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been sprung by the extraction fold) and place a folded dampened sponge or 2 x 2 over the wound.
Instruct the patient to maintain light biting pressure on this compress for 60 minutes. Repeat if
necessary to control hemorrhage. Caution the patient NOT TO RINSE the mouth for at least 12
hours since this may disturb the clot.- DRAINING A TOOTH ABSCESS
Two methods may be used to accomplish adequate drainage:
a. For a “pointed” abscess, incise the fluctuant area using a stab procedure. Blunt dissection with a
hemostat may help to establish drainage at the site. Suture a small drain or slice of surgical tubing
in the wound to maintain drainage and leave for 2-3 days. Local anesthetic should be used but pain
control may not be easy to obtain.
b. If decay is evident, establish drainage through the tooth. Stabilize the tooth firmly with the fingers;
remove the soft decay with a spoon-shaped instrument until an opening into the pulp chamber is
made. Finger pressure on the gingiva near the root of the tooth should force pus out through the
chamber opening.
- PRESERVING/TRANSPORTING AN AVULSED TOOTH
If tooth has been saved, transport the avulsed tooth in any clean, liquid medium (saline, milk, and saliva).
Do not let tooth dry out. Gently rinse tooth with 0.9% normal saline. Do not scrape off any debris or attempt
to scale the tooth. A completely avulsed tooth may be permanently retained if replaced in the socket with
minimal handling in less than one hour.
Chapter 11: Sexually Transmitted Diseases (STD)
STD: Urethral Discharges
COL Naomi Aronson, MC, USASee Gynecology and Male Genital Inflammation sections for more detail on STDs.
Introduction: Gonorrhea and chlamydia both present with urethral discharges. Patients are often co-infected
with both. Neisseria gonorrhoeae causes gonorrhea and appears on Gram's stain as a clump of gram-
negative intracellular diplococci. Asymptomatic infection can occur especially in the cervix, rectum and
oropharynx. Disseminated gonorrhea presents with infectious arthritis, tenosynovitis, and a characteristic
gunmetal blue skin lesion surrounded by a red halo, usually on the extremities (arthritis-dermatitis syndrome).
The incubation period is 2-14 days after exposure. Most nonspecific or non-gonococcal urethritis (NGU) and
cervicitis is caused by Chlamydia trachomatis, but Ureaplasma, genital Mycoplasma, Trichomonas and Herpes
simplex are also implicated. These are some of the most common sexually transmitted diseases in the U.S.
and a leading cause of female infertility. Infant eye and lung infections are consequent to maternal genital
infection with Chlamydia. Incubation period is 7-12 days after exposure. A thick mucus discharge with pain on
urination and genital ulcer should suggest Herpes simplex. Incubation period is 2-12 days after exposure.
Subjective: Symptoms
Male: Acute (< 3 days): Dysuria with discharge/without discharge- usually NGU Chronic (>10 days) urethral
stricture
Female: Acute (< 3 days): Dysuria or frequent urination, vaginal discharge, pain with intercourse, lower pelvic
pain Chronic (>10 days): PID, infertility
Either: Sub acute (3-10 days): Painful joints, gun metal blue skin lesions (GC), tenosynovitis
Focused History: Have you had unprotected sex with a new partner in the past 6 weeks? (incubation period
2 weeks for GC; longer for NGU) Have you had discharge stains in your underwear? (suggests gonorrhea)
For males - Are you having any difficulty retracting your foreskin? (suggests phimosis with GC)