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GUM Flashcards

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1
Q

causes of genital ulceration?

A
  • infectious (viral: HCV, varicella, CMV. bcaterial: syphilis, staph/strep, LGV, chancroid, donovanosis. fungal)
  • inflammatory/immune (crohns, blistering skin conditions, aphthous)
  • durg-related (FDE, topical reaction, IVDU)
  • traumatic
  • malignant
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2
Q

What tests are done for herpes?

A
  • take a swab (send for PCR) on a wet blister/ulcer not crusted over

also offer full STI screen, syphilis serology, HIV antibody test

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3
Q

management of herpes?

A
  • course of oral antiviral (e.g. aciclovir) 400mg TDS for 5 days
  • 5% lidocaine ointment
  • rest and analgesia
  • salt watering bathing
  • vaseline
  • avoid sexual contact while symptomatic
  • advise to disclose to partner
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4
Q

complications of herpes?

A
  • urinary retention (due to extreme pain when passing)
  • adhesions
  • meningism
  • emotional distress
  • recurrences
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5
Q

are herpes ulcers painless or painful?

A

painful !

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6
Q

differential diagnose for genital ulcers?

A
  • syphilis
  • herpes simples
  • lymphogranuloma venereum
  • aphthous ulceration
  • trauma
  • Mpox
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7
Q

how do you diagnose syphilis?

A

from lesions:
- dark ground microscopy
- treponemal PCR

in blood:
- treponemal enzyme immunoassay (EIA)
- treponema pallidum particule agglutination assay (TPPA)
- rapid plasma reagin test (RPR)

  • always perform full STI screen including HIV testing
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8
Q

first line treatment for syphilis?

A

early: benzathine pencillin IM one dose
late: benzathine penicillin IM 3 doses

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9
Q

what tests would you do on a symptomatic female?

A
  • high vaginal loop swab fro microscopy and pH testing - TV, BV, candida
  • vulvovaginal swab ‘dual NAAT’ - chlamydia and gonorrhea. may need throat and rectal
  • bloods: HIV.syph +/- Hep B/C

+/-:
- high vaginal charcoal swab
- gonorrhea cultures
- HSV PCR
- urinalysis
- preg test

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10
Q

what tests would you do on a symptomatic male?

A
  • urethral smear - GC/NSU, GC culture
  • first pass urine - GC/CT dual NAATs test
  • bloods HIV/syphilis +/- hep B/C

MSM may need rectal and pharyngeal swabs and culutres
other swabs - MC&S/candida/herpes
other test - urine dip

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11
Q

what tests would you do on a symptomatic male?

A
  • urethral smear - GC/NSU, GC culture
  • first pass urine - GC/CT dual NAATs test
  • bloods HIV/syphilis +/- hep B/C

MSM may need rectal and pharyngeal swabs and culutres
other swabs - MC&S/candida/herpes
other test - urine dip

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12
Q

what tests would you do on a symptomatic male?

A
  • urethral smear - GC/NSU, GC culture
  • first pass urine - GC/CT dual NAATs test
  • bloods HIV/syphilis +/- hep B/C

MSM may need rectal and pharyngeal swabs and culutres
other swabs - MC&S/candida/herpes
other test - urine dip

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13
Q

risk factors for candiasis?

A
  • immunosupression (hiv, steroids, chemo)
  • high oestrogen levels (preg, luteal phase, somes COCPs)
  • recent ABx
  • diabetes
  • mucosal breakdown (sexual contact, dermatitis)
  • recurrent candidiasis
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14
Q

how to treat candidal infection?

A

fluconazole 150mg stat or
clotrimazole 500mg pessary PV stat or
clotrimazole 1% cream for 2 wks

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15
Q

what are some important questions to ask regarding vaginal discharge?

A

colour
consistency
odour

associated symptoms: pain, bleeding, itchy, rash, triggers

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16
Q

what examinatons do you want to do on female patient?

A
  • external + vulval examination
  • speculum examination
  • bimanual examination (if abdo pain/deep dyspareunia )
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17
Q

what swabs are used for different organisms?

