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GUM Flashcards

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1
Q

What is bacteria vaginosis caused by ?

A
  • Overgrowth of anaerobic bacteria
  • Most commonly : Gardnerella vaginalis
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2
Q

What is the Amsel’s criteria for diagnosing BV?

A

3 of the following :

  • Thin, white homogenous discharge
  • Clue cells on microscopy: stippled vaginal epithelial cells
  • Vaginal pH > 4.5
  • Positive whiff test (addition of potassium hydroxide results in fishy odour)
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3
Q

what swab is required for diagnosing BV

A
  • Charcoal swab for microscopy, either high vaginal or self taken low swab
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4
Q

Treatment of BV

A
  • Symptomatic : oral metronidazole (5-7 days)
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5
Q

What complications in pregnant women is BV associated with ?

A
  • Late miscarriage
  • Preterm delivery
  • Chorioamnionitis
  • Low birth weight
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6
Q

Most common organism seen in vaginal candidiasis

A

Candida albicans (yeast infection)

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7
Q

Symptoms of vaginal candidiasis

A
  • Thick, white discharge that does not typically smell
  • Vulval and vaginal itching, irritation or discomfort
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8
Q

Management of vaginal candidiasis

A
  • oral fluconazole : 150 mg as a single dose
  • Clotrimazole 500 mg intravaginal pessary as a single dose if oral therapy is contraindicated
  • If there are vulval symptoms, consider adding a topical imidazole in addition to an oral or intravaginal antifungal
  • If pregnant = tropical only
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9
Q

What is recurrent vaginal candidiasis and how is it managed ?

A
  • 4 or more episodes a year
  • High vaginal swab for microscopy and culture
  • BM test for DM
  • Induction and maintenance regime : oral fluconazole every 3 days for 3 doses and maintain with oral fluconazole weekly for 6 mnths
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10
Q

what kind of bacteria is chlamydia trachomatis

A

Gram-negative

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11
Q

How is chlamydia diagnosed

A
  • Nucleic acid amplification test (NAATs)
  • Women : vulvovaginal swab first line
  • Men : Urine
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12
Q

If not asymptomatic, how can chlamydia present in women ?

A
  • Abnormal vaginal discharge
  • Abnormal vaginal bleeding (intermenstrual or postcoital)
  • Dysuria
  • Pelvic pain
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13
Q

How does chlamydia present in men ?

A
  • Urethral discharge or discomfort
  • Dysuria
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14
Q

what are the examination findings in chlamydia

A
  • Pelvic or abdominal tenderness
  • Cervical motion tenderness (cervical excitation)
  • Inflamed cervix (cervicitis)
  • Purulent discharge
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15
Q

First line management of uncomplicated chlamydia

A

Doxycycline 100mg twice daily for 7 days

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16
Q

When is doxycycline CI for chlamydia treatment and what can be given ?

A
  • Pregnancy and breastfeeding
  • Azithromycin 1g stat, then 500mg once daily for 2 days
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17
Q

Give 5 pregnancy-related complications with chlamydia

A
  • Preterm delivery
  • Premature rupture of membranes
  • Low birth weight
  • Postpartum endometritis
  • Neonatal infection (conjunctivitis and pneumonia)
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18
Q

Give 8 complications of chlamydia

A
  • PID
  • Chronic pelvic pain
  • Infertility
  • Ectopic pregnancy
  • Epididymo-orchitis
  • Conjunctivitis
  • Lymphogranuloma venereum
  • Reactive arthritis
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19
Q

stage one of lymphogranuloma venereum (LGV)

A

Primary -> painless ulcer. On penis in men, vaginal wall in women or rectum after anal sex

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20
Q

Second stage of LGV

A

Secondary -> lymphadenitis (in guinal or femoral lymph nodes)

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21
Q

Third stage of LGC

A
  • Tertiary -> inflammation of rectum and anus
  • Anal pain, change in bowel habit. tenesmus and discharge
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22
Q

How is LGV managed ?

