Genital Tract infections

Question 1

Pelvic Inflammatory Disease - pathophysiology

Answer 1

• Ascending infection from the endocervix
• This causes one or more of:

Endometritis
Salpingitis
Oophoritis
Parametritis
Tubo-ovarian abscess
Pelvic peritonitis 

Organisms:

• N. gonorrhea
• C. trachomatis
• Normal vaginal flora e.g. Gardnerella vaginalis
• Mycoplasma genitalum

Question 2

PID - Risk factors

Answer 2

• Age <25
• Early age of first SI
• Multiple sexual partners
• New partner in last 3 months
• Hx of STI in woman or her partner
• Any recent instrumentation of procedures, which includes:

TOP
IUD insertion in past 4-6 weeks
Hysterosalpingogram
IVF/ICSI

Question 3

PID - Presentation

Answer 3

• Lower abdominal pain
• Deep dyspareunia
• PCB or IMB
• Abnormal discharge
• CERVICAL CMOTION TENDERNESS
• Fever

Question 4

PID - investigations

Answer 4

Triple swabs:

• Endocervical swab (pink) - Chlamydia
• Endocervical swab (charcoal) - Gonorrhea
• HVS - thrush/BV/TV

Full STI Screen
Urinalysis
Pregnancy test (ddx - ectopic)

Question 5

What is Fitz-Hugh-Curtis Syndrome?

Answer 5

Severe cases
Adhesions can form around the liver causing RUQ pain
“Violin strings”

Question 6

PID - Mx

Answer 6

IM CEFTRIAXONE (same day)
Followed by 14 day course of antibiotics:
- Doxy + metronidazole 
or 
- Ofloxacin + metronidazole 

Follow-up in 72h (phone) to check for improvement

Avoid SI until antibiotics completed and partners treated
Contact tracing

Question 7

When would you admit for PID?

Answer 7

• Pregnancy
• Severe symptoms
• Signs of peritonitis
• Unresponsive to oral Abx

Question 8

Complications of PID

Answer 8

• Future ectopic - 6x more common
• Infertility
• Tubo-ovarian abscess
• Chronic pelvic pain

Question 9

Chlamydia - presentation

Answer 9

• Increased vaginal discharge
• Dysuria
• Dyspareunia
• PCB/IMB
• MUCUPURULENT CERVICITIS
• FRIABLE CERVIX
• Pelvic tenderness

Question 10

Which serotypes of Chlamydia cause what?

Answer 10

Serotypes A, B and C - cause eye disease

Serotypes D-K - cause genital chlamydia and neonatal infection

Question 11

Chlamydia Ix

Answer 11

• NAAT (endocervical pink swab)

- Recommend full STI screen

Question 12

Chalmydia Tx

Answer 12

7 days doxycycline 100mg BD
or
1mg Azithromycin single dose

Question 13

Chlamydia in pregnancy

Answer 13

• Increased risk of PROM, preterm labour, LBW
• increased risk of intrapartum fever and late post-partum endometritis
• Treat neonates with oral erythromycin

Question 14

Gonorrhoea - risk factors

Answer 14

• MSM
• Age <25
• previous gonorrhea infection
• Multiple sexual partners

Question 15

Gonorrhoea - presentation

Answer 15

• Abnormal discharge (thin, watery, green/yellow)
• Dysuria
• Dyspareunia
• Lower abdominal paoin
• Pelvic tenderness

IMB and PCB are rare

Question 16

Gonorrhoea - investigations

Answer 16

• NAAT - but test no earlier than 3 days since sexual contact with infected person
• ## Use the charcoal endocervical swab

Question 17

Gonorrhoea - management

Answer 17

Single dose IM ceftriaxone (1g)

Follow up in 1 week

Contact tracing

Test of cure for gonorrhoea

• Symptomatic - culture 3 days after tx
• Asymptomatic - NAAT 2 weeks after treatment