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Phase 3a > GU Medicine > Flashcards

GU Medicine Flashcards

1
Q

What is chlamydia caused by?

A

Chlamydia trachomatis

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2
Q

What are the features of chlamydia?

A

Women: increased vaginal discharge, dysuria, pelvic pain, post coital/ intermenstrual bleeding

Men: Urethral discharge, dysuria, testicular pain

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3
Q

What are the complications of chlamydia?

A

Epididymitis

Pelvic inflammatory disease

Endometritis

Ectopic pregnancies

Infertility

Reactive arthritis

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4
Q

What are the investigations for chlamydia?

A

Nuclear acid amplification tests (NAATs) investigation of choice

For NAAT-

First void urine sample for men

Vulvovaginal swab for women

Should be carried out 2 weeks after exposure

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5
Q

What age is screened for chlamydia?

A

15-24

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6
Q

What is the management of chlamydia?

A

Doxycycline 7 day course (contraindicated in pregnancy)

If pregnant or doxy contraindicated use azithromycin

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7
Q

Who should be notified from chlamydia infections?

A

Men with urethral symptoms- anyone 4 weeks prior to symptoms and after symptoms

Women and asymptomatic men- all partners from the last 6 months

Treat then test in partners

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8
Q

Extra information chlamydia?

A

No sexual contact for 1 week after treatment

Test of cure- 3 months later if under 25

In 6 weeks if pregnant

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9
Q

What causes gonorrhoea?

A

Neisseria gonorrhoeae

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10
Q

What are the features of gonorrhoea?

A

Males- purulent urethral discharge, dysuria

Women- cervitis- purulent discharge, pelvic pain

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11
Q

What are the investigations for gonorrhoea?

A

Microscopy

NAAT

Culture (for antibiotic resistance)

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12
Q

What is the treatment for gonorrhoea?

A

Ceftriaxone stat

If found to be sensitive before treatment- ciprofloxacillin stat

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13
Q

What type of bacteria is gonorrhoea?

A

Gram negative diplococci

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14
Q

What is non-specific urethritis?

A

Urethritis without a clear cause on microscope

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15
Q

What could be the cause of non-specific urethritis?

A

No cause found

Chlamydia trachomatis

Mycoplasma genitalium

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16
Q

What is the management of non-specific urethritis?

A

Doxycycline 7 day course

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17
Q

What type of organism if trichomonas vaginalis?

A

Flagellated protozoon

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18
Q

What are the features of trichomonas vaginalis?

A

Women- vaginal discharge- offensive, yellow/green, frothy
Itching
Dysuria
Pelvic pain
Strawberry cervix
pH >4.5

Men- usually asymptomatic but urethritis- discharge, dysuria, frequency

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19
Q

What is the investigation for trichomonas vaginalis?

A

Microscopy of wet mount shows motile trophozoites

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20
Q

What is the management of trichomonas vaginalis?

A

Oral metronidazole for 5-7 days

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21
Q

Difference between trichomonas and bacterial vaginosis?

A

BV- thin white discharge, microscopy shows clue cells

monas- frothy yellow-green discharge, vulvovaginitis, strawberry cervix, wet mount- motile trophozoites

Both- offensive vaginal smell, vaginal pH >4.5, treated with metronidazole

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22
Q

What causes bacterial vaginosis?

A

Gardnerella vaginalis
pH>4.5, normal vaginal flora dominated by anaeriobic

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23
Q

What are the features of bacterial vaginosis?

A

Offensive smelling fishy vaginal discharge (no soreness, itching etc)

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24
Q

Risks of bacterial vaginosis in pregnancy?

A

Increased risk of preterm labour, low birth weight and miscarrige

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25
Q

Four criteria for bacterial vaginosis diagnosis?

A

(Amsel’s criteria)

Thin, white discharge
Clue cells on microscopy
Vaginal pH >4.5
Positive whiff test

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26
Q

What is the management of bacterial vaginosis?

A

If women asymptomatic no treatment required

If symptomatic- oral metronidazole 5-7 days, stat if adherence an issue

Prevention information- wash with only water etc

If pregnant offer only metronidazole 5-7 days

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27
Q

What causes vaginal candidiasis?

A

Candida albicans

28
Q

What are the risk factors for candida albicans?

A

Diabetes mellitus

Antibiotics

Hyperoestrogenaemia (including HRT and the COCP)

Pregnancy

Immunosuppression: HIV

29
Q

What are the features of vaginal candidiasis?

A

Cottage cheese, non offensive discharge

Vulvitis- superficial dyspareunia, dysuria

Itch

Vulval erythema

30
Q

What are the investigations for vaginal candidiasis?

A

Clinical

Could do a high vaginal swab if unsure

31
Q

What is the management of vaginal candidiasis?

A

Oral fluconazole

Clotrimazole pessary

Topical imidazole

If pregnant only local treatments

Advice- only wash with water

32
Q

What are the two types of gential herpes?

A

HSV-1- cold sores

HSV-2- genital herpes

Either can cause cold sore or genital herpes

33
Q

What causes herpes?

