Re: A rant and a poll
From: Meenan, Anna (annam@uic.edu)
Sun May 21 00:21:11 2006
Since when? CDC recommends a test-of-cure 3-4 weeks after treatment
in pregnant women (Centers for Disease Control and Prevention.
Sexually transmitted diseases guidelines 2002. MMWR Morb Mortal Wkly
Rep 2002; 51:32-36.)
Urine PCR testing turns negative in 15 days.
Anna Meenan, MD
>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
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