Non-STIs

Question 1

What is the cause of candidiasis?

what are the associated risk factors?

Answer 1

• candida proliferation occurs when vaginal pH is more alkaline
• immunocompromised
• pregnancy
• sexually active
• Diabetes mellitus
• broad spectrum antibiotics

Question 2

how common is it?

Answer 2

• very common, experienced by 90% of women at some point

- 2nd most common type of vaginal infection

Question 3

what kind of history might they give?

Answer 3

• pruritus vulvae
• soreness/ itch
• superficial dyspareunia
• change in discharge (cottage cheese, non-offensive)
• dysuria

Question 4

what investigation would you do? and what is the management?

Answer 4

• HVS for microscopy and culture
• 500mg single dose co-trimazole vaginal pessary
• topical 10% cotrimazole (canisten)
• fluconazole 150mg PO (if not pregnant)
• 85% are cured with this

Question 5

what happens to vaginal flora in BV?

Answer 5

• excessive anaerobic bacteria
• decreased number of lactobacilli
• increase in gardnerella vaginalis
• pH becomes more alkaline

Question 6

what are the risk factors for BV?

Answer 6

• smoking
• multiple sexual partners
• low SES
• pregnancy (15% prevalence in antenatal clinics)

Question 7

what kind of signs and symptoms are there in BV?

Answer 7

• can be asymptomatic
• non purulent, homogenous discharge
• grey malodorous discharge
• fishy odour exacerbated during menstruation/ intercourse

Question 8

what investigations should be done, what criteria should be fulfilled?

Answer 8

• HVS for microscopy and culture

Amsel criteria (3 of 4):

• thick grey/white discharge with offensive odour adhering to vaginal wall
• litmus pH (>4.5)
• fish amine test positive
• microscopy >20% clue cells (vaginal epithelia cells) reduced lactobacilli

Question 9

how should it be managed?

Answer 9

• treatment unnecessary unless symptomatic/ pregnant/ undergoing gynae procedure
• oral metronidazole or topical clindamycin

Question 10

what are the complications of BV?

Answer 10

• can cause PROM/ pre-term labour/ chorioamnionitis

- increased transmission of HIV

Question 11

what are the infective causes of itching?

the non infective causes?

Answer 11

• candidiasis
• trichomoniasis
• scabies
• pthirus pubis (crabs)
• irritant vulvitis/ balanitis
• lichen planus/ simplex/ sclerosis

Question 12

what are the treatments for lichen simplex?

symptoms and treatment of lichen planus?

Answer 12

• plaques, with lichenification: emollients and moisturisers, mild steroids
• itchy papular eruption, found on flexor surfaces and genitalia, treat with emollients and steroids

Question 13

what is the signs and symptoms of lichen sclerosis?

treatment?

Answer 13

chronic inflammatory condition, causes narrowing of labia in women and glans in men

• causes pale atrophic skin with loss of architecture and erosions
• treatment is topical steroids and skin moisturisers

Question 14

what is the main risk factor for candida balanitis?

how does it present?

Answer 14

• diabetes

- presentation: sore inflamed glans, no retractable foreskin, discharge, dysuria. obstruction of meatus

Question 15

what is retires syndrome?

what do the lesions in circinate balanitis look like?

Answer 15

• conjunctivitis
• urethritis
• arthritis
• indistinguishable from psoriasis

Question 16

what is the treatment of scabies?

what is the treatment of pthyris pubis?

who gets molluscum contagiosum? what do they look like and how are they treated?

Answer 16

• permethrin 5% cream
• permethrin 1%
• often occurs in people who are immunosuppressed.
• well defined round papules with a punctum
• conservative treatment, cryotherapy