Concise Reviews for Primary-Care Physicians
Evaluation and Management of Vaginitis
Vaginitis is a common concern for women across the lifespan. Vaginal symptoms may impact quality of life, and clinicians are challenged in the evaluation and management of bacterial vaginosis, Candida vaginitis, trichomoniasis, desquamative inflammatory vaginitis, and genitourinary syndrome of menopause.Contraceptive Challenges in Women With Common Medical Conditions
Women have the opportunity to meet personal contraceptive goals with convenient, highly reliable, and easily reversible methods. Long-acting reversible contraception represents an increasingly popular option for most women throughout the reproductive lifespan. Nonetheless, many women and their health care providers are challenged by coexisting medical issues. We aim to help clinicians individualize contraception and use shared decision-making to enhance patient satisfaction and continuation with their method.Opioids in Older Adults: Indications, Prescribing, Complications, and Alternative Therapies for Primary Care
The fact that opioids are valuable tools for the management of pain has been known and used for thousands of years. Currently, millions of Americans are treated annually with opioids, and many of these patients are elderly. Opioids present risks to geriatric patients, some of which are unique to the population, and providers should have a good grasp of those risks. An understanding of how to select appropriate medications for the management of pain and of the myriad of alternatives available for pain management is vital to the care of older patients.Acute Flaccid Myelitis: A Clinical Overview for 2019
Acute flaccid myelitis (AFM) is characterized by flaccid paralysis of one or more limbs, often following a viral illness, with magnetic resonance imaging findings consistent with inflammation of the spinal cord gray matter. It is unclear whether all patients with AFM will have full recovery of neurologic function. Since 2014, there have been several clusters of AFM in the United States, with a 3-fold increase in reported AFM cases recorded in 2018 compared with the previous year. Epidemiological evidence supports a temporal association between respiratory enteroviral illness, particularly with enteroviruses D68 and A71, and clustering of AFM cases.Zika Virus in the Americas: A Review for Clinicians
Zika virus has recently emerged as a new public health threat. An arthropod-borne virus named after the Zika forest in Uganda, it was first discovered in 1947. The virus caused only sporadic cases of Zika infection in Africa and Southeast Asia until 2007, when the first large outbreak occurred in the Yap State in the Federated States of Micronesia. Another outbreak in French Polynesia in 2013 was notable for being associated temporally with an increase in cases of Guillain-Barré syndrome. In 2015, the virus was first reported in Brazil and since then has spread explosively through several additional countries in South and Central America and the Caribbean.Vaccine Hesitancy
Vaccine refusal received a lot of press with the 2015 Disneyland measles outbreak, but vaccine refusal is only a fraction of a much larger problem of vaccine delay and hesitancy. Opposition to vaccination dates back to the 1800s, Edward Jenner, and the first vaccine ever. It has never gone away despite the public's growing scientific sophistication. A variety of factors contribute to modern vaccine hesitancy, including the layperson's heuristic thinking when it comes to balancing risks and benefits as well as a number of other features of vaccination, including falling victim to its own success.What Clinicians Should Know About the 2014 Ebola Outbreak
The ongoing Ebola outbreak that began in Guinea in February 2014 has spread to Liberia, Sierra Leone, Nigeria, Senegal, Spain, and the United States and has become the largest Ebola outbreak in recorded history. It is important for frontline medical providers to understand key aspects of Ebola virus disease (EVD) to quickly recognize an imported case, provide appropriate medical care, and prevent transmission. Furthermore, an understanding of the clinical presentation, clinical course, transmission, and prevention of EVD can help reduce anxiety about the disease and allow health care providers to calmly and confidently provide medical care to patients suspected of having EVD.Middle East Respiratory Syndrome: What Clinicians Need to Know
A severe viral illness caused by a newly discovered coronavirus was first reported in the Middle East in 2012. The virus has since been named the Middle East respiratory syndrome coronavirus (MERS-CoV). MERS-CoV cases have been reported in several countries around the world in travelers from the Middle East. The illness has a high mortality rate. Limited human-to-human transmission has occurred including transmission to health care workers. The source of the virus remains unclear, but camels are a possible source.Current Issues in Contraception
Contraceptive management in women should take into account patient lifestyle and coexisting medical issues as well as method safety, efficacy, and noncontraceptive benefits. This review focuses on common and timely issues related to contraception encountered in clinical practice, including migraine headaches and associated risk of ischemic stroke, the use of combined hormonal contraception along with citalopram and escitalopram, contraceptive efficacy and safety in the setting of obesity, contraceptives for treatment of menorrhagia, the association of intrauterine contraception and decreased risk of cervical cancer, and the association of venous thromboembolism and combined hormonal contraception.An Update on Childhood and Adolescent Vaccines
In 2008, the recommendations for vaccines in children and adolescents changed substantially. The Advisory Committee on Immunization Practices expanded the routine use of influenza vaccines. New recommendations also addressed the newly licensed rotavirus vaccine. Furthermore, the Advisory Committee on Immunization Practices addressed the use of the meningococcal conjugate vaccine in children aged 2 to 10 years who are at high risk of that disease. Finally, the Food and Drug Administration and the Centers for Disease Control and Prevention reviewed the safety data collected about the human papillomavirus vaccine since its licensure and reaffirmed their recommendations for its use.West Nile Virus: Epidemiology, Clinical Presentation, Diagnosis, and Prevention
West Nile virus was recognized in the United States for the first time in 1999, when it caused an epidemic of encephalitis and meningitis in New York City, NY. Since then, the disease has been steadily moving westward, and human cases were recognized in 39 states and the District of Columbia in 2002. The infection is caused by a flavivirus that is transmitted from birds to humans through the bite of culicine mosquitoes. Most infections are mild, with symptoms primarily being fever, headache, and myalgias.Presenting Syndromes of Human Immunodeficiency Virus
Over the past 2 decades, numerous changes have occurred in the demographics and clinical course of the human immunodeficiency virus (HIV) infection. Since the initial reports of mucosal candidiasis, severe weight loss, and Pneumocystis carinii pneumonia as presenting manifestations of the late stages of immunodeficiency, clinicians have recognized a wide spectrum of manifestations associated with HIV disease. The original reports of severe immunodeficiency were simply the “tip of the iceberg.” Advances in antiretroviral therapy and prevention of opportunistic infections have made early diagnosis important.
