Infectious Diseases and Clinical Microbiology

Infectious diseases is an internal medicine specialty concerned with the diagnosis and treatment of conditions caused by bacteria, viruses, fungi, and parasites. It works in close collaboration with clinical microbiology: bedside examination, laboratory findings (full blood count, CRP, procalcitonin, urinalysis, culture and sensitivity), and imaging when indicated are all assessed together.

At Nis Clinic, this department serves outpatient clinic patients as well as consultation requests from General Surgery, Paediatric Surgery, Urology, and Plastic Surgery. Our approach differs from the notion of "antibiotics for every fever":

• Clinical judgement comes first. Prescribing antibiotics for a viral illness offers no benefit and contributes to resistance.
• Culture before antibiotics wherever possible. Isolating the causative organism becomes more difficult after treatment has started, and management becomes less targeted.
• Treatment duration is guided by evidence, not symptom. The rule of "never stop before ten days" no longer applies to every infection; three-to-five-day courses are now standard for some conditions.
• Patient education is part of treatment. Dosing times, side effects, and the follow-up date — all explained in writing and verbally.

Antibiotic resistance is one of the ten most critical public health threats identified by the World Health Organisation. Across the Mediterranean basin — including Northern Cyprus — resistance rates in certain bacteria have reached concerning levels. Responsible use matters for the individual patient and for the wider community.

The core principles we apply in our clinic:

• Choosing not to prescribe antibiotics is also a clinical decision. The majority of upper respiratory tract infections (sore throat, the common cold, early sinusitis) are viral in origin. Antibiotics offer no benefit in these cases; symptomatic support — fluids, rest, antipyretics — is sufficient.
• Throat culture and rapid strep testing. Where streptococcal infection is suspected, a culture or rapid antigen test is performed. We do not prescribe empirical antibiotics when Centor criteria are negative.
• Urine culture. Culture and sensitivity testing is standard for urinary tract infections that recur or fail to respond to initial treatment.
• Broad-spectrum agents only when necessary. Broad-spectrum medicines such as cephalosporins or fluoroquinolones are reserved for cases where narrow-spectrum options are inadequate.
• Dose and duration communicated clearly. We provide a written plan so that patients do not discontinue treatment prematurely.

This approach sometimes conflicts with patient expectations. "The doctor didn't give me antibiotics" is a reaction we recognise. Explaining why — and specifying which symptoms should prompt a return visit — is an integral part of the consultation.

Upper respiratory tract infections (sore throat, the common cold, sinusitis, otitis media) are the most common reason for attendance. During assessment we clarify three questions: viral or bacterial, is an antibiotic indicated, and which symptoms should prompt the patient to return?

• Sore throat: Centor score, rapid strep test, or culture. If Group A beta-haemolytic Streptococcus is not confirmed, an antibiotic is not required.
• Acute sinusitis: The first 7–10 days are treated as viral. Antibiotics are started when bacterial sinusitis criteria are met — symptoms persisting beyond ten days, high fever with profuse purulent discharge and facial pain, or a "double worsening" pattern.
• Acute bronchitis: In a non-smoking adult without chronic lung disease, an antibiotic is rarely necessary. Symptomatic monitoring for two to three weeks is generally appropriate.

Urinary tract infections (UTIs) carry a high lifetime prevalence in women. Our approach:

• Uncomplicated cystitis: In a young, otherwise healthy woman presenting with classic dysuria, increased urinary frequency, and lower abdominal pain — urinalysis plus a short course of an appropriate antibiotic. Empirical antibiotic selection is guided by local resistance patterns.
• Complicated UTI: Male patients, pregnant women, those with renal calculi or structural abnormalities, diabetes, or immunosuppression — culture is mandatory and the treatment course is extended.
• Suspected pyelonephritis: High fever, loin pain, nausea, and vomiting. Imaging and broader-spectrum intravenous antibiotics may be required; hospital admission is considered.
• Recurrent UTI: Three or more episodes per year. Behavioural measures, prophylactic therapy where indicated, and referral to Urology for structural assessment.

We recognise that patients may feel apprehensive about STI assessment. Confidentiality and a non-judgemental approach are the standard at our clinic. Consultation rooms are private, and all records are maintained within the bounds of doctor–patient confidentiality.

Northern Cyprus sees significant tourism and student mobility. This shapes the local STI epidemiology; we therefore maintain a low threshold for routine screening.

Screening is recommended in the following situations:

• After a new partner, or after unprotected intercourse
• When a current partner receives a diagnosis
• Genitourinary symptoms (discharge, dysuria, lesions, inguinal swelling)
• As part of an annual general health check-up

The standard panel covers HIV, syphilis (VDRL/RPR plus treponemal test), hepatitis B and C, chlamydia, and gonorrhoea. Herpes simplex testing, HPV-related investigations, and genital lesion assessment are added when clinically indicated.

Partner notification is an integral part of treatment. Treating only one individual leads to re-infection. We provide practical guidance on communicating with partners and, where appropriate, offer an anonymous partner notification letter.

Northern Cyprus is a tourism and transit destination. Travel medicine services are available for both residents travelling abroad and visitors arriving in the region.

The ideal time for a pre-travel consultation is four to six weeks before departure. This window allows multi-dose vaccine series (hepatitis B, rabies pre-exposure prophylaxis) to be completed. Patients who present later can still benefit considerably, but this is the optimal timeframe.

Our department covers:

• Risk assessment based on destination country and region (CDC and WHO travel health data are used as primary references)
• Vaccine planning — completing gaps in routine immunisation (tetanus–diphtheria booster, measles–mumps–rubella serology) and travel-specific vaccines (hepatitis A, hepatitis B, typhoid, rabies)
• Malaria prophylaxis for destinations where this is required
• Altitude illness, jet lag, and traveller's diarrhoea preparedness
• Travel kit and emergency plan for passengers with chronic conditions
• Risk–benefit discussion regarding respiratory viruses in the post-COVID-19 period

Child travellers receive separately planned paediatric vaccination schedules and age-appropriate investigations; assessment is carried out in conjunction with the Paediatric Health department when needed.

The value of an infectious diseases department to a clinic extends beyond outpatient attendances; it also means responding to infection consultation requests from other departments.

At Nis Clinic, the infectious diseases team routinely addresses the following:

• General Surgery: Postoperative wound infection, catheter-related infection, and re-evaluation of cases that fail to respond to empirical treatment.
• Paediatric Surgery: Perioperative antibiotic prophylaxis in children, differential diagnosis of postoperative fever, and wound monitoring following circumcision or other procedures.
• Urology and Internal Medicine: Complicated urinary tract infections, catheter-associated bacteriuria, prostatitis.
• Plastic Surgery: Distinguishing seroma from infection following aesthetic procedures, assessment of peri-implant infection.
• Dermatology: Antimicrobial selection for skin and soft-tissue infections such as cellulitis, abscess, and herpes zoster.

Consultation responses are provided as written notes; the recommendation specifies not just "start an antibiotic" but which organism is targeted, the dose, the duration, and which laboratory parameters to monitor.

The same rigour applies to healthcare-associated (nosocomial) infection management. Post-admission fever, catheter-tip culture results, and screening and decolonisation of multidrug-resistant organisms — all these processes are overseen by the department.