A

Doxycyline 100mg twice daily for 21 days

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23
Q

what organism causes gonorrhoea

A
  • Neisseria gonorrhoeae = gram negative diplococcus
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24
Q

How does gonorrhoea present in women

A
  • Odourless purulent discharge, possibly green or yellow
  • Dysuria
  • Pelvic pain
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25
How does gonorrhoea present in men ?
- Odourless purulent discharge, possibly green or yellow - Dysuria - Testicular pain or swelling (epididymo-orchitis)
26
how is gonorrhoea tested for ?
- Diagnosed : NAAT - Charcoal swab for microscopy, culture and sensitivites
27
How is gonorrhoea managed ?
- A single dose of IM ceftriaxone 1g if the sensitivities are NOT known - A single dose of oral ciprofloxacin 500mg if the sensitivities ARE known and the organism is sensitive to cipro
28
Should patients treated for gonorrhoea have a 'test of cure'
Yes : NAAT if asymptomatic, cultures if symptomatic 72 hours after treatment for culture 7 days after treatment for RNA NAAT 14 days after treatment for DNA NAAT
29
What are the complications of gonorrhoea
- PID -> Fitz-Hugh-Curtis syndrome - Disseminated gonococcal infection - Epididymo-orchitis - Prostatitis - Conjunctivits - Urethral strictures - Septic arthritis
30
What is disseminated gonococcal infection
- When bacteria from untreated gonococcal infection, spreads to the skin and joints - Causes : tenosynovitis, migratory polyarthritis and dermatitis
31
what is a key complication of gonorrhoea in pregnancy ?
- Gonococcal conjunctivitis in a neonate -> opthalmia neonatorum
32
Give the 3 most common causes of PID
- Chlamydia trachomatis - Neisseria gonorrhoeae - Mycoplasma genitalium
33
What symptoms does PID cause?
- Pelvic or lower abdominal pain - Abnormal vaginal discharge - Abnormal bleeding (intermenstrual or postcoital) - Deep dyspareunia - Fever - Dysuria
34
What may be seen on examination in PID ?
- Pelvic tenderness - Cervical motion tenderness (cervical excitation) - Inflamed cervix (cervicitis) - Purulent discharge
35
what investigations should be done if PID is suspected ?
- Pregnancy test - Full STI screen (high vaginal, urethral, endocervical) - Inflammatory markers (CRP) - Transvaginal / pelvic USS
36
What will be seen under a microscope in PID?
Pus cells
37
What is an example management regime of PID
- A single dose of intramuscular ceftriaxone 1g (to cover gonorrhoea) - Doxycycline 100mg twice daily for 14 days (to cover chlamydia and Mycoplasma genitalium) - Metronidazole 400mg twice daily for 14 days (to cover anaerobes such as Gardnerella vaginalis)
38
Give 6 complications of PID
- Sepsis - Abscess - Infertility - Chronic pelvic pain - Ectopic pregnancy - Fitz-Hugh-Curtis syndrome
39
What is Fitz-Hugh-Curtis Syndrome ?
- Complication of PID - Inflammation and infection of liver capsule (Glisson's capsule) - Causes adhesions between the liver and the peritoneum
40
What does Fitz-Hugh-Curtis Syndrome cause ?
- RUQ pain, referred to right shoulder tip
41
What kind of STI is trichomoniasis
- Parasite - Protozoan -> single-celled organism with flagella
42
If not asymptomatic, how does trichomoniasis present ?
- Vaginal discharge : frothy and yellow/green. - Itching - Dysuria - Dyspareunia - Balanitis (inflammation to the glans penis
43
What is seen on examination of the cervix in trichomoniasis ?
Strawberry cervix
44
How is trichomoniasis diagnosed ?
- Charcoal swab with microscopy - Posterior fornix of vagina in a woman - Urethral swab or first-catch urine in a man
45
How is trichomoniasis managed ?
- Oral metronidazole (5-7 days)
46
what can trichomoniasis increase the risk of ?
- Contracting HIV by damaging the vaginal mucosa - BV - Cervical cancer - PID - Pregnancy-related complications such as preterm delivery
47
What is herpes simplex virus (HSV) associated with
- HSV-1 = cold sores - HSV-2 = genital herpes
48
If not asymptomatic, how does HSV present ?
- Painful genital ulceration - Neuropathic type pain (tingling, burning or shooting) - Flu-like symptoms (e.g. fatigue and headaches) - Dysuria (painful urination) - Inguinal lymphadenopathy
49
How is HSV diagnosed ?
