GUM

Question 1

What are some causes of discharge?

Answer 1

Physiological (pregnancy, arousal, puberty, COCP)
Foreign body
Infection

Question 2

Describe the organism C. trachomatis:

Answer 2

Obligate intracellular gram-negative bacterium Serotypes D-K responsible for genitourinary infection

Question 3

How can chlamydia present?

Answer 3

Often asymptomatic

Dysuria, discharge, dyspareunia, PCB/IMB

Question 4

What diagnostic tests can be used for chlamydia?

Answer 4

Nucleic acid amplification test (NAAT) on vulvovaginal swab or endocervical swab
In men, first pass urine

Question 5

What is the treatment for chlamydia?

Answer 5

Doxycycline 100mg BD for 7 days

Question 6

What is the treatment for chlamydia in pregnancy?

Answer 6

Azithromycin 1g STAT or erythromycin 500mg BD for 10-14 days

Question 7

If chlamydia goes untreated in pregnancy, what are the risks?

Answer 7

PPROM
Prematurity
Neonatal conjunctivitis (5-12 days after birth) Pneumonia (1-3 months after birth)

Question 8

What are some complications of a chlamydia infection?

Answer 8

PID
Fitz-Hugh-Curtis
Reiter’s (arthritis, conjunctivitis, urethritis)
Tubal infertility
Risk of ectopic
Epididymo-orchitis

Question 9

Describe the organism Neisseria gonorrhoea:

Answer 9

Gram negative diplococcus

Question 10

How can gonorrhoea present?

Answer 10

Often asymptomatic
Urethral/vaginal discharge
Dysuria, lower abdo pain, IMB/PCB

Question 11

What diagnostic tests can be used for gonorrhoea?

Answer 11

NAAT on vaginal or endocervical swab

In males, first pass urine

Question 12

What is the treatment for gonorrohea?

Answer 12

Ceftriaxone 1g IM

Question 13

If gonorrhoea goes untreated in pregnancy, what are the risks?

Answer 13

PPROM
Prematurity
Chorioamionitis
Gonococcal conjunctivitis

Question 14

What are some complications of a gonorrhoea infection?

Answer 14

PID, Bartholin’s abscess, tubal infertility, risk of
ectopic
Epididymitis, prostatitis, Reiter’s, infective endocarditis,
disseminated gonococcal infection

Question 15

What type of organism is trichomonas vaginalis?

Answer 15

Protozoa

Question 16

How might trichomonas vaginalis present?

Answer 16

Thin, fish-smelling discharge (yellow-green)
Itch
Cervix may have ‘strawberry’ appearance

Question 17

How can TV be diagnosed?

Answer 17

NAAT (HVS), culture, microscopy

Question 18

What is the treatment for TV?

Answer 18

Metronidazole 2g PO stat or 400mg/12h PO for 5 days

Question 19

What organisms is bacterial vaginosis often caused by?

Answer 19

Gardnerella vaginalis, anaerobes and mycoplasmas

Question 20

What is the pathophysiology of bacterial vaginosis?

Answer 20

Disturbance in normal flora leading to reduction in numbers of lactobacilli, rise in pH and overgrowth of other species

Question 21

How can bacterial vaginosis present?

Answer 21

Thin, white, fish-smelling discharge

Question 22

How can bacterial vaginosis be diagnosed?

Answer 22

HVS is gram stained to examine vaginal flora, reduced lactobacilli, clue cells
Vaginal pH >4.5
KOH whiff test

Question 23

What is the treatment for bacterial vaginosis?

Answer 23

Metronidazole 2g PO/gel PV or clindamycin vaginal cream 7 nights

Question 24

Untreated bacterial vaginosis in pregnancy increases the risks of what?

Answer 24

Prematurity, miscarriage and chorioamnionitis

Question 25

How can genital candidiasis present?

Answer 25

``` Genital itch Burning Cottage cheese like discharge Dyspareunia Vulval redness ```

Question 26

What are some risk factors for genital candidiasis?

Answer 26

``` Pregnancy Contraceptive Steroids, immunodeficiencies Antibiotics Diabetes ```

Question 27

What is the treatment for genital candidiasis?

Answer 27

Topical azoles (clotrimazole 500mg pessary and cream) or oral fluconazole 150mg PO

Question 28

How should genital candidiasis be treated if pregnant or breastfeeding?

Answer 28

Topical azoles only

Question 29

What organism causes genital warts?

Answer 29

DNA human papilloma virus

Question 30

What are some risk factors for genital warts?

Answer 30

Early age at first intercourse, multiple partners, immunosuppression, smoking, diabetes

Question 31

What are some management options for genital warts?

Answer 31

Podophyllotoxin (clusters of small warts) Imiquimod (larger warts) Excision, cryotherapy, electrosurgery or laser surgery

Question 32

What viruses causes genital herpes?

Answer 32

HSV1 and 2

Question 33

How can genital herpes be spread?

Answer 33

Skin to skin genital contact Sex Oral sex with someone who suffers from cold sores

Question 34

How can genital herpes present?

Answer 34

Flu-like prodrome then vesicles/papules around genitals, anus and throat Discharge, dysuria, urinary retention, proctitis, itch

Question 35

What is the treatment for genital herpes?

Answer 35

Analgesia, antivirals within 5d: acyclovir

Question 36

How can genital herpes be diagnosed?

Answer 36

PCR from swab of open sore

Question 37

Describe the organism that causes syphilis:

Answer 37

Gram negative Treponema pallidum

Question 38

What are some risk factors for developing syphilis?

Answer 38

Unprotected sex, multiple partners, MSM, HIV infection

Question 39

What is the primary stage of syphilis infecton?

Answer 39

Macule -> papule -> painless ulcer (chancre)

Question 40

What is the secondary stage of syphilis infection?

Answer 40

Dissemination 4-10 weeks after chancre. | Rash, mucous patches, condyloma lata (raised plaques), fever, headache, myalgia, lymphadenopathy

Question 41

What is the tertiary stage of syphilis infection?

Answer 41

20-40 year after infection | Neurosyphilis, gummatous syphilis

Question 42

How can syphilis be diagnosed?

Answer 42

PCR of swab from active lesion, serology | Dark ground microscopy of chancre fluid

Question 43

What is the treatment for syphilis?

Answer 43

Benzylpencillin IM

Question 44

What are the risks of untreated syphilis in pregnancy?

Answer 44

Miscarriage, stillbirth, pre-term labour, congenital syphilis

Question 45

What are some signs of neonatal syphilis?

Answer 45

Rhinitis, snuffles, rash, hepatosplenomegaly, lymphadenopathy, anaemia, jaundice, ascites, saddle nose