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Hence purchase 100mg lady era otc women's health big book of exercises app, a thorough history buy generic lady era 100 mg line women's health center of grants pass, Clinical Pearl clinical examination buy cheap lady era breast cancer blog, and relevant laboratory investigations help the clinician in arriving at an early diagnosis and to • Liver can normally be palpable in young children. Splenomegaly can be classifed into three grades based on the size enlarged below the left costal A liver that is palpable clinically does not always indicate margin, i. It can also be displaced inferiorly by pathology involving diaphragm or thoracic organs, giving the impression Clinical Pearl of hepatomegaly. Hence, the liver span measured by percussion is more reliable and it should be more than the expected for the • A soft, thin spleen can be palpable in 15% of neonates, 10% of corresponding age to consider as hepatomegaly. At 12 years, the normal value for boys is 7–8 cm and for girls is Causes of persistent fever with hepatosplenomegaly in a 6–6. The normal range of liver span in various age­groups child: include: infants, 5–6. Hepatomegaly generally occurs {{ Viral via fve mechanisms: – Infectious mononucleosis 1. Pallor, jaundice, anorexia, rashes, and {{ Parasitic abdominal distension are the common associated complaints. These – Kala­azar signs and symptoms help in making a diferential diagnosis – Toxoplasmosis and guide initial investigations. Acute leukemia usually presents in 284 {{ Acute leukemia the age group of 2–10 years. In older children, careful questioning about knowledge about infections prevalent in the locality and their travel, insect exposure, ingestion of drugs, and environmental mode of presentations help in guiding initial investigations. Investigations should be tailored for every patient based on the A prodrome of upper respiratory infection is seen in Epstein­ clinical clues attained from history and clinical examination. History of myalgia or arthralgia may Otherwise, investigations may be misleading, diagnosis may be seen in viral infections and in leptospirosis. Acute onset of hepatomegaly associated with hyperbilirubinemia in an older Initial Investigations child raises the suspicion of infection with hepatitis A. Previous history of recurrent infections may give a clue to underlying Initial investigations in most patients would include: immunodefciency. History of raw milk consumption may • Complete blood count with diferential count and a be associated with Brucellosis infection. It gives important related to chronic infammatory diseases should be sought in information about the cell lines involved and the degree the older child. A peripheral smear with chronic cough is an important clue for a young child might show blasts, activated lymphocytes, evidence of presenting with disseminated tuberculosis. Previous history hemolysis, or malarial parasites which may be of diagnostic of repeated transfusions, jaundice, gallstones may be a clue importance for an underlying hemolytic anemia, now presenting with an • Liver functions, renal function tests (if required), in a child acute infection. Family history suggestive of a similar illness or with signs of liver or renal dysfunction or in any sick child a recent infectious illness may be a clue for a communicable or • Workup for common infectious causes including blood and a hereditarily predisposed illness. Other nonspecifc signs and urine cultures, serology against infections like Salmonella, symptoms include fatigue, anorexia, weight loss, blood in the Brucella, Rickettsia, leptospirosis, dengue, viral hepatitis stool, and abdominal distension. Although Plasmodium falciparum is most likely retardation, microcephaly, chorioretinitis, and purpura to be identifed from blood just after a febrile paroxysm, accompanied by hepatomegaly strongly suggests congenital the timing of the smears is less important than their being infection. Presence or absence of associated rash and the type obtained several times a day over a period of 3 successive of rash give rise to a diferent set of diferential diagnosis. A single negative blood smear does not exclude exanthems are by far the most common cause of fever