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GUM > Vaginal discharge and epidiymitis > Flashcards

Vaginal discharge and epidiymitis Flashcards

1
Q

STI causes of vaginal discharge?

A
  • Trichomonas vaginalis
  • Herpes
  • Gonorrhoea
  • Chlamydia
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2
Q

Non STI infective causes of vaginal discharge?

A
  • Bacterial vaginosis

* Vulvovaginal candidiasis

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3
Q

Non infective causes of vaginal discharge?

A 
•	Atrophic vaginitis
•	Irritant vaginitis
•	Vaginal/cervical/endometrial malignancy
•	Cervical ectopy
•	Cervical/endometrial polyp
Pessary in situ?
Foreign body?
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4
Q

What Qs should be asked for a pt presenting with vaginal discharge?

A
  • Change to vaginal discharge colour/smell/volume
  • Associated symptoms:
  • Abdo pain
  • Abnormal bleeding
  • Fever
  • Dyspareunia
  • Dysuria
  • Vulval pain
  • Vulvovaginal soreness/itching
  • Sexual history (recent partner change)
  • Cervical smear history
  • Gynae history (recent procedures, fistula formation?)
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5
Q

What are you looking for in an examination of pt w/vaginal discharge?

A

• Vulva: erythema, excoriation, dermatitis, fissures, ulcers, vulvitis
• Vagina: discharge, foreign body, vaginitis
• Cervix: Discharge, cervicitis, ectopy, polyp
Foreign body!?

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6
Q

Most common cause of vaginal discharge in women of child bearing age?

A

Bacterial vaginosis

Not an STI

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7
Q

What is BV?

A

Change in flora of vagina from lactobacillus (pH 3.5-4) to Gardnerella vaginalis (pH 4.5-6)
• 50% foul fishy smelling discharge
• 50% asymptomatic (screening not recommended)

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8
Q

Risk factors for BV

A
  • Change of partner
  • Receptive oral sex
  • Unprotected sexual intercourse
  • Presence of an STI
  • Women who have sex with women
  • Menstruation
  • IUD
  • Smoking
  • Vaginal douching
  • Black ethnicities
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9
Q

Diagnosis of BV?

A

Gram stained microscopy lack of lactobacilli

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10
Q

Complications of BV

A
  • Risk for HIV acquisition
  • Associated with other STIs
  • Associated with post-surgery complications
  • Stigma
  • Late miscarriage
  • Preterm birth
  • PROM
  • Recurrence
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11
Q

Treatment for BV

A

Treat if symptomatic/risk of ascending infection
• Metronidazole 400mg BD 5 days (only choice if pregnant)
• Intravaginal metronidazole gel
• Intravaginal clindamycin cream OD 7 days
• Soap substitute

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12
Q

Treatment of recurrent BV

A
  • Intravaginal metronidazole gel (0.75%) twice weekly

* Intravaginal probiotic lactobacilli / lactic acid gel (OTC)

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13
Q

What is vulvovaginal candidiasis?

A 
Thrush
Candida albicans (80-92%)
Non-albicans species: C. glabrata, C. tropicalis, C. krusei, C. parapsoilosis, Saccharomyces cerevisiae
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14
Q

Symptoms of candidiasis?

A
  • Vulval itch
  • Vaginal discharge
  • Vulval soreness
  • External dysuria
  • Superficial dyspareunia
  • 10-20% asymptomatic colonisation
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15
Q

Diagnosis of candidiasis?

A
  • Spores and hyphae seen
  • Culture
  • Examination with fissuring, erythema, curdy discharge, oedema, satellite lesions and excoriation
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16
Q

Treatment of candidiasis?

A

• Topical imidazoles e.g. clotrimazole pessary 500mg stat +/-clotrimazole cream
• Systemic azoles e.g. fluconazole 150mg stat
• Antifungals e.g. Nystatin vaginal tablets (for non-albicans species)
• Soap substitute, cotton pants
Only local treatment in pregnancy

17
Q

Risk factors for recurrent candidiasis?

A
  • Diabetes is a risk factor (glucose risk environment)
  • Immunosupression
  • Hyperoestrogenaemia (HRT, COCP)
  • Broad spectrum antibiotics
  • Link to allergy
18
Q

What is epididymitis?

A

Inflammation of the epididymides +/- testicular inflammation triggered by an infectious agent
• Unilateral/bilateral scrotal swelling
• Scrotal erythema
• Scrotal pain

19
Q

Differential diagnosis for epididymitis?

A
  • Torsion (if under 20yrs)
  • Inguinal hernia
  • Tumour (uncommon, usually not painful)
20
Q

Causes of epididymitis?

A
  • N. gonorrhoea (50% also have chlamydia)
  • C. trachomatis
  • E. coli (if over 35 and/or structural urinary tract abnormality
  • M. tuberculosis (rare, if chronic)
21
Q

Assessment of epididymitis?

A
  • Sexual Hx
  • STI screen
  • MSU and urine dip
22
Q

Management of epididymitis?

A

If under 35 assume STI while waiting for results
Doxycycline 100mg BD 14 days
Rest, analgesia, supportive underwear
Treat UTI of dipstick +ve
F/U 2 weeks, continue treatment for 1 month if not fully recovered
Partner tracing and notification

GUM (5 decks)

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