Sexual and Reproductive Health 3

Question 1

How does trichomonas vaginalis present?

Answer 1

asymptomatic 
offensive grey-green discharge 
vulval irritation 
superficial dyspareunia 
cervicitis has punctate erythematous appearance

Question 2

What is the diagnosis of trichomonas vaginalis?

Answer 2

wet film microscopy
special staining
culture of vaginal swabs

Question 3

What is the treatment for trichomonas vaginalis?

Answer 3

metronidazole

Question 4

What is endometritis?

Answer 4

infection in the cavity of the uterus
spread to the pelvis is common
usually secondary to instrumentation of uterus or complication of pregnancy

Question 5

How does endometritis present?

Answer 5

o Persistent + heavy vaginal bleeding
o Pain
o Tender uterus
o Cervical os open
o Poss septicaemia

Question 6

How is endometritis treated?

Answer 6

o Broad-spectrum abx

o ERPC if symptoms do not subside

Question 7

What is the cause of acute pelvic infection and PID?

Answer 7

ascending infection of bacteria in vagina and cervix

Question 8

What are the risk factors for PID?

Answer 8

young
poor
sexually active
nulliparous women

Question 9

How does PID present?

Answer 9

o Asymptomatic
o Later subfertility or menstrual problems
o Bilateral lower abdominal pain with deep dyspareunia
o Abnormal vaginal bleeding or discharge
o If severe, tachycardia, high fever, lower abdominal peritonism with bilateral
adnexal tenderness + cervical excitation

Question 10

What are the investigations for suspected PID?

Answer 10

• endocervical swabs for chlamydia and gonococcus
• blood cultures if fever
• WBC and CRP poss raised
• Pelvic USS excludes abscess or ovarian cyst
• laparoscopy with fimbiral biopsy and culture

Question 11

What is the treatment for PID?

Answer 11

• analgesics and parenteral cephalosporins (IM ceftriaxone followed by doxycycline and metronidazole/ofloxacin and metronidazole)
• if febrile, admit for IV
• if abscess, may need drainage

Question 12

What are the complications of PID?

Answer 12

abscess 
pyosalpinx 
tubal obstruction and sub fertility 
chronic pelvic pain/infection 
ectopic pregnancy more likely

Question 13

What is chronic pelvic inflammatory disease?

Answer 13

persisting infection
dense pelvic adhesions
fallopian tubes may be obstructed and dilated with fluid or pus

Question 14

How does chronic pelvic inflammatory disease present?

Answer 14

chronic pelvic pain or dysmenorrhoea
deep dyspareunia 
heavy irregular menstruation 
chronic vaginal discharge 
subfertility 
abdominal tenderness and fixed retroverted uterus

Question 15

How is chronic pelvic inflammatory disease diagnosed?

Answer 15

laparoscopy

Question 16

What is the treatment for chronic pelvic inflammatory disease?

Answer 16

analgesics and abs if active infection

adhesiolysis

Question 17

What are the RFs for HIV/aids?

Answer 17

multiple sexual partners 
migration from high prevalence countries 
failure to use barrier contraception 
IV drug use 
sexual contact with high risk males

Question 18

How is HIV diagnosed?

Answer 18

can be asymptomatic

development of opportunistic infection or malignancy or CD4 count <200 diagnostic of AIDS

Question 19

What are the gynaecology issues imp in HIV+ women?

Answer 19

yearly smears as cervical malignancy affects 1/3

genital infections esp candidiasis and menstrual disturbances are more common

Question 20

What are the principles of treating HIV?

Answer 20

combination antiretroviral regimens - turns HIV into a chronic controllable condition

contact tracing

Question 21

What are the principles of managing HIV in pregnancy?

Answer 21

Prevent vertical transmission to fetus by antiretroviral therapy, elective C-section +
avoidance of breastfeeding

Question 22

What are the national screening programmes for STDs?

Answer 22

National Chlamydia Screening programme, for sexually active under 25-
year-olds for information + access to sexual health services