Cpg c8 ectoparasites

• Clients with a presumptive or confirmed clinical diagnosis of uncomplicated pubic lice and/or • Clients with abnormal findings of clinical significance • Clients with secondary skin infections or irritations • Clients who are pregnant or breastfeeding • Clients with disseminated scabies infection GUIDELINE OBJECTIVES AND ANTICIPATED OUTCOMES • Provide appropriate topical antiscabetic/antiparasitic treatment for clients with confirmed • Identification of individual STI risk and provision of appropriate screening • Identify public health risks to control infections by: • Provision of STI education and information • Identification and exploration of sexual risk taking behavior • Partner notification and treatment as required BACKGROUND CONDITION DESCRIPTION PUBIC LICE Human lice are obligate human insect parasites and are responsible for the diseases pediculosis capitis, pediculosis corporis and pediculosis pubis. 1,2 Pubic lice (Phthirus pubis) are predominantly sexually transmitted. 1,3 The incubation period is between 5 days to several weeks. 4 They measure 3-4 mm in length. The female lice live for up to one month and lay up to 10 eggs per day, which hatch within 10 days. 3,4 The lice prefer axillary, eyebrow, eyelash, beard, pubic, limb and trunk hairs. 1,4 SCABIES Scabies is an infestation of the skin by the mite Sarcoptes scabiei. 5 Typical sites of infection are skin folds and flexor surfaces. In adults, the most common sites are between the fingers and on the wrists. 1,5 Clients present with a history of itching which is worse at night. Scabietic lesions may be visible as a grayish fine linear rash or ridge. 2,5 Visible mites may appear as a raised white oval with dark pigmentation. Secondary bacterial infection may also be present. Mites may be found in burrows at certain anatomical sites not influenced by the site of the initial infestation. 1,2,5 Clinical Practice Guidelines for Sexual Health Nurse Practitioner Section C8 • Maculae ceruleae (asymptomatic, macular, • Secondary bacterial infection of skin • Visible burrows and popular, vesicular Table C8.1: Signs and symptoms (photos courtesy of MSHC) INVESTIGATIONS AND DIAGNOSIS SCABIES • Presence of mites, ova or faecal pellets in • Diagnosis is made by direct examinat6ion • Definitive diagnosis is made by microscopic of the involved area and detection of pubic identification of mites or their eggs from Table C8.2: Diagnosis of pubic lice and scabies TREATMENT AND MANAGEMENT TREATMENT INDICATORS • Clinical diagnosis based on examination findings • Permethrin 5% cream- Up to one 30g tube applied and left on skin overnight • Loratadine 10mg one tablet daily as required Permethrin 5% cream is effective treatment for both scabies and pubic lice and has low toxicity. Apply as single application to clean dry skin, cover whole body except head, focusing on skin folds, leave for 8-12hrs, and wash off thoroughly. 6,7,8,9 • Do not apply to broken or infected skin SCABIES 6,7,9 In clients treated for scabies, itching may persist for up to four weeks post treatment. This is generally regarded as due to an allergic reaction to dead mites under the skin and is not necessarily indicative of treatment failure. Clinical Practice Guidelines for Sexual Health Nurse Practitioner Section C8 PUBIC LICE 6,8,9 Permethrin has activity against eggs because it retains residual activity for 2 weeks and remains on the hair for 14 days after treatment. Unhatched eggs are then killed. SYMPTOM MANAGEMENT 6,7,8,9 • Shaving genital hair can assist in treatment • Retreating with Permethrin 1 week after the first treatment maximizes cure rates. • Antihistamines may assist with reducing itch • Advise the client to avoid close body contact until treatment has been completed • Treatment failure may be due to reinfection • Eyelash infection can be treated with petroleum jelly application 5 times daily for 5-7 days • Treatment of eczematous skin conditions with corticosteroid creams is recommended to be • Clothing and bed linen need to be hot water machine washed (>60o C) • Mattress and doonas can be sprayed with insect repellent • For scabies discuss general hygiene with client PUBLIC HEALTH CONSIDERATIONS - FOLLOW UP AND REVIEW • Contact tracing is not required 5,6,7,8 • Sexual partners (of the last month) should be examined and treated to avoid reinfection • Review client in 1-2 weeks if symptoms continue Clinical Practice Guidelines for Sexual Health Nurse Practitioner Section C8 Skin discomfort, burning, stinging, erythema, eczema, rash, pruritus sodium benzoate Loratidine does not interact Headache, sedation, dry with alcohol Clinical Practice Guidelines for Sexual Health Nurse Practitioner Section C8 1. McMillan A. Arthropod infestations. In: McMillan A, Young H, Ogilvie M M, Scott G R, editors. Clinical practice in sexually transmissible infections. London: Saunders; 2002. p. 537-547. 2. Brown K. Genital skin disorders. In: Russell D, Bradford D, and Fairley C, editors. Sexual health medicine. Melbourne: IP Communications; 2005. p. 235-246. 3. Denham I, Bowden F. Genital and sexually transmitted infections. In: Yung A , McDonald M, Spelmen D, Street A, Johnson P, Sorrell T, McCormack J, editors. Infectious diseases a clinical approach. 2nd ed. Melbourne: IP Communications; 2005. p. 372-387. 4. Billstein S. Pubic lice. In: Holmes K K, Sparling P F, Mardh P A, Lemon S M, Stamm W E, et al, editors. Sexually transmitted diseases. 3rd ed. New York: McGraw Hill; 1999. p. 641-644. 5. Platts-Mills Thomas AE, Rein MF. Scabies. In: Holmes K K, Sparling P F, Mardh P A, Lemon S M, Stamm W E, et al, editors. Sexually transmitted diseases. 3rd ed. New York: McGraw Hill; 1999. p. 645-652. 6. Marrazzo J, Ocbamichael N, Meegan A, Stamm WE, editors. The practitioner’s handbook for the management of STD’s. 4th ed. Washington: University of Washington; 2007. 7. Melbourne Sexual Health Centre. Treatment guidelines: Scabies. Melbourne: Bayside Health; 2005. 8. Melbourne Sexual Health Centre. Treatment guidelines: Pubic Lice. Melbourne: Bayside Health; 2005. 9. Venereology Society of Victoria. National management guidelines for sexually transmissible infections. Melbourne: Venereology Society of Victoria; 2002. 10. Therapeutic Guidelines Limited. Therapeutic guidelines antibiotic version 13. Melbourne: Therapeutic 11. Queensland Health. Queensland clinical practice guidelines for advanced sexual and reproductive health nursing officers. Public Health Service Branch. Queensland Government. 2007. Clinical Practice Guidelines for Sexual Health Nurse Practitioner Section C8

Source: http://mshc.org.au/Portals/6/CPG%20C8%20Ectoparasites.pdf


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BRIEF CURRICULUM VITAE (June 2006) Matthew E. Falagas, M.D., M.Sc. PERSONAL AIBS office: Alfa Institute of Biomedical Sciences (AIBS), 9 Neapoleos Str. & Kifissias Ave., 151 23 Marousi, Athens, Greece (www.aibs.gr) Tel. (+30) 210-68.39.604, Fax (+30) 210-68.39.605, Mobile tel. (+30) 694-61.10.000 e-mail: m.falagas@aibs.gr, matthew.falagas@tufts.edu “Henry Dunant” Hospit

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