GUM Flashcards
1
Q
What is bacteria vaginosis caused by ?
A
- Overgrowth of anaerobic bacteria
- Most commonly : Gardnerella vaginalis
2
Q
What is the Amsel’s criteria for diagnosing BV?
A
3 of the following :
- Thin, white homogenous discharge
- Clue cells on microscopy: stippled vaginal epithelial cells
- Vaginal pH > 4.5
- Positive whiff test (addition of potassium hydroxide results in fishy odour)
3
Q
what swab is required for diagnosing BV
A
- Charcoal swab for microscopy, either high vaginal or self taken low swab
4
Q
Treatment of BV
A
- Symptomatic : oral metronidazole (5-7 days)
5
Q
What complications in pregnant women is BV associated with ?
A
- Late miscarriage
- Preterm delivery
- Chorioamnionitis
- Low birth weight
6
Q
Most common organism seen in vaginal candidiasis
A
Candida albicans (yeast infection)
7
Q
Symptoms of vaginal candidiasis
A
- Thick, white discharge that does not typically smell
- Vulval and vaginal itching, irritation or discomfort
8
Q
Management of vaginal candidiasis
A
- oral fluconazole : 150 mg as a single dose
- Clotrimazole 500 mg intravaginal pessary as a single dose if oral therapy is contraindicated
- If there are vulval symptoms, consider adding a topical imidazole in addition to an oral or intravaginal antifungal
- If pregnant = tropical only
9
Q
What is recurrent vaginal candidiasis and how is it managed ?
A
- 4 or more episodes a year
- High vaginal swab for microscopy and culture
- BM test for DM
- Induction and maintenance regime : oral fluconazole every 3 days for 3 doses and maintain with oral fluconazole weekly for 6 mnths
10
Q
what kind of bacteria is chlamydia trachomatis
A
Gram-negative
11
Q
How is chlamydia diagnosed
A
- Nucleic acid amplification test (NAATs)
- Women : vulvovaginal swab first line
- Men : Urine
12
Q
If not asymptomatic, how can chlamydia present in women ?
A
- Abnormal vaginal discharge
- Abnormal vaginal bleeding (intermenstrual or postcoital)
- Dysuria
- Pelvic pain
13
Q
How does chlamydia present in men ?
A
- Urethral discharge or discomfort
- Dysuria
14
Q
what are the examination findings in chlamydia
A
- Pelvic or abdominal tenderness
- Cervical motion tenderness (cervical excitation)
- Inflamed cervix (cervicitis)
- Purulent discharge
15
Q
First line management of uncomplicated chlamydia
A
Doxycycline 100mg twice daily for 7 days
16
Q
When is doxycycline CI for chlamydia treatment and what can be given ?
A
- Pregnancy and breastfeeding
- Azithromycin 1g stat, then 500mg once daily for 2 days
17
Q
Give 5 pregnancy-related complications with chlamydia
A
- Preterm delivery
- Premature rupture of membranes
- Low birth weight
- Postpartum endometritis
- Neonatal infection (conjunctivitis and pneumonia)
18
Q
Give 8 complications of chlamydia
A
- PID
- Chronic pelvic pain
- Infertility
- Ectopic pregnancy
- Epididymo-orchitis
- Conjunctivitis
- Lymphogranuloma venereum
- Reactive arthritis
19
Q
stage one of lymphogranuloma venereum (LGV)
A
Primary -> painless ulcer. On penis in men, vaginal wall in women or rectum after anal sex
20
Q
Second stage of LGV
A
Secondary -> lymphadenitis (in guinal or femoral lymph nodes)
21
Q
Third stage of LGC
A
- Tertiary -> inflammation of rectum and anus
- Anal pain, change in bowel habit. tenesmus and discharge
22
Q
How is LGV managed ?
A
Doxycyline 100mg twice daily for 21 days
23
Q
what organism causes gonorrhoea
A
- Neisseria gonorrhoeae = gram negative diplococcus
24
Q
How does gonorrhoea present in women
A
- Odourless purulent discharge, possibly green or yellow
- Dysuria
- Pelvic pain
25
How does gonorrhoea present in men ?