A
  • high vaginal swab - trichomonas vaginalis/candida/bacterial vaginosis
  • vulvovaginal swab - N. gonorrhoeae and C.trachomatis
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18
Q

what are the clinical features of vaginal candida?

A
  • thick, white discharge (cottage cheese like)
  • itching
  • soreness
  • vulval erythema +/- fissures, pH 4
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19
Q

what investigations need to be done when suspecting candida?

A
  • swabs taken from high vaginal walls
    (- culture may grow candida but doesn’t distinguish colonisation)
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20
Q

risk factors for candida infection

A
  • immunouspression
  • high oestrogen levels
  • recent ABx (up to 3 months before)
  • diabetes mellitus
  • mucosal breakdown (sexual contact, mucosal breakdown)
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21
Q

Tx for candida?

A
  • fluconazole 150mg PO STAT or clotrimazole 500mg pessary PV stat
    PLUS clotrimazole 1% cream top BD for 2 wks
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22
Q

what is the treatment fro recurrent candidiasis?

A

recurrent = > 4 times a yr

induction followed by maintenance:
- fluconazole 150mg every 72 hrs for 3 doses
- then fluconazole 150mg x1 a week for 6 months
- clotrimazole pessaries can be used if flucon. contraind.

(+ advice on douching, remove oestrogen e.g. POP)

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23
Q

what is bacterial vaginosis + how is it caused?

A
  • imbalance of vaginal flora
    loss of lactobacilli that maintain pH of vagina
    = overgrowth of normal, commensal, anaerobic and facultative bacteria
    rise in vaginal pH
    NOT AN STI
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24
Q

triggers for bacterial vaginosis?

