GUM

Question 1

What bacteria commonly causes bacterial vaginosis

Answer 1

Gardnerella vaginalis

Question 2

RF for BV 5

Answer 2

Multiple sexual partners, excessive cleaning, copper coil, antibiotics, smoking

Question 3

Presentation of BV 2

Answer 3

Fishy smell
watery grey or white discharge

itching , irritation or pain do NOT suggest BV

*Does increase risk of STI

Question 4

Investigations for BV 2

Answer 4

Vaginal pH >4.5 (3.5-4.5)
Swab for microcopy showing clue cells

Question 5

Mx for BV 1

Answer 5

Metronidazole - oral or gel

Question 6

Most common cause of candidiasis

Answer 6

Candida albicans

Question 7

RF for candidiasis

Answer 7

Increased oestrogen, diabetes, immunosuppressive, broad spectrum AB

Question 8

Presentation of Candidiasis

Answer 8

Thick white discharge that does NOT smell
Itching, irritation and discomfort

Question 9

Investigations for candidiasis

Answer 9

Vaginal pH - <4.5
Microscopy to confirm

Question 10

Mx of candidiasis

Answer 10

Oral, topical pessary antifungals
E.g. clotrimazole topical or fluconazole tablets

• Topical given if pregnant**

Question 11

Bacteria type causing chlamydia

Answer 11

Chlamydia trachomatis - gram negative anaerobic bacteria

Question 12

Symptoms of chlamydia

Answer 12

Usually asymptomatic
women: cervicitis (discharge, bleeding), dysuria
men: urethral discharge, dysuria

Question 13

Investigations for chlamydia

Answer 13

NAAT
Urine test

Question 14

Complications of chlamydia in men

Answer 14

Urethral discharge or discomfort
Painful urination (dysuria)
Epididymo-orchitis
Reactive arthritis

Question 15

Mx of chlamydia

Answer 15

• Doxy 7 days

Question 16

Bacteria causing gonorrhoea

Answer 16

Neisseria gonorrhoeae - gram-negative diplococcus

Question 17

Sx of gonorrhoea

Answer 17

More likely to be symptomatic than chlamydia
Odourless purulent discharge, possibly green or yellow
Dysuria
Pelvic pain

Question 18

Mx of Gonorrhoea

Answer 18

IM ceftriaxone

Question 19

Ix for gonorrhoea

Answer 19

NAAT testing
Urine

Question 20

Trichomonas

Answer 20

parasite spread through sex
Trichomonas is classed as a protozoan - lives in urethra

Question 21

Sx of trichomonas

Answer 21

Asymptomatic

Vaginal discharge - yellow green***
Itching
Dysuria (painful urination)
Dyspareunia (painful sex)
Balanitis (inflammation to the glans penis)

Question 22

Ix for Trichomonas

Answer 22

Strawberry cervix on speculum
Swab for microscopy

Vaginal pH >4.5

Question 23

Mx of trichomonas

Answer 23

Metronidazole

Question 24

Cx of Genital herpes

Answer 24

HSV I and II
- Usually HSV II

Question 25

Sx of herpes

Answer 25

Ulcers or blistering lesions affecting the genital area Neuropathic type pain Flu-like symptoms Dysuria Inguinal lymphadenopathy * Recurrent flares are not as bad

Question 26

Ix for herpes

Answer 26

Clinical Swab for viral PCR of lesion

Question 27

Mx of herpes

Answer 27

* Acyclovir

Question 28

Affects of herpes in pregnancy and Mx

Answer 28

* Can cause neonatal heroes simplex - high risk of death Mx - Acyclovir - current and prophylactic - cesarean

Question 29

How is HIV transmitted?

Answer 29

Unprotected sex, vertical transmission, mucous membranes, blood or bodily fluids Virus enters CD4 cells and destroys them

Question 30

How is HIV tested and monitored

Answer 30

Tested - Antibody testing Monitored - CD4 count and RNA viral load CD4<200 Iis severe

Question 31

HIV management

Answer 31

Antiretroviral therapy offered to all diagnosed irrespective of viral load and CD4 count Oral tablets given: 1st line - two NRTIs (e.g., tenofovir plus emtricitabine) plus a third agent (e.g., bictegravir).

Question 32

When is Prep given for HIV

Answer 32

- partner with HIV - Risky sexual behvaiours

Question 33

PEP

Answer 33

- Given post exposure but not 100% effective - <72hrs window PEP involves a combination of ART therapy. Pre-exposure prophylaxis (PrEP -

Question 34

Bacteria causing syphilis

Answer 34

Treponema pallidum

Question 35

Presentation of syphilis

Answer 35

Solitary painless ulcer, systemic symptoms, oral ulcer, rash, alopecia... - can progress to cardiovascular and neurological involvement

Question 36

Investigations for Syphilis

Answer 36

Antibody for T pallidum

Question 37

Mx of syphilis

Answer 37

IM - benzathine benzylpenicillin