of an issue at the end of the day with some of these things. Margaret 31:08 Yeah, I like the idea that someone in like, someone in your crew can have a microscope and at least tell you if you have Tric. Max 31:15 Yeah, for sure. For sure. Especially if you know, the symptoms, and the and the test match up. Yeah, possibly all labs may be able to be ordered. But the thing is, I'm a big fan of like, not going looking for things unless there's an actual... I don't know, unless someone's having a problem in that they feel like it means that something has changed from their baseline to such a degree that it's causing them...like, things aren't going well. Margaret 31:48 Yeah. Max 31:48 You know? And if something I always tell people, if something's been there on your body for a long time, and it's unchanged, it's probably not anything. You know, like, it's probably just a... it's probably just your variation on a theme, or it's some kind of weird little cyst that's just always gonna be there. And if if it's causing sort of psychological distress, distress, or something, that's totally fine. Like, we can deal with it. But if it's not changing or getting worse or anything, it's probably nothing. That...nothing worrisome. It might be something but it's not going to be something worrisome. Margaret 32:23 Yeah. Max 32:24 Yeah. Margaret 32:25 You mentioned also in diagnostic tools, like physical exams, like, what are the kinds of physical exams that we should be learning how to administer on ourselves and our friends? Max 32:35 Well, I think just sort of knowing what your body is like, like know, from the get-go, like not to be totally "to our bodies, ourselves," but I think there's something really good about knowing what's there. You know, and, like self exams are good in terms of people think about, like, you know, chest self exams, testicular self exams, those kinds of things. I think if someone really wants to pursue be... you know, knowing about other people's bodies, you know, knowing knowing what, what to listen for, would you listen at someone's heart and things like that are important things, you know, to know. But I think just having kind of a sense of oneself and like, "Oh, something isn't right. Something really isn't right," is is kind of the most important part when it comes to physical exams. Margaret 33:25 So just knowing your baseline basically, and knowing... Max 33:27 Knowing your baseline and knowing when something wildly deviates from your baseline. Margaret 33:33 Okay. Which of course always says the fun, like aging thing where you're like, Oh, that's a new spot. Max 33:38 Oh, yeah, totally. Or that hurts so much. Margaret 33:41 Oh, actually, okay here's a diagnostic question: What should I look for? What should 'one' look for when they look at moles? To try and figure out whether or not they're worrisome? Max 33:52 Is it? Is it new? Is it irregular? Like very irregular. Not like a nice little round, nice, like continuous border, but does it look raggedy? Right? Is it, is it kind of just like a different pigmentation from your skin color? Or is it like, like really black? Or is it like, going to bleed easy? Is it kind of bumpity all over as opposed to kind of a continuous smooth thing? In my experience, things that are worrisome that turn out to be cancer, things look worrisome. They look really different. Usually. Not always, but usually, you know, you see something and you're like, "What is that?" That's not something that's been on your body before. And again, if it's something that's unchanged, really, mostly it's been there for a long time. It's not doing anything. It's just chillin with you. Margaret 34:55 So, one of the things I want to ask about, that you talked about briefly before we before we started recording is, is access to medications. Obviously, medications are something that it's, you know, there's there's probably two types of answers to this question or almost two questions. And one of them would be like, "What can you gain access to in a situation where law is no longer a thing?" Versus "What can you gain access to within the existing society?" Like, how can you gain access to different things? And those are maybe related questions, and maybe not, but I'm curious. Max 35:31 I think they're related. I think I need to preface it, okay. Something that's really important to me is anti-microbial stewardship. And it's, it's up there with, you know, all kinds of stewardship, right, like Earth stewardship, meaning like, we have access to drugs that treat microbes. We have overuse to them as a society, right. And now we have these things called multi-drug-resistant organisms. And the way we prevent more of that is not is by not taking medicine that we don't need. Okay. And by taking medicine, that makes sense for the organism. So that's my only little caveat that I'm putting out there. Margaret 36:18 No, that's interesting. The way of phrasing it as like, part of stewardship makes a lot of sense. Like, so what's involved in...I mean, like, you know, I remember, was a kid, we'd all be like, "Oh, don't use antimicrobial soap, or you'll make everything worse," you know, and I don't know, that was us being like, proud about being dirty, or whether that was legitimate and, like, like, so what else is involved? I mean, there's also the like, you know, always complete your round of antibiotics, so that you like, actually destroy it versus like, you know, almost killing it having come back worse, but like, what are... Max 36:53 That's kind of changed a little, they've actually shortend a lot of courses. Margaret 36:55 Oh, interesting. Max 36:56 Yeah. You know, it used to be these sort of like long drawn out courses. We just want to make sure that someone's using the right, right drug for the right critter, right. And that we're not just taking medicine because we don't feel good. Because, there's a lot of things that may make people not feel good, that doesn't even have anti whatever's towards it, like anti-microbials. Because it might not be bacterial it might be viral, there might not be anything to do for it. You know, like the vast majority of of those, those two, three weeks, sort of sinusitis, doom, "I'm so sick, and I'm never going to be a well person." That's all viral illnesses, you know, there's not anything we can really do for them. If it's multi-symptom, like that, like runny nose, and yucky eyes, and a cough, and chest, and I mean pre-COVID virus, right? Viruses present a lot similarly to each other. Right. And viral illnesses make us kind of have viral illnesses, which are usually multi-symptom. And a lot of viruses, we just kind of have to suck it up and do the soup and neti pot and be miserable for a while. Margaret 38:15 Okay. Max 38:16 But so that, you know, we can target anti-microbials like anti-biotics like specifically to certain to certain things, because we can diagnose them pretty specifically with certain tools, or, you know, we kind of really know that these symptoms always kind of equal "this" or whatever. But it's just something good to keep in mind going into things. I mean, everybody does dumb things. And everybody...sometimes I have definitely...many times I've written prescriptions for things that I wasn't 100% sure of, because I want to make someone well, and we don't have access to all the diagnostics and... Margaret 38:56 Right. So it's just your best guess or whatever. Max 38:59 Yeah. But, not everybody should be taking azithromycin if they feel bad, ya know? But so I think that's my only thing going into things. It's just, you know, we should be we should be conscientious of these things. Um, because we only, you know, we have the potential to create total havoc when it comes to critters, right. I mean, yeah. I guess I think about accessing medications or anything. So, where do you get medications in the world, right, if you don't have like a provider or prescriber? So, most medicines, if they're like a tablet form, do not readily expire. So most medication... Margaret 39:50 I've heard the efficacy drops a little bit. Max 39:53 Maybe, maybe a little, but it takes a lot for the efficacy to drop, drop, drop. I mean, I guess Have you opened up an old thing of meds and it just looked very, very strange? Maybe...but if it's still there, most of the time, most medications, they just don't have the money to keep studying them out and out and out and out and out expiration wise and they get to the point where they're like, "It's probably not expired..." Certain...like tetracycline, maybe it causes a dangerous situation. So, stay away from old tetracycline and Ranitidine. Margaret 40:32 And that's an anti-biotic? Max 40:34 Oh, yeah, so tetracycline is the antibiotic. And that, that could be dangerous if, if it's old, theoretically, but it's not prescribed, like all that anymore. And Ranitidine, which is like a stomach med that's been taken off the market, it's an antacid style medication, it has some cancer causing compounds that could have occurred, that most things like if they're a tablet, they don't expire. Like it's completely reasonable to hoard medication. Margaret 41:05 Okay, is there a way to get the doctor to give you like, longer prescriptions? Like I've heard that like, sometimes people struggle to be like, I want my ADHD meds more, you know, and people are like, nervous to give larger best perscriptions or whatever. Max 41:21 That's tricky because they're control...sometimes they're controlled. And I think with controlled meds, providers are super squeamish. Margaret 41:28 Okay. Okay. Max 41:29 Which sucks. But, some meds just keeping them you know, just if you have them in your house, and, you know, maybe you didn't take them, as long as it's not liquid medicine or emergency medicine. So, if it's like an epi pen, or insulin, you want those things to stay, obviously, like, you don't want them to be expired. Margaret 41:52 Okay. Max 41:53 But you know, but inhalers seem to be okay. And I always just say, if you have like old meds, antibiotics, et cetera, keep them. Someone may need them. Right? Do you have a relative that's passed from this mortal coil or whatever, and you know, you're cleaning out their space? Maybe there's something that they might have that someone needs? Max 42:18 You know, I shouldn't I mean, this is like that...my pharmacist friend is going to roll over in her not grave, but like, but we're always told not to tell people this, but we're talking about, you know, access, if someone doesn't have access to medicine that they need, you know, how do we get them access to medication. So this is sort of talking about, like, you know, worst case scenario, but, and then I always think about, you know, if someone, if you got a prescription of something, say, and you took it, and it gave you a rash all over, and the doctor said, "Don't take it anymore, you're allergic to it," or you're like, "Oh, I threw up and I never took that, again," save it, because that's almost a full course of the medicine. It's probably the you know...which is fantastic. You know, if you if you were taking something for something like, like for HIV, and you were on anti-retrovirals, and you switched regimens, because you were cured... like wanted to take something new, save your old meds. So, because as long as you're not resistant to your old meds, your previous med regimen still works. And you could go back to it, and you could save yourself, like a couple months of heartache if something went down. Margaret 42:18 Yeah. Margaret 43:34 Okay. So theoretically. This is okay...Wait, no, I don't want to give terrible medical advice on this show. Nevermind. Max 43:44 I'm not trying to either. That's, why I'm like..."ahhhh!" Margaret 43:48 Because I'm like, well, how could someone get a backstock of you know, someone who's HIV positive and wants to have access to their medication, despite disruptions in supply chains, and whatever. I dunno people can figure that out themselves. Max 43:59 You know, I think about this all the time, I think about this all the time, do you have a friend that would be willing to get meds prescribed for them? Even if they you know, do you have a friend with insurance that would be willing to, to say that they had X, Y and Z in the low stakes way? I mean, it starts to become high stakes if controlled substances are involved. Right? That's when things become dangerous for everyone involved. And you know, could be... Max 44:02 And that would be stuff like painkillers, Ritalin. I forget the name of the larger...SSRIs. Max 44:39 Not SSRIs. Margaret 44:41 Oh really, okay. Max 44:42 But benzodiazepines... Margaret 44:45 Oh, that's what I was thinking of, benzos. I dont' take medication. Max 44:48 Yeah, I think that you know, you have to you have to go and and, you know, get special scripts for and things. Those are the things that they... Margaret 44:56 The stuff with street value, basically. The stuff that's fun to take. Max 44:58 Exactly. Those are the things sprays thick eyebrows. Yeah, yeah. And, and, you know, and there's a lot of surveillance of, you know, but if if if you're someone who needs thyroid medication to live, you know, and you have someone, you know, if you have access to other ways of getting your same medication, you know, that's not a medicine that's necessarily going to raise eyebrows or some of the medications can be very expensive. Sometimes, you know, people can ask their providers to give them 90 day supplies of things. I...you know, I think we try to do that all the time. And I think a lot of people who do have chronic health conditions are very savvy about pre planning. Margaret 45:47 Okay. Max 45:47 When it comes to medications, otherwise, you can't go anywhere. Margaret 45:50 Yeah. So so what else? How else does one access medications? Max 45:56 I think I talked about partners like if you if you have a partner or a friend who has health insurance, and you don't. And then if you know, anyone who's traveling to countries with pharmacies that don't require prescriptions. So there's a you know, handfuls of countries where one can just go into a pharmacy and just purchase medication. Margaret 46:15 And is this something that's like, like, what's the legality of taking like, let's not let's, let's pretend like we're not taking other controlled substances, let's talk thyroid pills or whatever, right? If I, if I go to a country where I can just get thyroid pills over the counter, I actually don't know whether you can get thyroid pills over the counter or whether they require Medicare? Is this a good example? Max 46:34 It's a great example. Okay, let's talk about levothyroxine. Can you go in to a pharmacy in some countries and just buy it? Yes. Do you have someone in your life that needs it desperately? Maybe? Go and get it. Margaret 46:46 What? What's the law about bringing it back into the country, something that requires a medication [perscription] in another country, and in this country? Max 46:54 So I can't speak specifically to any law, but it's not something that I've ever heard of penalized. Margaret 46:59 Okay. Max 47:00 Because again, it's not, it does...There's not a control piece there. Max 47:04 Okay. And again, we're not telling anyone to break any laws, and people should make their own decisions. And if it turns out that this stuff is illegal, that would also map to being morally wrong, because obviously, the laws of our society are just and worth valuing. Margaret 47:04 Right. Max 47:04 It's not a scam. It's not a, you know, I think if you set up like a capitalist, Super Buyers Club kind of concept thing where, you know, you're bringing levothyroxine back into the United States and selling it for I don't know, I would be like, you're pretty savvy, but you know, that I don't think it would be...I mean, otherwise, I think if you're just bringing back amounts, that makes sense for like, a person, a single person to use, I don't think there would be any surveillance of that at all. Max 47:50 Especially when it comes to people's health. Margaret 47:52 Yeah, totally. Max 47:54 And you know, some countries, some countries have it more restrictive than we do like, right, like so in Ireland, like, if you go to Ireland bring birth control to Ireland. People can't get birth control, you know, i was staying in the, I was staying in the Netherlands with some friends years ago, and they had a kid who had pretty severe allergies, like, you know, and you can't buy over-the-counter Benadryl in in the Netherlands at least when I was visiting. So we would just always bring Benadryl to the Netherlands, especially children's Benadryl. Margaret 48:29 Yeah. Yeah, that's funny. Cuz that's like, what I mean, people give that for anxiety when they don't want to give benzos you know, I don't know about Benadryl, specifically, but things in that catergory. Max 48:45 Like hydroxyine and things. Yeah, for sure. It's just wild, though, what is and isn't sort of acceptable, over the counter and not over the counter and all that in, in different places that you visit and, and we should just, you know, be be trucking things around, because these aren't things that are they're not, they're not controlled medications. They're not, you know, medications that are necessarily going to get someone in trouble, Margaret 48:48 Right. So what about um, it's funny because like, the classic example in a prepper mindset is that preppers are very concerned about the health of their fish. And they're very concerned about their fish getting diseases. And since they're so worried about their fish, they stockpile fish anti-biotics for their fish. And with the possible use, if absolutely worse, came to worse of taking them as humans, because theoretically like veterinary medicine isn't as controlled. But obviously this then gets into like current horse medicine craze with ivermectin, Max 49:10 Oh, ivermectin. Margaret 49:16 Or even