No abstract

One hundred women were interviewed at their first hospital antenatal visit to assess their knowledge of, and attitudes to, first versus second trimester screening for Down's syndrome. Overall, the women had limited knowledge of Down's syndrome, and the prenatal screening and diagnostic tests that are available. However, when informed, the majority of women expressed a clear preference for first trimester screening tests for Down's syndrome, regardless of the rate of miscarriage of Down's syndrome pregnancies between 10 and 15 weeks of gestation. These findings have implications for the planning of prenatal Down's syndrome screening programmes.

A 20-year-old Australian woman with poorly controlled type 1 diabetes presented with life-threatening Streptococcus pyogenes and Herpes simplex infection of her external genitalia following a routine perineal "Brazilian" bikini wax. Extensive pubic hair removal is now common among young adults in Australia and elsewhere. However, the infectious risks of these practices, particularly among immunosuppressed individuals, are often underappreciated.A 20-year-old Australian woman presented to our emergency department (Austin Health; Melbourne, Australia) with high fever and swelling of the external genitalia. She had poorly controlled type 1 diabetes mellitus as a result of nonadherence with insulin therapy, had a history of frequent episodes of diabetic ketoacidosis, and had a glycosylated hemoglobin level of 11.9%.Two weeks before presentation, the patient had undergone a "Brazilian" bikini wax at a beauty salon that involved removal of all hair from her mons pubis, vulva, and anus with hot wax. The patient experienced significant pain and some vulval bleeding during the procedure, which was performed by a trainee beauty therapist.During the subsequent 4 days, worsening vulval swelling, redness, and pain were noted, as well as a copious vaginal discharge. On the day of presentation, the patient reported excruciating perivulval pain, severe dysuria, fever, and a diffuse erythematous rash.The patient's last normal menstrual period finished 4 days before presentation, and there was no history of tampon use or of a foreign body in the vagina. She had 1 male sexual partner with whom she had been having unprotected sex for several months. There was no history of previous infective episodes or vaginal trauma.At presentation, the patient was found to be febrile (temperature, 38ЊC), hypotensive (blood pressure, 90/60 mm Hg), and tachycardic (heart rate, 100 beats/min), and she looked very unwell. There was an erythematous rash over the patient's chest and neck. The external genitalia were grossly swollenparticularly the vulva, the labia majora and minora, and the clitoris-with the urethra displaced inferiorly and cellulitis extending from around the vulva up onto the abdominal wall. The distribution of the cellulitis was consistent with the area onto which the wax had been applied. There was a copious, purulent vaginal discharge and prominent white exudate on the vulva. Examination was difficult because of the extreme swelling, but no vesicular lesions or ulcers were seen. Neither speculum nor bimanual vaginal examination was able to be performed because of severe pain. The findings of the rest of the physical examination were unremarkable. The initial differential diagnosis was severe perineal strepDownloaded from