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Obs and Gynae > Cervical Screening and STI > Flashcards

Cervical Screening and STI Flashcards

1
Q

Differential diagnosis for vaginal discharge

A

Infective (non-sexually transmitted)

  • bacterial vaginosis
  • candida

Infective (sexually transmitted)

  • chlamydia
  • gonorrhoea
  • trichomonas vaginalis
  • herpes simplex

Non-infective

  • foreign bodies
  • cervical polyps and ectopic
  • genital tract malignancy
  • fistulae
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2
Q

What is cervical ectropion?

A

Cells within cervix develop outside and form a red, inflamed patch

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3
Q

What laboratory test is performed on a high vaginal swab?

A

Microscopy, sensitivity and culture

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4
Q

What happens to borderline smears?

A

Mild dyskaryosis is tested for HPV

Those who are positive will be referred to colposcopy, negative are returned to routine callq

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5
Q

What is bacterial vaginosis?:

A

Overgrowth of bacteria in the vagina, specifically anaerobic bacteria

Caused by a loss of the lactobacilli “friendly bacteria” in the vagina

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6
Q

What are lactobacilli?

A

Main component of the healthy vaginal bacterial flora

Produce lactic acid that keeps the vaginal pH low

where there are less, pH is higher (more alkaline) enables anerobic bacteria to grow

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7
Q

Anaerobic bacteria associated with bacterial vaginosis

A

Gardnerella vaginalis (most common)

Mycoplasma hominis

Prevotella species

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8
Q

What are the risk factors for BV?

A

Multiple sexual partners (although it is not sexually transmitted)

Excessive vaginal cleaning (douching, use of cleaning products and vaginal washes)

Recent antibiotics

Smoking

Copper coil

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9
Q

How does BV present?

A

Fishy-smelling watery grey or white vaginal discharge

Itching, irritation and pain are not typically associated with BV

Half of women with BV are asymptomatic

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10
Q

What investigations are done on BV?

A

Vaginal pH can be tested using a swab and pH paper

Charcoal vaginal swab can be taken for microscopy

High vaginal swab taken during a speculum examination or a self-taken low vaginal swab

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11
Q

What is seen on microscopy in BV?

A

Clue cells

Clue cells are epithelial cells from the cervix that have bacteria stuck inside them, usually Gardnerella vaginalis

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12
Q

What is the treatment for BV?

A

Doesn’t usually require treatment

Metronidazole is abx of choice

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13
Q

What is PID?

A

Pelvic inflammatory disease is inflammation and infection of the organs of the pelvis

Caused by infection spreading up through the cervix

Significant cause of tubular infertility and chronic pelvic pain

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14
Q

What causes PID?

A

Most are aused by one of the sexually transmitted pelvic infections

Neisseria gonorrhoeae
Chlamydia trachomatis
Mycoplasma genitalium

Or less commonly:
Gardnerella vaginalis
Haemophilus influenzae
Escherichia coli

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15
Q

What are the RF associated with PID? (6)

A

Same as any other sexually transmitted infection:

Not using barrier contraception

Multiple sexual partners

Younger age

Existing sexually transmitted infections

Previous pelvic inflammatory disease

Intrauterine device (e.g. copper coil)

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16
Q

How does PID present? (6)

A

Fever

Pelvic or abdominal pain

Discharge

Bleeding (intermenstrual or postcoital)

Dyspareunia

Dysuria

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17
Q

What is found on examination in PID?

A

Pelvic tenderness

Cervical motion tenderness (cervical excitation)

Inflamed cervix (cervicitis)

Purulent discharge

Patients may have a fever and other signs of sepsis

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18
Q

What investigations are done for PID

A 
Test for causative organisms:
NAAT swabs for gonorrhoea and chlamydia
NAAT swabs for Mycoplasma genitalium if available
HIV test
Syphilis test

High vaginal swab can be used to look for bacterial vaginosis, candidiasis and trichomoniasis

Microscope can look for pus cells - Absence is useful for excluding PID

Pregnancy test
Inflammatory markers

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19
Q

How is PID managed?

A

Referral to GUM where appropriate

Abx started empirically before results to avoid delay in complications

Dependent on local guidelines
IM ceftriaxone to cover gonnorrhoea
Doxy - chlamydia and mycoplasma genitalium
Metronidazole to cover gardnerella

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20
Q

Complications of PID (6)

A

Sepsis

Abscess

Infertility

Chronic pelvic pain

Ectopic pregnancy

Fitz-Hugh-Curtis syndrome

21
Q

What is Fitz-Hugh-Curtis Syndrome?

A

Complication of pelvic inflammatory disease

Caused by inflammation and infection of the liver capsule (Glisson’s capsule)

Leads to adhesions between the liver and peritoneum

Bacteria may spread from the pelvis via the peritoneal cavity, lymphatic system or blood

Results in right upper quadrant pain (shoulder)
Laparoscopy can be used to visualise and also treat the adhesions

22
Q

How does candidiasis present?

A

Thick, white discharge that does not typically smell

Vulval and vaginal itching, irritation or discomfort

More severe:
Erythema
Fissures
Oedema
Pain during sex (dyspareunia)
Dysuria
Excoriation
23
Q

What investigations are carried out for candidiasis?

