403. Malaria, Fever in travellers and STI's Flashcards
In patients with suspected STI’s what areas should be examined?
Retract foreskin, inspect urethral meatus, scortum (standing up)
Vulval examiantion, speculum, bimanual, abdo/pelvis
Genitoanal area, protoscopy, inguinal lymph nodes, oral mucosa
Discuss the various types of syphillis?
Primary- <90d post infection, painless ulcers (chancre). Highly infectious
Secondary- 4-10 weeks, rash, mucou spatches, fever, headache, myalgia
Tertiary- 20-40yrs later, neurosyphillis- aseptic meningitis, focal neurology, argyll orbertson pupil.
Discuss the presentation of lymphogranuloma venerum
MSM
Painless papule/ulcer. Lymphadenopathy, fever, arthritis, pneumonitits.
What two tropical diseases can cause genital ulceration and lymphadenitis?
Chancroid and Donovanosis
Describe the various presnetations of vaginal discharge?
Candidiasis- cottage cheese and itch
Vaginosis- white fishy smelling vaginal discharge
Vagnialis- discharge and itch
Gonorrheoa- discharge, dysuria
Chlamydia- inter-menstrual beleding, dysuria, discharge
How is chlaymdia treated?
Azithromycin or dox 7 days
How is gonorrheoa treated?
Ceftriaxone and azithromycin
If complicated add dox and met
How is uretheritis treated?
azithromycin or dox 7 days
How is vaginalis treated?
Metrinidazole
How is vaginosis treated?
Oral or pV ,metronidazole
or clindamycin
How is candidiasis treated?
-azoles e.g. cloitrmazole cream
Oral fluconazole if severe
What are the key points for fever in the returning traveller?
Exclude malaria from all tropical travellers
Exclude HIV in all
Many will just have self limiting illnss from the UK
What diseases are common in sub saharan africa?
Malaria
HIV
Rickettsiae
What diseases are common in south east as
Malaria
Chikngunya
Dengue
Enteric fever
Name the common diseases of south and central asia as well as south america and the carribean?
Malaria
Dengue
Enteric Fever
In the middle east, mideterranian and north africa, what diseases are common?
BBrucellosis
Q-fever
Zika
What investigations woul dbe performed on a traveller returnign with a fever?
Malaria film
HIV test
FBC, LFT’s
Blood culture
Describe the presentation of thyphoid?
Fatigue, headache, anorexia
Stepwise fever
Abdo pain, bradycardia
Diorrheoa and hepatosplenomagaly in 2nd week
How is typhoid diagnosed?
BLood cultures
stool saple
Bone marrow
How is typhoid treated?
Azithromycin and IV ceftriaxone
Antipyretics, flui dmangement, nutrition
What causes the clinical manifestation of symptoms in malaria?
Rupture of altered red blood cells- erhtrocytic schizonts
What are they symptoms of malaria?
Non specific, look out for fever and travel history
heache, malaise, myalgia, diarroea, cough.
What are some differentials of malaria?
Dengue,
typhoid
hepatitis
meningitis/encephalitis
HIV
Viral heamorrhagic fever
What investigations are done in malaria?
Blood tests- microscopy of thick and thin or rapid test
FBC, U&E, glucose
ABG/lactate, urinalysis
How do you treat complicated falciparum malaria?
Artemehter- lumefantrine and dihydroartemisinin
If not available oral quinine sulphate and dox
How do you treat severe falciparaum malaria?
Atesunate regimen
or Quinine regimen
What is the treatment of choice for non falciparum malaria?
Chloroquine (cant be used in GD6P)
P vivax and P.ovale need primaquine for liver disease
How do you prevent getting malaria?
Insecticidal nets,
indoor spraying
sterile mosquito release
DEET
chloroquine or mefloquine or doxy
