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Y4 Obs & Gynae > Genitourinary Medicine > Flashcards

Genitourinary Medicine Flashcards

1
Q

What is bacterial vaginosis ?

A

Refers to an overgrowth of bacteria in the vagina specifically anaerobic bacteria.
Not an STI and is caused by a loss of the lactobacilli bacteria in the vagina.

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2
Q

How does lactobacilli keep the vaginal pH low ?

A

These bacteria produce lactic acid that keeps the vaginal pH low

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3
Q

What is the most common pathogen to cause bacterial vaginosis ?

A

Gardnerella vaginalis

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4
Q

What are the risk factors for bacterial vaginosis ?

A

Multiple sexual partners
Excessive vaginal cleaning
Recent antibiotics
Smoking
Copper coil

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5
Q

How does bacterial vaginosis present ?

A

Fishy-smelling watery grey or white vaginal discharge
Can be asymptomatic

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6
Q

What are some investigations for bacterial vaginosis ?

A

Vaginal pH - swabs
High vaginal swab

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7
Q

What is seen on microscopy in bacterial vaginosis ?

A

Clue cells

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8
Q

What is the management of asymptomatic bacterial vaginosis ?

A

Requires no treatment

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9
Q

What is the management of symptomatic bacterial vaginosis ?

A

Metronidazole
Clindamycin - second

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10
Q

What is a complication of bacterial vaginosis ?

A

Increased risk of catching an STI - gonorrhoea, chlamydia and HIV

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11
Q

What are complications of bacterial vaginosis in pregnancy ?

A

Miscarriage
Preterm delivery
Premature rupture of membranes
Chorioamnionitis
Low birth weight
Postpartum Endometritis

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12
Q

What is vaginal candidiasis ?

A

Refers to vaginal infection with the yeast Candida albicans

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13
Q

What are some risk factors of vaginal candidiasis ?

A

Increased oestrogen
Poorly controlled DM
Immunosuppression
Broad spectrum antibiotics

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14
Q

How does vaginal candidiasis present ?

A

Thick white discharge that doesn’t smell
Vulval and vaginal itching, irritation or discomfort

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15
Q

What can severe vaginal candidiasis lead to ?

A

Erythema
Fissures
Oedema
Pain during sex
Dysuria
Excoriation

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16
Q

How is a diagnosis of vaginal candidiasis made ?

A

Clinical
Vaginal swab to exclude bacterial vaginosis
Charcoal swab with microscopy

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17
Q

What is the management of vaginal candidiasis ?

A

Over the counter - canesten duo
Antifungal cream inserted into the vagina with an applicator
Antifungal pessary - clotrimazole
Oral Antifungal tablets - fluconazole

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18
Q

What is chlamydia trachomatis ?

A

A gram negative bacteria - intracellular organism meaning it enter and replicates within cells before rupturing the cell and spreading to others

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19
Q

What is the most common STI in the UK ?

A

Chlamydia

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20
Q

What can charcoal swabs confirm the diagnosis of ?

A

Bacterial vaginosis
Candidiasis
Gonorrhoea
Trichomonas vaginalis

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21
Q

What test is used to confirm chlamydia or gonorrhoea ?

A

NAAT to directly check for DNA or RNA of the organism

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22
Q

How does chlamydia present ?

A

Mostly asymptomatic
Abnormal vaginal discharge
Pelvic pain
Abnormal vaginal bleeding
Painful sex
Painful urination

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23
Q

What examination findings indicate chlamydia ?

A

Pelvic or abdominal tenderness
Cervical motion tenderness
Inflamed cervix
Purulent discharge

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24
Q

What is the treatment for chlamydia ?

A

Doxycycline 100mg twice a day for 7 days

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25
Q

What is doxycycline contraindicated in ?

A

Pregnancy and breastfeeding

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26
Q

What are the complications of chlamydia ?

