RESUMO
There has been an increasing worldwide incidence of invasive group A streptococcal (GAS) disease in pregnancy and in the puerperal period over the past 30 years. Postpartum Group A streptococci infection, and in particular streptococcal toxic shock syndrome (TSS) and necrotizing fasciitis, can be life threatening and difficult to treat. Despite antibiotics and supportive therapy, and in some cases advanced extensive surgery, mortality associated with invasive group A streptococcal postpartum endometritis, necrotizing fasciitis, and toxic shock syndrome remains high, up to 40% of postpartum septic deaths. It now accounts for more than 75,000 deaths worldwide every year. Postpartum women have a 20-fold increased incidence of GAS disease compared to non-pregnant women. Despite the high incidence, many invasive GAS infections are not diagnosed in a timely manner, resulting in potentially preventable maternal and neonatal deaths. In this paper the specific characteristics of GAS infection in the field of Ob/Gyn are brought to our attention, resulting in guidelines to improve our awareness, early recognition and timely treatment of the disease. New European prevalence data of vaginal GAS colonization are presented, alongside two original case histories. Additionally, aerobic vaginitis is proposed as a supplementary risk factor for invasive GAS diseases.
Assuntos
Promoção da Saúde , Pesquisa sobre Serviços de Saúde , Meios de Comunicação de Massa , Infecções Sexualmente Transmissíveis/prevenção & controle , Adulto , Atenção à Saúde , Intervenção Médica Precoce , Feminino , Humanos , Masculino , Educação de Pacientes como Assunto , Formulação de Políticas , Guias de Prática Clínica como Assunto , Comportamento Sexual , Infecções Sexualmente Transmissíveis/epidemiologia , Reino Unido/epidemiologiaAssuntos
Infecções por Chlamydia/diagnóstico , Chlamydia trachomatis/isolamento & purificação , Anti-Inflamatórios não Esteroides/uso terapêutico , Infecções por Chlamydia/tratamento farmacológico , Chlamydia trachomatis/efeitos dos fármacos , Conjuntivite de Inclusão/epidemiologia , Conjuntivite de Inclusão/microbiologia , Educação Médica Continuada , Feminino , Gastroenteropatias/epidemiologia , Gastroenteropatias/microbiologia , Humanos , Incidência , Masculino , Gravidez , Gravidez Ectópica/epidemiologia , Gravidez Ectópica/microbiologia , Prognóstico , Medição de Risco , Índice de Gravidade de Doença , Dermatopatias Infecciosas/epidemiologia , Dermatopatias Infecciosas/microbiologia , Reino Unido/epidemiologiaRESUMO
OBJECTIVES: To assess the feasibility and acceptability of training and examining medical students in taking a sexual history and to compare practice with other medical schools in the UK. DESIGN: A training programme involving group work, role play and clinical attachments was developed and applied to 131 students at the University of Bristol Medical School. They then underwent an objective structured clinical assessment using simulated patients. The practice of other medical schools was surveyed by postal questionnaire. RESULT: The students felt that the examination was a good test of their knowledge and skills. One student failed. Sexual history taking is taught in 17 of 22 medical schools but examined in only six. CONCLUSION: Both teaching and examining of sexual history taking skills are possible and are likely to occur increasingly in UK medical schools.
