In adults usually infected (fungal or bacterial) dermatitis, often with offensive discharge.
Precautions: consider umbilical fistula, carcinoma, umbilical calculus.
Swab for micro and culture.
Toilet—remove all debris and clean.
Keep dry and clean—daily dressings.
Consider Kenacomb ointment.
Umbilical granuloma in infants
Apply a caustic pencil gently daily for about 5 d.
A testis that is not in the scrotum may be ectopic, absent, retractile or truly undescended.
The problem of non-descent
Optimal time for assessment
Between 3 and 6 mths (before development of cremasteric reflex and thus confusion with a retractile testis)
Review 2½–3 yrs—?acquired maldescent
The optimal time for orchidopexy is 6–12 mths. Production of spermatozoa is adversely affected in undescended testes from 2 yrs onwards. Exploration for the uncommon impalpable testis is worthwhile.
Injections of chorionic gonadotrophic hormones are generally not recommended. They are ineffective except for borderline retractile testes.
Leads to increased cardiovascular disease, death rate and psychiatric illness.
Objective is to prevent resignation, hopelessness and deterioration of health. Encourage positive outlook with readiness to re-enter labour force.
School leavers, esp. non-achievers (beware of impulsive overdoses)
History of psychosomatic or physical disability
Children of the unemployed
Previous problematic marriages
Men with many dependants
Those >50 yrs with good job records
The important STIs that cause urethritis which may be asymptomatic (esp.♀s) are gonorrhoea and Chlamydia trachomatis.
Check with your laboratory. The conventional method is as follows.
The NAAT (PCR) Chlamydia urine test (95% specific) is the preferred test (in both sexes), traditionally on the first catch urine specimen (don't urinate for 4 hrs) then first 10 mL passed in an ordinary MCU jar. However, now the specimen can be collected at any time—there is no minimum time since the last urination.
New approaches are to collect a random sample by passing urine through a UriSWAB or self-collection from a tampon in females.