with malaria; it may be necessary to repeat the smears as often rash in children. Among them, dengue, dengue­like illnesses, as every 4–6 hours a day to confrm the diagnosis. Imaging of Abdomen Petechial rash may be seen in dengue hemorrhagic fever and meningococcal infections. Other fndings to be looked for include pallor, evidence of intestinal tuberculosis, etc. However, in neonate or an early infant with low birth weight if clinical presentation indicates severe malaria and there • Workup for tuberculosis including chest X­ray, Mantoux, is no alternative explanation these patients should be sputum, or gastric lavage for acid­fast bacilli must be treated accordingly. Investigations should be continued considered in a malnourished child or with a subacute simultaneously till a defnitive diagnosis is made and specifc or chronic presentation or a history of contact with an therapy must be initiated. This test has a sensitivity and infants and children presenting with fever specifcity close to 100% ){Fever with hepatosplenomegaly can be caused by infectious • Autoimmune etiology should be considered in an older (viral, bacterial, parasitic, and fungal), connective tissue child with rashes, arthralgia, polyserositis, or characteristic disorders, malignancies, hemophagocytic syndromes, and rash. Antinuclear antibody and double stranded deoxy­ other rare conditions ribonucleic acid should be sent in such cases ){In tropical regions, infections remain the most common cause • Fungal workup including fungal cultures from blood and of fever with hepatosplenomegaly urine, fungal serology, etc. However, in a sick child, initial empirical therapy is justifed pending investigation reports. Study of etiological and clinical profle of hepatosplenomegaly in children diagnosis of exclusion, which is made only after excluding between 1 month and 15 years of age. Indian J Dermatol with fever and hepatosplenomegaly, initial stabilization, Venereol Leprol. Any disturbance in these three factors will lead causes such as a polyp or a foreign body. However, if bleeding is to either bleeding or excessive clotting (thromboembolism). However, or greater than expected for extent of injury or the site of bleeding accurate diagnosis which is required for specifc therapy and bleeding is from multiple sites like skin and mucous depends on laboratory tests. A careful history also provides membrane, bleeding into interstitial tissue, muscles, joints, etc. Epistaxis Deviated septum, hypertrophic turbinate, Whenever a child presents with bleeding episode it is ectatic vessel necessary to decide: Oral Poor dental hygiene • Whether bleeding is signifcant? Upper Swallowed blood in newborn, varices, • Whether it is due to local causes, or whether it is a gastrointestinal hemangioma generalized hemostatic defect? Lower Rectal polyp, Meckel’s diverticulum, anal fssure • What is the nature of the bleeding episode? Is it due gastrointestinal to vascular, platelet, or a coagulation abnormality or a Hematuria Cystitis, bladder stone, renal tumor combination of two or more? Family history might be petechiae, purpura, superfcial, and few ecchymosis, epistaxis, negative, if the coagulation defect is mild or there is a and menorrhagia. It is often controlled by pressure and once spontaneous mutation, as is seen in 20% of patients controlled, it usually does not recur. However, in patients with with hemophilia A coagulation factor defciency, hematomas are usually deep (in • Site of bleeding: superfcial bleeding is more common in the muscles) and spreading, bleeding into cavities like joints platelet type of bleeding and most common platelet disorder and retroperitoneal space is known. This may recur bleeding especially muscle hematoma or joint hematoma and bleeding may not get controlled by pressure. Inherited versus Acquired Causes Acquired Causes Inherited Causes Conversely, patients with acquired disorders usually present • Age of presentation: inherited disorders usually present in later in life and have a negative family history. T ey may be infancy and early childhood with history of bleeding from associated with underlying systemic disorders like kidney the umbilical cord, without evidence of sepsis or slipped diseases and liver disorders, infections, etc.

