Natural Health and Herbal Remedies Blog – information on herbal medicine

Vulvitis is inflammation of the vulva and may be caused by:

primary or allergic contact irritations;

vaginal discharge due to infections (candidiasis, trichomoniasis etc.); vaginal discharge due non-infectious conditions (foreign bodies in the vagina, neoplasms of the genital tract);

primary dermatological conditions e.g. seborrhoeic dermatitis, eczema and psoriasis.

The clinical features depend on the aetiology but pruritis, discomfort, erythema and oedema are typical features. Management depends on the cause.

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No effective vaccine has been developed. Modification of behaviour is the only valid strategy for prevention of HIV infection. Education programmes to encourage sexual practices that reduce the exchange of genital secretions (‘safe sex’) may achieve risk reduction for sexually active individuals. Condoms provide a barrier if used properly and consistently but may be too easily damaged to offer reliable protection during anal intercourse.

Transmission from mother to infant may occur before, during or after birth; 25-50% of the infants of infected women become infected. Infected women should use contraceptives to avoid pregnancy; if pregnancy occurs, termination should be considered.

Contacts of HIV positive patients should be traced and offered testing and counselling.

Patients with HIV infection must be advised of the risk they pose to seronegative sexual partners.

A person who has HIV infection or is at risk of HIV infection must not make any blood, semen or tissue donation.

Because of the probable association between genital ulcerative disease and HIV transmission, the effective management of STDs is part of the general strategy for HIV control.

A number of publications have been produced by Commonwealth, State and Territory governments, by other agencies and by community groups to assist practitioners and patients in preventive education and in the management of HIV infection. These are available from health departments and various other agencies.

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The patient with early syphilis should return for repeat examination and serology at the following intervals:

at one month;

at regular 3 monthly intervals for 1 year, and

at 6 monthly intervals for the second year.

Patients with late syphilis should be followed indefinitely; patients with neurosyphilis should have periodic CSF examinations for at least 3 years.

The titre of the reagin test (VDRL or RPR) will fall until it becomes non-reactive or minimally reactive (e.g. 1/2) by the end of 2 years after effective treatment of early syphilis.

In late syphilis, low titres are usually found and only a slight reduction should be expected after treatment. In some cases, no change in titre occurs. Provided the CSF has been tested and found to be non-reactive, no further treatment is indicated.

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Patients, except pregnant females, who are sensitive to penicillin can be treated with spectinomycin (see below), tetracyclines or trimethoprim/sulphamethoxazole. Pregnant patients should be treated with erythromycin.

Penicillin resistant infection (first line treatment where PPNG is endemic) Adults:

Ceftriaxone 250 mg intramuscularly in a single dose OR

Spectinomycin 2 g intramuscularly in a single dose. (Spectinomycin should not be used in pregnancy)

Children:

Spectinomycin 40 mg/kg intramuscularly in a single dose.

Complicated infections (PID, septic arthritis, septicaemia etc.)

Complicated infections such as PID, prostatitis or epididymitis, arthritis, ophthalmic lesions, disseminated infection, meningitis, endocarditis, myocarditis or pericarditis require multiple dose therapy. Hospitalisation and specialist referral is usually indicated. These patients often require intravenous chemotherapy which is replaced by oral treatment on clinical improvement. Duration of treatment will be at least 7 days extended to at least 14 days for meningitis and at least a month for endocarditis.

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Wet mounts can be examined for the presence of trichomonads and ‘clue

cells’. Stained smears can be examined for the presence of polymorphonuclear leucocytes, gonococci, the aetiological agents of bacterial vaginosis and Candida (chapter 20).

The criterion for the diagnosis of urethritis is the presence of 5 or more

polymorphonuclear leucocytes per oil immersion high power field in 5 or more fields in a satisfactory area of a properly prepared urethral smear. Best results are obtained if the patient has not passed urine overnight; if this is not practicable, the patient should be asked to refrain from voiding for 4 hours before providing a urine sample.

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