A
  • sex
  • menses
  • receptive oral SI
  • vaginal douching
  • perfumed bath product
    s- change in sexual partners
  • presence of STI
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25
Tx of bacterial vaginosis?
metronidazole 400mg BD for 5 days
26
clincial features of trichonmonas vaginalis?
- frothy vaginal discharge - dysuria - vulval soreness/itching -> vulvitis, vaginitis - strawberry cervix seen in 2%
27
how to diagnose trichomonas vaginalis
swab posterior fornix (HVS) - microscopy, culture, NAATs
28
Tx of trichomonas vaginalis?
- metronidazole 400mg PO BD 5-7 days
29
what investigations need to be doen in men who have genital diascharge ?
- urine NAATs for gonnorrhea and chlamydia - swab from urethra (having held urine) - gram stained smear - gonorrhoea culture (if clinical suspicion high) (- MSU/urinalysis)
30
what is non specific urethritis (NSU) ?
inflammation of the urethra in the absence of a diagnosis of chlamydia or gonorrhoea
31
what are the clincial features os NSU?
urethral diacharge dysuria penile irritation
32
how woudl you diahnose NSU?
gram stain and microscopy of urethral sample
33
Tx of NSU?
- send STI screening - treat with 1/52 of doxycycline 100mg PO BD - abstain during treatment and treat partners
34
clicncial features of chlamydia in men and women ?
men: - discharge - dysuria - testicular pain women: - discharge - post coital bleeding - intermenstrual bleeding - lower abdo pain/ PID - dysuria 50% asymptomatic in MEN and 70% asymptomatic in WOMEN !!!
35
Tx of chlamydia?
- doxycycline 100mg PO BD 7 days (azithromycin in pregnancy) no test of cure needed
36
clincial features fo gonorrhea?
men: - purulent dscharge or epididymoorchitis, proctitis women: - purulent dishcarge, IMB or PCB, PID, proctitis
37
how to diagnose gonorrhoea?
NAAT testing - vulvovaginal, urine, rectal, pharyngeal (dependign on expsosure) culture - alwasy require prior to treatment for ABx sensitivities test of cure required !!!! @ 2 wks
38
Tx for gonorrhoea?
ceftriaxone 1g STAT IM, single dose - if sensitivities back back consider ciprofloxacin 500mg PO STAT
39
what are genital warts
condyloma acuminata (genital warts) are benign lesiosn caused by HPV (mostly 6 and 11) - sexually transmitted small skin coloured or pink growths on genital skin
40
symptoms of genital warts
warty growths in genital skin, painless and often asymptomatic little discomfort (sometimes itchy) distorted urinary stream with urethral lesions bleeding from cervical/urethral/anal lesions rarely - secondary infection
41
name some lesions that can be mistaken for genital warts
- skin tags - pearly penile papules - fordyce spots - molluscum contagiosum - condylomata lata (occur in secondary syphilis) - malignant or pre malignant conditions
42
Mx for genital warts?
- screen for other STIs - encourgae condom use - reassure that HPV is common and will resolve sponteneously - or can discuss through Tx options
43
Tx for genital warts?
- destruction (cryotherapy) - anti-mitotic agents (podophyllotoxin) - immune modifiers (imiquimod cream) - surgery
44
what is teh Tx/Mx for genital warts in pregnancy
- watch and wait, resolve post partum - topical cream treatments contraindicated - cryoablation is safe - surgical removal possible in extreme cases
45
nmae some infective cuases of genital ulcers/sores
herpes simplex herpes zoster syphilis topcial diseases: LGV, granuloma inguinale, chancroid
46
name the derm condition that can cause genital sorenss?
- fixed drug reactions - bechets - apthosis - lichen planus - pemphigus - malignancy
47
4 stages of herpes simplex virus ulcers?
1. painful tingly red macular lesions 2. fluid filled ulcers 3. burst and become painful ulcers 4. heal forming fry cakey lesion
48
how long is the incubation period for HSV?
3-14 days
49
what can HSV look like on the cervix?
confluent necrotic type lesions
50
how can HSV interfer with pregnancy?
if recurrent episode then low risk if primary infection !! in last trimester! then c section required occasional use of prophylactic aciclovir in last trimester
51
cliincial featuyres of syphilis?
single, painless, undurated ulcer known as chancre lymphadenopathy near lesion
52
what commonly causes PID?
- chlamydia and gonorrhoea - gardnerella vaginalis / anaerobes - mycoplasma genitalium
53
long term effects of PID?
- ifnertility - increased risk of ectopic pregnancy - chronic pelvic pain - tuboovarian abscess - fitz hugh curtis syndrome - RUQ pain, perihepatitis (= violin strign adhesions in peritoneal cavity attached to liver)
54
risk factors for PID?
- Hx of multiple partners - Coil insertion - chlamydia, gonorrhoea - young age < 25 - previous PID - TOP/miscarriage - douching/BV - new sexual partner - instrumentation of uterus
55
symptoms/signs of PID?
- lower abdo pain - deep dyspareunia - abnormal PV discharge, often purulent - PCB, IMB - fever, chills **can be aysmptomatic - cervical motion tenderness - adnexal tenderness - adnexal mass (if tuboovarian abscess) - contact bleeding from cervix
56
hwo to diagnose PID?
- very difficult !! based on clinical features of infection on examination - preggo test - to rule out ectopic - test for chlam + gonorr - dont wait for test results to come back to start Tx - elevated ESR/WCC/CRP - gram stained microscopy - look for endocervical pus cells - USS may show hydrosalpinx/free fluid/ abscess - MRI/CT may exclude/confirm other DDs (- laparoscopy if still unknown)
57
Mx of PID?
- rest - analgesia - broad spec ABx (500mg IM ceftrixone + 100mg doxy BD for 2 wks + 400mg metronidazole BD for 2 wks) - admit for obs if severe disease, pregnant, suspected tubo-ovarian abscess - abstain sex
58
what is the reasonign for partners notification?
- break the chain of transmission - prevent re-infection of the index patient - prevent complications of untreated infection - moral duty/ethics to inform
59
what are the partner notification methods?
- pt referral - provider referral - conditional or contract referral
60
Tx for trichomonas?
Metronidazole 2g PO STAT

Y4 medicine (18 decks)

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