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Flashcards in Gynaecology II Deck (87)
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1

Common types of genital tract infections

Chlamydia
Gonorrhoea
Warts
Herpes
Shyphilis

2

Symptoms of Chlamydia

Asymptomatic
discharge, bleeding dysuria

3

Investigations of Chlamydia

NAAT on vuvlovaginal or endocervical swab

4

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

7

How do genital warts present?

Fleshy protuberances, slightly pigmented, may bleed or itch

8

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)

9

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

10

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

11

How is herpes investigated?

clinical exam
viral culture/pcr
can scrape vesicle ulcer

12

What is the management of herpes?

Aciclovir (oral)

13

How does gonorrhoea present?

Discharge, dysuria

14

How is gonorrhoea diagnosed?

NAAT - endocervical or vulvovaginal swab

15

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

17

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

18

What predisposes to vaginal candidiasis?

DM
Immunosuppresion
Steroids
Pregnancy
HIV

Yeast - Candida albicans etc

19

What are the features of vaginal candidiasis?

Cottage cheese discharge
Non offensive
vulvitis, dyspareunia, d dysuria, itch
erythema - satellite lesions, fissuring

20

Diagnosis of vaginal candidiasis

Appearance
Culture - high vaginal swab

21

managent for vaginal candidiasis

Clotrimazole pessary or oral itroconazole/fluconzaole

22

What is PID?

Infection and inflammation of female pelvic organs due to ascending infection from the endocervix

23

What increases the risk of PID?

Young
STIs
many partners
uterine instrumentation
post partum endometritis

24

How does PID present?

pain
fever
deep dyspareunia
dysuria
menstrual issues
discharge
cervical excitation

25

Management of PID

Analgesia
Oral ofloxacin + metronidazole or c

ceftraixone + doxycycline + metronidazole

26

What are the causes of subfertility?

Male
Ovulation failure
Unexplained
Tubal damage

27

What is the management of DUB?

Progesterone (IUS)
COCP or tranexamic acid

28

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.

29

In HRT, what is required if a woman has a uterus?

Progesterone to protect from endometrial cancer

30

What are the risks and benefits of HRT?

+
Symptoms
Reduces OP and heart disease
Lowers risk of colorectal cancer

-
increases risk of breast cancer, VTE, stroke
Endometrial cancer if oestrogen only