Basic GU Flashcards
What’s the chlamydia concordance rates between partners?
75%
What’s the spontaneous clearance rate of chlamydia?
50% by 12 months
How many a) men and b) women are symptomatic for chlamydia?
Men 60%
Women 20%
In MSM what are Chlamydia rates a) rectally b) pharyngeal?
A) rectal 3-10.5%
B) pharyngeal 0.5-2.3%
What % of LGV is asymptomatic?
26%
Chlamydia treatment: what to give if azithro and doxy contraindicated.
Erythromycin 500mg BD for 14 days
Or
Ofloxacin 200mg BD for 7 days
Chlamydia treatment in pregnancy
Azithromycin Or Erythromycin 50pmg qds for 7 days Or Amoxicillin 500mg tds for 7 days
Time frame for a) opthalmia neonatorum b) pneumonia?
A) 5-12 days
B) 1-3 months
What’s the cause of LGV?
Ct serovarse L1 L2 L3
L2 most common
Lgv incubation period?
3-30 days
Lgv lymphadenopathy follows the primary lesion by how many days?
10-30
Lgv treatment
Doxycycline 100mg bd 3 weeks Or Erythromycin 500mg qds 3 weeks Or Azithromycin 1g once a week for 3 weeks
What % of gonorrhoea–> PID or epididymo-orchitis
14%
When is a confirmatory test reccomended for positive gonorrhoea?
If the positive predictive value of a population on <90%
What % of patients with gonorrhoea will also have chlamydia?
19%
Gonorrhoea transmission risk after 1 episode of sex for man to woman. And reduction with condom use?
Man to woman 60-80%
Reduced by 40% with a condoms
Gonorrhoea transmission risk after 1 episode of sex for woman to man. And reduction with condom use?
Woman to man 20%
Reduced by 75% by condom use
What’s can be used for treatment for gonorrhoea (other than ceftriaxone) if sensitivity is known? And what’s the UK resistance rate to this?
500mg ciprofloxacin only if known susceptible. UK resistance is 36.4%
What are alternative gonorrhoea treatments?
Cefixime 400mg po
Gebtanicin 240mg im
Spectinomycin 2g im (+ azithromycin if pregnant)
Treatment for disseminated gonorrhoea infection? 4 options.
Then oral switch options
Ceftriaxone 1g im or iv every 24 hours Or Cefotaxime 1g iv every 8 hours Or Ciprofloxacin 500mg iv every 12 hours Or Spectinomycin 2g im every 12 hours
24-48 hours after symptoms improve can switch to oral:
Cefixime 400mg bd
Ciprpfloxacon 500mg bd
Ofloxacin 400mg bd
Total 7 day treatment
Whats the estimated prevalence of M Gen in the general population?
1-2%
M gen is seen in what % of a) NGU b) PID
Ngu: 15-25%
Pid: 10-13%
What % of m gen carriers are symptomatic? A men b) women
Men <10%
Women <5%
Whats the abstinence advice for M Gen?
14 days from starting treatment (and until symptoms resolve)
What’s the UK rate of microcode resistance in M Gen?
40%
Whats the eradication rate of M Gen with doxycycline monotherapy?
30-40%
What’s the reccomended treatment for ‘simple’ M Gen?
Doxycycline 100mg bd for 7 days then azithromycine 1g then 500mg od for 2 days (max 2 weeks between the 2)
What’s the treatment for m gen PID and epididymo orchids?
Moxifloxaxin 400mg is for 14 days
What are the risks of moxifloxacin?
As a fluoroquinolone: tendinitis and tendon rupture, prolonged QT, peripheral neuropathy
Whats the treatment of m gen in pregnancy?
3 day course of Azithromycin
Other than chlamydia and m gen what are causes of NGU?
Ureaplasmas
TV
Adenovirus
HSV
What’s the diagnostic criteria for NGU?
> 5 PMNLs per high power field (x1000)
SARA occurs in what % of lower genital tract infections?
0.8-4%
What factors increase susceptibility to SARA?
Male gender
HLA b27 gene
Whats the time from sex to onset of arthritis?
Within 30 days (mean is 14 days)
Describe the point involvement pattern in SARA
Asymmetrical
1-5 joints
Usually lower limb (upper limb involvement is rare in the absence of psoriasis)
Whats the mean duration of 1st SARA episode?
4-6 months
What % have recurrent SARA symptoms?
50%
What % have chronic SARA symptoms >1 year?
17%
What skin lesions can be found in SARA?
Keratoderma blennorrhagica
Circinate balanitis
How long can it take pain and swelling to resolve following treatment for epididymo orchitis?
Swelling and tenderness can persist after treatment but should be significantly better. Will have completely resolved in 80% by 3 months
Whats the sensitivity of a wet slide diagnosis in TV?
45-60%
Whats the spontaneous cure rate of TV?
20-25%
Whats the intravaginal therapy cure rate for TV?
50%
What do to in the case of tv treatment failure
1) repeat 7 day course
2) higher dose metro eg 2g od or 800mg tds for 7 days (70% will respond)
3) resistance testing
4) high dose Tinidazole (92% will respond)
What % of women will have recurrent thrush?
6%
In recurrent thrush cases what would make you test for mannose binding lectin deficiency?
History of URTIs, otitis media, autoimmune conditions
Whata thrush treatment in pregnancy?
Clotrimazole pessary ON for 7 nights
Treatment for:
Candida glabrata
Candida krusei
Glabrata: mostly susceptible to azoles but may need higher dose eg fluconazole 200-300mg OD every 48 hours for a week
Krusei: resistant to fluconazole so non azole therapy for 14 days
What are the intra vaginal treatment options for BV?
0.75% metronidazole gel
2% clindamycin cream
Bilateral epididymo orchitis- what’s the rate on infertility?
13%
Infertility rate with PID
1 episode
2 episodes
3 episodes
8%
20%
40%
