Active Ingredients: Doxycycline
Seek medical advice if any neurological or psychiatric side effects occur. Note: This medication is only recommended for travellers on short term trips to areas where P.
Primaquine is also used to treat relapses of P. For further details, cautions, contraindications, or alternatives if you cannot take one of these regimens, including guidelines for pediatric dosages and Emergency Self Treatment, download our whitepaper How to Protect Yourself Against Malaria.
A recent community-based survey of RTIs in rural women in China found vaginal or cervical infections in nearly half of the women, with no correlations of RTIs with symptoms or signs of infection 16.
Poor correlation of signs and symptoms with infection There are several possible explanations for the poor correlations of symptoms and signs with infection observed in many of these studies.
For example, prevalent infections are asymptomatic more often than acute incident infections 2, 17, 18; multiple co-infections or non-infectious conditions could produce multiple symptoms, resulting in non-specificity of symptoms and signs, relative to any one infection 2; poor tests can have low sensitivity or specificity for active infections; unknown proportions of certain syndromes e.
Studies in clinical settings that primarily serve healthy asymptomatic women e.
Nonetheless, efforts to somehow make this approach more effective continue.
In clinical settings that serve women who are seeking care specifically for symptoms of RTIs and who have substantially higher prevalences of cervical infections, pelvic examination can yield better correlations with actual infections.
For example, in primary health care, gynaecology, or STD sexually transmitted disease clinic settings, signs of MPC or pelvic inflammatory disease are more likely to reflect incident cervical infection 2, 17, 18, often yielding positive predictive values high enough to warrant treatment with benefits outweighing the costs and adverse effects of medications, other programme costs, and increased pressure for selection of antimicrobial resistant pathogens 2, 17.
Similarily, the elicitation of symptoms and signs of abnormal vaginal discharge, as defined here, have been predictive of trichomoniasis, bacterial vaginosis, or both, in such clinical settings, including in Peru 27.
This suggestion is particularly relevant, not only because of the obstetrical and gynaecological complications of BV and trichomoniasis and possible associations of vaginal infections with susceptibility to HIV acquisition 22, but especially in view of the ReproSalud self-assessment study, in which women in 16 of 18 districts listed vaginal discharge as one of their top three reproductive health problems.
Formal evaluation of the benefit of metronidazole therapy in relieving such perceived symptoms in rural women seems warranted. Conclusion On the basis of our findings, Peru's national guidelines for the syndromic management of vaginal discharge were changed to recommend metronidazole for treatment for vaginal infections, and they no longer include treatment for cervical infection.
ReproSalud teams helped to implement these changes and advised women in their communities of the significance of symptoms of vaginal discharge, advising appropriate health care seeking.
Conflicts of interest: none declared.
References 1. Yong CL, Hablan las mujeres andinas.
Movimiento Manuela Ramos. In Spanish. Lower genital tract infection in women: urethral, cervical and vaginal infections.