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Umbilical discharge

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In adults usually infected (fungal or bacterial) dermatitis, often with offensive discharge.

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Precautions: consider umbilical fistula, carcinoma, umbilical calculus.

++ Management:
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  • Swab for micro and culture.

  • Toilet—remove all debris and clean.

  • Keep dry and clean—daily dressings.

  • Consider Kenacomb ointment.

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Umbilical granuloma in infants

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Apply a caustic pencil gently daily for about 5 d.

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Undescended testes

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A testis that is not in the scrotum may be ectopic, absent, retractile or truly undescended.

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The problem of non-descent
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  • Testicular dysplasia

  • Susceptible to direct violence (if in inguinal region)

  • Risk of malignant change (seminoma) is 5–10 times greater than normal

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Optimal time for assessment
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Between 3 and 6 mths (before development of cremasteric reflex and thus confusion with a retractile testis)

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Review 2½–3 yrs—?acquired maldescent

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Refer
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  • All undescended testes by 6 mths

  • Acquired maldescent

  • Concerned parents

  • Doubtful position of testis

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Optimal time for surgery
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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.

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Hormone injections
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Injections of chorionic gonadotrophic hormones are generally not recommended. They are ineffective except for borderline retractile testes.

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Unemployment

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Leads to increased cardiovascular disease, death rate and psychiatric illness.

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Objective is to prevent resignation, hopelessness and deterioration of health. Encourage positive outlook with readiness to re-enter labour force.

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Vulnerable groups
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  • 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

++ Role of GP
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  • Diagnostic awareness

  • Foreshadow problems

  • Caring, supportive counselling (very powerful)

  • Liaison with social services

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Urethritis

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The important STIs that cause urethritis which may be asymptomatic (esp.♀s) are gonorrhoea and Chlamydia trachomatis.

++ Collection of specimens
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Check with your laboratory. The conventional method is as follows.

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  • 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.

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These tests ...

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