ketamine. I mean, you know, we're talking about like, the Right takes ivermectin and the Left takes ketamine where everyone wants horse drugs. Like, how useful is like, how useful are things like fish antibiotics, or even like other veterinary medicines for cross species application in an apocalypse? And that's not why you bought them. It just happens to be the apocalypse and you happen to have them? Max 50:21 Well, I mean, so ivermectin has its uses, right? Like we use it in people to treat like, I don't know, like, Strongyloidiasis. Like it's an anti parasitic, so it has its uses. I think it's sometimes about the preparation of things. Like is something, if you're giving it to your fish? Like, what how would you make it? I think it would be about figuring out how to make it so that it was in people. People form. In terms of dosage. Margaret 50:57 Right. Max 50:58 Right, and figuring out that kind of thing. And I think it depends on the antibiotic. Margaret 51:03 Okay. Max 51:04 Yeah. Margaret 51:04 So some of them will actually only be applicable to fish, whereas some of them might actually be applicable across species? Max 51:10 I think most of them should be applicable cross species, if it's something that is a drug that both species use. Margaret 51:18 Okay. Max 51:19 Like, so if I don't know what fish antibiotics are available? I wish I did. Because it I could say, "Oh, this, this amoxicillin could absolutely be used for fish and people. You know, I mean, I think it's more just about like, how do you figure out... because, you know, it's probably with the fish, it's probably like some kind of, like, drops that you put in the water? Or? Because, it can't imagine how you would give your fish their antibiotics. Margaret 51:44 I'm a bad prepper I should know this stuff. But I don't actually know a ton about bunkers, or fish antibiotics, or buying gold. Margaret 51:47 Is it flakes? Is it in flakes? Yeah. Max 51:54 But I mean, I think yeah, I mean, I think at the end of the day, we're going to have to find ways to access these things. You know, I think the big deal is going to be like, how are we going to eventually manufacture things that we... because we are going to need antibiotics, we are going to need anti-parasitics, and all these sorts of things. Margaret 52:15 Well, my general mindset around that, you know, people have asked me this a long time, people might ask it more about like, "How in an anarchist society, would you X, Y and Z," right? Like people will be like, well, "I need..." I'm just gonna use thyroid medication forever as my example just because like years ago, like 10 years ago, a friend of mine asked me this question directly, you know, and they were like, "Well, I need a thyroid pill every day. Or I'll die? How would an anarchist society make it?" And my answer has always been, or I don't know, however, we do it now, right? Because like, people and physical infrastructure will likely still exist in various ways through various types of crises. And the things that are more disrupted are the, the mechanisms of control and the organizational mechanisms that, you know, distribute these things, or even pay the people to make them, right, that kind of stuff could be disrupted. But by and large, you're still going to have people who know how to make antibiotics, and you're still gonna have, you know, the...the supply chain might get disrupted, which is a problem, right? But then even then, it's like, you know, well, there's people who know how to grow grain in the West and Midwest. And there's people who know how to load it onto trains, there's people who know how to drive those trains to the coasts to feed people, and we probably won't lose that. But we might lose the system that tells everyone to do those things. And I don't know whether it's a cheap out, but... Max 53:40 it's obviously like anarchists and BioPharm. Like, it's not like we're like in this universe, like where it's just, you know...there's all kinds of folks. I just sort of think about it, like, in terms of times of times have like interim times times of like crisis. How do we make sure that people have access to things? Which I think were gonna have to work on. Margaret 54:02 Yeah, no, that makes sense. Because, it's like, there is a difference between talking about disaster and talking about like an anarchist society or whatever. Max 54:09 Yeah. Margaret 54:10 Okay. So one of the things that you mentioned, kind of related to this, but in an actual like, apocalypse scenario, right every...I'm no longer being euphemistic. Although, of course, I was never been euphemistic. But, I'll be euphemistic if i includes zombies in this in this disaster, but whenever you watch a zombie movie, they like raid the pharmacy, right? Max 54:29 Which is such a good idea. Margaret 54:31 Yeah. So what would you raid like if you're in the apocalypse and like you are trying to set up your I guess, like clinic or you're trying to take care of people, while there's like nuclear fallout and zombies and, I don't know, roving militias, but different than the current roving militias, what are you looking for? Max 54:52 When a...you know in an apocalypse situation? I think about this so much I've had so many fun conversations with my peers. It's actually wonderful to work in an infectious diseases practice and ask everybody what they would bring, because it was one of the biggest, like conversations, like arguments that came up about anti-microbials, antibiotics that was just amazing. I don't think I would be thinking in terms of setting up a clinic, I think it would be very much in terms of like, "What can't I get?" and I would try to get broad spectrum antibiotics. So if I had to name them, I would get doxycycline, and levofloxacin, and or ciprofloxacin, and or a medication called amoxicillin. amoxicillin, amoxicillin clavulanate, because I can't talk today, I would get albuterol. And mostly, that's for selfish reasons, because I'm a little asthmatic. And also, because asthma. I would try to get prednisone, epinephrine, like epi pens, and some...anything for like pain and fever. Those would be like, really, really high up there on my list. But I would, if I had to have pick a single antibiotic, I would choose doxycycline, all the way, which is part of my big arguments with all my coworkers. But you know, everybody has their things. Margaret 56:26 They're not big doxy, they're not big doxy-fans? Max 56:29 All of them. Everyone is. They would all have it on their list, but everybody had it on different sections of their list. Margaret 56:36 Yeah, it was an interesting conversation. And then I think if, if things were a little more mellow, and had a little more time in there, I would start to grab stuff that was like, sort of more meaningful for just long term existence. Right? And I think about this in terms of my, my friends and my people and stuff, but um, you know, like queer folks and, and, and PAW's [Post Acute Withdrawl] folks and stuff, but, so I think, alright, I would, you know, maybe grab...let me see, do I have my list up even? Margaret 56:36 Okay. Margaret 57:13 In your bug-out bag is the like...you keep a laminated, like if you hit the store, this is what you get list. Max 57:23 Yeah, exactly...if you have 10 more minutes in the store you know... Margaret 57:27 If you brought the large bag put in.... Max 57:30 So like insulin, you know, requires refrigeration. But if you could get any kind of grab 70/30 cause you can keep the largest number of people, probably. I would grab testosterone and estradiol. Probably morphine, because it's really useful in a lot of different situations, and in cardiac situations. And then if I had to choose like two HIV meds, I would choose Biktarvy and Prezista, or probably Biktarvy and Prezcobix, cause that combination of medicine covers for a huge number of resistant HIV strains. And also, it's just, I would just have it and be like, "Here, let's keep people around for longer." Margaret 58:16 Yeah. Max 58:17 I don't know. Those are sort of, that's sort of my short list. I...honestly, if I was if I was raiding, a pharmacy, and...I would just grab everything that I could get my hand on. Seriously, because it all would come in handy at some point, you know, especially if it was antibiotic. Margaret 58:36 Yeah. Max 58:37 Or like something for giardiasis , that would also be something I would probably get on there. Margaret 58:42 I had giardia once, it was not my favorite thing that's ever happened to me. Max 58:45 It's not the...it's...I had it too. It's not fun. Margaret 58:48 Yeah. Which is why I'm such a big like filter water person. Because I definitely got it from unfiltered water at a big gathering once. Max 58:56 I got it from swimming in, from swimming in the river by my old house. Margaret 59:02 See, that's better because that's like a reasonable thing to do. Whereas, I should have known better, you know? Max 59:07 It wasn't...it was not that reasonable. Believe me it's a filthy river. Margaret 59:11 I'm Sorry. Max 59:13 It's okay, it was a blast, but i was like "Ooooh," Margaret 59:18 No pun intended? Max 59:20 Yeah, that's true, too. Margaret 59:24 Okay, but what...it seems like okay, you raid the pharmacy, it would just set up shop in the pharmacy. Just get like, you know, all your friends with rifles, defend the pharmacy and become a pharmacist. Max 59:35 That's true. I would be a terrible pharmacist. I have no precision in anything I do. Margaret 59:41 Yeah, okay. Max 59:42 I would bring in my pharmacist friends. Margaret 59:45 Okay. So you'd be the doctor at the pharmacy? Max 59:48 No, I don't know what I would do. If I didn't...I don't know, healthcare is like it's a job. But I like doing it also. I don't know, I'm sort of thinking about your friend who, who we're talking to, in the interview about working during COVID.... Margaret 1:00:11 Are you having feels about the working during COVID? Max 1:00:15 Big time. It's been a wild thing. Everyone's sad. Margaret 1:00:22 Yeah, Max 1:00:23 Yeah. But no, it's just more just sort of like, would I do health care if it wasn't my job? And I think I would, but I think I would do it in a totally different capacity. Margaret 1:00:37 How would you do differently if in a, in an anti-work environment where you didn't have to? Max 1:00:43 I would walk in the woods with people and talk about their health in a totally different way. Margaret 1:00:48 Yeah. Max 1:00:49 Yeah. You know, and, or visit them in their homes. And I would have a ton of time. And I would like get to know what they were doing in their lives in a way that I can't in like tiny little weird rooms, with a limited amount of time and that kind of thing. Margaret 1:01:12 I even just think about one time someone was doing some alternative healing with me, actually helped. I used have a chronic injury in my chest. And it's, it certainly wasn't the thing that cured it, but it helped. But as they're doing this thing, they're like, playing soft ambient music and like, you know, like, talking softly to me, and like, the lights are dim, and it's a very calm environment. And I'm like, "Why can't the dentist be this way?" You know? Like, why do you gotta go to the dentist, and it's not like, I don't know, like, someone's rubbing your feet and like telling you, everything's gonna be fine. You know? Max 1:01:55 I can't go to the dentist until...unless I'm like, high out of my mind on some kind of benzodiazepine. Like I can't, I have to literally kind of create like a, like a non remembering experience every time I go to the dentist. So like, I go to the dentist, and I'm like, "Do whatever you want." And then three years later, I go back and have the same experience. Margaret 1:02:24 Yeah. Max 1:02:25 Which is probably a self fulfilling prophecy of dentistry. Margaret 1:02:28 Yeah. Max 1:02:29 Yeah, but then it's always like a tooth removal. Margaret 1:02:32 With what you're talking about, about, you know, all the medical care providers being so tired. And obviously, this thing that I'm talking about doesn't solve like, COVID, right? But what you're talking about about wanting to help people become...gain expertise and control over their own bodies, it seems like that would help, you know, because it's like, like with the bike repair example, right? Like, I don't know, when I wrote a bike all the time, like I could, I could swap out the handlebars, I could tighten the brakes, I could patch a tire. Or I could patch a tube. But, I couldn't. But, I couldn't align the spokes. I could have learned to align the spokes, but like I, I didn't, you know, and I certainly wasn't building bikes. And every time I look at the derailleur, my head would break. And like, and so there's, there's always going to be a role for bike shops, even if everyone's good at bikes. And... Max 1:03:31 Right. Margaret 1:03:32 And so having, you know, crews of people who are specialized in allopathy, as the thing they do, the thing that they're most interested in, will always make sense. But like, just having more people able to do more of it on our own seems like it really just helps everyone. It doesn't help the people who want to make a ton of money off of things, or have a ton of control over how people live and what they do, you know. Max 1:04:01 Yeah, I think that's totally real. I think it will also alleviate things on patients. I think that when people know themselves and can come to their provider, with a sense of what's going on with their bodies and navigate the system in a way that feels a little bit more, I hate to be corny, but like empowered. Like, I think that's super legitimate. I think that one of the ways that healthcare just screws people over constantly, is that no one knows how to deal with it. They don't know what to ask for. They just they are in a little room and all of a sudden someone comes in tells them a bunch of stuff they're supposed to do gives them some papers and shews them out. Margaret 1:04:42 Yeah. Max 1:04:43 And it's there's nothing in there that that creates a relationship. There's nothing in there that creates...I don't know. I don't know. I think that people being in charge of their own bodies is is awesome. Margaret 1:05:00 Yeah, and it's, it's something that like, I had this realization about school, as well as like doctors or whatever. Like, at some point, especially with like higher education, if you go to college, it doesn't make any sense to me that the teachers like, are in charge of you. Because they're, they're literally people that you're hiring to teach you. Like, you're giving them money, and they're teaching you and that's cool. That's great. But they, they act like, "Oh, well, if you miss class, then you're in trouble." It's like, what trouble? Like, why? Why would this institution have any leverage over you?And Margaret 1:05:39 And that's kind of how I feel about the medical world is that like, it always helps me, and I'm actually almost lucky in that I've been, well, now I have regular insurance, but I was sort of underinsured for most of my adult life. And so I relied heavily on public health and clinics. And I actually found that people on public health they are way more tired, but they're also working there because they like care. And so they're like frazzled and annoyed, but they also like, fundamentally care more often, I also am more likely to end up at like LGBTQ clinics and things like that. And that also helps me. But it...the main thing that helps me is that I kind of remember I'm like, in there, and I'm like, the doctor is not in charge of me. Like, either I'm paying or the state is paying or whatever for service. It's like, it's like going to the bike repair shop, you know, like, you're like, if I go into the bike repair shop, and they just yell at me about how I'm riding my bike. I'm like, I mean, you could tell me that if I ride this bike this way, it's gonna get destroyed. And that makes sense. But you can't tell me I can't ride my bike that way. Like, I don't know. Max 1:05:39 Always true Max 1:06:46 Yeah. But like going on that metaphor, right, like, same thing, like, how many times have people gone to the bike shop and been treated shitty, and then left out feeling like, super demoralized? And like, they can't ride their bike? Margaret 1:07:02 Yeah, totally. Max 1:07:03 And Like I think about that too, like, there's so much of that. I don't know, it's that it's that it's the realm of expertise. And like, you know, it's like, once, once someone is like, in this certain space, they get to have all the power and authority. And I always tell people, like, if you're the doctor, and you don't like what's going on, just leave. Margaret 1:07:25 Yeah. Max 1:07:26 Just leave, like, unless you like, are in a bad way and are really, really, really sick. Like, if you're there to get get access to things or something and you're not being treated well just get out of there if things are not going well. Margaret 1:07:41 Yeah. Max 1:07:42 Because that's going to end up being a squirrely relationship. And there's some really bad doctors, there's some really bad nurse practitioners, there's some really bad everybody, but like, there's, you know, there's people that are unkind and not not good, and are just going to tell you what they think, is the matter with you before they've even met you. Margaret 1:08:01 Yeah, and, and, just like this, like sense of that, people thinking that they have power over you, because we have these institutions that sort of claim it, but it's like, you're, you're in charge of yourself. Like, I mean, there's, there's institutions that exist to try and stop you from being in charge of yourself, you know, like, there's a certain things that we could do that would then have other people throw us in prison or whatever, right? But like, that doesn't mean we're not in charge of ourselves. It just...Well, it does, but, you know, on th