- Can be made clinically - Viral PCR swab from the lesion to confirm
50
How is genital herpes treated ?
- Oral aciclovir
51
How is a primary genital herpes infection contracted before 28 weeks gestation managed ?
- Oral aciclovir - Regular prophylactic aciclovir starting from 26 wks - Asymptomatic = vaginal delivery
52
How is primary genital herpes contracted >28 wks gestation managed ?
- Ora aciclovir during the - Regular prophylactic aciclovir. - C section
53
what causes syphilis ?
Spirochaete Treponema pallidum
54
What is the primary stage of syphilis?
- Chancre - painless ulcer at the site of sexual contact - Local non-tender lymphadenopathy - Often not seen in women (the lesion may be on the cervix)
55
what is secondary syphilis ?
- Systemic symptoms : fever, lymphadenopathy - Rash on trunk, palms and soles - Condylomata lata - Buccal 'snail track' ulcer - These symptoms can resolve after 3 – 12 weeks and the patient can enter the latent stage.
56
what is latent syphilis ?
- Patient is asymptomatic whilst still being infected - Early latent syphilis occurs within two years of the initial infection - Late latent syphilis occurs from two years after the initial infection onwards.
57
what is tertiary syphilis
- Gummatous lesions (gummas are granulomatous lesions that can affect the skin, organs and bones) - Aortic aneurysms - Neurosyphilis
58
What are the signs of neurosyphilis ?
- Headache - Altered behaviour - Dementia - Tabes dorsalis (demyelination affecting the spinal cord posterior columns) - Ocular syphilis (affecting the eyes) - Paralysis - Sensory impairment
59
What is a specific finding in neurosyphilis ?
- Argyll-Roberton pupil : constricted pupil that accomodates when focusing on a near object but does not react to light
60
How is syphilis treated ?
IM benzathine benzylpenicilin
61
Explain the different test results obtained when looking at syphilis
- Positive non-treponemal test + positive treponemal test = consistent with active syphilis infection - Positive non-treponemal test + negative treponemal test = consistent with a false-positive syphilis result e.g. due to pregnancy or SLE (see list above) - Negative non-treponemal test + positive treponemal test = consistent with successfully treated syphilis
62
What kind of virus is HIV and what is it's effect on the body?
- RNA retrovirus - Destroys CD4 T-helper cells.
63
First-line test for HIV screening of asymptomatic individuals or pts with signs and symptoms of chronic infection
- Fourth generation : checks for HIV antibody and P24 antigen. Window period of 45 days.
64
What 2 ways can HIV be monitored ?
- CD4 count - Viral load -> HIV RNA per ml of blood.
65
what is given prophylactically to all patients with HIV?
-Co trimoxazole (if CD4<200/mm3) - Protect against pneumocystis jirovecii pneumonia (PCP)
66
How often are women with HIV offered cervical smears ?
- Yearly, due to increased risk of HPV infection and cervical cancer
67
What vaccines are avoided in HIV?
- Live vaccines (e.g. BCG and typhoid)
68
What does mycoplasma genitalium cause ?
Non-gonococcal urethritis
69
What is the investigation for mycoplasma genitalium ?
- NAAT - First urine sample in the morning for men - Vaginal swabs (can be self-taken) for women - Check every +ve sample for macrolide resistance and perform a 'test of cure'
70
How mycoplasma genitalium managed
- Doxycycline 100mg twice daily for 7 days then; - Azithromycin 1g stat then 500mg once a day for 2 days (unless it is known to be resistant to macrolides)
71
How is mycoplasma genitalium treated in pregnancy and breastfeeding ?
Azithromycin alone
72
what are the complications of mycoplasma genitalium ?
- Urethritis - Epididymitis - Cervicitis - Endometritis - PID - Reactive arthritis - Preterm delivery in pregnancy - Tubal infertility
73
Most appropriate treatment of oral candidiasis in immunocomprimised patients (e.g. HIV)
Fluconazole
74
4 RF for vaginal candidiasis
- Diabetes mellitus - Drugs: antibiotics, steroids pregnancy§- Immunosuppression: HIV
75
Principles of management in PID
1. Analgesia 2. Antibiotics 3. Encourage partner notification and treatment 4. Patient education regarding safe sex
76
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