A

Pelvic inflammatory disease
Chronic pelvic pain
Infertility
Ectopic pregnancy
Epididymo-orchitis
Conjunctivitis

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27
Q

What are the complications of chlamydia in pregnancy ?

A

Preterm delivery
Premature rupture of membranes
Low birth weight
Postpartum Endometritis
Neonatal infection

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28
Q

How does chlamydial conjuctivitis occur ?

A

As a result of sexual activity where genital fluid comes into contact with the eye.
Through hand to eye contact

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29
Q

How does chlamydial conjuctivitis present ?

A

Chronic erythema
Irritation
Discharge lasting more than 2 weeks
Unilateral

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30
Q

What is neisseria gonorrhoea ?

A

Gram negative diplococcus bacteria
It infects mucous membranes with a columnar epithelium and spreads via contact with mucous secretions from infected areas.
STI

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31
Q

How does gonorrhoea present ?

A

Odourless purulent discharge possibly green or yellow
Dysuria
Pelvic pain

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32
Q

How is gonorrhoea investigated ?

A

NAAT using a endocervical swab

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33
Q

What is the management of gonorrhoea ?

A

If sensitivities are not known - single dose of IM ceftriaxone 1g
If sensitivities are known - single dose of oral ciprofloxacin 500mg

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34
Q

What are some complications of gonorrhoea ?

A

Pelvic inflammatory disease
Chronic pelvic pain
Infertility
Conjuctivitis
Urethral strictures
Disseminated gonococcal infection
Skin lesions
Fitz-Hugh Curtis syndrome
Septic arthritis

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35
Q

What is disseminated gonococcal infection ?

A

A complication of untreated gonococcal infection where the bacteria spreads to the skin and joints

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36
Q

What is disseminated gonococcal infection ?

A

A complication of untreated gonococcal infection where the bacteria spreads to the skin and joints.

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37
Q

What is mycoplasma genitalium ?

A

A bacteria that causes non-gonococccal urethritis.
STI

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38
Q

What can a mycoplasma genitalium infection lead to ?

A

Urethritis
Epididymitis
Cervicitis
Endometritis
Pelvic inflammatory disease
Reactive arthritis
Preterm delivery in pregnancy
Tubal infertility

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39
Q

What are some investigations for mycoplasma genitalium ?

A

NAAT - vaginal swabs

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40
Q

What is the management of mycoplasma genitalium ?

A

Doxycycline 100mg twice daily for 7 days
Azithromycin 1g stat then 500mg once a day for 2 days

41
Q

What is the treatment of mycoplasma genitalium in pregnancy ?

A

Azithromycin only as doxycycline is contraindicated in pregnancy

42
Q

What is pelvic inflammatory disease ?

A

Inflammation and infection of the organs of the pelvis caused by infection spreading up through the cervix.

43
Q

What is salpingitis ?

A

Inflammation of the Fallopian tubes

44
Q

What is oophoritis ?

A

Inflammation of the ovaries

45
Q

What is Parametritis ?

A

Inflammation of the parametrium which is the connective tissue around the uterus

46
Q

What is peritonitis ?

A

Inflammation of the peritoneal membrane

47
Q

What pathogens cause pelvic inflammatory disease ?

A

STI’s :
Neisseria gonorrhoea ( more severe )
Chlamydia trachomatis
Mycoplasma genitalium
Non-STI :
Gardnerella vaginalis
E.Coli

48
Q

What are some risk factors for pelvic inflammatory disease ?

A

Not using contraception
Multiple sexual partners
Younger age
Existing STI
Previous pelvic inflammatory disease
Intrauterine device

49
Q

How does pelvic inflammatory disease present ?

A

Pelvic or lower abdominal pain
Abnormal vaginal discharge
Abnormal bleeding
Pain during sex
Fever
Dysuria

50
Q

What are the examination findings for pelvic inflammatory disease ?

