AAP Says Benefits of Circumcision Outweigh Harms
A new policy statement from the AAP says the benefits of circumcision outweigh the harms

The benefits include:

• Lower risk for UTI before age 1 
• Reduced risk for STIs (e.g., HIV, HSV, HPV)
• Reduced risk for penile cancer 

The group says the procedures benefits justify access to those parents who desire it and warrants third-party payment for circumcision of male newborns.

The AAP did, however, stop short of recommending routine circumcision, saying that decision is best left to parents.  ACOG also endorses this policy statement.

Reference: AAP Policy Statement

New CDC recommendations about Hep C screening

One time hepatitis C screening for all patients born from 1945 to 1965

Guideline

• The Centers for Disease Control and Prevention recommends that all Americans born between 1945 and 1965 should have a one-time screening for hepatitis C virus (HCV), according to new finalized guidelines

• The CDC also recommends that all persons identified with HCV should receive a brief alcohol screening and intervention and be referred to the appropriate care and treatment services for HCV

Rationale

• About 2.7 to 3.9 million people in the U.S. are infected with HCV and approximately 45% to 85% of those with HCV are unaware that they are infected

• A CDC review found that hepatitis C mortality increased significantly from 1999 to 2007

• Nearly three quarters of these deaths occurred in baby boomers

• In addition, an NHANES study found a 3.25% prevalence in this age group

Reference: MMWR

CDC Updates Gonorrhea Treatment Guidelines

Bottom Line:

• The CDC no longer recommends cefixime (suprax) as a first-line treatment for gonorrhea 
• The only first line therapy now is ceftriaxone 250mg IM x1
• If ceftriaxone is unavailable, the updated guidelines allow use of cefixime (400 mg PO x1), but recommend a test-of-cure at 1 week.
  

The change was based on evidence that susceptibility to cefixime decreased among U.S. Neisseria gonorrhoeae isolates between 2006 and 2011.

In its 2010 treatment guidelines, the CDC recommended combination therapy with a cephalosporin (ceftriaxone or cefixime) plus oral azithromycin or doxycycline.

Reference: MMWR Article

Guidelines for Breast Cancer Screening

Reference:  http://www.nejm.org/doi/full/10.1056/NEJMcp1101540

Identify the Image

What's the diagnosis?

A 2-year-old girl was referred for an abnormal whitening (leukocoria) of the left pupil, as well as a divergent squint (Panel A). Her visual acuity was markedly impaired. Ophthalmologic examination revealed retinal detachment. Computed tomography showed left intraocular calcification (Panel B, arrow).

See comments for answer.