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Re: A rant and a poll From: Atkinson, Samuel M (ATKINSONS@ECU.EDU) Sat May 20 19:31:40 2006 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: mjutras@gate.net: "Re: tubal ligation" Previous message: Meenan, Anna: "Re: A rant and a poll" Maybe in reply to: Anna Meenan, MD: "A rant and a poll" Next in thread: Garry E. Siegel, M.D.: "Re: A rant and a poll" Reply: Garry E. Siegel, M.D.: "Re: A rant and a poll" Reply: Meenan, Anna: "Re: A rant and a poll" I think we are a little off base here..A test of cure is not recommended in a pt treated for chlamydia. Chlamydia is an intracellular organism and stays in the cervical cells for an inordinate period of time..more than 6-8 weeks. A gen probe will be positive for mos even though infection is cured..I doubt that you are using a cell culture..the only way to prove persistence..and it is expensive and has HIGH RATE of false positives..And reinfection is difficult as most patients develop an antibody.. I agree with John. repeat gen probe with strep test at 36 weeks and treat with an anti.chlamydia and strep antibiotic if pos. No real worry to infant as eyes will be treated with an antichlamydial treatment any way in the nursery regardless. In NC chlamydia is a reportable infection..HIPPA to the contrary and Pub hlth will tract down contacts. I suspect the same is true in your state. sAm SAM ATKINSON,MD Prof,O/G,Brody SOM Greenville NC ________________________________ From: ob-gyn-l@obgyn.net on behalf of Dr. John Provatopoulos B.Sc. = -- ________________________________ M.D.C.M. F.R.S.C. Sent: Sat 5/20/2006 5:00 PM To: Multiple recipients of list OB-GYN-L Subject: Re: A rant and a poll At Sat, 20 May 2006, Anna Meenan, MD wrote: > >Just need to blow off steam and wondering how everyone else stands on a >question. > >The background: Working in outreach clinic yesterday. Positive >chlamydia test on a patient who's been positive twice before. In fact, >she's 20 weeks and has never been negative yet in this pregnancy (been >treated appropriately and recommended to get partner(s) treated). She >had an appointment that day so we planned to talk to her then. She >no-shows (3rd time this pregnancy). My medical >assistant/receptionist/lab/translator, who obviously has nothing better >to do with her time, calls all of the phone numbers this pt. has given >us at various times and cannot reach her at any of them, most having >been disconnected. A pt. who would be an in-law of hers if any of them >were married, and who has come in together with her on other occasions, >has an appointment and does show up. Assistant asks her if there is any >other way to contact pt. #1. She says she will contact her and have >her call us, which she did. Pt#1 calls back and screams at my assistant >that she should not involve pt.#2 in her affairs. Assistant is very >diplomatic, in spite of the fact that Pt. is screaming so loud I can >hear every word from across the room. We arrange to get pt. treated >again but the question now arises as to whether we should call in an Rx >for her partner. Listening to her abusive tirade from across the room >and recalling a commercial I had seen on TV just the night before >(malpractice lawyer soliciting pts who had ever had Stevens-Johnson or >TEN and had ever taken Vioxx, Celebrex, ibuprofen, Clinoril, or >ZITHROMAX), I declined to phone in an Rx for FOB, who i have never met, >based on the attitude of pt.#1 and the knowledge that this is obviously >one person who will sue me at the drop of a hat if anything goes wrong. >There is a clinic right in town that will treat partners on a >sliding-scale fee basis, so access is not a problem for FOB. > >So what would y'all do in this situation? > >-- >Anna Meenan, MD > Repeat the Chlamydia swab at the same time as group b(36 wks), even if prof of cure is negative, as for the other stuff I learnt A long time ago its beyond my controll. -- Take care, John Next message: mjutras@gate.net: "Re: tubal ligation" Previous message: Meenan, Anna: "Re: A rant and a poll" Maybe in reply to: Anna Meenan, MD: "A rant and a poll" Next in thread: Garry E. Siegel, M.D.: "Re: A rant and a poll" Reply: Garry E. Siegel, M.D.: "Re: A rant and a poll" Reply: Meenan, Anna: "Re: A rant and a poll"

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