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Complicated cases tosterone biosynthetic defect order 100mg lady era fast delivery womens health of blairsville, 5α reductase activity buy cheapest lady era menstrual blood art, should be referred to a highly specialised tertiary centre or androgen sensitivity buy lady era 100 mg low cost breast cancer 9mm tumor. Tese investigations are best where multidisciplinary input is required from the clin- undertaken in a tertiary centre which has expertise in ical geneticist, paediatric endocrinologist, paediatric dealing with this condition. Prenatal management of disorders pregnancies) but this depends on the local prevalence of sex development. J Pediatr Urol 2012; of both type 1 and type 2 diabetes in women of child- 8(6): 576–84. Consensus state- of type 1 diabetes in women aged 15–40 years in ment on management of intersex disorders. Long-term in type 2 diabetes in Far Eastern, Middle Eastern, outcome of prenatal dexamethasone treat- Hispanic American, African, South Asian, and ment of 21-hydroxylase defciency. Pregnancy in a diabetic mother carries Useful website (for parents and a greater risk to both mother and the ofspring than professionals) pregnancy in the general obstetric population. Terefore, maternal insulin dosage Bashier Dawlatly and Rina Davison requirements increase as pregnancy progresses – up to 2–3 times the pre-pregnancy doses. Maternal renal Most women will demonstrate glycosuria at some disease and proliferative retinopathy may accelerate time during their pregnancy owing to a fall in the during and afer pregnancy, thereby making regular renal tubular threshold for glucose. Any suspicion of diabetes must be confrmed by blood Effect of pre-existing diabetes on pregnancy outcome glucose measurement. About 2–5 percent of pregnant Recent data confrm that women with poorly women will have one form of diabetes. Perinatal, stillbirth and pregnancy: neonatal mortality rates are all 5–10-fold higher pre-existing type 1 diabetes; than in non-diabetic pregnancies. Congenital pre-existing type 2 diabetes; abnormalities are up to three times higher than the gestational diabetes, which is hyperglycaemia frst rec- background rate, particularly neural tube defects ognised in pregnancy. Box 1 Obstetric and perinatal First trimester management Accurate dating of the pregnancy is an obstetric complications of pre-existing diabetes imperative and is best confrmed by ultrasound examination at the time of the nuchal screening Maternal between 11 and 14 weeks’ gestation. Patients should Miscarriage be reviewed regularly in the antenatal diabetic clinic Pre-eclampsia Increase in caesarean section rate for discussion of blood glucose self-monitoring Premature labour results and advice on increasing insulin requirements. Long-term risk of type 2 diabetes Second and third trimester management Fetal The keystone of management is achieving maternal Congenital abnormalities: normoglycaemia. Increasing maternal insulin resist- ● HbA1c <8–5% risk ance necessitates an increased insulin dose. The tar- ● HbA1c >10–25% risk get capillary blood glucose should be 4–5 mmol/L Macrosomia – prolonged labour, prematurity, fasting and 4. All preg- birth trauma Intrauterine growth restriction nant diabetic women should be on a strict low- Neonatal hypoglycaemia (8–60% prevalence) sugar, low-fat, high-fbre diet and a four-times-daily Respiratory distress syndrome basal bolus regime, i. Obstetric supervision 4–8 weeks’ gestation by a specialist midwife and obstetrician should be Later risk of obesity and diabetes more frequent than for uncomplicated pregnancy. A detailed ultrasound of the fetus at 18–20 weeks’ gestation with particular assessment of the fetal heart Management of pre-existing diabetes is necessary. Uterine artery Doppler at the same time The essential basis of treatment is good metabolic will help identify women at risk of pre-eclampsia and control, most importantly beginning before concep- fetal growth restriction. The risk of late unexplained fetal death may be less Box 2 Pre-conception management of when blood glucose control is good. The timing and pre-existing diabetes mode of delivery has to balance the risk of prema- turity with its associated complications against the Patient education regarding benefts of tight dia- risk of late