Post-Coital Bleeding

Question 1

Which 3 organs are gonna be the cause?

Answer 1

Uterine
Cervical
Vaginal

Question 2

(PCB) Vaginal Causes

What are the 3 vaginal causes of PCB?

Answer 2

Infection
Trauma
Atrophy

Question 3

Infective causes of PCB?

What infective diseases could cause PCB?

Answer 3

Non STI

Candidiasis (Thrush)
Bacterial Vaginosis

STI

Chlamydia
Gonorrhea

Question 4

Candidiasis

What is the most striking feature of Candidiasis and what other signs/symptoms would you expect to see?

Answer 4

‘Cottage Cheese’ discharge
Itch

Red/inflamed vulva/vagina
Superficial Dyspareunia
Dysuria

Most common vaginal infection, ~20%

Question 5

Candidiasis

Give 3 important risk factors for candidiasis infection?

Answer 5

Pregnancy
Diabetes
Abx

Question 6

Candidiasis

How would you diagnose candidiasis?

Answer 6

Swab and culture

Don’t necessarily have to culture before treating

Question 7

Candidiasis

What is the treatment for candidiasis?

Answer 7

Oral fluconazole / clotrimazole pessary

Question 8

Fluconazole

What O&G risks are there to using this drug?

Answer 8

Pregnancy - ?harm to foetus - miscarriage and birth defects. Evidence not strong, low dose is probably fine.

Breast feeding - not recommended

Clotrimazole has no pregnancy or breastfeeding risks.

Question 9

Bacterial Vaginosis

What is the most striking feature of Candidiasis and what other signs/symptoms would you expect to see?

Answer 9

Grey white discharge
Fishy odour (amines)
NO itch/redness

Question 10

Bacterial Vaginosis

What are the risk factors

Answer 10

Douching

Question 11

Bacterial Vaginosis

How would you diagnose bacterial vaginosis

Answer 11

Examination: look at the discharge
↑Vaginal pH
+ve Whiff test (fishy odour)

Microscopy - Clue cells (epithelial cells with bacterial dots on them)

Ax - PID, preterm labour

Question 12

Bacterial Vaginosis

What is the treatment for Bacterial Vaginosis?

Answer 12

Topical metronidazole (nitroimidazole)
OR
Clindamycin (licosamide)

Both safe in pregnancy and breastfeeding

Question 13

Bacterial Vaginosis

What other presentation would warrant investigation for this disease?

Answer 13

PID

Preterm labour

Question 14

Chlamydia

What is the most striking feature of Chlamydia and what other signs/symptoms would you expect to see?

Answer 14

Discharge with odour
Fever, abdo pain
Ureitis

Question 15

Chlamydia

Risk factors

Answer 15

Unprotected sex

Question 16

Chlamydia

Diagnosis?

Answer 16

Urine (NAAT) - PCR

Question 17

Chlamydia

Rx?

Answer 17

Doxycycline
Azithromycin

partner inform and Rx

Question 18

Chlamydia

Complications?

Answer 18

Sub/infertility, chronic pelvic pain

Reiter’s Syndrome - triad of urethritis, arthritis and conjunctivitis

Question 19

Gonnorhea

Sx?

Answer 19

o Asymptomatic
o Vaginal discharge
o Urethritis

o	Bartholinitis (inflammation of the Bartholi glands)
o	Cervicitis

Question 20

Bartholinitis

What is this?

Answer 20

Pea shaped gland at opening of vagina, can be infected

pain and soreness in the region of one of the labia minora
swelling in the same area
possibly a slight discharge from the same region.

Question 21

Gonnorhea

RF?

Answer 21

Unprotected sex

Question 22

Gonnorhea

Dx?

Answer 22

Endocervical swab, urine NAAT (PCR)

Question 23

Gonnorhea

Complications?

Answer 23

Septic arthritis

• knee or wrist symptoms

Question 24

Gonnorhea

Rx?

Answer 24

Ceftriaxone

partner inform and Rx

Question 25

Traumatic causes of PCB? What are the traumatic causes for PCB?

Answer 25

Lack of lubrication - not enough arousal - Oestrogen levels are low. This happens during breastfeeding and with menopause. Rough sex

Question 26

Vaginal Trauma Complications?

Answer 26

Although not common, vaginal lacerations are usually the cause of postcoital bleeding that is heavy enough to bring a woman to the emergency room after sex. The vagina has a rich blood supply and these types of lacerations bleed a lot. Usually, it means stitches or suturing are needed to stop the bleeding. Sometimes it even means a trip to the operating room. So if very heavy PCB in A&E, think sex

Question 27

Vaginal Trauma DIagnosis?

Answer 27

Examination - look for lacerations

Question 28

Vaginal Atrophy Sx?

Answer 28

Dyspareunia, itching, dryness, prolapse Happens in menopause Rx - Treat menopause (HRT), lubricants and moisturiser

Question 29

Cervical causes of PCB What cervical causes are there for PCB?

Answer 29

Cervicitis Ectropion Neoplasia

Question 30

Cervicitis Causes?

Answer 30

STI (see Chlamydia and Gonorrhea) Allergic Reactions -latex -hygiene products Bacterial Overgrowth - overgrowth of vaginosis in vagina can make it spread to cervix

Question 31

Cervicitis Symptoms?

Answer 31

Discharge Pain during sex Painful urination

Question 32

Cervicitis Diagnosis?

Answer 32

Examination | - speculum - look for inflammation

Question 33

Cervical causes of PCB - Ectropion Sx?

Answer 33

When eversion of the cervix causes columnar epithelium of the endocervix to be visible (as a red area around the external os) Discharge, PCB

Question 34

What investigations should you do if you find an ectropion on examination?

Answer 34

Cervical Smear See cervical smear section for further details

Question 35

Ectropion Rx?

Answer 35

Cryotherapy - only indicated if very severe

Question 36

Uterine causes of PCB?

Answer 36

Endometrial hyperplasia Polyps Fibroids Check heavy menstrual bleeding for further information