- Odourless purulent discharge, possibly green or yellow
- Dysuria
- Testicular pain or swelling (epididymo-orchitis)
26
how is gonorrhoea tested for ?
- Diagnosed : NAAT
- Charcoal swab for microscopy, culture and sensitivites
27
How is gonorrhoea managed ?
- A single dose of IM ceftriaxone 1g if the sensitivities are NOT known
- A single dose of oral ciprofloxacin 500mg if the sensitivities ARE known and the organism is sensitive to cipro
28
Should patients treated for gonorrhoea have a 'test of cure'
Yes : NAAT if asymptomatic, cultures if symptomatic
72 hours after treatment for culture
7 days after treatment for RNA NAAT
14 days after treatment for DNA NAAT
29
What are the complications of gonorrhoea
- PID -> Fitz-Hugh-Curtis syndrome
- Disseminated gonococcal infection
- Epididymo-orchitis
- Prostatitis
- Conjunctivits
- Urethral strictures
- Septic arthritis
30
What is disseminated gonococcal infection
- When bacteria from untreated gonococcal infection, spreads to the skin and joints
- Causes : tenosynovitis, migratory polyarthritis and dermatitis
31
what is a key complication of gonorrhoea in pregnancy ?
- Gonococcal conjunctivitis in a neonate -> opthalmia neonatorum
32
Give the 3 most common causes of PID
- Chlamydia trachomatis
- Neisseria gonorrhoeae
- Mycoplasma genitalium
33
What symptoms does PID cause?
- Pelvic or lower abdominal pain
- Abnormal vaginal discharge
- Abnormal bleeding (intermenstrual or postcoital)
- Deep dyspareunia
- Fever
- Dysuria
34
What may be seen on examination in PID ?
- Pelvic tenderness
- Cervical motion tenderness (cervical excitation)
- Inflamed cervix (cervicitis)
- Purulent discharge
35
what investigations should be done if PID is suspected ?
- Pregnancy test
- Full STI screen (high vaginal, urethral, endocervical)
- Inflammatory markers (CRP)
- Transvaginal / pelvic USS
36
What will be seen under a microscope in PID?
Pus cells
37
What is an example management regime of PID
- A single dose of intramuscular ceftriaxone 1g (to cover gonorrhoea)
- Doxycycline 100mg twice daily for 14 days (to cover chlamydia and Mycoplasma genitalium)
- Metronidazole 400mg twice daily for 14 days (to cover anaerobes such as Gardnerella vaginalis)
38
Give 6 complications of PID
- Sepsis
- Abscess
- Infertility
- Chronic pelvic pain
- Ectopic pregnancy
- Fitz-Hugh-Curtis syndrome
39
What is Fitz-Hugh-Curtis Syndrome ?
- Complication of PID
- Inflammation and infection of liver capsule (Glisson's capsule)
- Causes adhesions between the liver and the peritoneum
40
What does Fitz-Hugh-Curtis Syndrome cause ?
- RUQ pain, referred to right shoulder tip
41
What kind of STI is trichomoniasis
- Parasite
- Protozoan -> single-celled organism with flagella
42
If not asymptomatic, how does trichomoniasis present ?
- Vaginal discharge : frothy and yellow/green.
- Itching
- Dysuria
- Dyspareunia
- Balanitis (inflammation to the glans penis
43
What is seen on examination of the cervix in trichomoniasis ?
Strawberry cervix
44
How is trichomoniasis diagnosed ?
- Charcoal swab with microscopy
- Posterior fornix of vagina in a woman
- Urethral swab or first-catch urine in a man
45
How is trichomoniasis managed ?
- Oral metronidazole (5-7 days)
46
what can trichomoniasis increase the risk of ?
- Contracting HIV by damaging the vaginal mucosa
- BV
- Cervical cancer
- PID
- Pregnancy-related complications such as preterm delivery
47
What is herpes simplex virus (HSV) associated with
- HSV-1 = cold sores
- HSV-2 = genital herpes
48
If not asymptomatic, how does HSV present ?
- Painful genital ulceration
- Neuropathic type pain (tingling, burning or shooting)
- Flu-like symptoms (e.g. fatigue and headaches)
- Dysuria (painful urination)
- Inguinal lymphadenopathy
49
How is HSV diagnosed ?
