Gynaecology > Infections > Flashcards

Infections Flashcards

(51 cards)

Study These Flashcards
1
Q

What is bacterial vaginosis most commonly caused by?

A

Gardnerella vaginalis.

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2
Q

Classic presentation of bacterial vaginosis

A
  • Vaginal discharge: watery, grey-white, thin, foamy
  • fishy smell esp after sex or menstruation
  • vulvar/vag itch.
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3
Q

Dx bac vaginosis (4)

A

Amsel’s criteria

Presence of 3 or more:
1. Typical vaginal discharge: greyish thin homogenous 
2. Vag ph >4,5
3. Positive amine whiff test (add 10% KOH to discharge-enhance fishy odour).
4 presence of clue cells on smear microscopy (vag epithelial cells studded with adherent coccobacilli)
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4
Q

Rx bac vaginosis

A

Only treat symptomatic , pregnant or planning pregnancy.

Metronidazole 500 mg oral twice daily for 7 days. If pregnant, only begin end of first semester.

Alternative: vaginal preparations metronidazole gel 0,75% 5g daily for 5 days or clindamycin cream 2% 5 g nightly 7 days or clindamycin 300 mg oral bd 7 days

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5
Q

How is bac vaginosis spread

A

STI

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6
Q

What is condyloma acuminata

A

Genital warts

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7
Q

What is condyloma acuminata caused by

A

HPV 6 and 11

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8
Q

How are genital warts transmitted

A

STI

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9
Q

diagnosis condyloma acuminata

A
  • colposcopy after apply 3-5% acetic acid. Show acetowhite lesions
  • schiller’s test: stain with iodine solution. Healthy tissue stain dark brown, abnormal tissue unstained-appear white or yellow
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10
Q

Rx condyloma accuminata if small

A
  • Aldara(imiquimod) (immune response modifier)
  • podofilox (podophyllotoxin)
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11
Q

Rx medium size condyloma accuminata (3)

A
  • Cryotherapy
  • electrocautery
  • laser
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12
Q

Rx large size condyloma accuminata

A

Electrocautery under general anaesthesia

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13
Q

Rx condyloma accuminata in pregnancy

A

Laser therapy. Medical rx not known if safe.

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14
Q

How often test mothers for HIV? (6)

A
  • Universal at first prenatal visit. If negative:
  • repeat 3 monthly in pregnancy
  • at labour/ delivery
  • at 6 week immunisation EPI visit
  • 3 monthly while breastfeeding
  • 6 weeks after completing bf
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15
Q

How manage mother with positive rapid HIV test? (7)

A
  • Confirm with second rapid
  • hb, CD4, creatinine
  • stage HIV clinically
  • initiate art ( if Tb confirmed before art, initiate Tb therapy and AZT. 2 weeks later once stable switch AZT to fdc)
  • review in 1 week for hb, CD4, creatinine results
  • screen for Tb at each visit ( may delay rx), acute neuropsychiatric illness ( efavirenz contraindicated), renal impairment (no tenfovir )
  • check vl 3 months after started art
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16
Q

Name contraindication efavirenz

A

Neuropsychiatric illness

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17
Q

Name contraindication tenofovir

A

Renal disease creat >85
(Switch to azt)

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18
Q

Name 4 side effects HIV FDc

A
  • Dizzy
  • strange dreams
  • potential renal toxicity (tenofovir)
  • rash (unlikely)
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19
Q

How manage newly diagnosed HIV with CD4 < 200

A

Start Bactrim 1 week after FDC

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20
Q

How manage newly diagnosed HIV with CD4 < 100

A

Test for cryptococcal antigen and give Bactrim

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21
Q

Management positive HIV test at labour? (3)

Study These Flashcards
A
  • Single dose NvP + single dose Truvada (emtricitabine + tenofovir) + AZT 3 hourly in labour
  • start FDC next day regardless of CD4
  • HIV PCR to neonate. Start nvp 12 weeks + AZT 6 weeks; follow up in 1 week to retest
22
Q

Name 4 causes bacterial vaginosis

Study These Flashcards
A
  • gardnerella vaginalis
  • mobiluncus spp
  • Mycoplasma hominis (rx azithromycin); Ureaplasma
  • Bacteroides spp : prevotella
23
Q

Normal vaginal ph?

24
Q

Cause vulvovaginal candidiasis?