Trichomoniasis, most commonly known as Trich, is a devastating disease affecting cattle.

This episode focuses on some of the literature supporting seven days of metronidazole treatment for Trichomonas infection recommended in the CDC 2021 STI Treatment Guidelines. View episode transcript and references at www.std.uw.edu.Editor and host Dr. Meena Ramchandani is an Assistant Professor of Medicine at the University of Washington (UW) and Medical Director of the Public Health – Seattle & King County Sexual Health Clinic. This podcast is dedicated to an STD [sexually transmitted disease] literature review for health care professionals who are interested in remaining up-to-date on the diagnosis, management, and prevention of STDs.

Many STIs and Trichomoniasis can be spread through oral sex. We talk about how to detect it, avoid it, and treat it. Plus, the emotional shame, anger, and resentment that can impact your quality of life. Join us at Podcast-A-Palooza! https://podcast-a-palooza.com/SUP SHOW NOTES: How common is Trichomoniasis? How did I get Trichomoniasis? Who can get Trichomoniasis? Symptoms of Trichomoniasis Treating Trichomoniasis Do I tell others I have Trichomoniasis? Emotional impact of Trichomoniasis Prevention for Trichomoniasis Resources and Links (see below): Where to find us: Website: SwingerUniversity.com E-mail: SwingerUniversity@gmail.com Send us your questions: SwingerUniversity.com/contact/ TikTok: TikTok.com/SwingerUniversity Twitter: Twitter.com/SwingerUPodcast Instagram: @swingupodcast YouTube: Youtube.com/c/SwingerUniversityPodcast Get Kasidie Full Membership for 30 days FREE *Some links may contain affiliate links! RESOURCES https://www.mayoclinic.org/diseases-conditions/trichomoniasis/symptoms-causes/syc-20378609 https://www.cdc.gov/std/trichomonas/stdfact-trichomoniasis.htm https://www.emedicinehealth.com/can_a_man_give_a_woman_trichomoniasis/article_em.htm https://www.plannedparenthood.org/learn/stds-hiv-safer-sex/trichomoniasis https://www.cdc.gov/std/treatment-guidelines/trichomoniasis.htm https://www.cdc.gov/std/healthcomm/stdfact-stdriskandoralsex.htm#anchor_1638992941914 https://www.researchgate.net/publication/286165338_The_impact_of_sexually_transmitted_diseases_on_quality_of_life_Application_of_three_validated_measures   CONDOMS https://www.cosmopolitan.com/sex-love/a25922204/cosmopolitan-condom-power-to-decide-survey/   FEMALE CONDOM https://fc2.us.com/how-to-use/fc2-female-condom-step-by-step-instructions-english/   HOW TO USE A DENTAL DAM https://www.cdc.gov/condomeffectiveness/docs/dental-dam-info-sheet-508.pdf   AT HOME STI TEST KITS https://www.letsgetchecked.com/home-std-test/ https://www.stdtriage.com/ https://www.mylabbox.com/product-category/sexual-health/

Trichomoniasis is the most common, non-viral, sexually transmitted infection. Pathologists providing laboratory testing for this infection should understand the advantages and disadvantages of the commercially available, FDA approved/cleared methods, explains Mayo Clinic pathologist Bobbi Pritt, MD, FCAP, in this CAPcast. Dr. Pritt led the development of the Clinical Pathology Improvement Program offerings on this topic (capatholo.gy/3x9XUCy).

One morning you wake up and go to the bathroom, you notice that it burns when you urinate. You also notice that you have itching and redness to your genital area. So, you go to the doctor to see what's the matter. After running a few tests, your doctor tells you that you have trichomoniasis. What do you need to do to feel better? Are there steps you can take to prevent it in the future? 

Bryan shares with Hoadley his love for the Chicago Cubs, Harry Caray, WGN Radio and The 7th Inning Stretch. tHen he shares his disdain for Conor McGregor's slaughter of the Wrigley Tradition of singing Take Me Out! Finally, the gang reviews a government produced movie from the 1940's warning soldiers of STD's, loose women and the danger of unclean sex. It's an eye-opening film that shows the backwards attitudes toward women, sex and movie making! LINKS:Want a TCB limited edition collectible sticker? Each series sticker is limited and first come, first serve. Click HERE to find out how!Or send a text or voicemail to 661-Best-2-Yo (1.661.237.8296)Watch this episode on YoutubeTCBTV-minusSponsorStreamlight Lending By SunTrust Bank (Use Code TCB for additional interest savings)DBSAlliance For Mental Health HelpMagic Spoon (Use Code TCB)FUM (Use Code TCB) Smokeless Pipe for Smoking SesationMEMPHO Music Fest (Oct 1st-3rd 2021)Castbox is the TCB partner for the Mempho Fest showsSubscribe to The Commercial Break Podcast Youtube ChannelNew Episodes on Tuesdays and now Fridays everywhere!Text or leave us a message: 1-(661)-BEST-2-YO  |  (1-661-237-8296)

Everything you will wanna know about the STD Trichomoniasis the details no one every talks about! --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app --- Send in a voice message: https://anchor.fm/bvtalks/message Support this podcast: https://anchor.fm/bvtalks/support

Dr John Toney, Professor of Medicine and the Morsani College of Medicine and Chief of Epidemiology at the James A Haley Veterans Hospital shares new recommendations in the management of STDs and STIs. He begins by discussing recent epidemiologic trends in STDs in the US, including the increasing trend in new reported cases over the last 5 years. he then focuses on causes of urethritis/cervicitis, including Gonorrhea and Chlamydia. The updated treatment recommendations for GC and Chlamydia are also discussed. Next, Dr. Toney discusses Syphilis. He explains the rationale behind Treponemal and Non-treponemal tests and how they are used to diagnose the stage of syphilis that is present. Treatment options for early and late syphilis are also explored. Lastly, Dr. Toney discusses Herpes genitalis and Trichomoniasis.

Trichomoniasis is the most common, non-viral, sexually transmitted infection. Pathologists providing laboratory testing for this infection should understand the advantages and disadvantages of the commercially available, FDA approved/cleared methods, explains Mayo Clinic pathologist Bobbi Pritt, MD, FCAP, in this CAPcast. Dr. Pritt led the development of the Clinical Pathology Improvement Program offerings on this topic (https://capatholo.gy/3x9XUCy).