A

Pelvic tenderness
Cervical motion tenderness
Inflamed cervix
Purulent discharge

51
Q

What investigations should be performed when suspecting pelvic inflammatory disease ?

A

NAAT swabs for gonorrhoea and chlamydia
HIV test
Syphilis test
High vaginal swab - bacterial vaginosis, candidiasis and trichomoniasis
Pregnancy test

52
Q

What is the management of pelvic inflammatory disease ?

A

A single dose of IM ceftriaxone 1g
Doxycycline 100mg twice daily for 14 days
Metronidazole 400mg twice daily for 14 days

53
Q

What are the complications of pelvic inflammatory disease ?

A

Sepsis
Abscess
Infertility
Chronic pelvic pain
Ectopic pregnancy
Fitz-Hugh-Curtis syndrome

54
Q

What is Fitz-Hugh-Curtis syndrome ?

A

A complication of pelvis inflammatory disease and is caused by inflammation and infection of the liver capsule leading to adhesions between the liver and peritoneum.

55
Q

How does fitz-Hugh-Curtis syndrome present ?

A

RUQ pain - referred to right shoulder tip if there is diaphragmatic irritation.

56
Q

How is Fitz-Hugh-Curtis syndrome managed ?

A

Laparoscopy
Adhesiolysis - treat the adhesions

57
Q

What is trichomonas vaginalis ?

A

A type of parasite that spreads through sexual intercourse.
It is classed as a protozoa - single celled organism with flagella.

58
Q

What can trichomonas increase the risk of ?

A

Contracting HIV
Bacterial vaginosis
Cervical cancer
PID
Pregnancy related complications

59
Q

How does trichomoniasis present ?

A

Asymptomatic
Vaginal discharge - frothy, yellow/green
Itching
Dysuria
Dyspareunia
Balanitis

60
Q

How does trichomoniasis look on examination ?

A

Strawberry cervix - tiny haemorrhages

61
Q

How is a diagnosis of trichomoniasis made ?

A

Charcoal swab with microscopy - posterior fornix swab
Urethral or first catch urine - men

62
Q

What is the management of trichomoniasis ?

A

Referral to GUM
Treatment with metronidazole

63
Q

Where does herpes remain latent in the body ?

A

Trigeminal nerve ganglion for cold sores
Sacral nerve ganglia for genital herpes

64
Q

What are some signs and symptoms of genital herpes ?

A

Ulcers or blistering lesions
Neuropathic type pain - tingling, burning
Flu-like symptoms
Dysuria
Inguinal lymphadenopathy

65
Q

How is a diagnosis of genital herpes made ?

A

Clinical
Viral PCR swab from a lesion

66
Q

What is the management of genital herpes ?

A

GUM referral
Aciclovir
Paracetamol
Topical lidocaine
Oral fluids
Avoid intercourse

67
Q

What is the main issue of genital herpes in pregnancy ?

A

Neonatal herpes simplex infection

68
Q

What is the management of genital herpes in pregnancy ?

A

Aciclovir followed by prophylactic aciclovir starting from 36 weeks onwards
C section recommended

69
Q

What is AIDS ?

A

AIDS occurs when HIV is not treated. The disease progresses and then the person becomes Immunocompromised leading to opportunistic infections and AIDS-defining illnesses

70
Q

What is HIV ?

A

An RNA retrovirus which enters and destroys CD4 t helper cells of the immune system.

71
Q

How does HIV present ?

A

An initial seroconversion flu-like illness occurs within a few weeks of infection. Then asymptomatic until the condition has progressed to immunodeficiency. This may occur years after initial infection.

72
Q

How is HIV transmitted ?

A

Unprotected anal, vaginal or oral sexual activity
Mother to child - vertical
Mucous membrane, blood or open wound exposed to infected fluids

73
Q

What is an AIDS defining illness ?

A

Illnesses associated with end stage HIV infection. These occur where the CD4 count has dropped to a level that allows for unusual opportunistic infections and malignancies to appear.

