GUM Lectures Flashcards
Causes of proctitis
LGV lymphomagranuoma venerum Gonorrhoea non-LGV chlamydia herpes shigella Hep A
Other: IBS, haemorrhoids,/polyps, malignancy
What causes LGV
1/3 invasive servers of chlamydia trachomatis. L1,L2, L3. Rectal chlamydia, seen most commonly in homosexual men
Classical presentation of LGV
proctitis
ulceration
inguinal lymphadenopathy
buboes
D.D testicular pain
infections
trauma
torsion
tumours (rare)
investigations for testicular pain
infection:
- first void urine (chlamydia & gonnorhea)- more likely
- mid-stream (urinary pathogens)
- swabs
what is acute epididymis-orchitis
what must u exclude
Clinical syndrome of pain, swelling and inflammation of the epididymis +/- testes (MUST EXCLUDE TORSION)
Where does the infections come from?
- local from utethra (STI or enteric organism)
- bladder (urinary)
- MUMPS orchitis & TB (high risk groups)
Signs of acute epididymis-orchitis on examination
Tenderness on affected side, may be bilat
Palpable swelling of epididymis (tail to head)
There may also be:
o urethral discharge
o secondary hydrocele
o erythema and/or oedema of the scrotum on the affected side
o pyrexia
Investigation for acute epididymo-orchitis
Microscopy: urethral or FPU
Urethral culture
NAATs (FPU)
Dipstick & MSU
Other: consider MUMPS & TB
Treatment
Abstain
Ceftriaxone + prolonged course of doxycycline
What skins/musuc membranes and STIs spread to
Eye: bacterial conjunctivitis (chlamydia & gonorrhoea)
Sexually acquired reactive arthritis: <1% chlamydia
Disseminated gonococcal infection
What is reiter’s syndrome?
triad of urethritis, arthritis, conjunctivitis
complication of chlamydia in pregnancy
Associations with IUGR, Premature rupture of membranes, pre-term delivery, low birth weight
Need to treat quickly to prevent complications to baby & prevent reinfection.
Risk already have complications
(azythromycin + follow up)
complication of gonoorhoea in pregnancy
Low birth weight, preterm birth
complications in neonatal period?
ophthalmia neonatorum: presents 1-2 weeks due to chlamydia = conjunctivitis & purulent discharge
neonatal pneumonitis due to chlamydia
both need systemic antibiotics (erythromycin)
Causes of ulcers on foreskin
Herpes simplex
Genital warts (HPV)
syphilius
What investigations would you do?
Swab from ulcer
Blood test:
HIV/Syphilis
Urine test: chlamydia & gonorrhoea
Describe the two types of herpes
Median recurrence rates after primary for each?
HSV1: oral & genital (more common), recurrent 1 x year
HSV2: recurrent anogenital symtoms, approx 4 x year
Very painful
Outbreaks tend to be in same dermatome
Are reactivations always symptomatic?
No: can be asymptomatic (20%): viral shielding (still infectious)
Treatment of herpes simplex.
- Treat the pain!
- Salt water bathing + urinate in the shower
- Topical anaesthetic/oral analgesia.
- Aciclovir 400mg 3 x a day for 5 days.
Patient info:
1) How is HSV spread?
2) is it going to come back?
3) Can I pass it on to someone else?
4) Can they have sex?
1) Direct contact with mucous membrane or skin
2) This was probably a primary episode Frequency of recurrence depends on type HSV 1 (orolabial and genital) ~1 / year HSV 2 (genital) ~4 / year Recurrence rates usually decrease over time Asymptomatic in 20%
3) Virus now latent in local sensory ganglia. Most infectious during a recurrence.
Asymptomatic viral shedding occurs
4)
- Acknowledge distress
- Condoms reduce transmission
- Avoid sex during recurrences
- Disclosure is advised and should be documented
Single, non tender ulcer on penis.
MSM/homosexual
Likely cause?
Tests?
Discussion?
Syphilis, cancer
Blood test
Swab: Dark ground microscopy (diplococci & pus cells: urithtitis) & PCR
- Heb B vaccine (accelerated) course.
- Partner notification
- HIV risk
- Safer sex
- Repeat ‘window period’ bloods
Single, non tender ulcer on penis. MSM/homosexual
Likely cause?
Tests?
Discussion?
- Syphilis.
shingles, apthous ulcers, lichen sclerosus/planus/ malignancy (PIN,VIN). severe eczema, Crohns, moon’s blaanitis/
Blood test
Swab: Dark ground microscopy (diplococci & pus cells: urithtitis) & PCR
Urine
- Heb B vaccine (accelerated) course.
- Partner notification
- HIV risk
- Safer sex
- Repeat ‘window period’ bloods
What bacteria causes syphilis & appearance on dark-field microscopy
Treponema pallidum
spirochaete bacterium