TrichomoniasisGonorrheaChlamydia

Syphilis hatten sie alle. Napoleon, Katharina die Große und van Gogh, Beethoven, Heine und Goya, Nietzsche und Schopenhauer. Iwan der Schreckliche ließ aus Frust und Schmerz Leute ermorden, Heinrich VIII. litt unter syphilitischen Geschwüren und krankheitsbedingt fehlendem Nachwuchs. Dass er sich von der römischen Kirche trennte und die anglikanische gründete, hat mit den Nebenwirkungen seiner Erkrankung zu tun. Ohne Syphilis wäre die Welt eine andere. Mit der Erfindung des Penicillin 1928 allerdings, bekam man die Krankheit, die auch Lues genannt wird, langsam in den Griff. Vielerorts war sie seither völlig verschwunden. Nun ist sie zurück, allein in Deutschland infizieren sich jährlich etwa 8000 Menschen damit. Genau wie Tripper, das in den Industrienationen ebenfalls lange ausgerottet war. In Folge 14 des "Gyncast" geht es um sexuell übertragbare Krankheiten. Während Tripper und Syphilis ihr großes Comeback erleben, waren Chlamydien und Trichomoniasis, Herpes genitalis und Hepatitis nie weg. Die Tagesspiegel-Redakteurinnen Esther Kogelboom und Julia Prosinger besprechen mit Dr. Mandy Mangler, Chefärztin am Auguste-Viktoria-Klinikum, woran das liegt und welche Rolle dabei die medizinischen Fortschritte im Kampf gegen HIV spielen. Außerdem beantworten sie, ob Tripper mit einer Mundspülung vorgebeugt werden kann, sich Chlamydien im Schwimmbad ausbreiten können und bei welchem Befund man seine Ex-Partner*innen rasch anrufen sollte. Welche Krankheit produziert schäumenden Ausfluss und welche eitrige Gummen? Wann sind Apps sinnvoll oder hilft nur ein Besuch bei Fachärzt*innen? Welche Impfungen lohnen sich und warum sind nur bestimmte Krankheiten bei den Gesundheitsämtern meldepflichtig? Welche Untersuchungen machen die Gynäkolog*innen automatisch und wo bekommt man kostenfreie Tests? Wie sinnvoll sind Testkits aus dem Internet für zu Hause und warum hat Kaiser Tiberius das Küssen verboten? Produktion: Markus Lücker

In this week's episode, Dr. Oakley and Holly dive into an often stigmatized topic related to our gynecological health. STIs are shrouded in loads of shame, secrecy and regret. And it's not just young people getting them—women in their 30s and 40s get them, too. In fact, the number of older people getting them is actually growing. We smash the stigma and learn that women living with an STI aren't alone. The Lady Bod Podcast is presented by St. Elizabeth Healthcare and Physicians.

In this week's episode, Dr. Oakley and Holly dive into an often stigmatized topic related to our gynecological health. STIs are shrouded in loads of shame, secrecy and regret. And it’s not just young people getting them—women in their 30s and 40s get them, too. In fact, the number of older people getting them is actually growing. We smash the stigma and learn that women living with an STI aren’t alone. The Lady Bod Podcast is presented by St. Elizabeth Healthcare and Physicians.

Our birder Alain Clavette joins us to talk about a seasonal disease sweeping the avian population: trichomoniasis.

Cow/calf producers need to be proactive and watch their breeding herd carefully for trichomoniasis and Dr. Gregg Hanzlicek, Kansas State University College of Veterinary Medicine clinical associate professor talks about detecting and treatment of this venereal disease on today"s Beef Buzz.

• The weekly cattle market update • Options and protocols for keeping trichomoniasis from entering a cattle herd • Agricultural news • Kansas 4-H Campference is coming up… 00:01:30 – Cattle Market Update:  Livestock economist Lee Schulz of Iowa State University sizes up the cattle market trends: he comments on the latest slaughter weight numbers as an indicator of the backlog of market-ready cattle, and talks about the increasing pace of beef slaughter as the industry recovers from the COVID-19 situation. 00:12:51 – Fighting Trichomoniasis:  K-State veterinarian Gregg Hanzlicek is back to talk about additional cattle herds in Kansas testing positive for trichomoniasis, a costly cattle reproduction disease...he looks at the options and protocols for keeping it from entering a breeding herd, as well as preventing it from spreading further in the Kansas cattle production sector. 00:24:19 – Ag News:  Eric Atkinson covers the day's agricultural news headlines. 00:32:34 – 4-H Campference:  K-State 4-H specialist Beth Hinshaw discusses 4-H Campference taking place later in June as a virtual event for youth ages 10-12.   Send comments, questions or requests for copies of past programs to ksrenews@ksu.edu. Agriculture Today is a daily program featuring Kansas State University agricultural specialists and other experts examining ag issues facing Kansas and the nation. It is hosted by Eric Atkinson and distributed to radio stations throughout Kansas and as a daily podcast.   K‑State Research and Extension is a short name for the Kansas State University Agricultural Experiment Station and Cooperative Extension Service, a program designed to generate and distribute useful knowledge for the well‑being of Kansans. Supported by county, state, federal and private funds, the program has county Extension offices, experiment fields, area Extension offices and regional research centers statewide. Its headquarters is on the K‑State campus in Manhattan.

Episode 13: Treat the Partner(s): EPT The sun rises over the San Joaquin Valley, California, today is May 22, 2020. The COVID 19 pandemic has created a limited access to PPE in many health centers around the nation. Last week, Amazon also prioritized individual physicians for COVID-19 Supplies in providing much needed PPE for private practices. As a result, AAFP members and others working on the front lines of the pandemic have direct access to hundreds of items related to PPE, disinfectants, sanitizing products, diagnostic equipment and other materials. Way to go Amazon! Thank you for your business. Welcome to Rio Bravo qWeek, the podcast of the Rio Bravo Family Medicine Residency Program. We train residents and students to prevent illnesses and bring healing and hope to our community. Our mission: To Seek, Teach and Serve. Sponsored by Clinica Sierra Vista, Providing compassionate and affordable care to patients throughout Kern and Fresno counties since 1971. “Don't let success determine your happiness but instead let your happiness determine your success” –Salah Barhoum What a great quote. When you are happy, you are successful. We can see our happiness as the highest level of our success. Today our guest is a successful man, Joseph Gomes. He is a very entertaining guy with a great sense of humor and very intelligent, he is known by his friends as Joe. Welcome Dr Gomes. 1. Question number 1: Who are you? My name is Dr. Joseph Gomes, I am a father of 2 twin munchkins and R2 in the Rio Bravo Family Medicine Residency program in Bakersfield, CA. I was most recently bestowed the honor of being elected as one of the 3 chief resident physicians for the 2020-2021 academic year, which I am quite excited about. I completed my undergraduate degree, a BS in Biomedical Sciences at CSUS in Sacramento, CA and completed medical school via the American University of the Caribbean School of Medicine. I like playing with my kids and eating cupcakes. 2. Question number 2: What did you learn this week? I think if I were to attempt to list all that I learned, or forgot and was reminded of this past week we would run out of time. However, I am here to talk about a topic that I don’t think gets very much attention and that’s the subject of Expedited Partner Therapy, or EPT for short. I was exposed to this concept for the first time during my intern year and was shocked that it was something that wasn’t more well-known or discussed in the resident community. EPT Definition EPT is “the clinical practice of treating the sex partners of patients diagnosed with chlamydia or gonorrhea by providing prescriptions or medications to the patient to take to his/her partner without the health care provider first examining the partner.” Patient’s sex partners from the past 60 days should be treated. EPT is for gonorrhea and chlamydia only. How would you write the prescription to treat gonorrhea if the treatment is IM Ceftriaxone? The current recommended treatment for gonorrhea is an IM dose of ceftriaxone AND a single dose of oral azithromycin 1 gram. The CDC recommends using cefixime and azithromycin in EPT. General Guidelines for EPT • Prescribe treatment for gonorrhea and chlamydia under the index patient’s name or their partners’ names. • Prescription should be accompanied by treatment instructions and warnings about taking medications • Gonorrhea health education and counseling • A statement advising that partners seek personal medical evaluation, particularly women with symptoms of PID. • No sexual intercourse for 7 days after treatment (ACOG, 2018) EPT is not recommended for: • MSM (high risk for coexisting infections, especially undiagnosed HIV infection) • Suspected child abuse • Sexual assault • Any other situation when patient safety is compromised • EPT has lower evidence in HSV, scabies, pubic lice, and trichomonas. 3. Question number 3: Why is that knowledge important for you and your patients? Per the Kern County Health Department website, based on published data from 2017, Kern County alone has approximately 1 new STI case per hour, each day. With the vast majority of these cases being Chlamydia, followed by Gonorrhea, Syphilis and lastly HIV. Of note, Hep B data was not published in 2017, but I fully expect its inclusion in the forthcoming publication. And specifically, regarding Chlamydia, Kern County is the 3rd worst in the state, following San Francisco and Alpine counties and as a county has a 38% increased average number of cases compared to other counties in the state. For syphilis, Kern is actually a bit worse. Kern County syphilis rates in 2017 were 333% higher when compared to other counties in the state. More disappointing than that, Kern County had 313% increase in CONGENITAL syphilis cases and ranked the 2nd worst in the state behind Fresno. This is a big deal. Not just in this county, but nation-wide. STI rates continue to climb and this is just one mechanism by which we can help prevent the continued spread of infection.  Why is this important? To prevent what is referred to as the “Ping Pong” effect. The phenomenon in which sexual partners re-infect each other with the same sexually transmitted disease (STD). First, an individual who has the STD infects his or her partner. The partner may then re-infect the individual, after the individual has been cured from that particular STD. This often occurs because individuals and their partners may or may not be aware that they have an STD, since symptoms are not always present. The 3 major players include Gonorrhea, Chlamydia and Trichomoniasis.  EPT is permitted in all 50 states, save for one, South Carolina. Get it together South Carolina! 4. Question number 4: How did you get that knowledge? I prefer self-study and read by myself the topics that interest me. Also, I enjoy watching videos such as the AAFP 2020 Lectures Series for Board Review. 5. Question number 5: Where did that knowledge come from? Websites used: CDC website, Kern County Public Health Website, Z-dogg MD podcast, which I highly recommend, published as Incident Report 197 in 2018. Additional information: Something I did not know is that through the Kern County Public Health department, those who have been diagnosed with an STI can anonymously notify their sexual partner via their website at KernPublicHealth.com (https://dontspreadit.com/). This is a fantastic resource as a myriad of factors contribute to neglecting to notify sexual partners, including, but not limited to undue shame, guilt, hostility and the obvious avoidance of confrontation. The public health department eliminates much of this through their website. Speaking Medical (Medical word of the Week): Fasciculation by Dr Monica Kumar A fasciculation is a small involuntary muscle contraction and relaxation also known as a muscle twitch. Approximately 70 percent of fasciculations are benign in etiology. However, the remaining 30 percent of the cases can be due to hypomagnesemia, benzodiazepine withdrawals, acetylcholinesterase inhibitor use, caffeine use, rabies, and other lower motor neuron disorders such as ALS, poliomyelitis, and spinal muscular atrophies. In order to further evaluate the etiology behind the fasciculations, a thorough neuromuscular examination should be performed. Further evaluation with an electrolyte panel, electromyography, nerve conduction studies, neuromuscular ultrasound, or muscle biopsy can also be performed in determining the cause. If you have a patient with eye twitching, it may be a fasciculation, but it also could be them winking at you. Espanish Por Favor (Spanish Word of the Week): Enfermo by Dr Claudia Carranza The Spanish word of this week is enfermo. Enfermo or enferma means ill/sick in Spanish. This word comes from Latin root “infirmus”, which can be broken down into “in” and “firmus” meaning “not firm”. This is understood as “not standing” or “not well”. Patients can come to you with the complaint: “Doctor, estoy enfermo” or “Doctor, me siento enfermo o enferma”, which means: “Doctor I’m ill, or I feel sick”. At this point, you will know they do not feel well and you can start investigating what’s going on. Now you know the Spanish word of the week, “ENFERMO”. Have a great week! For Your Sanity (Joke of the Week) by Dr Verna Marquez and Dr Steven Saito Teacher: "Kids, what does the chicken give you?" Student: "Meat!" Teacher: "Very good! Now what does the pig give you?" Student: "Bacon!" Teacher: "Great! And what does the fat cow give you?" Student: "Homework!" —What’s the difference between a rectal thermometer and an oral thermometer? —The taste. —Doctor, my ear is ringing, what should I do? —You should answer it! Now we conclude our episode number 13 “Treat the Partner(s): EPT”. For partners who are unlikely to seek medical attention, Cefixime and Azithromycin is the current recommended regimen for gonorrhea; and azithromycin 1-gram single dose is the recommended treatment for chlamydia. This practice is not only permissible, but it is endorsed by the CDC, AAFP, ACOG, and many other organizations. Also, next time a patient winks at you, think of the word fasciculation. If your patient tells you they are enfermos, don’t panic, you are being trained to cure your ill patients. This is the end of Rio Bravo qWeek. We say goodbye from Bakersfield, a special place in the beautiful Central Valley of California, United States, a land where growing is happening everywhere. If you have any feedback about this podcast, contact us by email RBresidency@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. This podcast was created with educational purposes only. Visit your primary care physician for additional medical advice. Our podcast team is Hector Arreaza, Claudia Carranza, Monica Kumar, Verna Marquez, and Steven Saito. Audio edition: Suraj Amrutia. See you soon! References:  “Expedited Partner Therapy”, Centers for Disease Control and Prevention, https://www.cdc.gov/std/ept/default.htm, accessed on May 18, 2020.  ACOG Committee Opinion, Number 737, June 2018, https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/06/expedited-partner-therapy, accessed on May 18, 2020.  “Treating an STD Patient’s Partner WITHOUT Seeing Them??”, ZDogg MD, November 5th, 2018, https://zdoggmd.com/incident-report-197/  STDs in Kern County 2017 Data Update, Kern County Public Health Department: https://kernpublichealth.com/wp-content/uploads/STDs-in-Kern-County-update-2017-web.pdf  Anonymous Partner Notification: https://dontspreadit.com/