intrauterine death and macrosomia with betic control to improve pregnancy outcome its attendant complications. It usually develops or insulin in the second or third trimester induced by changes Start pre-conceptual folic acid 5 mg daily in carbohydrate metabolism and decreased insulin sensitivity. Previous gestational dia- First-degree relative with diabetes betes is very likely to recur, and ofen the woman A history of polycystic ovarian syndrome remains diabetic. Dextrose and insulin infusions should be continued until the women are eating and drinking normally. Management Once eating and drinking, they should return to Diet, education, and frequent blood glucose monitor- their pre-pregnancy insulin doses immediately afer ing at home is essential. It may be that even lower criteria will be shown ing and drinking, they can usually return to their to decrease the prevalence of fetal macrosomia. Regular ultrasound assessment for fetal growth is not needed unless the glycaemic control is not satisfactory Women with gestational diabetes treated with insulin or metformin and/or insulin need to be prescribed. It The insulin should be stopped immediately afer the woman needs hypoglycaemic agents, then induc- delivery once these women are eating and drinking. If control is gestational diabetes require a fasting blood sugar good on diet only, then induction of labour can be 6–10 weeks afer delivery to ensure type 2 diabetes deferred to 40–41 weeks. As with all cases of upper gastrointestinal bleed- Melaena is the passage of black, tarry, foul-smelling ing, clinical evaluation is key to determining the stools and occurs if blood loss is >50 mL. Assessment of the woman’s haemodynamic status forms the mainstay of the ini- Presentation tial management and will determine the need for Haematemesis with or without melaena. There may be associated symptoms of lethargy, dizziness, prompt fuid resuscitation and urgent endoscopy. Calculating a severity score for bleeding can help ‘risk There may be signs of hypovolaemic shock. A thorough history and examination will point Management of haematemesis to the underlying aetiology of haematemesis in the 1 Full blood count, clotting, urea and electrolytes, liver majority of instances. The passage of at least 50 mL of blood into the Malaena 1 upper gastrointestinal tract gives rise to melaena – Syncope 2 the passage of black, tarry, foul-smelling stools – and Liver disease 2 occurs a few hours afer bleeding has occurred. Nausea and vomiting occurs in 70–85 per Gastroduodenal erosions 8–15% 3 cent of pregnancies, but will not normally cause fur- Oesophagitis 5–15% ther problems beyond the frst trimester. Hyperemesis Gastro-oesophageal varices 7–10% gravidarum, however, can cause intractable vomit- ing, which usually occurs at 8–12 weeks’ gestation to the treatment for Helicobacter pylori) will sometimes and has an incidence of 0. The common causes of haematemesis within the general population are illustrated in Table 2. Oesophageal disseminated intravascular coagulation/coagulopa- variceal bleeding has been reported in up to 78 per thy, and Osler–Weber–Rendu syndrome. Variceal bleeding is ofen severe and frequently accompanied by haemodynamic instabil- Bleeding from the nose, mouth, or throat can be swal- ity, requiring prompt resuscitation and endoscopic lowed and later vomited, masquerading as blood loss therapy (banding or injection sclerotherapy). Careful history and their absence does not exclude portal hypertension examination will again distinguish this from gastroin- and varices. The physiological changes that occur during Gum disease in pregnancy would rarely be severe pregnancy may exacerbate the pathophysiologi- enough to cause haematemesis. To avoid complications, known cirrhotics should undergo Hiatus hernia and refux oesophagitis endoscopic screening and eradication of varices Hiatus hernia is a common fnding. The incidence of either pre-conception or early in the second tri- both hiatus herniae and associated refux oesophagi- mester. Prophylactic treatment with non-selective tis is increased owing to the raised intra-abdominal beta-blockers such as propranolol should be consid- pressure and the efect of increased progestogens on ered to reduce portal pressures and reduce the risk the smooth muscle of the lower oesophageal sphinc- of variceal bleeding.

