American family physician
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Genital herpes is a sexually transmitted infection caused by herpes simplex virus (HSV) type 1 or 2. It affects at least 500 million people worldwide and is a lifelong condition involving initial infection and periodic reactivation with variable viral shedding. There are no vaccinations for the prevention of HSV, and routine serologic screening is not recommended in asymptomatic individuals. ⋯ Complications of genital herpes include encephalitis, meningitis, and urinary retention. During pregnancy, antiviral suppression is recommended starting at 36 weeks of gestation in patients with a known history of genital herpes. Elective cesarean delivery should be offered to patients with active lesions to reduce neonatal exposure to HSV.
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Diabetic ketoacidosis (DKA) is a life-threatening complication of type 1 and type 2 diabetes resulting from an absolute or relative insulin deficiency. It can occur in patients of all ages and can be the initial presentation of diabetes, especially in young children. Polyuria and polydipsia are the most common symptoms, followed by nausea, vomiting, abdominal pain, weight loss, severe fatigue, dyspnea, and preceding febrile illness. ⋯ Amylase, lipase, hepatic transaminase levels, troponin, creatine kinase, blood and urine cultures, and chest radiography are additional tests to consider. Treatment involves fluid and electrolyte replacement, insulin, treatment of precipitating causes, and close monitoring to adjust therapy and identify complications. Prevention strategies include identifying diabetes before DKA develops, educating patients to manage high-risk situations, and ensuring uninterrupted access to therapies for diabetes.