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Treatment: Alternative regimens ♦ Clindamycin 300 mg orally twice daily for 7 days ♦ Clindamycin ovules 100 g intravaginally at bedtime for 3 days Treatment during pregnancy ♦ Pregnant women should be treated with oral metronidazole or oral clindamycin. Note: Patients must avoid alcohol while taking metronidazole. This combination may cause a disulfiram-like reaction. Patients taking ritonavir or tipranavir may also experience symptoms because of the small amount of alcohol in the capsules. Treatment Failure Multiple conditions or pathogens may present concurrently. Perform testing for other conditions as suggested by symptoms, or if symptoms to do not resolve with initial treatment: ♦ ♦ ♦ ♦ ♦ ♦ ♦ Perform herpes culture if indicated by lesions; see chapter Herpes Simplex, Mucocutaneous. Test for chlamydia and gonorrhea if indicated; see chapter Chlamydia and Gonorrhea. Perform urinalysis (with or without culture and sensitivities) if urinary symptoms are prominent. If an irritant or allergen is suspected, including N-9, discontinue use. If symptoms are related to the use of latex condoms, switch to polyurethane male or female condoms. For tenderness on cervical motion or other symptoms of PID, see chapter Pelvic Inflammatory Disease. Perform workup or obtain referral as needed for other abnormalities found on bimanual examination. For information on other STIs or related conditions, see the CDC’s treatment guidelines at http://www.cdc. gov/std/treatment. Section 5—Complaint-Specific Workups | 5–47 Patient Education ♦ ♦ ♦ ♦ ♦ ♦ Patients must avoid any form of alcohol while taking metronidazole and for 24 hours after the last dose. Alcohol and metronidazole together can cause severe nausea, vomiting, and other immobilizing symptoms. Patients taking ritonavir may experience symptoms because of the small amount of alcohol in the capsules and should call their health care providers if nausea and vomiting occur. Clindamycin cream and ovules are oil based and will weaken latex condoms, diaphragms, and cervical caps. Patients should use alternative methods to prevent pregnancy and HIV transmission. Recurrence of BV is common. Patients should contact their health care providers and return for repeat treatment if symptoms recur. Instruct patients to avoid douching. To avoid being reinfected by Trichomonas, patients should bring their sex partners to the clinic for evaluation and treatment.
5–48 | Clinical Manual for Management of the HIV-Infected Adult/2006 References ♦ ♦ ♦ ♦ ♦ ♦ Abularach S, Anderson J. Gynecologic Problems. In: Anderson JR, ed. A Guide to the Clinical Management of Women with HIV. Rockville, MD: Health Resources and Services Administration, HIV/AIDS Bureau; 2005. Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines 2006. MMWR 2006;55(No. RR-11):1-100. Cohn SE, Clark RA. Sexually transmitted diseases, HIV, and AIDS in women. In: The Medical Clinics of North America, Vol. 87; 2003:971-995. Hawkins JW, Roberto-Nichols DM, Stanley-Haney JL. Protocols for Nurse Practitioners in Gynecologic Settings, 7th ed. New York: Tiresias Press, Inc.; 2000. Joesoef MR, Schmid GP, Hillier SL. Bacterial vaginosis: review of treatment options and potential clinical indications for therapy. Clin Infect Dis. 1999 Jan;28 Suppl 1:S57-65. Schwebke JR. Gynecological consequences of bacterial vaginosis. In: Obstetrics and Gynecology Clinics of North America, Vol. 30; 2003:685-694.
