common infection in primary care and treatment

common infection in primary care

1. DR FADHLY SHARIMAN BIN HJ YAHAYA r COMMON INFECTIONS IN PRIMARY CARE AND TREATMENT (NAG 2019)

2. Outline of presentation Fungal Infections / dermatophytes Cutaneous Viral infection Parasitic infection DFU UTI in special population Sexually transmitted infection

3. Fungal Infection

4. Fungal Infection Page 154

5. Fungal Infection Page 155

6. Fungal Infection Page 154

7. Fungal Infection (Onicomycosis) Page 154

8. Fungal Infection Page 156

9. Fungal Infection Page 156

10. Fungal Infection Summary 1 st line with only topical treatment: Tenia Corporis, Tenia cruris, Tenia Fasciaei = till clearance plus 2 weeks Tenia Manuum, Tenia Pedis = 4-8 weeks Cutaneous Candidiasis = till clear Tinia versicolor (special) * Remember for KIV resistant / persistent case in dermatophytes on topical treatment Recommended for combination tx (topical + oral): Tenia capitis / barbae Pulse therapy: Tinea unguium / onicomycosis

11. Cutaneous Viral Infection Herpes Simplex Herpes Zoster Varicella Zoster Coxsackie Virus

12. Cutaneous Viral Infection Page 122

13. Cutaneous Viral Infection Page 156

14. Summary of treatment of Genital Herpes Guideline for management of STI, KKM ,2024

15. Viral Infection Page 157

16. Parasitic Infection Page 157

17. Summary of scabies treatment Guideline for management of scabies, KKM ,2015

18. Summary of scabies treatment Guideline for management of scabies, KKM ,2015

19. Treatment in specific considerations Guideline for management of scabies, KKM ,2015

20. Parasitic Infection Page 158

21. Diabetic Foot Ulcer

22. DFU Page 168

23. DFU Page 169

24. UTI in pregnancy Clinical spectrum of UTI in pregnancy Asymptomatic Bacteriuria (ASB) Lower Urinary Tract Infection Acute Cystitis Acute Urethritis Acute Pyelonephritis Urosepsis

25. UTI in pregnancy (ASB) Page 184

26. UTI in pregnancy (ASB) Consensus Guideline on the management of UTI in pregnancy, 2021

27. UTI in pregnancy (AC/AU) Page 182

28. UTI in pregnancy (AC/AU) Consensus Guideline on the management of UTI in pregnancy, 2021

29. Pyelonephritis (non pregnant) Page 183

30. Pyelonephritis in pregnancy Consensus Guideline on the management of UTI in pregnancy, 2021

31. Prevention of recurrent / persistent infection UTIs recur in approximately 4 to 5 percent of pregnancies, and the risk of developing pyelonephritis is the same as the risk with primary UTIs All pregnant women who had undergone treatment for urinary tract infection should have a repeat urine culture at least 2 weeks after treatment and at third trimester Page 184 Consensus Guideline on the management of UTI in pregnancy, 2021

32. Sexual Transmitted Infection

33. Introduction to STI The first three are the most notified STI disease in Malaysia Syphillis Gonorrhea HIV Need notifications (Prevention and Control of Infectious Disease Act 1998) all three above + chancroid Others common STI: Clamidya, Trichomoniasis, HPV, Hep B, C Common presentation: Penile / vaginal discharged, Genital Ulcer

34. Sexual transmitted Infection Page 136

35. Sexual transmitted Infection Page 137

36. Sexual transmitted Infection Page 138

37. Sexual transmitted Infection Page 138

38. Sexual transmitted Infection Page 140

39. Sexual transmitted Infection Page 141

40. Sexual transmitted Infection Page 142

41. Sexual transmitted Infection Page 142

42. Sexual transmitted Infection Page 143

43. Modified Syndromic Approach to STI The syndromes which are currently used for the approach are: Anogenital ulcer disease syndrome Urethral discharge syndrome Vaginal discharge syndrome Lower abdominal pain syndrome Anorectal discharge syndrome Guideline for management of STI, KKM ,2024

44. Syndromic approach to anogenital ulcer Guideline for management of STI, KKM ,2024

45. Syndromic approach to anogenital ulcer Guideline for management of STI, KKM ,2024

46. Urethral Discaharged Syndrome (Men) Guideline for management of STI, KKM ,2024

47. Urethral Discaharged Syndrome (Men) Guideline for management of STI, KKM ,2024

48. Persistent Urethral Discaharged Syndrome (Men) Guideline for management of STI, KKM ,2024

49. Urethral Discaharged Syndrome (Men) Guideline for management of STI, KKM ,2024

50. Vaginal Discaharged Syndrome (Based on Risk Assessment) Guideline for management of STI, KKM ,2024

51. Vaginal Discaharged Syndrome Guideline for management of STI, KKM ,2024

52. Vaginal Discaharged Syndrome (Based on sperculum examination) Guideline for management of STI, KKM ,2024

53. Vaginal Discaharged Syndrome (Based on sperculum examination) Guideline for management of STI, KKM ,2024

54. Syndromic approach to management of lower abdominal pain Guideline for management of STI, KKM ,2024

55. Syndromic approach to management of lower abdominal pain Guideline for management of STI, KKM ,2024

56. Syndromic approach to management of anorectal syndrome Guideline for management of STI, KKM ,2024

57. Syndromic approach to management of anorectal syndrome Guideline for management of STI, KKM ,2024

58. Summary of treatment Symptoms DD Treatment 1 Anogenital ulcer disease syndrome Herpes / Syphillis / Chancroid / LGV Depend on dd (Acyclovir / IM B.Penicillin / Azithromycin/ Doxy) 2 Urethral discharge syndrome NG, Clamidya (KIV TV, MG) IM Ceftriaxon + Doxy (KIV add Metronidazole + Azithro) 3 Vaginal discharge syndrome Candidiasis, BV (KIV NG, Clamidya) Clotrimazole Pess + Metronidazole (KIV add IM Ceftriaxone + Doxy) 4 Lower abdominal pain syndrome PID IM Ceftriaxone + Doxycyclin + Metronidazole 5 Anorectal discharge syndrome NG, Clamidya, LVG IM Ceftriaxone + Doxy Modified Syndromic Approach of STI

59. Take home message Get the diagnosis right Evidence based from the guideline With the right prescribtion, try adding correct instruction to the patient.

60. Thank you for your attention