A

Herpes simplex virus

34
Q

What are the features of herpes?

A

Painful genital ulceration (dysuria, pruritis)

Primary infection often more severe than recurrent episodes (systemic features such as headache, fever and malaise)

Tender inguinal lymphadenopathy

Urinary retention may occur

35
Q

What are the investigations for herpes?

A

Nucelic acid amplification tests (NAAT)

36
Q

What is the management of herpes?

A

General measures: saline bathing, analgesia, topical anaethetic agents

Oral aciclovir

37
Q

Pregnancy and herpes?

A

Maybe elective caesarean if primary attack occurs after 28 weeks gestation

38
Q

What causes genital warts?

A

HPV (human papillomavirus)- especially 6 and 11

Well established that 16, 18 and 33 cause cervical cancer

39
Q

What are the features of genital warts?

A

Small fleshy lumps- may bleed or itch

Could be asymptomatic

40
Q

What is the management of genital warts?

A

Topical podophyllum or cryotherapy commonly used first line depending on location and type of lesion

Imiquimod topical cream 2nd line

41
Q

What causes syphilis?

A

Treponema pallidum

Gram negative spirochaete

42
Q

What are the different stages of syphilis infection?

A

Primary, secondary and tertiary

Neurosyphilis can occur anytime

43
Q

What are the primary features of syphilis?

A

Chancre- painless ulcer at the site of sexual contact

44
Q

What are the secondary features of syphilis (6-10 weeks after primary infection)?

A

Systemic symptoms- fevers, lymphadenopathy

Rash on trunk, palms and soles

Buccal snail track ulcers

45
Q

What are the tertiary features of syphilis?

A

Gummatous (nodules that break down into ulcers and heal slowly)

Aortic aneurysms

46
Q

What are the investigations for syphilis?

A

Non-treponemal (not specific):

Rapid plasma reagin (RPR) and Venereal Disease Research Laboratory (VDRL)

Treponemal (specific but can stay positive after treated):

TP-EIA, TPHA

47
Q

What is the management of syphilis?

A

Intramuscular benzathine penicillin is first line (benzylpenicillin)

48
Q

What are the stages of HIV?

A
  1. Acute infection
  2. Seroconversion- myalgia, fever, rash, severe sore throat
  3. Asymptomatic phase- loss of CD4 cells
  4. AIDS
49
Q

What are the investigations of HIV?

A

HIV antibody- develop antibodies at 4-6 weeks but 99% by 3 months

HIV antibody and HIV antigen p24 (combination tests)- 2-3 weeks after exposure

HIV RNA

50
Q

What to monitor in HIV?

A

CD4 count and viral load

51
Q

What is the management of HIV?

A

HAART therapies:

NRTIs- nucleoside analogue reverse trascriptase inhibitors

NNRTIs

Protease inhibitors

Integrase inhibitors

52
Q

What are the AIDS defining illnesses?

A

Pneumocystis jiroveci- cotrimoxazole- causes pneumonia

Oesophageal candidiasis

53
Q

What can be used to control HIV?

A

PEP (post exposure prophylaxis)- soon as possible after exposure- within 7 hours

PrEP (pre exposure prohylaxis)- antiretroviral therapy for MSM at risk of HIV

54
Q

What are the complications of hepatitis B?

A

Chronic hepatitis

Fulminant liver failure

55
Q

Hep B investigations?

A

Serology

56
Q

Hep B management?

A

Rest- notifiable disease

57
Q

Balanitis?

A

Infection with bacteria or candida

Wash your bellend

58
Q

What is
Fitz-Hugh-Curtis syndrome?

A

Complication of PID

Female hepatic capsulitis

Chlamydia RUQ pain

59
Q

How long to take retrovirals after HIV exposure?

A

4 weeks

60
Q

HIV seroconversion features?

A

Sore throat
Lymphadenopathy
Malaise, myalgia, arthralgia
Diarrhoea
Maculopapular rash
Mouth ulcers
Rarely meningoencephalitis

61
Q

What to do if a HIV combined test is positive?

A

Repeat it

62
Q

What are disseminated gonococcal infection (DGI) and gonococcal arthritis

A

Complications of gonnorhoea

Tenosynovitis
Migratory polyarthritis
Dermatitis (lesions can be maculopapular or vesicular)

63
Q

What type of bacteria causes Chlamydia?

A

An obligate intracellular pathogen

64
Q

When is a vaginal delivery reccomended in women with HIV?

A

Viral load is less than 50 copies/ml at 36 weeks

65
Q

What shows a previous syphilis infection?

A

VDRL negative, TPHA positive

66
Q

Syphilis investigation summary?

A

Positive non-treponemal test + positive treponemal test
consistent with active syphilis infection

Positive non-treponemal test + negative treponemal test
consistent with a false-positive syphilis result e.g. due to pregnancy or SLE (see list above)

Negative non-treponemal test + positive treponemal test :
consistent with successfully treated syphilis

67
Q

Genital herpes investigation?

A

NAAT

HSV serology in recurrent

Phase 3a (17 decks)

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