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1
Q

-Fishy smelling watery grey or white vaginal discharge

A

-Bacterial vaginosis

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2
Q

What causes BV

A

-Overgrowth of anaerobic bacteria in the vagina

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3
Q

Why does BV occur?

A

-Reduced no. of lactobacilli
-Lactobacilli produce lactic acid keeping the pH below 4.5
-Without them, the pH rises allowing anaerobic bacteria to multiply

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4
Q

What is the most common cause of BV?

A

-Gardnerella vaginalis

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5
Q

What is seen on microscopy in BV

A

-‘Clue cells’

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6
Q

What is the antibiotic of choice in BV?

A

-Metronidazole (oral or vaginal gel) -> avoid alcohol when taking
- 5 to 7 days

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7
Q

What are the complications of BV?

A

-Increased risk of catching STI
-Several complications in pregnancy : miscarriage, preterm, PROM, chorioamnitis, low borth weight, postpartum endometritis

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8
Q

-Thick white discharge that does not typically smell
-Vulval and vaginal itching, irritation or discomfort

A

-Thrush

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9
Q

What is the most common cause of vaginal candidiasis (thrush)

A

-Candida albicans

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10
Q

What are the treatment options for thrush ?

A

1st line = oral fluconazole single dose

-Antifungal cream (clotrimazole)
-Antifungal pessary (clotrimazole)
-Oral antifungal tablets (fluconazole)

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11
Q

-Frothy yellow/green vaginal discharge that smells fishy
-Non specific Sx : itching, dysuria, dyspareunia

A

-Trichomoniasis

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12
Q

What is trichomonas vaginalis

A

-Parasite STI

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13
Q

How is trichomoniasis diagnosed

A

-Standard charcoal swab with micoscopy
-Woman : posterior fornix of vagina
-Men : urethral swab or first-catch urine

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14
Q

How is trichomoniasis treated ?

A

-Metronidazole

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15
Q

What 5 things can trichomoniasis increase the risk of ?

A

-Contracting HIV
-Bacterial vaginosis
-Cervical cancer
-PID
-Pregnancy-related complications

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16
Q

What kind of bacteria is chlamydia ?

A

-Chlamydia trachomatis
-Gram negative
-Most common STI

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17
Q

What is the national chlamydia screening programme

A

-> Aims to screen every sexually active person <25 for chlamydia annually or when they change sexual partner

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18
Q

What might the cervix look like on examination in trichomoniasis ?

A

-> Strawberry cervix

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19
Q

What are charcoal swabs used for ?

A

-> They allow microscopy, culture and sensitivities of any bacteria
-> They can be used for endocervical swabs or high vaginal swabs
-They can confirm : BV, thrush, gonorrhoeae, trichomonas vaginalis, GBS

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20
Q

What does NAAT specifically test for?

A

-> DNA or RNA of organism
-> Chlamydia and gonorrhoea
-> Women : vulvovaginal swab, endocervical or first catch urine swab
-> Men : first catch urine

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21
Q

How is chlamydia diagnosed ?

A

-> Nucleic acid amplification test (NAAT)

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22
Q

How is chlamydia treated?

A

-1st line : doxycycline 100mg twice a day for 7 days

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23
Q

What is lymphogranuloma venereum

A

->Condition affecting the lymphoid tissue arund the site of infection with chlamydia

