Vulvovaginal candidiasis is a common problem worldwide and is multifactorial in origin. Many women suffer recurrent episodes that can have a serious impact on their quality of life. The authors outline the clinical characteristics and aetiology of recurrent vulvovaginal candidiasis, and provide guidance on diagnosing the condition and the treatment options available.
We assessed our unit's documentation of the HIV status of 146 identifiable existing children of 146 women audited, out of our total cohort of 329 HIV-positive women. For 23 women (16%) there was no documentation of the presence or absence of children. For 81 children of 43 (29%) women the HIV status was unknown. Of these children, at least eight (5.5%) reside in the UK and could be accessed for testing. It is essential that documentation and testing of children of HIV-positive women takes place to prevent potentially fatal late-stage presentations of AIDS and onward transmission of HIV as young people become sexually active.
Objectives The management of women at high risk of HIV infection who repeatedly decline HIV testing in pregnancy is not covered in any national guideline. In Leeds, we had a case which prompted us to consider maternal rights plus our duty of care to the infant once born. Methods Leeds has an established HIV and Syphilis in Pregnancy Multidisciplinary Team (MDT). The main issues pertaining to a pregnant woman persistently declining HIV testing were discussed within the MDT: identification of pregnant women declining testing; universal testing versus testing by risk stratification of their infants; calculation of vertical transmission risk; definition of unacceptable risk; timing of the decision to request court authority to test the infant; advanced preparation of court authority request papers. Results It was decided that an HIV transmission risk > 1 in 1000 justified testing an infant at birth. The MDT decision to request court authority for infant HIV testing would be made at 32–34 weeks of gestation, allowing the court papers to be prepared in advance of delivery. The Leeds Obstetrics and Paediatric Guidelines were reviewed, amended and approved by the Trust Guideline Group, Risk Management team and legal team. These guidelines are outlined within the article. The Neonatal guideline also is accessible via this link: http://nww.lhp.leedsth.nhs.uk/common/guidelines/detail.aspx?ID=177 Conclusions If a woman at high risk declines HIV testing in pregnancy, it remains possible to significantly reduce the risk of vertical transmission once the child is born, but the window of opportunity is small. Therefore, it is vital to have pathways already in place to address this prior to delivery.
BackgroundResearch has shown links between earlier age at sexual intercourse and higher sexual risk-taking and substance abuse, as well as between earlier pregnancy and an unhappy childhood. We wanted to investigate the clinical needs and behavioural risk factors of our local cohort of very young people.AimTo investigate the socio-demographic and clinical characteristics of all under 14-year olds attending sexual and reproductive health services in Glasgow over a 1-year period from 1 August 2009 to 31 July 2010.MethodData analysis by retrospective case-note review.Results81 under 14s attended a total of 142 times over the year. The mean age was 13.2 years; the youngest 11 years old. 70.4% were female. 61.7% were sexually active. 63% attended for contraception, half of these requesting condoms; 14% for a sexual health screen (SHS) and 14% for a pregnancy test (PDT). 32.1% of the whole cohort were already known to social services; for sexually active females this proportion increased to 49%, and for those requesting a PDT it was 58.3%. Substance abuse was documented in 26% of all those who were sexually active, a third of those requesting a PDT, and half of those requesting a SHS. 4/9 sexually active 12-year olds had a history of sexual abuse. Two clients had previous pregnancies reported; one had a sexually transmitted infection diagnosed. Only 24% of sexually active clients were documented as using any contraception, including condoms. Of the 71 clients with documentation, 18.3% had child protection concerns.DiscussionSignificant risk factors are evident especially related to substance, sexual and domestic abuse. A large proportion of under-14s attending sexual health services are known to social services suggesting a history of family and/or school problems. The importance of assessing all potential socio-demographic risk in young people is highlighted, especially in those who are sexually active, requesting pregnancy tests or sexual health screens.
Background/introduction We describe a case of a 34 yr old Black African women fully suppressed on HAART for 9 yrs presenting with recurrent episodes of HIV encephalopathy with abnormal MRI brain scan and detectable HIV in CSF. Following ARV switch her cognitive function and scans had improved and remains undetectable in CSF. Aim(s)/objectives Started HAART in 2005 and remained asymptomatic and fully suppressed on (Kivexa/Atvr/rit) CD4 > 500 mm. Presented initially in 2014 to Neurology with acute confusion, headaches and convulsions. CSF revealed pleocytosis with V/L 811 copies and neg for infective screen. MRI scan revealed diffuse non-specific signals consistent with HIV encephalopathy. On recovery she was monitored in clinic and remained virologically controlled but with residual neurocognitive impairment characterised by short term memory loss and difficulty concentrating. She then represented 9 months later with focal motor signs and confusion resolving within 48 hrs MRI scan no focal lesion. Rpt CSF revealed V/L of 960 copies. Results In view of persistant CSF viraemia she was switched to higher CPE score (from 7 to 12) HAART regimen of Trizivir/ Maraviroc. Subsequently she fully recovered cognitive function and rpt CSF at 3/12 confirmed full suppressed VL with resolving brain scan. Discussion/conclusion This case demonstrates that in well controlled pts on HAART who develop presumptive neuro-HIV and in absence of other potential causes, the value of CSF V/L in in constructing a HAART regimen with improved CSF penetration can result in significant improvement in both clinical and objective markers such as MRI scans.
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