Practicing safe sex may not be something you have done for awhile but if you are starting out in the swinger lifestyle, or are little rusty on your facts, this is definitely the podcast to listen to.  We are covering STIs, HIV, oral sex, and testing.  Swingers tend to be big on testing and we are going to break that down for you too. Show Notes Safe Sex In The Swinger Lifestyle Is Oral Sex Safer? STI Types & Timelines HIV Testing & How It Works How Do You Know If You Are Really Safe? Resources Resources STIs Types, Timelines, and Symptoms: Chlamydia: 1-3 weeks, 50% Men & 70% women = no symptoms. Genital Herpes: 4-7 days, most people don't have any symptoms when first infected. Genital Warts: 2-3 months, most people with the virus don't develop obvious warts. Gonorrhea: 10 days, 10% Men & 50% Women = no symptoms. Pubic Lice & Scabies: 5 days - 5 weeks Syphilis: 2-3 weeks, symptoms not obvious and may come and go. Trichomoniasis: 4 weeks, 50% Men & Women = no symptoms. HIV: 2-6 weeks, some get symptoms, some don’t. VIP Testing Services https://viptestingservices.com/services/std-testing-services/ How soon can I take an HIV test? http://i-base.info/guides/testing/how-soon-can-i-take-a-test The Aids Institute https://www.theaidsinstitute.org/education/aids-101/how-do-hiv-tests-work-0 CDC Fact Sheets https://www.cdc.gov/std/healthcomm/fact_sheets.htm SEXUALLY TRANSMITTED DISEASE SURVEILLANCE 2017 https://www.cdc.gov/std/stats17/default.htm HOW DO HIV TESTS WORK? https://www.theaidsinstitute.org/education/aids-101/how-do-hiv-tests-work-0 HOW SOON CAN I TAKE AN HIV TEST? http://i-base.info/guides/testing/how-soon-can-i-take-a-test HIV TRANSMISSION https://www.cdc.gov/hiv/basics/transmission.html ORAL STD FACTS & RISKS https://www.cdc.gov/std/healthcomm/stdfact-stdriskandoralsex.htm HOW SOON DO STI SYMPTOMS OCCUR? https://www.nhs.uk/common-health-questions/sexual-health/how-soon-do-sti-symptoms-appear/

Trichomoniasis Can Cut a Calf Crop in Half

Signs, Symptoms, Treatment, and Prevention

What does a vagina smell like?https://www.healthline.com/health/womens-health/vagina-smells#1Normal smells for a healthy vaginaTangy or fermentedIt’s very common for vaginas to produce a tangy or sour aroma. Some compare it to the smell of fermented foods. In fact, yogurt, sourdough bread, and even some sour beer contain the same type of good bacteria that dominate most healthy vaginas: Lactobacilli.If it smells curiously similar to that sour IPA you had last weekend, don’t freak out.Reasons for a tangy odorAcidity. The pH of a healthy vagina is slightly acidic, between 3.8 and 4.5. “The Lactobacilli bacteria keep the vagina acidic,” says Minkin. “This protects against an overgrowth of the bad kinds of bacteria.”Coppery like a pennyMany people report smelling a coppery, metallic vaginal odor. This is usually nothing to worry about. Rarely, it signifies a more serious problem.Reasons for a coppery odorBlood. Blood contains iron, which has a metallic smell. The most common reason for blood is menstruation. During your period, blood and tissue shed from your uterine lining and travel through your vaginal canal.Sex. Light bleeding after sex can be common. This is usually due to vaginal dryness or vigorous sex that can cause small cuts or scrapes. To prevent this, try using lube.A coppery smell can also be due to less common, but serious, causes of vaginal bleeding. The metallic scent shouldn’t linger too long after your period is over. If your vagina has had contact with semen, this may change the pH level and cause a metallic smell.Sweet like molassesWhen we say sweet we don’t mean freshly baked cookies sweet. We mean robust and earthy. But don’t fret, a sweetish tinge is no cause for concern.Reasons for a sweet odorBacteria. Yep, bacteria again. Your vaginal pH is an ever-changing bacterial ecosystem. And sometimes this means you might smell a little sweet.Chemical like a newly cleaned bathroomAn odor similar to bleach or ammonia could be a couple of different things. Sometimes, this odor is a reason to see a doctor.Reasons for a chemical odorUrine. Urine contains a byproduct of ammonia called urea. A buildup of urine in your underwear or around your vulva could put off a chemical smell. Keep in mind, urine smelling strongly of ammonia is a sign of dehydration.Bacterial vaginosis. It’s also possible a chemical-like smell is a sign of bacterial vaginosis. “A chemical smell often falls under the category of fishy,” says Minkin.Bacterial vaginosis is a very common infection. Symptoms include:a foul or fishy odorthin gray, white, or green dischargevaginal itchingburning during urinationSkunky like BO or a smoked herbal, earthy scentNo, it’s not just you. Many people find a similarity between body odor and marijuana. Sadly, there isn’t a good scientific answer for this, although Vice did take a stab at it. But thanks to the sweat glands down there, at least we do know why vaginas and body odor can smell so similar.Reasons for a skunky odorEmotional stress. Your body contains two types of sweat glands, apocrine and eccrine. The eccrine glands produce sweat to cool your body down and the apocrine glands respond to your emotions. These apocrine glands populate your armpits and, you guessed it, your groin.When you are stressed or anxious, the apocrine glands produce a milky fluid. On its own this fluid is odorless. But when this fluid contacts the abundance of vaginal bacteria on your vulva, it can produce a pungent aroma.Fishy or that fillet you forgot aboutYou’ve probably heard an abnormal vaginal odor described as fishy. In fact, fresh fish shouldn’t smell like much at all. Decomposing fish is the more apt comparison. Why? Trimethylamine, which is the chemical compound responsible for both the distinct aroma of rotting fish and some abnormal vaginal odors.Reasons for a dead fish odorBacterial vaginosis. “You get bacterial vaginosis when there’s an overgrowth of anaerobic bacteria in the vagina,” says Minkin. “And these anaerobic organisms are odorous.”Trichomoniasis. Trichomoniasis is the most common curable sexually transmitted infection and easily treatable with a course of antibiotics. It’s known for its pungent fishy odor. “The trichomoniasis infection can be quite smelly,” says Minkin. “It’s a more pronounced fishy odor than bacterial vaginosis.”Rotten like a decaying organismA rotten odor that makes your nose wince and your face contort is definitely not the norm. If the smell is putrid, like a dead organism, it may not be your vagina but something in your vagina.Reasons for a rotten odorA forgotten tampon. Inadvertently letting a tampon go days, even weeks, inside a vagina is much more common than you’d think. “I can’t tell you how many tampons I’ve taken out of patients,” says Minkin. “This happens to lots and lots of people. It isn’t something you need to be embarrassed about.”See your doctor if an odor is accompanied by:itching or burningpainpain during sexthick, cottage cheese dischargevaginal bleeding unrelated to your periodMenopause changes the pH level with the change estrogen levels. Pregnancy changes the pH level tooPlus your smell of smell can be enhanced while pregnant and you might smell your vagina more, but don’t worry no one else can.

In this podcast, resident physician Lindsay Drummond will discuss the common causes of vaginal discharge, a frequent presenting complaint in family physician and gynecologist's offices.   At the end of this episode, listeners will be able to: Identify characteristics of normal vaginal discharge List common causes for pathologic vaginal discharge, including: Bacterial Vaginosis, Trichomoniasis, Candidiasis, Cervicitis Describe clinical features and investigations to help differentiate causes Identify appropriate treatments For references for this podcast, please visit: http://obginyeg.libsyn.com/

John talks about two relatively common infections both of which have the capacity to lay dormant and resurface later to infect a different partner. Situations such as this can cause quite a strain on the trust in a relationship. It's helpful to do research about the infections for your own general knowledge and seek professional medical advice for effective treatments.As always, if you enjoyed the show, follow us and subscribe to the show you can find us on iTunes or on any app that carries podcasts as well as YouTube. Please remember to subscribe and give us a nice review. That way you’ll always be among the first to get the latest GSMC Sex Podcasts.We would like to thank our Sponsors: GSMC Podcast NetworkAdvertise with US: http://www.gsmcpodcast.com/advertise-with-us.html Website: http://www.gsmcpodcast.com/sex-podcast.htmlGSMC YouTube Channel: https://www.youtube.com/watch?v=pWRiBchnNJ4&list=PLF8Qial15ufpA9FIYaOBxltIBo88g2CRMDisclaimer: The views expressed on the GSMC Relationship Podcast are for entertainment purposes only. Reproduction, copying, or redistribution of The GSMC Relationship Podcast without the express written consent of Golden State Media Concepts LLC is prohibited.

We honor @DanaVivianWhite and @DrewMcCaskill as social media moguls. Plus, L. Yates and S. Rhyheim for their deep strokes and strides in 2019. MANSCAPED - Proper manscaping requires precision engineered tools. Not only does a man's sensitive areas require it; but, both hygiene and ergonomics demand it. https://www.manscaped.com/ Send us questions, comments, and business inquiries, to hereforitpod@gmail.com We’re on Patreon! Join the #HereForItHive at www.patreon.com/HereForItPod Social Studies – Society's Expectations for Men Versus Women https://www.pewsocialtrends.org/2017/12/05/americans-see-different-expectations-for-men-and-women/   Sexual Health –  Trichomoniasis  https://www.cdc.gov/std/trichomonas/stdfact-trichomoniasis.htm   Follow us on social media @HereForItPod and hereforitpod.com www.instagram.com/hereforitpod www.twitter.com/hereforitpod www.facebook.com/hereforitpod Don't forget to leave us a comment or review on Apple Podcasts! Search our name in the Podcasts app, click the Reviews tab, click Write A Review. http://apple.co/2y6zmMi

Financial Dominance, aka  FinDommes bka PayPigs, is a thing that you want to hear about. Plus, a teaching assistant accused of sexually abusing a teenage boy in Houston, Texas claims she was trying to turn him straight. Send us questions, comments, and business inquiries, to hereforitpod@gmail.com We’re on Patreon! Join the #HereForItHive at www.patreon.com/HereForItPod Social Studies – Society's Expectations for Men Versus Women https://www.pewsocialtrends.org/2017/12/05/americans-see-different-expectations-for-men-and-women/   Sexual Health –  Trichomoniasis  https://www.cdc.gov/std/trichomonas/stdfact-trichomoniasis.htm   Follow us on social media @HereForItPod and hereforitpod.com www.instagram.com/hereforitpod www.twitter.com/hereforitpod www.facebook.com/hereforitpod Don't forget to leave us a comment or review on Apple Podcasts! Search our name in the Podcasts app, click the Reviews tab, click Write A Review. http://apple.co/2y6zmMi

Getting people to discuss STIs and STDs in the lifestyle is like trying to get someone to discuss their parent's sex life.  Right?  Hell no. It gets worse when you actually GET one.  Both in your relationship and with the friends and partners we make in the lifestyle, it's SO important to be able to communicate and keep communicating. Mickey & Mallory took the leap in this week's Casual Swinger when we engaged with lifestyle sex therapist and marriage counselor, Dr. Ieshai Bailey! We talk to the good doctor about how to help your relationship survive when an STI/STD strikes, how to discuss testing in lifestyle relationships BEFORE one strikes, and coming to terms with it personally when it happens. "You caught a WHAT!?," is all about you and your relationships.  Survive & thrive in a world that isn't safe with a great conscience, perfect communication, and incredible experiences...despite the perils that exist. Join us this week for the second of a TWO part series... and learn how to ensure your relationship survives if this happens to you! Links Podcast A Palooza Event: May 2019 Book your ticket to Podcast-A-Palooza today! Naughty in Nawlins Schedule CDC STD Statistics Dr. Ieshai Bailey Marriage and Sex Therapy

ອົງການສາທາຣະນະສຸກໂຣກບອກເຕືອນວ່າຄົນໃນໂລກນີ້ເຖິງຫຼາຍກ່ວານຶ່ງລ້ານຄົນເປັນພະຍາດກັມຣົມໃນແຕ່ລະມື້ລະວັນ. ພະຍາດສ່ວນໃຫຍ່ນັ້ນເປັນຊະນິດທີ່ຖືກປ້ອງກັນໄວ້ໄດ້ແລະປິ່ນປົວໄດ້ ແຕ່ອົງການສາທາຣະນະສຸກໂລກກໍເຕື່ອນວ່າພະຍາດດັ່ງກ່າວບາງຊະນິດດື້ດ້ານຢາຂ້າເຊື້ອໂຣກຕ່າງໆຢູ່...

