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4th Year GOSH > Bacterial STIs > Flashcards

Bacterial STIs Flashcards

(45 cards)

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1
Q

Things to ask in all male sexual histories?

A 
Pain in testes/scrotum
Swellings
Itching or sore skin
Skin changes
Discharge
Dysuria
Pain in joints/eyes/elsewhere
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2
Q

Things to ask in all female sexual histories?

A 
Discharge
Dysuria/frequency
Vaginal itching/soreness
Genital skin changes
Abdo pain
Pain during/after sex
Systemic symptoms
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3
Q

Tests to do in all female sexual history tings?

A

Swab any vulval ulcer/break in skin - herpes/T.pallidum PCR

VVS - chlam, gon NAAT

HVS - candida, BV, TV

Endocervical swab - gon culture

HIV/Syphilis serology

MSU

?smear - SMEAR IS FIRST

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4
Q

Tests to do in all male sexual history tings?

A

Swab any breaks in skin/ulcers - herpes/T.pallidum PCR

Urethral swab - gram stain/culture for gon

First void urine - chlam/gon NAAT

Syphilis/HIV serology

MSU - dipsitck if appropriate

MSM - (Rectal/pharyngeal swabs - NAAT and culture for chlam and gon)

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5
Q

How does chlamydia present in women?

A

Vaginal discharge
Dysuria
PCB/IMB
Pelvic pain

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6
Q

Treatment of chlamydia?

A

Azithro 1g stat - safe in prego
Doxycycline 100mg BD 7/7 - not in prego
Partner notification
No sex until completed course

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7
Q

Yellow/frothy discharge?

A

TV

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8
Q

Homogenous white discharge?

A

BV

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9
Q

Cottage cheese discharge?

A

Candida

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10
Q

Yellowish discharge from os?

A

Gonnorrhoea

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11
Q

Treatment for BV/TV?

A

400mg metronidazole BD 7/7

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12
Q

Treatment for candida?

A

Clotrimazole

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13
Q

Causes of dysuria in a female?

A

UTI, chlamydia, gonorrhoea, genital herpes. genital candidiasis, trichomonas vaginalis, vulval dematoses

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14
Q

Causes of PCB in young woman?

A

Infection - chlamydia, gonorrhoea
Cervical abnormality - polyp, CIN, malignancy, ectropion
PID

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15
Q

Causes of urethral discharge in a man?

A

Chlamydia - 50% asymptomatic, clear discharge

Gonorrhoea - lots and lots of yellow/green discharge

Non-gonococcal urethritis - gram stained urethral smear (>5 PMNL per high power field)

UTI - MSU if symptoms suggestive

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16
Q

Treatment for gonorrhoea?

A

Ceftriaxone 500mg IM stat

Azithromycin 1g PO

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17
Q

Causes of rash on penis?

A

Infection - candidad, staph/strep, anaerobes, trichamonas, gardanella, syphiilis

Derm - circinate balanitis, lichen sclerosis, zoons balanitis, erythroplasia of queryat, lichen planus, psoriasis, eczema, pemphigus

Miscellaneous - trauma, irritant, poor hygiene, contact allergy, fixed drug eruption, Steven-Johnson syndrome

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18
Q

General management of rash on penis?

A

Salt water bathing
Avoid soaps while inflammation persists
Use aqueous cream/E45 wash as soap substitute

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19
Q

Management of penis candida?

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A

Topical antifungals - canestan BD until symptoms resolved

20
Q

Management of eczema/psoriasis?

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A

Moderately potent topical steroid e.g. betnovate cream

21
Q

Management of lichen planus?

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A

usually self limiting

22
Q

Management of lichen sclerosis?

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A

Potent topical steroid. Requires long term follow up as small risk of malignant transformation

23
Q

Management of scabies/pubic lice?

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A

Topical permethrin and treat all household contacts

24
Q

Causes of sexually acquired proctitis/rectal symptoms?

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A 
Lymphogranuloma venerum
Gonorrhoea
Non-LGV chlamydia
Herpes
Shigella
Hepatitis A
Non-sexually acquired (IBD, haemorrhoids, polyps, malignancy)
25
Causes, diagnosisand management of LGV?
Causes - 3 types of chlamydia trachomatis. Dense sexual networks in big cities, associated with big sex parties, chem sex, Hep C outbreaks. Diagnosis - only in central lab if NAAT chlamydia +ve. Management - abstain, partner notification, safer sex advice, need for WP blood testing. Doxycycline 3 week course. Follow up - risk of permanent damage (fibrosis, strictures, fistulae) may need surgery
26
Causes of painful swollen testicle?
Infections, trauma, torsion, tumours (I and 3 Ts)
27
What is acute epididymo-orchitis?
Syndrome of pain, swelling and inflammation of epididymis/testes (must exclude torsion)
28
Causes of acute epididymo-orchitis?
Local extension from urethra (chlamydia, gon, enteric organisms from insertive anal) From bladder (urinary pathogens) Consider mumps orchitis and TB in high risk groups
29
Management of acute epididymo-orchitis?
Abstain until you and partner treated Ceftriaxone then 10-14 days of doxycycline If STI cause unlikely --> ofloxacin/ciprofloxacin
30
Local complications of STIs?
``` FEMALE PID, endometritis, salpingitis Tubal infertility, ectopic pregnancy Peri-hepatitis (Fitz-Hugh Curtis) Bartholin's abscess ``` MALE Epididymo-orchitis, prostatitis Proctitis
31
Skin/mucus membrane manifestations of STIs?
Acute bacterial conjunctivitis Disseminated gonococcal infection Reactive arthritis
32
What is reactive arthritis?
Sterile inflammation of synovial membranes, tendons, fascia, triggered by infection at distant site. Urethritis, arthritis, conjunctivitis Associated with HLA-B27
33
Chlamydia pregnancy complications?
IUGR, PROM, pre-term delivery, low birth weight
34
Gonorrhoea pregnancy complciations?
LBW, preterm birth
35
BV/TV pregnancy complications?
Implicated with adverse pregnancy outcomes
36
What is opthalmia neonatorum?
Presents after 1-2 weeks of life Conjunctivits, chemosis (oedema of conjunctiva), purulent exudate NAAT forchlam and gon from everted eyelide Gram stain and culture for GC STI screen in parents
37
What is neonatal pneumonitis?
Due to chlamydia - occurs 1-3 months of age Staccato cough, tachypnoea CXR - hyperinflation, bilateral diffuse infiltrates Nasopharyngeal swabs/tracheal aspirates for chlamydia NAATs Erythromycin Screen and treat parents
38
What organism is TV?
Flagellated protozoan
39
What organisms cause BV?
Gram -ve enterobacteria
40
Symptoms of TV?
Vaginal discharge - thick or thin, frothy or yellow, unpleasant smell. Soreness/itching in and around the vagina Dysuria Lower abdominal pain
41
Signs of TV?
Strawberry cervix | Raised pH of vaginal discharge
42
Diagnosis of TV?
HVS | Wet slide preparation to visualise protozoa under microscope
43
Causes of BV?
Imbalance of vaginal flora with overgrowth of gram -ve organisms Vaginal douching/perfumed soaps Unprotected sex (presence of semen in vagina) Hormonal changes in female cycle
44
Symptoms of BV?
White/grey discharge Fishy smell May be asymptomatic
45
Diagnosis of BV?
HVS and dry slide for microscopy Reduction in normal lactobacilli Gram variable bacilli adhering to shed epithelial cells

4th Year GOSH (23 decks)

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