Flashcards in Gynaecology II Deck (87)
Common types of genital tract infections
Symptoms of Chlamydia
discharge, bleeding dysuria
Investigations of Chlamydia
NAAT on vuvlovaginal or endocervical swab
Management of Chlamydia
Azithromycin 1g single dose or doxycycline 7 day course
Complications of chlamydia
Types of genital warts
6+11 are common 16,18,33 increase CIN
How do genital warts present?
Fleshy protuberances, slightly pigmented, may bleed or itch
How are genital warts investigatioed?
diagnosed clinically or if non-wart HPV it is dx via appearance on cervical cytology (smear tests) or colposcopy (whitening on application of acetic acid)
What is the management of genital warts?
1st line: topical podophyllum or cryotherapy depending on the type of lesion
Multiple, non-keratinised warts are generally best treated with topical agents
Solitary, keratinised warts respond better to cryotherapy
2nd line: Imiquimod is second line topical cream
Presentation of herpes
Primary infection is worse –
Prodrome (tingling/itching of skin in affected area).
Flu-like illness +/– inguinal lymphadenopathy.
Vulvitis and pain (may cause urinary retention).
Small, characteristic vesicles on the vulva, but can be atypical with fissures, erosions, erythema of skin.
Multiple painful ulcers developed from vesicular lesions (mouth or genitals), which eventually crust over
Systemic Sx: Fever and myalgia
How is herpes investigated?
can scrape vesicle ulcer
What is the management of herpes?
How does gonorrhoea present?
How is gonorrhoea diagnosed?
NAAT - endocervical or vulvovaginal swab
What is the management of gonorrhoea?
Ceftriaxone 500mg IM stat + azithromycin to cover for chlamydia
presentation, investigation and management of trichomonas
Vaginal discharge, vuvlovagintiis, strawberry cervix, pH >4.5, men usually asymptomatic.
Micropscopy -wet smear motile trophozoites
One off metronidazole 2g
Presentation, investigation and management of Bacterial vaginosis
Asymptomatic. Discharge - fishy offensive smell.
Amsels criteria: 3/4
thin homogeneous discharge, pH >4.5, positive whiff, clue cells on microscopy
Oral metronidazole 5-7 days
Often seen in sexually active women
What predisposes to vaginal candidiasis?
Yeast - Candida albicans etc
What are the features of vaginal candidiasis?
Cottage cheese discharge
vulvitis, dyspareunia, d dysuria, itch
erythema - satellite lesions, fissuring
Diagnosis of vaginal candidiasis
Culture - high vaginal swab
managent for vaginal candidiasis
Clotrimazole pessary or oral itroconazole/fluconzaole
What is PID?
Infection and inflammation of female pelvic organs due to ascending infection from the endocervix
What increases the risk of PID?
post partum endometritis
How does PID present?
Management of PID
Oral ofloxacin + metronidazole or c
ceftraixone + doxycycline + metronidazole
What are the causes of subfertility?
What is the management of DUB?
COCP or tranexamic acid
What is the management of menopause?
Hormonal - HRT O+/- P
Vaginal oestrogen topical for atrophy
HRT to prevent symptoms but avoid long term use.
In HRT, what is required if a woman has a uterus?
Progesterone to protect from endometrial cancer