Show Notes Jeff: Welcome back to EMplify, the podcast corollary to EB Medicine’s Emergency Medicine Practice. I’m Jeff Nusbaum, and I’m back with my co-host, Nachi Gupta. This month, we’re moving from the trauma bay back to a more private setting, to discuss Emergency Department Diagnosis and Treatment of Sexually Transmitted Diseases. Nachi: And for those of you who follow along with the print issue and might be reading in a public place, this issue has a few images that might not be ideal for wandering eyes. Jeff: I’d say we need a “not safe for work” label on this episode, though I think we are one of the unique workplaces where this is actually quite safe. Nachi: And we’re obviously pushing for “safe” practices this month. The article was authored by Dr. Pfenning-Bass and Dr. Bridges from the University of South Carolina School of medicine. It was edited by Dr. Borhart of Georgetown University and Dr. Castellone of Eastern Connecticut Health Network. Jeff: Thanks, team for this deep dive. Nachi: STDs or STIs are incredibly common and often under recognized by both the public and health care providers. Jeff: In addition, the rates of STDs in the US continue to rise, partly due to the fact that many patients have minimal to no symptoms, leading to unknowing rapid spread and an estimated 20 million new STDs diagnosed each year. Treating these 20 million cases amounts to a whopping $16 billion dollars worth of care annually. Nachi: 20 million! Kinda scary if you step back and think about it. Jeff: Definitely, perhaps even more scary, undiagnosed and untreated STDs can lead to infertility, ectopic pregnancies, spontaneous abortions, chronic pelvic pain and chronic infections. On top of this, there is also growing antibiotic resistance, making treatment more difficult. Nachi: All the more reason we need evidence based guidelines, which our team from South Carolina has nicely laid out after reviewing 107 references dating back to 1990, as well as guidelines from the CDC and the national guideline clearinghouse. Jeff: Alright, so let’s start with some basics: pathophysiology, prehospital care, and the H&P. STDs are caused by bacteria, viruses, or parasites that are transmitted vaginally, anally, or orally during sexual contact, or passed from a mother to her baby during delivery and breastfeeding. Nachi: In terms of prehospital care, first, make sure you are practicing proper precautions and don appropriate personal protective equipment to eliminate or reduce the chance of bloodborne and infectious disease exposure. In those with concern for possible sexual assault, consider transport to facilities capable of performing these sensitive exams. Jeff: As in many of the prehospital sections we have covered -- a destination consult could be very appropriate here if you’re unsure of the assault capabilities at your closest ER. Nachi: And in such circumstances, though patient care comes first, make sure to balance medical stabilization with the need to protect evidence. Jeff: Exactly. Moving on to the ED… The history and physical should be conducted in a private setting. For the exam, have a chaperone present, whose name you can document. The “5 Ps” are a helpful starting point for your history: partners, practices, prevention of pregnancy, protection from STDs, and past STDs. Nachi: 5 p’s, I actually haven’t heard this mnemonic before, but I like it and will certainly incorporate it into my practice. Again, the 5 p’s stand for: partners, practices, prevention of pregnancy, protection from STDs, and past STDs. After you have gathered all of your information, make sure to end with an open ended question like “Is there anything else about your sexual practices that I need to know?” Jeff: Though some of the information and even the history gathering may make you or the patient somewhat uncomfortable, it’s essential. Multiple partners, anonymous partners, and no condom use all increase the risk of multiple infections. Try to create a rapport that is comfortable and open for your patient to provide as much detail as they can. Nachi: And as with any infectious work up, tachycardia, hypotension, and fever should all raise the concern for possible sepsis. In your sepsis source differential, definitely consider PID in addition to the usual sources. As a mini plug for a prior issue, PID was actually covered in the December 2016 issue of Emergency Medicine Practice, in detail. Jeff: Getting back to the physical exam: though some question the utility of the pelvic exam as our diagnostics get better, the literature suggests the pelvic definitely still has a big role both in diagnosing and differentiating STDs and other pathology. Don’t skip this step when indicated. Nachi: Now that we have a broad overview, let’s talk about specific STDs, covering diagnosis, testing, and treatment. Jeff: If following along in the article, appendices 1, 2 and 3, list detailed physical exam findings for the STDs were going to discuss, while table 3 lists treatment options. A great resource to use while following along or as a reference during a clinical shift! Nachi: First up, let’s talk chlamydia, the most common bacterial cause of STDs, with 1.7 million reported infections in 2017. Most are asymptomatic, which increases spread, especially in young women. Jeff: Chlamydia trachomatis has a 2-3 day life cycle in which elementary bodies enter endocervical and urethral cells and replicate, eventually causing host cell wall rupture and further spread. Nachi: Though patients with chlamydia are often asymptomatic, cervicitis in women and urethritis in men are the most common presenting symptoms. Vaginal discharge is the most common exam finding followed by cervical ectropion, endocervical mucus, and easily induced bleeding. Other presenting symptoms include urinary frequency, dysuria, PID, or even Fitz-Hugh-Curtis syndrome, which is a PID induced perihepatitis. In men, epididymitis, prostatitis, and proctitis are all possible presenting symptoms also. Jeff: And of note, chlamydia can also cause both conjunctivitis and pharyngitis. Nachi: This article has a ton of helpful images. Check out figures 1 and 2 for some classic findings with chlamydial infections. Jeff: When testing for chlamydia, nucleic acid amplification is the test of choice as it has the highest sensitivity, 92% when tested from a first-catch urine sample vs. 97% from a vaginal sample. While these numbers are similar, and you’re gut may be to forego the pelvic exam, consider the pelvic exam to aid in the diagnosis of PID and to evaluate for cervicovaginal lesions or other concomitant stds. Nachi: Similarly, in men, the test of choice is also a nucleic acid amplification test, with a first catch urine preferred over a urethral swab. Jeff: And lastly, nucleic acid amplification is also the test of choice from rectal and oropharyngeal samples, though you need to check with your lab first as nucleic acid amplification is not technically cleared by the FDA for this indication. Nachi: Treatment for chlamydia is simple, 1g of azithromycin, or doxycycline 100 mg BID x 7 days. Fluoroquinolones are a second line treatment modality. Jeff: In pregnant women, chlamydia can lead to ectopic pregnancy, premature rupture of membranes, and premature delivery. The single 1g azithromycin dose is also safe and effective with amox 500 mg TID x 7 days as a second line. Pregnant women undergoing treatment should have a documented test-of cure 3-4 weeks after treatment. Nachi: Next up, we have gonorrhoeae, the gram-negative diplococci. Gonorrhea is the second most commonly reported STD, affecting 0.8% of women and 0.6% of men, with over 500,000 reported cases in 2017. Jeff: Gonorrhea attaches to epithelial cells, altering the surface structures leading to penetration, proliferation and eventual systemic dissemination. Nachi: Though some may be asymptomatic, women often present with cervicitis, vaginal pruritis, mucopurulent discharge, and a friable cervical mucosa, along with dysuria, frequency, pelvic pain and abnormal vaginal bleeding. Jeff: Men often present with epididymitis, urethritis, along with dysuria and mucopurulent discharge. Proctitis, pharyngitis, and conjunctivitis are all possible complications. Nachi: In it’s disseminated form, gonorrhea can lead to purulent arthritis, tenosynovitis, dermatitis, polyarthralgias, endocarditis, meningitis, and osteomyelitis. Jeff: In both men and women the test of choice for gonorrhea again is NAAT, with endocervical samples being preferred to urine samples due to higher sensitivity. In men, urethral and first catch urine samples have a sensitivity and specificity of greater than 97%. Nachi: And as with chlamydial samples, the FDA has not approved gonorrhea NAAT for rectal and oropharyngeal samples, but most labs are able to process these samples. Jeff: Yeah, definitely check before you go swabbing samples that cannot be run. Lastly, in regards to testing, though it won’t likely change your management in the moment, the CDC does recommend a gonococcal culture in cases of confirmed or suspected treatment failure Nachi: It’s also worth noting that although NAAT can be used in children, but culture is additionally preferred in all settings due to legal ramifications of sexual abuse. Jeff: It pains me just to think about how awful that is. Ugh. Moving on to treatment: when treating gonorrhea, the current recommendation is to treat both with cefitriaxone and azithro. 250 mg IM is the preferred dose, up from just 125 mg IM which was preferred dose two decades ago along with 1g of azithro. Nachi: And if ceftriaxone IM cannot be administered easily, 400 mg PO cefixime is the second line treatment of choice. If there is a documented cephalosporin allergy, PO gemifloxacin or gentamycin may be used. And for those with an azithomycin intolerance, a 7 day course of doxycycline may be substituted instead. Jeff: In pregnant women, gonococcal infections are associated with chorioamnionitis, premature rupture of membranes, preterm birth, low birth weight, and spontaneous abortions. Pregnant woman therefore should be treated with both ceftriaxone and azithro in the same manner as their non pregnant counterparts. Nachi: There is also one quick controversy to discuss here. Jeff: oh yeah, go on… Nachi: The CDC currently recommends the IM dose of ceftriaxone, not IV. And this is because of the depot effect. However, it’s unclear if this effect is in fact true, as IM and IV ceftriaxone levels measured in blood 24 hours later are similar. So if the patient has an IV already, should we just give the ceftriaxone IV instead of IM? Jeff: I think it is probably okay, but I’ll wait for a bit more research. For now, I would continue to stick with the CDC recommendation of IM as the correct route. Nachi: And with the continuing rise of STD’s and the public health and economic burden we are describing here, I think the IM route, which is known to be effective, should still be used -- until the CDC changes their recommendations. Next up we have the great imitator/masquerader, syphilis, caused by the spirochete Treponema pallidum. LIke the other STDs we’ve discussed so far, cases of syphilis are also on the rise with over 30k cases in 2017, a 10% increase from 2016. Jeff: Syphilis is spread via direct contact between open lesions and microscopic abrasions in the mucous membranes of vagina, anus, or oropharynx. The organism then disseminates via the lymphatics and blood stream. Nachi: Infection with syphilis comes in three stages. Primary syphilis is characterized by a single, painless lesion, or chancre, which occurs about 3 weeks after inoculation. 6-8 weeks later, secondary syphilis develops. This often presents with a rash, typically on the palms and soles of the feet, or with condyloma lata, or lymphadenopathy. Jeff: Tertiary syphilis doesn’t appear until about 20 years post infection and it includes gummatous lesions and cardiac involvement including aortic disease. Nachi: Patients at any stage may go long periods without any symptoms, which is known as latent syphilis. In addition, at any stage a patient may develop neurosyphilis, which can present with strokes, altered mental status, cranial nerve dysfunction, and tabes dorsalis. Jeff: In early syphilis, dark-field examination is the definitive method of detection, though this is impractical in the ED setting. There are, instead, 2 different algorithms to follow. The CDC traditional algorithm recommends a nontreponemal test like rapid plasma reagin or RPR or the venereal disease research lab test also called VDRL, followed by confirmational treponemal test (fluoresent treponemal antibody absorption or FTA-ABS or T pallidum passive agglutination also called TP-PA). More recently there has been a shift to the reverse sequence, with screening with a treponemal assay followed by a confirmatory nontreponemal assay. Nachi: The reason for the change is that there is an increased availability of rapid treponemal assays. And where available, the reverse sequence offers increased throughput and the ability to detect early primary syphilis better. The CDC, however, still recommends the traditional testing pathway -- that is nontreponemal tests first like RPR or VDRL, followed by treponemal tests like FTA-ABS or TP-PA. The article also notes that emergency clinicians should rely on clinical manifestations in addition to serologic testing, when determining whether to treat for syphilis. Jeff: For neurosyphilis, the CSF-VDRL test is highly specific but poorly sensitive. In cases of a negative CSF-VDRL but still with high clinical suspicion, consider a CSF FTA-ABS test, which has lower sensitivity, but is also highly specific and may catch the diagnosis. Nachi: Treatment for primary, secondary, and early latent syphilis is with 2.4 million units of Penicillin G IM. For ocular and neurosyphilis, treatment is with 18-24 million units of pen G IV every 4 hours or continuously for 10-14 days. In patients who have a penicillin allergy, skin testing and desensitization should be attempted rather than azithromycin due to concerns for resistance. Jeff: For pregnant women, PCN is the only proven therapy. Interestingly, there is some evidence to suggest that a second IM dose may be beneficial in treating primary and secondary syphilis in pregnancy though data are limited. Nachi: We also have to mention the Jarisch-Herxheimer reaction before moving on. This is a syndrome of fevers, chills, headache, myalgias, tachycardia, flushing and hypotension following high dose PCN treatment due to a massive release of endotoxins when the bacteria die. This typically occurs in the first 12 hours but can occur up to 24 hours after treatment. Treatment is supportive. Concern of this reaction should never delay PCN treatment!! Jeff: The next condition to discuss is Bacterial vaginosis, or BV, which, interestingly, is not always an STD. It is therefore critically important to choose your words wisely when speaking with a patient who has BV. Nachi: That is an important point that is worth repeating. BV is not always an STD. So what is BV? BV occurs when there is a decrease or absence of lactobacilli that help maintain the acidic pH of the vagina leading to an overgrowth of Gardnerella, bacteroides, ureaplasma and mycoplasma. BV does not occur in those who have never had intercourse and it may increase the risk of other STDs and HIV. Jeff: 50% of women with BV are asymptomatic, while the others will have a thin, grayish-white, homogeneous vaginal discharge with a fishy smell, along with pruritis. Nachi: To diagnose BV, most use the amsel criteria, which requires 3 of following 4: 1) a thin, milky, homogeneous vaginal discharge, 2) the release of a fishy odor before or after the addition of potassium hydroxide, 3) a vaginal pH > 4.5, and 4) the presence of clue cells in the vaginal fluid. These criteria are 90% sensitive and 77% specific, with clue cells being the most reliable predictor. Jeff: And for those of us without immediately available microscopy, you can make the diagnosis based on characteristic vaginal discharge alone. Treat with metronidazole, 500 mg BID for 7 days, metronidazole gel, or an intravaginal applicator for 5 days, with the intravagainal applicator being better tolerated than the oral equivalent Nachi: BV in pregnancy increases risk of preterm birth, chorioamnionitis, postpartum endometriitis and postcesarean wound infections. Pregnant patients are treated the same as nonpregnant or with 400 mg of clindamycin BID x 7 days. Jeff: Always nice when there is really only one treatment regimen across the board. And that will be a general theme for treatment options in pregnancy with a few exceptions. Nachi: Next up we have Granuloma inguinale, or donovanosis, which is caused by Klebsiella granulomatis. Jeff: Granuloma inguinale is endemic to India, the Caribbean, central australia, and southern africa. It is rarely diagnosed in the US. Nachi: Granuloma inguinale presents with highly vascular, ulcerative lesions on the genitals or perineum. They are typically painless and bleed easily. If