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Genital Tract infections Flashcards

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1
Q

What is bacterial vaginosis

A

loss of lactobacilli and increase in anaerobic and highly specific BV-associated bacteria in the vagina

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2
Q

what bacteria are commonly associated with bacterial vaginitis

A

G.vaginalis

atrophium vaginae

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3
Q

what are the clinical features of bacterial vaginitis

A

grey-white discharge

fishy odour

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4
Q

how do you diagnose bacterial vaginitis

A

decreased vaginal pH (>4.5, usually around 7)
grey-white discharge
fishy-odour
‘clue cells’ on microscopy

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5
Q

how do you treat bacterial vaginitis

A

metronidazole

clindamycin cream

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6
Q

what is the common patient population for bacterial vaginitis

A

women of reproductive age

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7
Q

what are risk factors for vaginal candidiasis infection

A

pregnancy
diabetes
antibiotic use

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8
Q

what are clinical features of vaginal candidiasis infection

A

lumpy white ‘cottage cheese’ discharge
vulval irritation/itching
superficial dyspareunia
dysuria

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9
Q

how do you diagnose vaginal candidiasis infection

A

cultures

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10
Q

what is the treatment for vaginal candidiasis

A

topical imidazole

oral fluconazole

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11
Q

what is toxic shock syndrome

A

rare complication of keeping a tampon in for too long due to staph aureus toxin release

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12
Q

what are clinical features of toxic shock syndrome

A

high fever
hypertension
multisystem organ failure

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13
Q

how do you treat toxic shock syndrome

A

ICU admission and IV Abx

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14
Q

what are risk factors for STIs

A 
number of partners (>3 within 6 months, or a newpartner in the last 3 months)
concurrent partners 
not using condoms
other STIs
<20
sexual preference
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15
Q

what is the most common sexually transmitted disease in the world

A

Chlamydia

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16
Q

what proportion of women have genital symptoms with a chlamydia infection

A

<30%

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17
Q

what are some symptoms of chlamydia infection

A 
altered vaginal discharge 
intermenstrual bleeding 
post-coital bleeding 
low abdominal pain
dyspareunia
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18
Q

what is the main complication of chlamydia infection

A

pelvic infection leading to infertility

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19
Q

what atypical presentation is chlamydia associated with and what are its clinical features

A

sexually active arthritis, presenting with :