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24
Q

What are the 3 stages of LGV

A
  1. Painless ulcer
  2. Lymphadenitis (inguinal or femoral lymph nodes)
  3. Proctitis and anus inflammation : anal pain, tenesmus, discharge and change in bowel habits
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25
How is LGV treated
-> Doxycycline 100mg twice daily for 21 days
26
What swabs are used to detect chlamydia in the throat or rectum ?
-> Rectal and pharyngeal NAAT swabs
27
What kind of bacteria is Neisseria gonorrhoeae?
-Gram negative diplococcus
28
-Female : odourless purulent discharge (green/yellw), dysurua, pelvic pain -Male : same discharge, dysuria, epididymo-orchitis
-Gonorrhoea
29
What swabs are used in gonorrhoea ?
-NAAT to detect -Charcoal swab for sensitivites and resistance
30
How is gonorrhoea managed?
-Refer to GUM -Single dose of 1g IM ceftriaxone if sensitivities not known -Single dose of 500mg oral ciprofloxacin if sensitivities know
31
When is a 'test of cure' done for gonorrhoea ?
-72 hrs after treatment for culture -7 days after treatment for RNA NAAT -14 days after treatment for DNA NAAT (NAAT if asymptomatic, cultures if symptomatic)
32
What is a key complication of gonorrhoea ?
-> Gonococcal conjunctivitis -> In neonates : ophthalmia neonatorum
33
What is a complication of untreated gonorrhoea ?
-> Disseminmated gonococcal infection : spreads to skin and joints
34
What causes cold sores and genital herpes and how is it spread ?
-HSV -Direct contact with affected mucous membranes
35
After initial infection, where does HSV become latent ?
-Cold sores : trigeminal nerve ganglion -Genital herpes : sacral nerve ganglia
36
- Initial severe gingivostomatitis - cold sores - Painful genital ulceration
-HSV : cold sores / genital herpes -Initial infection usually lasts 3 weeks and is more severe -Can have recurrent episodes
37
How is HSV diagnosed ?
-Usually clinical, can be confirmed with viral PCR swab
38
How is genital herpes treated?
- Oral aciclovir
39
What is the risk of genital herpes in pregnancy ?
-> Neonatal herpes simplex infection contracted during labour and delivery
40
What causes syphillis and how is it transmitted ?
-> Treponema pallidum -> STI -> vertical transmission -> IVDU -> Blood transfusion and other transplants
41
Explain the 4 possible stages of syphillis
1 : Primary : painless ulcer (chancre) 2 : Secondary : systemic sx (3-12 wks) -> skin and mucus membranes 3 : Latent : become asymptomatic despite still infected. Early latent : within 2 yrs. Late latent : > 2yrs. 4 : Tertiary : gummas, cardiac and neuro complications
42
-Painless genital ucler, resolving after 3-8 wks -Local lymphadenopathy
Primary syphillis
43
- Healed genital lesion - Macropapular rash on trunk, hands and soles - Condylomata lata : painless, warty lesions on genitalia - Fever - Lymphadenopathy - Alopecia - Ulcers
Secondary syphillis
44
How can neurosyphillis present ?
Headache Altered behavipur Dementia Tabes dorsalis Ocular syphilis Paralysis Sesonry impairment
45
What is a specific finding in neurosyphilis ?
-> Argyll-Robertson pupil -> Constricted pupil that accommodates when focusing on near object but does not react to light -> 'Prostitutes pupil' : accommodates but does not react
46
How is syphilis diagnosed if there is an active lesion (e.g. primary syphilis)
-Sample from site of infection with dark field microscopy or PCR
47
How is syphilis treated ?
-Deep IM dose of benzathine benzylpenicillin
48
What STI can cause non-gonococcal urethritis ?
-Mycoplasma genitalium
49
How is mycoplasma genitalium diagnosed ?
-NAAT using first urine sample in men and vaginal swabs in women
50
How is mycoplasma genitalium managed ?
-> Doxycycline 100mg twice daily for 7 days THEN : -> Azithromycin 1g stat then 500mg once a day for 2 days (this alone in pregnancy, doxy is CI) -> Moxifloxacin in complicated infections
51
What is contact tracing in STI's
-Involves contacting previous partenrs to attend clinics to be tested and/or receive treatment
52
What is HIV and how does it affect the body?
-RNA retrovirus -Destroys CD4 T-helper cells -Initial seroconversion flu like illness -Asymptomatic until the condition progresses to immunodeficiency and causes AIDS-defining illness an d opportunistic infections
53
How is HIV screened for and diagnosed ?
-Screening : antibody testing -Diagnosis : testing for p24 antigen -PCR testing HIV RNA tests directly for viral copies in the blood giving viral load.
54
How is HIV monitored
-> CD4 count -> Viral load
55
-Women : abnormal vaginal discharge and bleeding, pelvic pain, dyspareunia, dysuria -Men : urethral discharge, dysuria, epididymo-orchitis and reactive arthritis
-Chlamydia
56
what is seen on examination in chlamydia
Pelvic/abdo tenderness Cervical excitation Inflamed cervix Purulent discharge
57
Gummatous lesions Aortic aneurysm Neurosyphilis
Tertiary syphillis
58
What investigations indicate a person has been previously treated for syphilis
-VDRL negatiive and TPHA positive -VDRL = active disease -TPHA = treated = IgG antibodiers
59
Give 6 pregnancy related complications of chlamydia
Preterm delivery premature rupture of membranes Low birth weight Postpartum endometritis Neonatal conjunctivits and pneumonia Chorioamnionitis
60
give 4 features of congenital syphilis
Generalised lymphadenopathy Hepatosplenomegaly Rash Skeletal malformations
61
What can you be more susceptible to after antibiotics
Thrush
62
How often is cervical cytology offered in HIV +ve patients
-> Annual
63
what is advised for birth if a primary attack of herpes occurs during pregnancy at greater than 28 wks gestation
Elective c section at 28 wks
64
what main strands cause genital warts
HPV 6 and 11
65
what is used 1st and 2nd line for genital warts
- 1st : Topical podophyllum or cryotherapy - 2nd : imiquimod
66
what 2 tests are done for syphilis with no primary lesion
1. Non-treponemal tests : RPR and VDRL and assess antibodies produced. 2. Treponemal-specific tests : TPHA
67
what syphilis tests results would suggests active syphilis
- Non treponema (VDRL) +ve - Treponemal (TPHA) +ve
68
what syphilis tests result would suggest treated syphilis
- Non treponemal (VDRL) -ve - Treponemal (TPHA) +ve

3a (45 decks)

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