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Morphea/Linear Scleroderma Morphea/linear scleroderma involves isolated patches of hardened skin lady era 100mg on line pregnancy 7 months symptoms. Diagnosis is by clinical suspicion buy discount lady era 100 mg on-line womens health of blairsville, presence of autoantibodies (especifcally anti-centromere and anti-scl70/anti-topoisomerase antibodies) and occasionally by biopsy buy on line lady era menstrual yoga. Anti-centromere antibody is more common in the limited form (80-90%) than in the systemic form (10%), and anti-scl70 is more common in the diffuse form (30-40%). Splenic macrophages in Gaucher’s disease differ from histiocytosis is positivity for which of the following? Two biopsies take from the (d) Keratin 14 lesion proper show benign appearing papillomatosis with hyperkeratosis and acanthosis infltrating the sub- 3. In familial Mediterranean fever, the gene encoding the frozen section biopsy in histopathology laboratory? A 14 years old girl on exposure to cold develop pallor of (c) Neural extremities followed by pain and cyanosis. Which of the following diseases have an underlying (a) Triad of diarrhea, dementia and dermatitis mitochondrial abnormality? Most common second malignancy in patients with (a) Dermatitis, glossitis, steatorrhea familial retinoblastoma is: (Karnataka 2004) (b) Dermatitis, glossitis, alopecia (a) Teratoma (c) Mental changes, diarrhea, alopecia (b) Medullary carcinoma (d) Dermatitis, dementia, diarrhea (c) Osteosarcoma 45. Frozen section biopsy in not used for: (Bihar 2005) (c) Disarrangement of tooth (a) Enzyme (d) Dysplastic leukoplakia (b) Amyloid 43. Endothelial cells have: (Bihar 2003) (c) Pleomorphic adenoma (a) Weibel Palade bodies (d) None (b) Gamma Gandy bodies (c) Both 56. They are essential for normal colla- gen fbrillogenesis in various connective tissues like cornea. Prognostic factors in Neuroblastoma • Age and stage: Good prognosis in infants regardless of stage. Note: Most characteristic cytogenetic abnormality in neuroblastoma is 1p deletion. It is important to distinguish verrucuous carcinomas from squamous cell carcinoma as these tend to remain localized and are cured by wide excision, however they may undergo malignant transformation to invasive squamous cell carcinomas. Features of verrucuous carcinomas • Predilection for males > 50 years • Predisposed in tobacco users, poor oral hygiene • Grossly, it is a soft, large, wart like (papillomatous) lesion which may show fungation • Microscopically: – Cytological features of malignancy are absent or minimal and rare – Epithelium is thickened and thrown into papillary folds – The folds project both above and below the level of surrounding mucosa and crypt like surface grooves exhibit marked, pre-keratin plugging. Because some are too small to be detected cytogenetically, they are termed as microdeletion syndromes The important microdeletion syndromes are: 1. Miller-Dieker syndrome 17p 13 Deletions involving the long arm of chromosome 22 (22q 11) are the most common microdeletions identifed to date. A pair of connexins from adjacent cells joins to form a gap junction that bridges the 2-4 mm gap between the cells. The presentation of multiple faccid bullae and oral lesions in a young boy is suggestive of Pemphigus vulgaris. An im- portant histological fnding in pemphigus is acantholysis which is dissolution, or lysis, of the intercellular adhesion sites within a squamous epithelial surface. The suprabasal acantholytic blister that forms is characteristic of pemphigus vulgaris. The antibody in pemphigus vulgaris reacts with desmoglein 1 and 3, a component of the desmosomes that ap- pear to bind keratinocytes together. By direct immunofuorescence, lesional sites show a characteristic netlike pattern of intercellular IgG deposits. The bullae are tense and oral lesions are present in 10-15% of affected individuals. The disease results from formation of an- tibodies against gliadin and is associated with celiac disease. By direct immunofuorescence, dermatitis herpetiformis shows granular deposits of IgA selectively localized in the tips of dermal papillae. There is selective involvement of su- perfcial epidermis at the level of the stratum granulosum. It usually affects the scalp, face, chest, and back, and the mucous membranes are only rarely affected. The blanching, or pallor, represents the ischemic phase of the phenomenon and results from vasospasm of digital arteries. During the ischemic phase, capillaries and venules dilate, and cyanosis results from the deoxygenated blood that is present in these vessels. A sensation of cold or numbness or paresthesia of the digits often accompanies the phases of pallor and cyanosis. Abnormalities of the digital vessels may contribute to the development of Raynaud’s phenomenon in this disorder. Occasionally, persistent digital ischemia develops and may result in ulcers or