Study These Flashcards
A

Mostly c albiccans but can also be C globrata

25
Risk factors vulvo vaginal candidiasis? (4)
- Diabetes and other immunosuppressive - pregnancy - hormonal contraceptives - recent antibiotic use
26
Clinical presentation vulvo vaginal candidiasis (5)
- Pruritis - dyspareunia - dysuria from erythema - thick curdy discharge - erythema, swelling, excoriations from itching
27
Diagnosis vulvo vaginal candidiasis
Mostly clinical but can do - Wet preparation (saline, 10% koh ) or gram stain of vaginal discharge showing budding yeasts, hyphae or pseudohyphae Consider swab from anterior fornix for MCs if recurrent or suspected resistant
28
Treatment vulvo vaginal candidiasis (3)
- OTC: clotrimazole 2 % cream 5g intravaginally daily 3 days (can also use miconazole, tioconazole) - Prescription: butoconazole 2% cream (single dose bioadhesive) 5g intravaginal (can also use terconazole) - Oral: fluconazole 150 mg single dose In Pregnancy can only be treated with topical azoles and longer, 7-14 days If complicated/recurrent (>4/year) , longer therapy and suppression therapy with fluconazole weekly for 6 months in recurrent.
29
Cause syphilis?
Treponema pallidum (spirochete)
30
Name the 4 stages syphilis and their time frames and contagion
Primary: 3-4 weeks after exposure. Highly contagious Secondary: 2-6 months after initial infection. Contagious Latent: early latent a year or less after infection, late latent more than 1 year. Tertiary: not contagious
31
Clinical presentation primary syphilis?
- Single painless ulcer/ chancre on vulva, vagina, cervix - erodes and heals spontaneously within 1 -8 weeks - painless inguinal lymphadenopathy Serological tests negative.
32
Clinical presentation secondary syphilis?
- Non-specific: malaise, anorexia, headache, diffuse lymphadenopathy - generalised maculopapular rash. on palms, soles, trunk, limbs which resolves within 4-10 weeks but may reoccur any time within 4 years - condyloma lata: anogenital, broad based, fleshy grey lesions Serological tests positive
33
Clinical presentation latent syphilis?
Asymptomatic 25% will progress to tertiary/ neurosyphilis
34
Clinical presentation tertiary syphilis? (3)
- Vulva gumma: nodules that enlarge, ulcerate and are necrotic - neurological → early: cn palsy, meningitis, stroke, altered mental status, auditory/ophthalmic abnormalities → late: tabes dorsalis (dorsal column degeneration), general paresis - cardiovascular: aortic aneurysm, dilated aortic root
35
Microscopic diagnostic tests syphilis? (2)
- Dark field microscopy - direct fluorescent antibody for t pallidum (dfa - tp) (better)
36
Serologic diagnostic tests syphilis? (5)
Nontreponemal (screening) (monitor rx) - venereal disease research lab (vdrl) slide test - rapid plasma reagin (rpr) test Treponemal (confirmation) (positive for life) - fluorescent treponema antibody absorption (fta-abs) - t palladium haemagglutination assay (tpha) - t palladium particle agglutination assay (tppa)
37
Treatment primary/ secondary/early latent syphilis? (3)
Benzathine penicillin G 2,4 million units IM stat Follow up: quantative titres (nontreponemal test) at 6 and 12 months for primary + secondary syphilis 6,12,24 months early latent syphilis More frequent in HIV
38
Treatment late latent syphilis? (2)
Benzathine penicillin G 2,4 million units IM weekly X3 doses Follow up after 6,12 and 24 months
39
Treatment neuro syphilis? (2)
Iv aqueous penicillin G 3-4 million units 4 hourly for 10-14 days Follow up: CSF evaluation every 6 months until normal values
40
Clinical presentation gonorrhoea? (10)
Local symptoms, if present: - Mucopurulent cervical/vaginal discharge - postcoital bleed - AUB - cervical excitation tenderness - concomitant UTI - dysuria Mostly asymptomatic, present with complications later: - PID (15.%) - Tubal factor infertility - ectopic - chronic pelvic pain - disseminated gonococcal infection: tender necrotic skin lesions, tenosynovitis, monoarticular arthritis
41
Who should be screened for gonorrhoea
- All sexually active women <25 (and for chlamydia) - high risk sexual behaviour - genital symptoms Not done in sa but ideal
42
Diagnosis gonorrhoea (3)
- nucleic acid amplification test (naat) (preferred): endocervical or vaginal dry swab held for 15-30 sec - gram stain: gram negative diplococci with atypical kidney bean shape - culture (valuable in resistant disease)
43
Treatment uncomplicated gonorrhoea cervicitis (2)
- ceftriaxone 250 mg IM stat + - azithromycin 1 mg po stat OR doxycycline 100 mg po bd x7 days (Also covers chlamydia)
44
Treatment disseminated gonorrhoea Infection (2)
- Ceftriaxone 1 g IM or iv daily until response then switch to - oral cefixime 400 mg po bd for 7 days
45
Prophylaxis gonorrhoea conjunctivitis to infants
Erythromycin 0,5% ointment
46
Clinical presentation chlamydia? (4)
Even more asymptomatic than gonorrhoea. But if present: - mucopurulent endocervical discharge - urethral syndrome: dysuria, frequency, pyuria, no bacteria on culture - postcoital/intermenstrual bleeding due to cervicitis - chronic: chronic pelvic pain, fitz-hugh - Curtis syndrome (peritonitis)
47
Diagnosis chlamydia (2)
- NAAT test - culture
48
Treatment chlamydia (2)
Azithromycin 1g oral + Doxycycline 100 mg oral bd x 7 days (Also give ceftriaxone because high rate gonorrhoea co-infection)
49
What is lymphogranuloma venereum?
Caused by chlamydia trachomatis stereotypes L1, L2 or L3.
50
lymphogranuloma venereum clinical course? (4)
- Within 1-6 weeks after infection: small, painless, primary papule/ulcer on vulva / vagina - then: unilateral regional inguinal/femoral lymphadenopathy +/- systemic symptoms - untreated→ buboes (conglomerate of pustular abscess) → sinus drainage / inguinal ulceration - anogenitorectal syndrome if acquired by anal sex: genital fistula, lymphoedema, perirectal abscess, proctitis, rectal stricture.
51
Treatment lymphogranuloma venereum?
Doxycycline 100mg po bd x21 days
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