Flashcards in Gynaecology II Deck (87)
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1
Common types of genital tract infections
Chlamydia
Gonorrhoea
Warts
Herpes
Shyphilis
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Symptoms of Chlamydia
Asymptomatic
discharge, bleeding dysuria
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Investigations of Chlamydia
NAAT on vuvlovaginal or endocervical swab
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Management of Chlamydia
Azithromycin 1g single dose or doxycycline 7 day course
5
Complications of chlamydia
PID
Reiters
Ascending infection
6
Types of genital warts
6+11 are common 16,18,33 increase CIN
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How do genital warts present?
Fleshy protuberances, slightly pigmented, may bleed or itch
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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)
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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
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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
Tender lymphadenopathy
Local oedema
Dysuria
Systemic Sx: Fever and myalgia
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How is herpes investigated?
clinical exam
viral culture/pcr
can scrape vesicle ulcer
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What is the management of herpes?
Aciclovir (oral)
13
How does gonorrhoea present?
Discharge, dysuria
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How is gonorrhoea diagnosed?
NAAT - endocervical or vulvovaginal swab
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What is the management of gonorrhoea?
Ceftriaxone 500mg IM stat + azithromycin to cover for chlamydia
16
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
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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
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What predisposes to vaginal candidiasis?
DM
Immunosuppresion
Steroids
Pregnancy
HIV
Yeast - Candida albicans etc
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What are the features of vaginal candidiasis?
Cottage cheese discharge
Non offensive
vulvitis, dyspareunia, d dysuria, itch
erythema - satellite lesions, fissuring
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Diagnosis of vaginal candidiasis
Appearance
Culture - high vaginal swab
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managent for vaginal candidiasis
Clotrimazole pessary or oral itroconazole/fluconzaole
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What is PID?
Infection and inflammation of female pelvic organs due to ascending infection from the endocervix
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What increases the risk of PID?
Young
STIs
many partners
uterine instrumentation
post partum endometritis
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How does PID present?
pain
fever
deep dyspareunia
dysuria
menstrual issues
discharge
cervical excitation
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Management of PID
Analgesia
Oral ofloxacin + metronidazole or c
ceftraixone + doxycycline + metronidazole
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What are the causes of subfertility?
Male
Ovulation failure
Unexplained
Tubal damage
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What is the management of DUB?
Progesterone (IUS)
COCP or tranexamic acid
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What is the management of menopause?
lifestyle
Hormonal - HRT O+/- P
Vaginal oestrogen topical for atrophy
HRT to prevent symptoms but avoid long term use.
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In HRT, what is required if a woman has a uterus?
Progesterone to protect from endometrial cancer
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