74
Q

What are some AIDS defining illnesses ?

A

Kaposi’s sarcoma
Pneumocytitis jiroveci pneumonia
Cytomegalovirus infection
Candidiasis - oesophageal or bronchial
Lymphomas
TB

75
Q

What investigations are performed when suspecting HIV ?

A

Antibodies to HIV and the p24 antigen

76
Q

What is used to monitor HIV ?

A

Testing the CD4 count in the blood
HIV RNA indicated the viral load

77
Q

What is the management of HIV ?

A

Specialist HIV, infectious disease or GUM centres
Antiretroviral therapy medications ( 2 NRTI’s like tenofovir + emtricitabine and a third agent like bictagravir )

78
Q

What should be given as prophylactic treatment in HIV patients with a CD4 count below 200 ?

A

Prophylactic co-trimoxazole to protect against pneumocystis jiroveci pneumonia

79
Q

What prophylaxis is given to the baby after delivery in a mother with a HIV count of under 50 copies ?

A

Given zidovudine for 2-4 weeks

80
Q

What prophylaxis is given to a high risk baby after delivery in a mother with HIV ?

A

Zidovudine, lamivudine and nevirapine for 4 weeks

81
Q

Is breastfeeding safe in HIV ?

A

No

82
Q

When should post-exposure prophylaxis be started to reduce the risk of transmission of HIV ?

A

Less than 72 hours

83
Q

What is medications are used as post-exposure prophylaxis in HIV ?

A

Combination of ART therapy
Emtricitabine / tenofovir and raltegravir for 28 dyas

84
Q

What is the medication of choice for pre-exposure prophylaxis of HIV ?

A

Emtricitabine / tenofovir

85
Q

What is syphilis caused by ?

A

Is caused by the bacteria treponema pallidum - it is a spirochete a spiral shaped bacteria.
STI

86
Q

How is syphilis transmitted ?

A

Oral, vaginal or anal sex
Vertical transmission
IV drug use
Blood transfusions

87
Q

What is primary syphilis ?

A

Involves a painless ulcer at the original site of infection

88
Q

What is secondary syphilis ?

A

Involves systemic symptoms particularly of the skin and mucous membranes particularly of the skin and mucous membranes. These symptoms can resolve after 3-12 weeks then the patient enters the latent stage.

89
Q

What is latent syphilis ?

A

Occurs after the secondary stage of syphilis where symptoms disappear and the patient becomes asymptomatic despite still being infected.

90
Q

What is tertiary syphilis ?

A

Can occur many years after the initial infection and affect many organs of the body.

91
Q

What is Neurosyphilis ?

A

Occurs if the infection involves the CNS presenting with neurological symptoms

92
Q

How does primary syphilis present ?

A

A painless genital ulcer that tends to resolve over 3-8 weeks
Local lymphadenopathy

93
Q

How does secondary syphilis present ?

A

Maculopapular rash
Condylomata lata
Low grade fever
Lymphadenopathy
Alopecia
Oral lesions

94
Q

How does tertiary syphilis present ?

A

Gummatous lesions
Aortic aneurysms
Neurosyphilis

95
Q

How does Neurosyphilis present ?

A

Headache
Altered behaviour
Dementia
Tabes dorsalis - demyelination affecting the spinal cord posterior columns
Ocular syphilis
Paralysis
Sensory impairment

96
Q

What is an Argyll-Robertson pupil ??

A

It is a constricted pupil that accommodates when focusing on a near object but does not react to light.

97
Q

What is used as a screening test for syphilis ?

A

Antibody testing to the T pallidum bacteria

98
Q

What tests are used to confirm the presence of t.pallidum ?

A

Dark field microscopy
Polymerase cain reaction ( PCR )

99
Q

What is the management of syphilis ?

A

GUM referral
Single deep IM benzathine benzylpenicillin
Contact tracing

Y4 Obs & Gynae (4 decks)

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