disseminated, Granuloma inguinale can lead to intra-abdominal organ and bone lesions and elephantiasis-like swelling of the external genitalia. Jeff: Granuloma inguinale can can be diagnosed by microscopy from the surface debris of purulent ulcers. Nachi: Once you have the diagnosis, the CDC recommends treatment with azithromycin for at least 3 weeks and until all lesions have resolved. Jeff: Next we have lymphogramuloma venereum or LGV. Nachi: LGV is a C. Trachomatis infection of the lymphatics and lymph nodes. This is predominantly a disease of the tropics and subtropical areas of the world. Jeff: On exam, in the primary stage, you would expect a small, painless papule, pustule, nodule or ulcer on the coronal sulcus of the penis or on the posterior forchette, vulva, or cervix of women. The primary stage eventually progresses to the secondary stage, which is characterized by unilateral lymphadenopathy with fluctuant, painful lymph nodes known as buboes. Nachi: Check out figure 11 for a great classic image of the “groove sign” which is involvement of both the inguinal and femoral lymph nodes, and is seen in 15-20% of cases. And actually even more common than the groove sign is a presentation with proctitis. Jeff: Testing for LGV should be based on high clinical suspicion, and NAAT should be performed on a sample from the primary ulcer base or from aspirate from a bubo. Nachi: Treatment for LGV is with doxycycline 100 mg BID x 21 days. Jeff: So, to summarize, for LGV, remember painful lymphadenopathy, especially in those with proctitis. Treat with doxy. Nachi: Next we have Mycoplasma genitalium, which causes nongonococcal urethritis in men and mucopurulent cervicitis and PID in women. Jeff: Unfortunately, there is no diagnostic test for M. genitalium, and it should be considered clinically, especially in the setting of recurrent urethritis. Nachi: Treat with azithro, but not 1g x 1. Instead, M. Genitalium should be treated with a course of azithro, with 500 mg on day 1 followed by 250 mg daily for 4 days. Moxifloxacin is an alternative. Jeff: Simple enough. Moving on to everybody’s favorite, genital herpes. Nachi: umm, I’m not sure sure anybody would call herpes their favorite. Why would you even say that? Jeff: i don’t know, seemed natural at the time… Regardless, primary genital herpes is caused by either HSV1 or HSV2. Though only an estimate, and likely an underestimate at that, it is estimated that at least 1 in 6 people in the US between 14 and 49 have genital herpes. Nachi: That’s much higher than I would have thought. Jeff: Patients usually contract oral herpes from HSV-1 due to nonsexual contact with saliva and genital herpes due to sexual contact with an infected person. Nachi: Keep in mind, however, that HSV1 can and will also cause genital infections if spread via oral sex. Jeff: Localized symptoms include pain, itching, dysuria, and lymphadenopathy and systemic symptoms include fever, headache, and malaise. In women, look for herpetic vesicles on the external genitalia along with tender ulcers in areas of rupture, see figure 12 for a characteristic image. Nachi: Though symptoms tend to be more severe in woman, men may present with vesicles on the glans penis, penile shaft, scrotum, perianal area, and rectum or even with dysuria and penile discharge. Jeff: HSV1 and 2 infections also have the ability to recur, though recurrences tend to become less frequent and severe over time. Nachi: It’s noteworthy that there is also a direct correlation between stress levels and the severity of an HSV outbreak. Jeff: Herpes can be diagnosed by viral culture of an unroofed vesicle or by NAAT. PCR based assays can also differentiate between HSV1 and HSV2 Nachi: While there is no cure, antivirals may help prevent and shorten outbreaks. Ideally you should begin treatment within 72 hours of lesion appearance. Treat with acyclovir, valacyclovir, or famciclovir. In addition, don't forget about adjuncts like analgesia, sitz bathes, and urinary catheter placement for severe dysuria. Jeff: HSV can also be vertically transmitted from mother to child so in pregnancy, treat with acyclovir 400 mg 3x/day for 7 days or valacyclovir Nachi: And because transmission is so easy, babies born to mothers with active lesions should be delivered by cesarean section. Jeff: Let’s move on to human papillomavirus, or HPV. There are over 100 types of HPV with 40 being transmitted through skin to skin contact, typically via vaginal and anal intercourse. Nachi: Most infections are asymptomatic and clear within 2 years. Jeff: Right, but one of the main reasons this is such a big deal is that HPV types 16 and 18 are oncogenic strains and can lead to cervical, penile, vulvar, vaginal, anal, and oropharyngeal cancers. Amazingly, HPV is responsible for more than 95% of the cervical cancers in women. Nachi: Hence the importance of the new vaccine series that most young adults and children are now opting for. Vaccination should occur in women through age 26 or men through age 21 if not previously vaccinated. Jeff: Critically important to take advantage of a vaccine that can prevent cancer! Nachi: And though not as important in terms of health consequences, just be aware that HPV 6 and 11 may lead to anogenital warts, known as condyloma acuminata. Jeff: In terms of exam findings, as you just mentioned, most infections are asymptomatic and self-limited. If symptoms do develop, HPV typically causes those cauliflower like or white plaque like growths lesions on the external genitalia, perineum, and perianal skin. Nachi: For testing, there is a limited role in the ED. Diagnosis should be made by visual inspection, followed eventually by a biopsy. Jeff: And just like the biopsy, which is unlikely to be done in the emergency department, most treatment is also not ED based. Treatment options include cryotherapy, immune-based therapy, and surgical excision, which has both the highest success rates and lowest recurrence. Nachi: Next up, we have trichomoniasis. Jeff:Trichomoniasis is a single-celled, flagellated, anaerobic protozoa, that directly damages the epithelium, causing microulcerations in the vagina, urethra, and paraurethral glands. Nachi: With an estimated 3.7 million infected people in the US, this is something you’re also bound to see. Jeff: Risk factors include recent or current incarceration, IV drug use, and co-infection with BV. Nachi: Note the common theme here - co infection. It’s very common for patients to have more than one STD, so make sure not to anchor when you think you’ve nailed the diagnosis. Jeff: On exam the majority of both women and men are asymptomatic. In women, you may find a purulent, frothy vaginal discharge, vaginal odor, vulvovaginal irritation, itching, dyspareunia, and dysuria Nachi: And don’t forget about the classic colpitis macularis, or the strawberry cervix. Though this is frequently taught and stressed, it’s actually only seen in 2-5% of infected women. Jeff: But to be fair, a strawberry cervix and frothy vagianl discharge together have a specificity of 99% for trich, which is really not bad. Nachi: While many EDs sadly aren’t blessed with a wet mount, the wet mount has the advantage of being simple, convenient, and generally low cost. Jeff: While all of that is true regarding the wet mount, it’s no longer first line, again with NAAT being preferred, as it’s highly sensitive, approaching 100%. Nachi: And for those of us who don’t have access to NAAT, there are also antigen-detecting tests which don’t perform quite as well, but they are much more sensitive than the traditional wet mount. Jeff: Treatment for trichomoniasis is with oral metronidazole, 2g in a single oral dose a or 500 mg twice a day for 7 days. Alternatively, the more expensive tinidazole, 2g for 1 dose, is actually superior according to the most recent evidence. Nachi: For pregnant patients, trichomoniasis is unfortunately associated with premature delivery and premature rupture of membranes, with no improvement following treatment. Still, patients should be tested and treated, preferentially with metronidazole, to relieve symptoms and prevent partner spread. Jeff: We have two more special populations to discuss in this month’s issue - those in correctional facilities and sexual partner treatment. If you are lucky enough to be involved in treating those in correctional facilities, keep in mind that rates of gonorrhea, chlamydia, syphilis, and trichomoniasis are higher in persons in both juvenile and adult detention facilities than the general public. Nachi: In general for patients in correctional facilities, maintain a lower threshold for just about everything. This is just an at-risk population. Jeff: Let’s move on to sexual partners, and expedited partner therapy or EPT. Nachi: Once you’ve diagnosed a patient with an STD, you can also provide a prescription or medication to the patient to give to their partner or partners. Jeff: This practice is critically important to stop partners from unknowingly spreading the STD further which is a real problem. Unless prohibited by law, emergency clinicians should routinely offer EPT to patients with chlamydia, gonorrhea, or trichomoniasis. To see your states’ current status, the CDC maintains a list of the status in all 50 states. Nachi: In terms of specific partner therapies, for chlamydia, EPT can be accomplished with a single 1g dose of azithromycin or doxycyclin 100 mg bid for 7 days. Consider concurrent treatment for gonococcal infection also. Jeff: For Gonorrhea, EPT includes a single oral dose of 400 mg of cefixime and a 1g oral dose of azithromycin. Nachi: For EPT for syphilis, unfortunately the partner has to present to the ED for a single IM injection of penicillin G. While this does place a burden on the partner, it opens up an opportunity for additional serologic testing and possibly treatment of his or her partners as well. Jeff: Routine EPT for those with BV is not recommend as the data shows that partner treatment does not affect rates of relapse or recurrence. Nachi: For genital herpes, you should counsel patients and their partners that they should abstain from sexual activities when there are lesions or prodromal symptoms. Make sure to refer partners for evaluation as well. Jeff: Since there isn’t much data on HPV partner notification, for now, encourage patients to be open with their partners so they may seek treatment as well. Nachi: And lastly, for Trichomoniasis, EPT includes 2 g of metronidazole or 500 mg BID for 7 days or that single 2g dose of tinidazole. Jeff: In general, it is always better to have the partner present to a physician for diagnosis and treatment, but EPT is an option when that seems unlikely or impossible. Nachi: Also, when possible be sure to inquire about drug allergies and provide some guidelines on ER presentation for allergic reactions. Jeff: So that wraps up EPT. Let’s discuss disposition. Though most will end up going home, a few may require IV medications, such as those with severe HSV, disseminated gonococcus, and neurosyphilis. Nachi: Admission should also be strongly considered in those who are pregnant or with concern for complications. Those with severe nausea, vomiting, high fever, the inability to tolerate oral antibiotics, and those failing oral antibiotics should also be considered for admission. Jeff: But if your patient doesn’t meet those criteria, as most will not, and they are headed home, stress the importance of follow up. Especially for those with gonorrhea and chlamydia, for whom a test of cure after completion of their medication is recommended. This is even more important for pregnant women. Nachi: Chlamydia, gonorrhea, HIV, and syphilis are among the many infectious diseases that require mandatory reporting. Definitely familiarize yourself with your states’ reporting laws, as most of these patients will be headed home and you’ll want to make sure you don’t miss your chance to prevent further spread. Jeff: Perfect, so that’s it for this month’s issue. Let’s close out with some high yield points and clinical pearls. Nachi: STDs are under recognized by patients and healthcare professionals. They can often present with minimal or no symptoms and are passed unknowingly to partners. Jeff: STD’s can have devastating effects during pregnancy on the fetus. Treat these patients aggressively in the ER. Nachi: The rising rate of STD’s continues to be an economic burden on the U.S. healthcare system. Jeff: Patients can present with multiple STD’s concurrently. Avoid premature diagnostic closure and consider multiple simultaneous processes. Nachi: Urinary tract infections and STD’s can present similarly. Be sure to do a pelvic exam to avoid misdiagnosis. For the exam, always have a chaperone present. Jeff: Acute unilateral epididymitis is most commonly a result of chlamydia in men under the age of 35. Nachi: Chlamydia is the most common bacterial STD. The diagnostic test of choice is nucleic acid amplification testing (NAAT). Treat with azithromycin or doxycycline. Jeff: Gonorrhea is the second most common STD. The diagnostic test of choice here is again NAAT. Treat with ceftriaxone and azithromycin. Nachi: Gonorrhea can lead to disseminated infection such as purulent arthritis, tenosynovitis, dermatitis, polyarthralgias, endocarditis, meningitis, and osteomyelitis. Jeff: Syphilis has a wide variety of presentations over three stages. For concern of early syphilis, send RPR or VDRL for nontreponemal testing as well as an FTA-ABS or TP-PA for treponemal testing. Nachi: Tertiary syphilis can present with gummatous lesions or aortic disease many years after the primary syphilis infection. Jeff: At any stage of syphilis, the central nervous system can become infected, leading to neurosyphilis. Nachi: Bacterial vaginosis presents with a white, frothy, malodorous vaginal discharge. Treat with metronidazole. Jeff: Genital herpes is caused by HSV-1 or HSV-2. Diagnosis can often be made clinically. If sending a sample for testing, be aware that viral shedding is intermittent, so you may have a falsely negative result. Antivirals can help prevent or shorten outbreaks and decrease transmission. Nachi: Lymphogranuloma Venereum presents with small, painless papules, nodules, or ulcers. Groove sign is present in only 15%-20% of cases. Jeff: Consider Fitz-Hugh-Curtis syndrome in your differential for a sexually active patient with right upper quadrant pain. Nachi: Offer expedited partner therapy to all patients with STD’s to prevent further spread Jeff: So that wraps up Episode 27 - STDs in the ED! Incredibly high yield topic with lots of pearls. Nachi: As always, additional materials are available on our website for Emergency Medicine Practice subscribers. If you’re not a subscriber, consider joining today. You can find out more at ebmedicine.net/subscribe. Subscribers get in-depth articles on hundreds of emergency medicine topics, concise summaries of the articles, calculators and risk scores, and CME credit. You’ll also get enhanced access to the podcast, including any images and tables mentioned. PA’s and NP’s - make sure to use the code APP4 at checkout to save 50%. Jeff: I’ll repeat that, since saving money is important. APPs, use the promotion code APP4 at checkout to receive 50% off on your subscription. Speaking of PAs - for those of you attending the SEMPA conference in just a few weeks, make sure to check out the EB Medicine Booth, #302 for lots of good stuff. For those of you not attending the conference, just be jealous that your colleagues are hanging out in New Orleans. Nachi: And the address for this month’s credit is ebmedicine.net/E0419, so head over there to get your CME credit. As always, the you heard throughout the episode corresponds to the answers to the CME questions. Lastly, be sure to find us on iTunes and rate us or leave comments there. You can also email us directly at EMplify@ebmedicine.net with any comments or suggestions. Talk to you next month! Most Important References 3. Workowski KA, Bolan GA. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep. 2015;64(Rr- 03):1-137. (Expert guidelines/systematic review) 5. Torrone E, Papp J, Weinstock H. Prevalence of Chlamydia trachomatis genital infection among persons aged 14-39 years- -United States, 2007-2012. MMWR Morb Mortal Wkly Rep. 2014;63(38):834-838. (Expert guideline/systematic review) 98. Schillinger JA, Gorwitz R, Rietmeijer C, et al. The expedited partner therapy continuum: a conceptual framework to guide programmatic efforts to increase partner treatment. Sex Transm Dis. 2016;43(2 Suppl 1):S63-S75. (Systematic review; 42 articles) 103. Centers for Disease Control and Prevention. 2018 National Notifiable Conditions (Historical). National Notifiable Diseases Surveillance System (NNDSS). Accessed March 10, 2019. (CDC website) 105. Carter MW, Wu H, Cohen S, et al. Linkage and referral to HIV and other medical and social services: a focused literature review for sexually transmitted disease prevention and control programs. Sex Transm Dis. 2016;43(2 Suppl 1):S76-S82. (Systematic review; 33 studies)

