REPRODUCTIVE Flashcards
** Torsion of the testes
CF:
peak age:
IVX:
Management
1.
2.
- Due to abnormal mobile mesentery of testes –> ischaemia
CF: SUDDEN ONSET SEVERE PAIN in scrotum and groin. Worse when testicle elevated. walking uncomfortable Testes tender- may lie high - Scrotal skin RED + oedematous Absent Cremaster reflex N+V
Peak age 12 yrs (11-30)
RF: undescended
IVX: Examine both
Transilumination (+ve is hydrocele)
Doppler USS compare both and obsevre blood flow
reduced blood flow is diagnostic for torsion
Management:
- Manual external detorsion by outward rotation of testes - success = immediate releif of all symptoms
- Urgent surgical exploration within 6 HOURS - untwist and fix both testes Orchiopexy
** Suspected Ectopic Pregnancy
Most common site?
RF:
CF:
IVX:
TX:
acute
subacute - doses
-Mainly Fallopian tube ampulla
RF: Tubal disease e.g PID, advanced maternal age, smoking
CF: Key features:
Amenorrhoea for 6-8 weeks,
Lower abdominal pain: non-specific,
Classically U/L colicky intermittent → constant, localised to iliac fossa, Abnormal vaginal (PV) bleeding
Shoulder tip pain, Collapse and dizzy, D+V
IVX: Bi-Manual to elicit cervical motion tenderness
Speculum, Abdo exam, Bloods
Urine HCG pregnancy test
BHCG- if raised conduct Transvaginal US
TX: ADMIT, IV Fluids, Cross-match 4-6 units, Anti-D if patient known Rhesus -ve.
Haemodynamically unstable = Urgent Laparoscopy- salpingostomy
SUBACUTE
- Surgical or Medical with Methotrexate 50mg single dose and review hCG on day 4 and 7 and if falls less than 15% repeat dose
Genital Warts aka condylomata Accuminata
HPV type
CF:
Management
HPV 6/11 causes most
Median incubation = 3 months
Most contagious when visible
CF: asymptomatic or multiple vulval warts- painless and slow growing. Local skin irritation.
IVX: Smear test, colposcopy, full STI screen.
Management: Podophyllin paint -apply weekly.
Advise barrier contraception with new partners
Clinic: Crypotherapy with liquid nitrogen
Vaccine includes 6/11 now
Genital herpes
types
RF:
CF: prodrome
IVX
Managment
drug + topical
HSV 1 = mouth
HSV2 = Angogential
RF: Multiple sexual partners, STI, early age 1st intercourse
CF: Febrile Flu prodrome 5-7 days, painful blisters in genital area, tender lymph nodes
IVX: Viral culture PCR from ulcer
Management: Refer to GUM clinic, infection lifelong
5 days Aciclovir TDS
+ topical tidnocaine
HIV
RF
Treatment
RF: msm, IVDU, Sex workers, sex with person from africa/ caribeean /sea
cd4 count low
Opportunistic infections
HAART treatment
Gonorrhoea
Gram -ve
symptomatic % in who?
Syx:
IVX
Management:
RF: 15-24, Recent sexual activity abroad, inconsistent condom use
CF: symptomatic in most men + 50% women
Men–> urethreal infection pain on weeing, rectal infection
Women: altered vaginal discharge
IVX: NAAT test
- urine in men and endocervical or vulvovaginal in women
Management: GUM clinic, partner notfication
CEFTRIAXONE 500MG IM + 1G AZITHROMYCIN 1G stat
GC = gemma collins
Syphillis
Trep Pallidium
Primary
Secondary
Tertiary
TX
Primary: Chancre at site of infection, small painless ulcer heals 2-6 weeks
Secondary: systemic syx- night time headache, malaise, fever, aches
Tertiary: dementia
IVX: NAAT
TX: screen other STIs and HIV
BEN PEN 2.4 IM single dose
Prostatitits
Most comon cause under 35s
RF
CF
Management
Antibiotic
- Inflammation of the prostate gland
Bacterial most common in under 35s- usually E.coli
RF: STIs and UTIs
CF: fever, malaise, arthralgia, urinary freq, dysuria, nocturne, pain on ejaculation + premature ejaculation
Gland may feel nodular
IVX: FBC, U+E, culture,
Management: Analgesia
Acute: Suprapubic urine catheter if retention
Ciprofloxacin 4 weeks
Balantitis
Causes:
RF:
Management:
Inflammation of glans penis
Cause: candidia, staph, psoriasis, irritation
RF: Diabetes + use of oral abx
IVX: blood/ urine test if DM possible, swab discharge for microscopy
Management: Daily cleaning with warm water, avoid triggers
candida = clotrimazole
Phimosis
• When foreskin can not be pulled back past the galns (shouldnt be before 2)
CF: painful erections,swelling and redness, adhesions
IVX: swab
Management: personal hygeiene, topical steroid application
Paraphimosis
- Occurs when a tight prepuce is retracted and then unable to be replaced as the glans swells = This is a urological emergency
CF: Oedema and pain on erection
Management: gentle compression with a saline soaked swab
gradual manual reduction - glans pushed back while index fingers pull precupuce back over glans –> if fail refer to urologist
Erectyl dysfunction
IVX in all patients?
MAnagement;
1st line
• Inability to attain and maintain an erection sufficient for satisfactory sexual performance
Cause: Vascular e.g CVD, HTN, smoking, neurological hormonal, drugs eg antihypertensivves, diuretics, psychological, DM
RF: obesity, lack of exercise
CF: Sudden onset, Early collapse of erection, Self-stimulated or waking erections
IVX: GU exam PR > 50yrs, morning sample total testosterone, fasting glucose HbA1c in all patients
Management: stop RF
testicular failure- give testosterone
Sex therapy
1st line = Phosphodiesterase inhibitors SILDENAFIL
Epididymo-orchitits
CF
Common age?
IVX
Management
- Pain, swelling and inflammation of the epididymis, with or without inflammation of the testes.
Patients 15-30 and over 60
mumps orchitis occurs in up to 40% postpubertal boys
Cause: chalmydia, gonnorhea, e.coli, mumps
CF: UNILATERAL scrotal pain and swelling of relatively acute onset +- symptoms of urtethritis
Signs: Tenderness to palpation on affected side
IVX: STI swab and cultures, microscopy and culture midstream urine, clour doppler USS to differentiate with torsion.
Management: Screen and treat STIs, rest, analgesia and scrotal support
NSAIDS
Empirical therapy CEFTRIOXONE IM + doxycycline 100mg by mouth
Urethritis
Common cause
IVX
Treatment
- Inflammation of the urethra. Usually (but not always) caused by a sexually transmitted infection (STI).
- Classified as gonococcal urethritis, non-gonococcal urethritis (NGU), or persistent/recurrent urethritis.
CF: Urethral discharge, urethreal pruritis, mucopurulent +-blood
IVX: FPU or NAAT, Urine tip to exclude UTI
Management:
NGU - Doxycycline
Gonoccocla: Ceftriaxone 500mg IM stat
Prevention: safe sex and regular STI testing
Testicular Cancer
95% are germ cell tumours
seminoma + non-seminomatous
RF: male infertility, kleinfelters, infantile hernia
CF: lump in body of testis, testicular or abdo pain. dragging sensation, recent hx of trauma made them notice, hydrocele, gynaecomastia
IVX: bilateral USS, assay of tumour markers
- AFP and beta hCG
Staging via thoraco-abdo CT
Management: Radical Orchidectomay or Chemo or radio + sperm storage for those if required.
