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Umbilical discharge

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

Precautions: consider umbilical fistula, carcinoma, umbilical calculus.

Management:

  • 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.

Undescended testes

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

The problem of non-descent

  • Testicular dysplasia

  • Susceptible to direct violence (if in inguinal region)

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

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

Refer

  • All undescended testes by 6 mths

  • Acquired maldescent

  • Concerned parents

  • Doubtful position of testis

Optimal time for surgery

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.

Hormone injections

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

Unemployment

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.

Vulnerable groups

  • 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

  • Diagnostic awareness

  • Foreshadow problems

  • Caring, supportive counselling (very powerful)

  • Liaison with social services

Urethritis

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

Collection of specimens

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.

These tests ...

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