Text Based Asynchronous Telehealth

Who We Treat
Adult men (18+) who:
• Have difficulty achieving or maintaining an erection
• Are seeking treatment such as sildenafil or tadalafil
• Have stable symptoms or prior safe use of ED medications
• Do not have concerning cardiovascular symptoms

Who We Don’t Treat
Patients who:
• Take nitrate medications (nitroglycerin, isosorbide)
• Have active chest pain, unstable heart disease, or recent heart attack/stroke
• Have severe uncontrolled blood pressure
• Have sudden erectile dysfunction related to trauma or neurologic symptoms
• Are under 18

Who We Treat
Adult women (18–65) with typical symptoms such as:
• Burning with urination
• Urinary frequency or urgency
• Mild lower abdominal discomfort
• Symptoms present for less than 7 days

Patients must confirm that:
• They are not pregnant
• They do not have symptoms suggesting a kidney infection

Antibiotic Stewardship
Antibiotics will only be prescribed when symptoms clearly meet criteria for uncomplicated cystitis. If symptoms are mild, unclear, or atypical, patients may instead be advised to obtain in-person testing or evaluation.

Who We Don’t Treat
Patients who:
• Are pregnant or unsure of pregnancy status
• Have fever, chills, nausea, or vomiting
• Have flank or back pain (possible kidney infection)
• Are male
• Have recurrent UTIs (more than 3 per year)
• Have significant kidney disease
• Are unable to confirm they are not pregnant

Who We Treat
Patients with:
• Recurrent cold sores (oral herpes)
• Recurrent genital herpes outbreaks
• Symptoms consistent with previously diagnosed herpes

Typical symptoms include:
• Tingling or burning before lesions
• Small painful blisters or sores

Who We Don’t Treat
Patients who:
• Have a severe first-time outbreak with systemic symptoms
• Have eye pain or eye redness (possible ocular herpes)
• Have significant immune suppression
• Have lesions that do not appear consistent with herpes

Who We Treat
Patients with mild to moderate acne including:
• Whiteheads or blackheads
• Mild inflammatory acne on the face, chest, or back
• Patients seeking prescription topical medications or certain oral medications

Female patients must confirm that:
• They are not pregnant and not attempting to become pregnant

Some oral acne medications can be teratogenic, and pregnancy testing cannot be performed through asynchronous telemedicine.

Who We Don’t Treat
Patients who:
• Are pregnant or unsure of pregnancy status
• Have severe cystic acne requiring isotretinoin (Accutane)
• Require procedural treatments such as injections or drainage

Note: Isotretinoin (Accutane) will not be prescribed through MsgMD.

Who We Treat
Patients with mild respiratory symptoms such as:
• Nasal congestion
• Sinus pressure
• Runny nose
• Mild sore throat
• Mild cough

Antibiotic Stewardship
Antibiotics will only be prescribed when symptoms meet evidence-based sinusitis criteria, such as:

• Symptoms lasting more than 10 days without improvement, OR
• Severe symptoms such as high fever and facial pain lasting at least 3–4 days, OR
• Worsening symptoms after initial improvement (“double worsening”)

Most viral infections will be treated with supportive care rather than antibiotics.

Who We Don’t Treat
Patients who:
• Have shortness of breath
• Have chest pain
• Have high fever with severe illness
• Have significant immune suppression or complex medical conditions
• Are infants or medically complex elderly patients

Description: Treatment for typical seasonal allergy symptoms such as sneezing, congestion, and itchy/watery eyes.
Inclusion: Typical allergy symptoms, prior similar episodes.
Exclusion: Shortness of breath, wheezing, or fever.

Description: Evaluation and treatment for eye redness and discharge consistent with conjunctivitis.
Inclusion: Eye redness with discharge or crusting.
Exclusion: Eye pain, vision changes, light sensitivity, or contact lens–associated pain.

Description: Treatment for uncomplicated vaginal yeast infections.
Inclusion: Itching, irritation, thick white discharge.
Exclusion: Pelvic pain, fever, or pregnancy concerns requiring in-person evaluation.

Description: Treatment for bacterial imbalance causing vaginal discharge or odor.
Inclusion: Thin discharge, fishy odor.
Exclusion: Pelvic pain, fever, or pregnancy-related concerns.

Description: Treatment of uncomplicated rashes, eczema, and contact dermatitis.
Inclusion: Itchy rash with uploaded photo.
Exclusion: Fever, rapid spread, pus/drainage, or involvement of eyes/face/genitals.

Description: Treatment of allergic-type hives and skin welts.
Inclusion: Intermittent itchy raised welts.
Exclusion: Lip/tongue swelling, breathing difficulty, chest pain, or arrhythmia symptoms.
Note: Oral steroids require in-person evaluation.

Description: Treatment for mild nausea and travel-related motion sickness.
Inclusion: Mild nausea, able to tolerate fluids, travel-related symptoms.
Medication Option: Scopolamine patch if appropriate.
Exclusion: Severe vomiting, dehydration, abdominal pain, chest pain, or arrhythmia symptoms.

Description: Treatment for mild generalized anxiety symptoms.
Inclusion: Mild anxiety symptoms over past 2 weeks.
Exclusion: Suicidal thoughts, mania symptoms (no sleep/high energy), or severe functional impairment.

Description: Treatment for mild depressive symptoms.
Inclusion: Low mood, low energy, sleep or appetite changes.
Exclusion: Suicidal ideation, mania symptoms, or severe functional impairment.

Description: Support for nicotine cessation with medication options.
Inclusion: Current nicotine use and desire to quit within 30 days.
Options: NRT (patch/gum/lozenge), varenicline, bupropion.
Exclusion: Seizure history (for bupropion), severe uncontrolled psychiatric symptoms, or active suicidal ideation.