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Fire Through Finals > Women's Health: Sexually Transmitted Infections > Flashcards

Women's Health: Sexually Transmitted Infections Flashcards

1
Q

How do you differentiate the STIs producing white discharge?

A

Candida // bacterial vaginosis
Thick // thin
Itch // KOH addition makes fish smell

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2
Q

What are the risk factors for candida?

A

High oestrogen
Altered immunity: antibiotics, T2DM, Immuncompromised

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3
Q

How do you diagnose and treat candida infection?

A

high vaginal swab

  1. Oral fluconazole 10mg
  2. Clotrimazole 500mg pessary
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4
Q

How do you manage recurrent candida?

A

Blood glucose to exclude diabetes
Oral fluclonazole every 3 days for 3 doses
THEN Oral fluclonazole weekly for 6 months

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5
Q

How do you investigate bacterial vaginosis?

A

3/4 Amsel’s criteria

  • Thin, white discharge
  • Vaginal pH >4.5
  • Positive Whiff test
  • Strippled vaginal epithelial cells (clue cells) on microscopy
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6
Q

How do you treat bacterial vaginosis?

A

Oral metronidazole 5-7 days
top met/clindamycin are alternatives

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7
Q

What organism tends to be the cause of bacterial vaginosis?

A

Gardnerella vaginalis

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8
Q

What is the significance of bacterial vaginosis in pregnancy?

A

Risk of preterm, low birth weight and choriomanionitis

Still give metronidazole

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9
Q

How does trichomonas vaginalis compare to bacterial vaginosis

A

Also has smelyl discharge but is frothy yellow not white

Very itchy

Vulva ulceration + ‘strawberry cervix’

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10
Q

How do you investigate trichomonas vaginalis?

A

High vaginal swab and PCR/NAATs to exclude differentials

wet mount microscopy shows motile trophozoites

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11
Q

How is trichomonas vaginalis treated?

A

Oral metronidazole 5-7 days OR one off 2g dose

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12
Q

How do chlamydia and gonorrhea compare in terms of…

Pathogen

Discharge

Pain

A

Gonorrhea // Chlamydia

GM -ve diplococcus // GM -ve intracellular

Green, odourless // pus-like +/- intermenstrual bleeding

urination, defecation // F: intercourse + cervicitis; M: urination, testicular

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13
Q

What are the investigations for differentiating chlamydia and gonorrhea?

A

NAAT using swab for females, first pass urine for males

3 days after gonococcal infection

2 weeks after chlamydial

Then culture for sensitivity

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14
Q

How do you treat

Gonorrhea

Chlamydia

A

G: Ceftriaxone 500mg IM OR Cefixime 400mg PO + Oral azithromycin 2g

C: Oral doxycycline 100mg BD (7 days) OR Oral azithromycin 1g then 500mg two days

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15
Q

A sore wrist, spreading joint pain and a rash in a young adult raises suspicion of what?

A

Disseminated gonococcal infection

Need to admit to ID

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16
Q

Sexually active female presents with RUQ pain, what could be the cause?

A

Perihepatitis, along with other RUQ causes

17
Q

How do HSV, Chanroid, Syphilis and LG compare in terms of

Ulceration

Lymph node

Other features

Pathogen

A

HSV // Chancroid // Syphilis // LG

Painful, multiple // Painful, ragged border // Painless, single // painless, single

None // unilateral painful lymphadenopathy // none // unilateral painful lymphadenopathy

// Proctocolitis is a late feature

HSV 1+2 // H. ducreyi // Trepnonema pallidum // C. trachomatis (L1-3)

18
Q

Painless pustle that progresses to ulcer –> painful lymph nodes –> proctocolitis indicates what?

A

Lymphogranuloma venerum

Complication of chlamydia L1-3 infection

19
Q

What strain of chlamydia causes genital symptoms?

A

D-K

20
Q

How do you diagnose and treat HPV

A

Clincal

Podophyllotoxin // imiquimod // cryotherapy

21
Q

What investigations help diagnose gential herpes

A

PCR swab of deroofed blister

+ IgG serology

22
Q

What is the treatment of genital herpes?

A

Aciclovir 400mg TDS if early

+ lidocaine for pain relief

23
Q

What is the investigations for syphilis?

A

Treponemal (immunoassay, haemagglutination) and non-treponemal (RPR, VDRL)

+ve treponema +ve non-treponemal = active infection

-ve trep, +ve non-trep = False positive (SLE, pregnancy)

+ve trep, -ve non-trep = Treated infection

+ PCR, dark ground microscopy

24
Q

How do treat syphilis?

A

IM Benzathine (Doxycycline if allergic)

25
Q

If benzathine causes fever, rash and raised HR what do you do?

A

If no wheeze or hypotension then give antipyretics

26
Q

How do pubic lice present and how do you treat?

A

Intense itch and burrows

Give malathion lotion

27
Q

If someone with HIV has symptoms, what are the early features?

A

Fever

Rash

Aseptic meningitis

Myalgia

Pharyngitis

28
Q

After initial symptoms, how does HIV present?

A

2nd stage: 30% get lymphadenopathy *>1cm, >2sites, >3months)

Followed by fever, night sweats, diarrhoea +/- opportunistic infection

29
Q

Who are more likely to be infected by HIV?

A

Black-African, MSM

Hx non-consensual or infections

Hetero men most underdiagnosed

30
Q

How is HIV tested for?

A

p24 antigen + HIV antibody combination test

Perform at 4 weeks, repeat at 12 weeks

31
Q

How is HIV treated pre and post-exposure?

A

Pre: prEP (truvada, raltegivir)

Post: Antiretroviral therapy of 2NRTIs + another agent

32
Q

abacavir, tenofovir, didanosine, -tabines, vudines are all examples of what?

A

NRTIs

33
Q

What class of antiretrovirals causes the following

Renal impairment, osteoporosis

anaemia, myopathy, black nails

pancreatitis

rashes

diabetic, cushingoid

A

NRTIs

zidovudine

didanosine

NNRTIs

protease inhibitors

34
Q

What lab results do you monitor in HIV?

A

RNA for viral load (get to 0)

CD4+ count (stay above 200)

35
Q

What conditions within the following categories are seen in HIV?

Respiratory

Cancers

Skin

A

TB, Pneumocystis jirovecci

Kapowskis and NHL (EBV), Cervical (HPv)

All the Hs (HSV, HPV, histioplasmosis

36
Q

How can vertical transmission be reduced between mother and baby in pregnancy?

What circumstances would a vaginal delivery be considered?

A

Zidovudine 4hrs before C-section + Either neonatal zidovudine (if maternal <50/ml) or triple therapy

viral load <50/ml at 36 weeks

37
Q

How can you differentiate gonococcal dissemination from septic arthritis or reactive arthritis?

Joints affected

Associated symptoms

Joint fluid findings

Pathogen

A

Dissemination // Septic // Reactive

Migrates // Single // single

rash // restricted movement // uveitis, urethritis

yellow // yellow // nothing

Gonnorhoea // Gonorrhoea in young, S. aureus in old //

Fire Through Finals (32 decks)

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