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Am Fam Physician. 2022;105(3):234

What strategies are effective for prevention of human papillomavirus infection?

Human papillomavirus vaccination is the primary recommended modality for preventing vaccine-type human papillomavirus infections, precancerous cervical lesions, and anogenital warts. Limiting the number of sex partners, delaying first intercourse until a later age, and consistently using condoms also decrease the risk of human papillomavirus infection. Smoking and alcohol cessation should be recommended to reduce the risk of human papillomavirus persistence and the development of human papillomavirus–related malignancies.

Can physical activity prevent the development of depression?

Physical activity is associated with a lower risk of developing depression and depressive symptoms.

What is the most effective treatment for onychomycosis?

Oral terbinafine (Lamisil) has the highest effectiveness of any available therapy for onychomycosis and should be recommended as first-line treatment for most patients who have no contraindications.

Do epidural corticosteroid injections safely reduce pain and disability in patients with sciatica?

According to a Cochrane review involving patients with sciatica, epidural corticosteroid injections provide a small and probably clinically insignificant reduction in leg and back pain in the immediate term (less than two weeks), and a small to moderate reduction in disability in the short (two weeks to three months) and intermediate (three months to 12 months) terms.

What medication is effective at reducing the frequency of tension headaches?

According to guidelines on headache management from the U.S. Department of Veterans Affairs and the U.S. Department of Defense, amitriptyline effectively prevents tension-type headaches after three months of treatment, reducing headache frequency and the need for abortive medications.

Is surgical glue an effective alternative to suturing for first-degree obstetric lacerations?

Compared with sutures, surgical glue can repair first-degree obstetric lacerations with similar cosmetic and functional outcomes, less pain, less time, and reduced local anesthetic use.

Additional Online Only AFP Clinical Answers

In which patients would management of alcohol withdrawal be appropriate in the primary care setting?

Patients with mild alcohol withdrawal syndrome (score less than 10 on the Clinical Institute Withdrawal Assessment for Alcohol Scale, Revised) can be treated safely in the primary care setting.

What are the treatment options for primary dysmenorrhea?

Nonsteroidal anti-inflammatory drugs (NSAIDs) should be used as first-line treatment for primary dysmenorrhea. Combined estrogen-progestin oral contraceptives are considered an alternative first-line treatment or an adjunct to NSAIDs for primary dysmenorrhea. The levonorgestrel-releasing intrauterine system (Mirena) is effective for the treatment of primary dysmenorrhea. Nonpharmacological interventions such as exercise, high-frequency transcutaneous electrical nerve stimulation, heat therapy, or self-acupressure can serve as alternative or adjunctive therapies.

Should we choose ARBs over ACEIs for management of hypertension?

A meta-analysis and a large cohort study suggest that angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) have similar cardiovascular outcomes. However, ACEIs are associated with an increased risk of adverse effects compared to ARBs. Although these studies support the use of ARBs as initial drug therapy, switching patients who are already doing well on an ACEI to an ARB is not necessarily warranted.

Editor's Note: Several of the answers above first appeared in the new AFP Clinical Answers email, which is sent each month to recipients of the AFP email table of contents. Sign up to receive AFP emails.

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