Cervical Screening and STI Flashcards
Vaginal Discharge Hx
Colour Consistency Blood Duration Timing Cyclical / constant Odour Previous Hx, sexual and menstrual hx
DDx
Infective (non STI) - bacterial vaginosis, candida
Infective (STI) - chlamydia, gonorrhoea, trichomonas, herpes simplex virus
Non-infective - foreign bodies, cervical polyps and ectopy, genital tract malignancy, fistulae
CIN
Appear white when stained with acetic acid.
1 - no tx needed, often return to normal
2 and 3 - may be removed
Dyskariosis
NOT a histological dx
Merely a description of how abnormal the cells on the surface of the cervix appear
Low grade
High grade - moderate or severe
HPV testing
HPV triage: borderline or mild dyskariosis - test for HPV - if negative returned to routine call
HPV test of cure: all women who are treated for CIN will have a test for HPV 6 months following their treatment - if negative no more follow up and returned to routine call, if positive then colposcopy
HPV vaccination
Introduced in September 2008 for girls 12-13 years
Cervarix - 16 and 18
Gardasil - 16, 18, 6 and 11
2012 - swapped to Gardasil
Bacterial Vaginosis (NOT AN STI)
Most common cause of abnormal vaginal discharge in women of reproductive age
Offensive, fishy smelling vaginal discharge, without soreness or irritation
O/E - usually a thin layer of white discharge covering vaginal wall
Common organisms - Gardnerella vaginalis, Prevotella spp, Mycoplasma hominis and more (they increase pH)
Bacterial Vaginosis RF
Sexual activity, new sexual partner, other STIs, ethnicity, IUCD, vaginal douching, bubble baths, receptive oral sex, smoking
Protective factors - COCP, condoms, circumcised partner
Dx
Can be difficult therefor can be empirical:
Typical symptoms and signs
Not at increased risk of STI (including being < 25)
Not postnatal / post miscarriage / post gynae surgery
Not pregnant
Not recently had tx for BV
No signs of alternative cause (fever, bleeding, pain, itch)
Raised pH if paper available to measure
Tx
Oral metronidazole 400-500 mg bd for 5-7 days. Tx of choice. May be used in pregnancy.
Oral metronidazole 2g stat (avoid in pregnancy)
Metronidazole vaginal gel
Oral clindamycin / clindamycin vaginal gel
Complications - endometritis, PID, increased risk of acquiring STIs, late miscarriage, preterm delivery, premature rupture of membranes, low birth weight, postpartum endometritis
Chlamydia
Most common STI in the UK - often asymptomatic
Females - vaginal discharge, dysuria, abdo pain, fever, intermenstrual and postcoital bleeding, deep dyspareunia
Males - urethritis with dysuria and urethral discharge / epididymo-orchitis presenting as unilateral testicular pain and swelling
Signs (chlamydia)
Women - inflamed cervix (‘cobblestone’) with contact bleeding, mucopurulent discharge, abdo tenderness, adnexal tenderness, cervical excitation
Men - epididymal tenderness, mucoid / mucopurulent discharge, perineal fullness due to prostatitis
Chlamydia Tx
Screening for other STIs, partner notification
Abx: Doxycycline 100mg bd 7 days (CI in pregnancy) / single dose of 1g azithromycin
Pregnancy: 1g azithromycin stat / erythromycin 500mg qds for 7 days or bd for 14 days (nausea can result in compliance issues) - TEST OF CURE IN 3 WEEKS