STIs/PID Flashcards
(23 cards)
What are causative organisms of PID?
Chlamydia= most common
gonorrhoeae
Mycoplasma genitalium/hominis
What are features of PID?
Lower abdominal pain
Deep dyspareunia
Vaginal discharge- purulent
Vaginal bleeding- Intermenstrual/post coital
Cervical Excitation- on bimanual exam
What are investigations for PID?
Pregnancy test- exclude ectopic
High vaginal swab- can be negative
Bloods- inflammatory markers
What is the management of PID?
Low threshold for treatment due to uncertainty of diagnosis and long term risk of delayed treatment
1) IM ceftriaxone followed by PO doxycycline 100mg BD and PO metronidazole 400mg BD for 14 days
2) PO ofloxacin and metronidazole for 14 days
3) PO moxifloxacin for 14 days
What is the inpatient treatment of PID?
IV ceftriaxone and IV doxycycline (followed by PO metronidazole and doxycycline)
IV clindamycin and IV gentamicin (followed by PO clindamycin and metronidazole)
What are complications of PID?
Peri-hepatitis (Fitz Hugh Curtis Syndrome)
- RUQ pain
Infertility
Chronic Pelvic Pain
Ectopic Pregnancy
What are features of Chlamydia?
Asymptomatic
Women- discharge/bleeding/dysuria/cervicitis
Men- urethral discharge, dysuria
What investigations are needed for chlamydia?
NAAT swab- vaginal swab in women, urine in men
What is the management of chlamydia?
1) Doxycycline 7 days
2) Azithromycin 1g OD for one day 500mg OD for 2 days
Pregnant women azithro.erythro/amox should be done
Contact tracing for men partners within 4 weeks and women within 6 months
What are features of gonorrhoea?
Male- urethral discharge, dysuria
Females- cervicitis
Rectal/pharyngeal infection- asymptomatic
What is the management of gonorrhoea?
1) IM ceftriaxone 1g STAT
2) If known sensitivities add ciprofloxacin 500mg stat
3) If needle phobic then cefixime and azithromycin should be used
What are features of bacterial vaginosis?
Caused by Gardnerella Vaginalis
Grey, fishy discharge
How is BV diagnosed?
Thin, white discharge
Clue cells on microscopy
Vaginal pH .4.5
Positive whiff test
What is the management of BV?
If woman asymptomatic then no treatment unless undergoing TOP
If symptoms then oral metronidazole for 5-7 days or single dose metronidazole 2g if adherence issue
In pregnancy is the same but single dose not given
What are features of trichmonas vaginalis?
Vaginal discharge- offensive, yellow/green, frothy
Vulvovaginitis
Strawberry cervix
pH >4.5
Microscopy will show motile trophozoites
What is the management of trichomonas?
Oral metronidazole for 5-7 days
What causes syphilis?
Treponema pallidum
What are features of primary syphilis?
Chancre- painless ulcer
Local non tender lymphadenopathy
Not seen in women
What are features of secondary syphilis?
6-10 weeks post infection
Systemic symptoms fever, lymphadenopathy
Rash on trunk/soles
Snail track ulcers
Condylomata lata- painless warty lesions on genitalia
What are features of tertiary syphilis?
Gummas- granulomatous lesions on skins/bones
Ascending aortic aneurysm
Neurosyphilis- general paralysis of the insane
Argyll-Robertson Pupil
What are investigations for syphilis?
Swabs from ulcer site
Treponemal tests e.g. EIA/CLIA detect IgG/IgM
- not good at monitoring symptoms
Non-treponemal test e.g. VDRL antigen test
-used to monitor treatment
What is the management of syphilis?
1) IM benpen
What is a complication of syphilis?
Jarisch Herxheimer reaction
- acute treatment response
Fevers/rigors/malaise/tachycardia
resolves after 24 hours
No wheeze/hypotension
Self limiting
