Infections Flashcards
(32 cards)
What is pelvic inflammatory disease?
Inflammation of upper genital tract (above cervix) including endometrium, fallopian tubes, ovaries, pelvic peritoneum +/- contiguous structures
What is the aetiology of PID?
Sexually transmitted - chlamydia trachomatis, n. gonorrheae, mycoplasma
Non-sexually transmitted - anaerobic - e.coli, strep, staph etc.
Which signs would make you suspicious of PID? (Must haves (3) + one or more of… (6))
Must have: lower abdominal pain, cervical motion tenderness, adnexal tenderness (latter two elicited by bimanual palpation)
Plus one or more of: temperature >38, mucopurulent cervical discharge, positive for chlamydia or gonorrhea or other vaginal flora, pelvic abscess or inflammatory mass on U/S or bimanual, leukocytosis,elevated ESR or CRP
can also complain of dyspareunia and menstrual changes
What investigations are used to diagnose PID? (5)
Diagnosis is almost always based on hx and clinical findings
- Bloodwork - beta-HCG (always rule out pregnancy in this population), CBC, blood cultures if suspect septicaemia
- Urinalysis
- Speculum examination - vaginal swab for gram stain and C&S, cervical cultures for gonorrhoea and chlamydia
- US - usu. transvaginal, free fluid or pelvic/tubo-ovarian abacess
- Laparoscopy (gold standard) - but may miss subtle inflammation of tubes or endometritis
When is inpatient treatment of PID warranted? (4)
- Severe clinical disease such as fever, tubo-ovarian abscess or peritonitis
- Pregnant
- Surgical emergency cannot be excluded (e.g. ovarian torsion or appendicitis)
- Unable to tolerate outpatient therapy or failed oral therapy
How is mild to moderate PID treated?
Outpatient
Ceftriaxone + metronidazole + azithromycin + either azithromycin (1 week later) OR doxycycline (12 hourly for 2 weeks)
How is severe PID treated?
Inpatient
ceftriaxone + azithromycin + metronidazole
What are the basic principles of PID management? (8)
- Antibiotics dependent on severity
- Rest and simple analgesia when required
- Patient to avoid sexual intercourse for a week or until symptomatically better
- Prophylactic Candida treatment
- Offer sexual partners screening for STI
- Contact tracing for chlamydia, gonorrhoea
- No need for removal of IUCD if patient wishes to continue to use it
- Follow-up: at 72 hours and at 2 weeks
What are the clinical features of chlamydia? (6)
- Asymptomatic (80% of women)
- Muco-purulent cervical discharge
- Urethral syndrome: dysuria, frequency, pyuria
- Pelvic pain
5 Post-coital bleeding or intermenstrual bleeding - Symptomatic sexual partner
How is chlamydia investigated?
- First void urine test PCR OR
2. Cervical sample for PCR
How is chlamydia managed? (4)
- Azithromycin single dose
- Treat gonorrhoea because high rate of infection - ceftriaxone
- Treat partners
- Report
Which STIs are tested using a vaginal swab?
Bacterial vaginosis - not an STI
Trichomoniasis
Candida - not an STI
Which STIs are tested using a cervical swab?
Gonorrhoea
Chlamydia
What are the clinical features of gonorrhoea? (6)
Same as chlamydia
- Asymptomatic (80% of women)
- Muco-purulent cervical discharge
- Urethral syndrome: dysuria, frequency, pyuria
- Pelvic pain
5 Post-coital bleeding or intermenstrual bleeding - Symptomatic sexual partner
How is gonorrhoea investigated?
Cervical/rectal/throat MCS
How is gonorrhoea managed? (4)
- Ceftriaxone
- Treat chlamydia because of co-infection - azithromycin
- Treat partners
- Reportable disease
What are the clinical features of genital herpes? (5)
- May be asymptomatic
- Prodromal symptoms: tingling, burning, pruritus
- Multiple, painful, shallow ulcerations with small vesicles appear 7-10d after initial infection (lesions are infectious)
- Inguinal lymphadenopathy, malaise and fever
- Can have dysuria
How is genital herpes investigated?
Viral swab of lesions for complex PCR
Consider full STI screen in patients presenting for first time
How is genital herpes managed?
Acyclovir - not curative. Can shorten episode if commenced within 72 hours of symptoms
List 4 clinical features of candidiasis.
- Whitish, cottage cheese discharge
- Intense pruritus
- Swollen, inflamed genitals
- Vulvar burning, dysuria, dyspareunia
What does a vaginal swab for candidiasis show?
Hyphae and spores
How is candidiasis treated? (2)
- Oral fluconazole OR
2. Vaginal imidazole e.g. clotrimazole cream
What are the clinical features of bacterial vaginosis? (4)
- Grey thin diffuse discharge
- Can be asymptomatic
- Fishy odour, esp. after coitus
- Absence of vulvar/vaginal irritation
How is bacterial vaginosis treated?
- Oral or vaginal gel - metronidazole