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Table of Contents Clinical Manual f
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Clinical Manual for Management of t
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Preface—About this Manual | Clini
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Previous Editions Atlanta Contribut
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♦ ♦ ♦ ♦ ♦ | Clinical Manu
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1-2 | Clinical Manual for Managemen
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Initial Physical Examination Backgr
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Genitals/Rectum • Inspect the gen
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Initial and Interim Laboratory and
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Section 1—Testing and Assessment
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Patient Education ♦ ♦ ♦ ♦ D
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Section 2—Health Maintenance and
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References ♦ ♦ ♦ ♦ ♦ ♦
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Occupational Postexposure Prophylax
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P: Plan Laboratory Testing Provide
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For hepatitis C, no recommended pro
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as hepatitis C or another sexually
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for treatment is appropriate, and b
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contact with the patient. Patients
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tablet daily of trimethoprim-sulfam
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Opportunistic Infection Prophylaxis
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Discontinuing Primary Prophylaxis P
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Latent Tuberculosis Background Late
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INH may cause liver toxicity and it
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Patient Education ♦ ♦ ♦ ♦
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Reducing Maternal-Infant HIV Transm
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Some states require written informe
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contraindicated during pregnancy be
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Section 3—Antiretroviral Therapy
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Nelfinavir (Viracept) Adequate drug
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Section 4—Complications of Antire
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♦ ♦ ♦ Toronto General Hospita
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Adverse Reactions to HIV Medication
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♦ ♦ ♦ ♦ ♦ Vital signs: No
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egimen, symptoms of fatigue could i
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Recreational Drugs and Antiretrovir
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Section 4—Complications of Antire
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LSD, Mescaline, Psilocin, and Methy
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Page 185 and 186: ♦ ♦ ♦ ♦ ♦ Navas E, Martin
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Page 202 and 203: Eye Problems Background The immunos
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Page 210 and 211: Fever Background Although fever may
Page 212 and 213: Headache Background Headache may ha
Page 214 and 215: Lymphadenopathy Background Lymphade
Page 216: Treatment Treatment will depend on
Page 222 and 223: Neurologic Symptoms Background The
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Page 226 and 227: Pulmonary Symptoms Background Short
Page 228: Treatment Once the diagnosis is mad
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Page 238 and 239: Candidiasis, Oral and Esophageal Ba
Page 240: Maintenance therapy Use caution whe
Page 246 and 247: Cervical Dysplasia Background Cervi
Page 248: Patient Education ♦ ♦ ♦ ♦ P
Page 254 and 255: Cryptosporidiosis Background Crypto
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Page 266 and 267: Gonorrhea and Chlamydia Background
Page 268 and 269: Treatment of Gonorrhea Treatment op
Page 270 and 271: Hepatitis B Infection Background He
Page 272 and 273: ♦ ♦ ♦ ♦ ♦ Some patients t
Page 274 and 275: Hepatitis C Infection Background He
Page 276 and 277: pregnancy. Ribavirin is teratogenic
Page 278 and 279: Herpes Simplex, Mucocutaneous Backg
Page 280: References ♦ ♦ ♦ ♦ ♦ Cent
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Kaposi Sarcoma Background Kaposi sa
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Treatment Treatment of KS is not co
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Molluscum Contagiosum Background Mo
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Mycobacterium avium Complex Backgro
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Table 1. Interactions between Rifab
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Mycobacterium tuberculosis: Treatme
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P: Plan Diagnostic Evaluation Durin
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Table 1. Regimens for Treatment of
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Rifabutin may be substituted for ri
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Non-Hodgkin Lymphoma Background Non
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Patient Education ♦ ♦ ♦ ♦ S
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Toxoplasmosis Background Toxoplasma
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♦ Atovaquone 1,500 mg orally twic
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Linear Gingival Erythema Background
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Background Necrotizing ulcerating p
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Oral Health Background Examination
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Maxillary Tori; Mandibular Tori S:
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Periodontal Disease Background The
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Oral Hairy Leukoplakia Background O
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Oral Ulceration Background Oral ulc
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Oral Warts Background Oral warts ar
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Anxiety Disorders Background Anxiet
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Patient Education ♦ ♦ Behaviora
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Insomnia Background Insomnia is a c
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Suicidal Ideation Background Transi
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Section 8—Neuropsychiatric Disord
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P: Plan ♦ ♦ ♦ ♦ ♦ Check t
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Correctional Settings Background Ca
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Adherence Adherence is one of the m
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Karnofsky Performance Scale Backgro
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