gangrene. In most severe cases, the small vessels are occluded by a proliferative endarteritis. Raynaud’s phenomenon occurs in about 30% of patients with dermatomyositis or polymyositis. It frequently develops in patients with rheu- matoid arthritis and may be related to the intimal proliferation that occurs in the digital arteries. Thromboangiitis obliterans is an uncommon cause of Raynaud’s phenomenon but should be considered in young men, particularly those who are cigarette smokers. The development of cold-induced pallor in these disorders may be confned to one or two digits of the involved extremity. Occasionally, Raynaud’s phenomenon may follow acute occlusion of large and medium-sized arteries by a thrombus or embolus. The latter situation often involves one or two digits and should not be confused with Raynaud’s phenom- enon. In patients with thoracic outlet compression syndrome, Raynaud’s phenomenon may result from diminished intravascular pressure, stimulation of sympathetic fbers in the brachial plexus, or a combination of both. Raynaud’s phenomenon occurs in patients with primary pulmonary hypertension; this is more than coincidental and may refect a neurohumoral abnormality that affects both the pulmonary and digital circulations. Zinc defciency might in part account for the im- munodefciency that accompanies severe malnutrition. This is because wild type-2 strains are al- ready eradicated and not circulating in the community since 1999. Manifestations Most human coronaviruses are widespread affecting people of most part of the world and produce mild respiratory tract infection. It is inaffective for Coxiella burnettii At 80ºC for 30 min for 3 – Vaccine bath: 60ºC for 1 hr. Sterilization at a Temperature of 100ºC: – Boiling, Koch’s or Arnold’s steam sterilizer – Tyndalisation (Intermittent sterilization)-100 c for 20 min for 3 days. Used 0 for Sugar solution, gelatin Sterilization and Disinfection, Hospital Waste Management, Bacteriology of Water, Milk and Air 3.

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Burnt out cases with marked registered to the estimated number of cases) deformities may be kept in special rehabilitation centers cheap lady era 100 mg with visa womens health lynchburg. The last is a good indicator of the has to be viewed from this viewpoint and its success or efficacy of the drug regimen purchase lady era 100mg on line menstruation bathroom. Institutional rehabilitation Epidemiological indicators relate to the effectiveness is costly and time-consuming generic lady era 100mg on line women's health clinic phoenix. These include age, sex and of leprosy patients given rehabilitation training in area wise incidence and prevalence rates. According to the Director, Gandhi Memorial Leprosy Foundation, Wardha, two studies There are many voluntary organizations working in the conducted there showed that more than half patients field of leprosy in India. These include: discharged from leprosy rehabilitation centres were just • Leprosy Mission: This was the first voluntary orga- not traceable at the address given, most having taken to nization for leprosy work in India. Of those traced, none was earning his livelihood 1874 by Bailey in Chamba, Himachal Pradesh. Continue dapsone Severe skin complication Extensive scaling, itching, ulcers in the mouth and stop dapsone. Refer to hospital (Exfoliative dermatitis) eyes, jaundice and reduced urine output immediately. Never restart Abdominal symptoms Abdominal pain, nausea, and vomiting on high symptomatic treatment. Refer to hospital (Nephritis) Reduced urine output Rifam picin No significance Redish coloration of urine, saliva and sweat Reassure the patient Hepatitis (Liver damage) Jaundice (yellow color of skin, eyeballs and urine) Stop rifampicin. Refer to hospital Loss of appetite and vomiting Restart after the jaundice subsides Flu like illness Fever, malaise and bodyache Symptomatic treatment Allergy Skin rash Stop rifampicin Clofazim ine No significance Brownish-red discoloration of Reassure the patient, it will skin, urine, and body fluids go after completion of treatment Ichthyosis Dryness and thickening of Apply oil to the skin. However this drug is also not recommended for use in pregnant women and children below five years of age. The government started the National Leprosy Control 270 Two other important organizations active in the field Program in 1955. The objective was “to control the of leprosy are the Jalma Central Institute of Leprosy spread of disease and to render modern treatment faci- lities to patients”. Remarks the goal set was “to achieve arrest of the disease activity existing in all the known leprosy cases in the country by the Leprosy One per 4. The program receives 100 percent Survey, One per 25,000 5744 In low endemic education and population areas, attached to a financial support from the Center government. At the district Survey: This is done house to house, at