A

Vaginal pH can help differentiate between BV, trichomonas, and candidiasis (pH<4.5)

A charcoal swab with microscopy can confirm the diagnosis

24
Q

What are the management options for candidiasis?

A

Antifungal cream (i.e. clotrimazole) inserted into the vagina with an applicator

Antifungal pessary (i.e. clotrimazole)

Oral antifungal tablets (i.e. fluconazole)

25
Q

what is available for candidiasis otc?

A

Canesten Duo

Single fluconazole tablet and clotrimazole cream

26
Q

How does chlamydia present?

A

75% women asymptomatic

Consider if sexually active and:

Abnormal vaginal discharge
Pelvic pain
Abnormal vaginal bleeding (intermenstrual or postcoital)
Painful sex (dyspareunia)
Painful urination (dysuria)
27
Q

What is the management for chlamydia?

A

Doxycycline 100mg twice a day for 7 days (contraindicated in pregnancy and breastfeeding)

28
Q

Other management for chlamydia

A

Abstain from sex for seven days of treatment

Refer all patients to genitourinary medicine (GUM) for contact tracing and notification of sexual partners

Test for and treat any other sexually transmitted infections

Provide advice about ways to prevent future infection

Consider safeguarding issues and sexual abuse in children and young people

29
Q

Complication with chlamydia (8)

A

Chronic pelvic pain

Infertility

Reactive arthritis

Conjunctivitis

Lymphogranuloma venereum

Ectopic pregnancy

Pelvic inflammatory disease

Epididymo-orchitis

30
Q

What are the pregnancy related complications with chlamydia? (5)

A

Preterm delivery

Premature rupture of membranes

Postpartum endometritis

Low birth weight

Neonatal infection (conjunctivitis and pneumonia)

31
Q

How does gonorrhoea present?

A

Odourless purulent discharge, possibly green or yellow

Dysuria

Pelvic pain

32
Q

How is gonnorrhoea diagnosed?

A

Nucleic acid amplification testing (NATT) is use to detect the RNA or DNA of gonorrhoea

Urine sample

Charcoal endocervical swab should be taken for microscopy, culture and antibiotic sensitivities

33
Q

what is the management for gonorrhoea?

A

Referred to GUM clinic

A single dose of intramuscular ceftriaxone 1g if the sensitivities are NOT known

A single dose of oral ciprofloxacin 500mg if the sensitivities ARE known

Need NAAT testing for test of cure

34
Q

Complications of gonorrhoea (10)

A

Pelvic inflammatory disease

Chronic pelvic pain

Infertility

Conjunctivitis

Urethral strictures

Disseminated gonococcal infection

Skin lesions

Fitz-Hugh-Curtis syndrome

Septic arthritis

Endocarditis

35
Q

What is Disseminated Gonococcal Infection?

A

(GDI) is a complication of untreated gonococcal infection, where the bacteria spreads to the skin and joints. It causes:

Various non-specific skin lesions
Polyarthralgia (joint aches and pains)
Migratory polyarthritis (arthritis that moves between joints)
Tenosynovitis
Systemic symptoms such as fever and fatigue

36
Q

Presentation of mycoplasma genitalum

A

Presentation is very similar to chlamydia

Most cases do not cause symptoms

Urethritis is a key feature

37
Q

How is mycoplasma genitalum diagnosed?

A

Nucleic acid amplification tests (NAAT) to look specifically for the DNA or RNA if the bacteria

Vaginal swabs

38
Q

What is the treatment for MG?

A

Doxycycline 100mg twice daily for 7 days then;

Azithromycin 1g stat then 500mg once a day for 2 days (unless it is known to be resistant to macrolides)

Moxifloxacin is used as an alternative or in complicated infections

39
Q

What is trichomoniasis vaginalis?

A

Type of parasite spread through sexual intercourse

Protozoan, and is a single-celled organism with flagella

40
Q

How does trichomoniasis present?

A

Up to 50% of cases of trichomoniasis are asymptomatic

Vaginal discharge - frothy and yellow-green, may have a fishy smell

Itching

Dysuria (painful urination)

Dyspareunia (painful sex)

41
Q

What is found on examination in trichomoniasis?

A

strawberry cervix

Testing the vaginal pH will reveal a raised ph (above 4.5), similar to bacterial vaginosis

42
Q

How is trichomoniais treated?

A

Metronidazole

GUM referral

43
Q

How does herpes present?

A

Ulcers or blistering lesions affecting the genital area

Neuropathic type pain (tingling, burning or shooting)

Flu-like symptoms (e.g. fatigue and headaches)

Dysuria (painful urination)

Inguinal lymphadenopathy

44
Q

What is the treatment for herpes?

A

Aciclovir

45
Q

What bacteria is caused ny syphillis?

A

Treponema pallidum

46
Q

How does primary syphillis present?

A

Primary syphilis can present with:

A painless genital ulcer (chancre). This tends to resolve over 3 – 8 weeks

Local lymphadenopathy

47
Q

How is syphillis diagnosed?

A

Dark field microscopy

Polymerase chain reaction (PCR)

To confirm presence of T. Pallidum

48
Q

What is the management of syphillis?

A

IM benzathine benzylpenicillin (penicillin)

Obs and Gynae (19 decks)

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