urethritis
conjunctivitis
arthritis

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20
Q

how do you diagnose a chlamydia infection

A

NAATs of vaginal swabs

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21
Q

how do you treat chlamydia

A

azithromyicin or doxycycline

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22
Q

what kind of bacteria is gonorrhea

A

gram negative diplococcus

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23
Q

how does gonorrhea present in men

A

urethritis

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24
Q

how does gonorrhea present in women

A 
vaginal discharge
urethritis
bartholinitis 
cervicitis
pelvic infection
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25
what are the complications of gonorrhea infection (although they are rare)
septic arthritis | bacteraemia
26
how do you diagnose a gonorrhea infection
NAATs of vulvovaginal swabs
27
how do you treat gonorrhea
if not quinolone resistant: azithromycin or cefixime 2nd line: IM ceftriaxone
28
what is linked with causing genital warts
HPV (6,11,16,18)
29
how do genital warts spread
physical contact
30
how do you diagnose genital warts
clinical diagnosis
31
how do you treat genital warts
chemical application podophyllin podophyllotoxin trichloroacetic acid imiquimod or cryotherapy
32
what is the recurrence rate of genital warts
25%
33
what causes gentital herpes
HSV1 and HSV2 - but more predominantly HSV2
34
which herpes simplex virus is associated with mouth infections (coldsores)
HSV1
35
what are common features of symptomatic Herpes infection
stinging/itching in affected area small vesicles which then burst and crust over dysuria local lymphadenopathy
36
which herpes infections recur more/less
HSV2 + 6 recur more, HSV1 recurs less
37
what is the treatment for herpes infections
oral aciclovir for all first indications | IV aciclovir in severe infections
38
what causes syphillis
T.pallidum
39
what are the 3 types of syphillis and their clinical features
Primary Only clinical feature is a single ulcer – called a chancre ``` Secondary Occurs only if there is an untreated primary Develops week later Rash Flu-ike illness Warty genital/perioral growths Systemic vasculitis Hepatitis Uveritis Alopecia ``` After this stage it can become latent for years and will progress to tertirary syphillis at some point Tertiary Rare Develops years after the primary infection ``` Any organ can be affected, leading to Dementia Aortic regurgitation Tabes dorsalis Gummatis in the skin and bone ```
40
how do you diagnose syphillis infection
syphilis enzyme immunoassay | VRDL test
41
how do you treat syphillis infection
parenteral (IM) penecillin
42
what is trichomonas
a protozoa
43
what are the typical symptoms of a trichomonas infection
``` offensive green-grey discharge (70%) vulval irritation dysuria superficial dyspareunia asymptomatic in 50% ```
44
how do you diagnose trichomonas infection
NAATs | wet film microscopy may identify motile trichomonas in 60% of cases
45
how do you treat trichomonas infection
systemic metronidazole
46
what is endometritis
isolated infection of the endometrium
47
what commonly causes endometritis
birth complications - e.g. some placenta left in the uterus post birth ``` common orgnanisms are: e-coli staph aureus chlamydia gonorrhea clostridia ```
48
what are the clinical features of endometritis
persistent and heavy bleeding/pain tender uterus cervical os open
49
what is a complication of endometritis
sepsis
50
how do you treat endometritis
broad spectrum antibiotics evacuation of retained products of conception if required sepsis 6 if required
51
what is another name for pelvic inflammatory disease
salpingitis
52
what is the lifetime incidence for pelvic inflammatory disease
2%
53
what are risk factors for pelvic inflammatory disease
``` number of partners (>3 within 6 months, or a newpartner in the last 3 months) concurrent partners not using condoms other STIs <20 sexual preference ```
54
what is protective for pelvic inflammatory disease
COCP/IUS
55
what kind of infection causes pelvic inflammatory disease and name some common organisms
multimicrobial chlamydia and gonorrhea
56
what is fitz-hugh-curtis syndrome
perihepatitis due to pelvic inflammatory disease characterised by RUQ pain due to adhesions forming between anterior liver and peritoneal wall
57
what is the clinical presentation of pelvic inflammatory disease
deep dyspareunia bilateral abdominal pain abnormal bleeding discharge subfertility if presenting for a long time some acute cases may present with tachycardia, fever and peritonism with bilateral adnexal tenderness
58
what are differentials for acute pelvic inflammatory disease
ovarian torsion ovarian cyst rupture appendicit s
59
how should you investigate pelvic inflammatory disease
endovervical swab for STIs WBC CRP pelvic USS - excludes abscesses and cysts laproscopy - gold standard = fimbral biopsy and cultures
60
what is the treatment for pelvic inflammatory disease
parenteral cephalosporins (IM ceftriaxone) followed by doxycycline/ofloxacin and metronidazole IV therapy reserved if patients severely unwelll abscesses may need draining
61
what are complications of pelvic inflammatory disease
``` tubal obstruction infertility chronic pelvic infection chronic pelvic pain increased chance of ectopic pregnancy ```
62
what does chronic PID cause
dense pelvic adhesions with severe fallopian tube obstruction +/- fluid/pus retention
63
what are common symptoms of chronic PID
Chronic pelvic pain Dysmenorrhoea Deep dyspaerunia Subfertility Chronic vaginal discharge Heavy and irregular menstruation
64
what might you find on examination in chronic PID
tenderness + fixed uterus
65
how do you investigate chronic PID
TV USS may identify any fluid in the tubes Laporoscopy is best tool Cultures are often negative
66
how do you treat chronic PID
Analgesia and antibiotics if active infection Adhesion removal Salpingectomy

Gynaecology (14 decks)

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