- Can be made clinically
- Viral PCR swab from the lesion to confirm
50
How is genital herpes treated ?
- Oral aciclovir
51
How is a primary genital herpes infection contracted before 28 weeks gestation managed ?
- Oral aciclovir
- Regular prophylactic aciclovir starting from 26 wks
- Asymptomatic = vaginal delivery
52
How is primary genital herpes contracted >28 wks gestation managed ?
- Ora aciclovir during the
- Regular prophylactic aciclovir.
- C section
53
what causes syphilis ?
Spirochaete Treponema pallidum
54
What is the primary stage of syphilis?
- Chancre - painless ulcer at the site of sexual contact
- Local non-tender lymphadenopathy
- Often not seen in women (the lesion may be on the cervix)
55
what is secondary syphilis ?
- Systemic symptoms : fever, lymphadenopathy
- Rash on trunk, palms and soles
- Condylomata lata
- Buccal 'snail track' ulcer
- These symptoms can resolve after 3 – 12 weeks and the patient can enter the latent stage.
56
what is latent syphilis ?
- Patient is asymptomatic whilst still being infected
- Early latent syphilis occurs within two years of the initial infection
- Late latent syphilis occurs from two years after the initial infection onwards.
57
what is tertiary syphilis
- Gummatous lesions (gummas are granulomatous lesions that can affect the skin, organs and bones)
- Aortic aneurysms
- Neurosyphilis
58
What are the signs of neurosyphilis ?
- Headache
- Altered behaviour
- Dementia
- Tabes dorsalis (demyelination affecting the spinal cord posterior columns)
- Ocular syphilis (affecting the eyes)
- Paralysis
- Sensory impairment
59
What is a specific finding in neurosyphilis ?
- Argyll-Roberton pupil : constricted pupil that accomodates when focusing on a near object but does not react to light
60
How is syphilis treated ?
IM benzathine benzylpenicilin
61
Explain the different test results obtained when looking at syphilis
- 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
62
What kind of virus is HIV and what is it's effect on the body?
- RNA retrovirus
- Destroys CD4 T-helper cells.
63
First-line test for HIV screening of asymptomatic individuals or pts with signs and symptoms of chronic infection
- Fourth generation : checks for HIV antibody and P24 antigen. Window period of 45 days.
64
What 2 ways can HIV be monitored ?
- CD4 count
- Viral load -> HIV RNA per ml of blood.
65
what is given prophylactically to all patients with HIV?
-Co trimoxazole (if CD4<200/mm3)
- Protect against pneumocystis jirovecii pneumonia (PCP)
66
How often are women with HIV offered cervical smears ?
- Yearly, due to increased risk of HPV infection and cervical cancer
67
What vaccines are avoided in HIV?
- Live vaccines (e.g. BCG and typhoid)
68
What does mycoplasma genitalium cause ?
Non-gonococcal urethritis
69
What is the investigation for mycoplasma genitalium ?
- NAAT
- First urine sample in the morning for men
- Vaginal swabs (can be self-taken) for women
- Check every +ve sample for macrolide resistance and perform a 'test of cure'
70
How mycoplasma genitalium managed
- Doxycycline 100mg twice daily for 7 days then;
- Azithromycin 1g stat then 500mg once a day for 2 days (unless it is known to be resistant to macrolides)
71
How is mycoplasma genitalium treated in pregnancy and breastfeeding ?
Azithromycin alone
72
what are the complications of mycoplasma genitalium ?
- Urethritis
- Epididymitis
- Cervicitis
- Endometritis
- PID
- Reactive arthritis
- Preterm delivery in pregnancy
- Tubal infertility
73
Most appropriate treatment of oral candidiasis in immunocomprimised patients (e.g. HIV)
Fluconazole
74
4 RF for vaginal candidiasis
- Diabetes mellitus
- Drugs: antibiotics, steroids
pregnancy§- Immunosuppression: HIV
75
Principles of management in PID
1. Analgesia
2. Antibiotics
3. Encourage partner notification and treatment
4. Patient education regarding safe sex
76