On this episode we got super serious and talked about the numbers and statistics when it comes to STIs in the black and brown community. Dr. Kiesha Benn joined us for an informational session on how to advocate for yourself when it comes to speaking to your doctors, knowing your status, prevention, etc. This is Part 1 of a 2 part series on STIs in our communities and how we need to use our voices more to speak up for our needs. We addressed the most common STIs such as HPV, Chlamydia, Genital herpes, Gonorrhoea (the clap), Hepatitis B, HIV, Trichomoniasis, and Syphilis. We got into which ones are curable and which aren't, how you should take care of yourself if you're infected, and more. This episode is full of information that everyone needs to know!

En el programa de esta semana hablamos de tricomoniasis, a proposito de un estudio recientemente publicado que cuestiona el uso de dosis única de metronidazole que figura como una de las opciones primarias de tratamiento de esta infección. Referencias:    Patricia Kissinger y colaboradores. Single-dose versus 7-day-dose metronidazole for the treatment of trichomoniasis in women: an open-label, randomised controlled trial. Lancet Infectious Diseases. Nov 2018.    CDC. Trichomoniasis   Frase de la Semana: La tomamos de Roberto Bolaños.  Nació en Santiago de Chile el 28 de abril de 1953. Escritor chileno afincado en España desde finales de la década de 1970. Autor de extraordinario talento, forzó los límites de la literatura en una serie de novelas con las que se consagró como una de las voces más importantes y personales de la narrativa latinoamericana. En sólo una década, segun palabras del tambien escritor Chileno Jorge Edward, Bolaño “se convirtió en un cuentista y novelista central, quizás el más destacado de su generación, sin duda el más original y el más infrecuente”. En 1999 ganó el Premio de Novelas Romulo Gallegos con su novela “Los Detectives Salvajes” y en el 2008 el National Book Critics Cicle Award. Bolaños fallecio el 15 de Julio del 2003.   La frase dice:   “La soledad sí que es capaz de generar deseos que no se corresponden con el sentido común o con la realidad”  

October Quick Summary October Articles CCR by triage nurses, IM sedation in the ED, Orthostatic VS ???, Intranasal vasoconstrictors effect on BP, Antibiotics for Appendicitis ?, Single dose vs 7 day dose metronidazole for Trichomoniasis, Vanc/Zosyn and AKI, "Occult" PTX and HTX and management, Nebulized TXA for Secondary Post-Tonsillectomy Hemorrhage, IV Lidocaine for Renal Colic, Rural Level III Centers in a trauma system, Ground vs Flight RSI (EMS), Procedural Sedation - Consensus Practice Guideline

Trichomoniasis is the most common curable sexually transmitted infection. It is caused by the protozoan parasite, Trichomonas vaginalis. In the United States, the Centers for Disease Control and Prevention (CDC) estimates 3.7 million people have the infection. Joining me today to discuss this protozoa is Parasitology teacher and author of Parasites, Tales of Humanity's Most Unwelcome Guests, Rosemary Drisdelle.

Trichomoniasis is the most common curable sexually transmitted infection. It is caused by the protozoan parasite, Trichomonas vaginalis. In the United States, the Centers for Disease Control and Prevention (CDC) estimates 3.7 million people have the infection. Joining me today to discuss this protozoa is Parasitology teacher and author of Parasites, Tales of Humanity’s Most Unwelcome […] The post Trichomonas vaginalis: The sexually transmitted parasite appeared first on Outbreak News Today.

Kit Fairley discusses The Lancet Infectious Diseases' new Commission on sexually transmitted infections.

 Vincent and Dickson welcome new TWiP host Daniel to discuss the association of a new Mycoplasma with Trichomoniasis, and to introduce a new feature to the show, a case study. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Links for this episode: Association of Mycoplasma with trichomoniasis (PLoS One) Biggest DNA genomes (Wikipedia) Send your case study solutions to twip@twiv.tv Letters read on TWiP 80 Contact Send your questions and comments (email or mp3 file) to twip@twiv.tv Subscribe Subscribe to TWiP (free) in iTunes, by the RSS feed or by email  

Wed, 09 May 2012 14:32:40 GMT http://saveyourskin.ch/podcast/EN/2.5.4_2.5.5_2.5.6.Unspecific_Urethritis.mp4 Prof. Dr. Dr. h. c. Günter Burg, MD Zürich & Prof. Dr. Walter Burgdorf, MD 2013-03-10T14:32:37Z Prof. Dr. Dr. h. c. Günter Burg, MD Zürich & Prof. Dr. Walter Burgdorf, MD no N

Wed, 09 May 2012 14:32:40 GMT http://saveyourskin.ch/podcast/DE/2.5.4_2.5.5_2.5.6.Unspecific_Urethritis.mp4 Prof. Dr. Dr. h. c. Günter Burg, MD Zürich 2013-03-10T14:32:37Z Prof. Dr. Dr. h. c. Günter Burg, MD Zürich no Unsp