schools, by level, the District Leprosy Officer is responsible for imple- family visits, and through health educational approaches, mentation and supervision of the Program. At the voluntary reporting, contact examinations and referral peripheral level, the Medical Officer Incharge of Leprosy services. Diagnosis is confirmed by the doctor and, Control Unit/Center and the Medical Officer in the sometimes, in the absence of a doctor, by the Primary Health Center, to which a Survey, Education nonmedical supervisor. The mass media like radio, The program has the following four strategies: television, newspapers and journals are used. Treatment: The line of treatment is indicated by the • Provide services through mobile leprosy treatment doctor or the nonmedical supervisor. Treatment is units with the help of primary health care staff in delivered by the leprosy paramedical worker who holds moderate and low endemic districts. Domiciliary treatment is also given through and the community to increase awareness and to the network of outdoor clinics. The new multidrug regimen is implemented under the close supervision of the doctor. Learning Material on Leprosy for Capacity Building – Genital scabies of Medical Officers. Delhi: many countries, especially among females between 15 Hind Kustha Nivarak Sangh, Delhi Branch, 1985. Delhi: Arnold world, the trend being towards more and earlier sexual Heinemann, 1984;138-50. A striking increase in the incidence of sexually transmitted diseases, especially “gonorrhea”, has been observed since 1960. In some countries the reported Sexually Transmitted Diseases or incidence for persons below 17 years of age doubled Venereal Diseases for boys and tripled for girls between 1966 and 1971. The adjective venereal is derived from Venus, the The age group 16 to 17 years showed a fifty to eighty- Goddess of love. Venereal diseases are transmitted fold increase over the age group below 15 years, through sexual intercourse. Rarely, transmission may be indicating the start of sexual activity by a large group of high-risk adolescents at that point. Acquired syphilis manifests the following three stages: Secondary Stage Prim ary Stage It lasts four weeks to six months after the appearance A small red spot is noticed on the penis 3 to 4 weeks of chancre. It is painless and develops skin rashes, enlargement of glands and pain and gradually into a well defined hard sore or hard chancre swelling in bones and joints. The untreated sore heals in 6 to 8 are seen on the moist surfaces like anus, vulva and the weeks. Ulcer in throat and white mucous another fortnight, the glands in neck, axilla and patches inside the cheeks may also occur. Tertiary Stage Diagnosis: Serous exudate from the sore is positive The characteristic feature here is the formation of for the causative agent. Serological tests become positive gummata (nodules), which may suppurate and form 6 to 8 weeks after sexual intercourse and remain so in ulcers on the skin. The tests depend on two classes of antibodies and in internal organs like liver, spleen, testes and lungs. It becomes positive condylomata and mucous patches in the second stage, during the primary stage, reaches its maximum when saliva and urine may also contain the germs. Congenital syphilis is transmitted to the child Secondary syphilis: Contacts during preceding six from the mother through placenta. The patient remains infective as long as primary sore, Late and late latent syphilis: Marital partners and children condylomata, mucous patches or ulcerating gummata of infected mothers. Some patients may be intermittently Specific Teatment1,11 infective for 2 to 4 years. Adequate penicillin therapy • For early syphilis and for syphilis of 2 years’ duration ends infectivity within 24 hours. Infection leads to gradual development of penicillin allergy, oral tetracycline or erythromycin resistance to T. Congenital syphilis can be prevented by serological • For pregnant women, same as above but tetra- examination during pregnancy and treatment of positive cycline not to be used. Acquired syphilis can be prevented by: • For spouse, examination and, if necessary, treatment • Health and sex education aimed at controlling unsafe for syphilis must be carried out. Disability due to late manifestations of syphilis can – An initially high titre of a nontreponemal test fails be prevented by proper treatment of known patients. Isolation: Precautions need to be taken when handling – Above 2 years age: Same as adult dose for early blood and body fluids of patients in primary and syphilis. Women form The acute stage is characterized by inflammation of the larger reservoir since infection at the cervix is painless urethra in males and of urethra, cervix and vagina in and remains undiagnosed and untreated. There is acute burning sensation with pain and chemotherapy renders a case noninfective within hours, pus discharge while passing urine.