Cervical Screening and STI Flashcards
Differential diagnosis for vaginal discharge
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
What is cervical ectropion?
Cells within cervix develop outside and form a red, inflamed patch
What laboratory test is performed on a high vaginal swab?
Microscopy, sensitivity and culture
What happens to borderline smears?
Mild dyskaryosis is tested for HPV
Those who are positive will be referred to colposcopy, negative are returned to routine callq
What is bacterial vaginosis?:
Overgrowth of bacteria in the vagina, specifically anaerobic bacteria
Caused by a loss of the lactobacilli “friendly bacteria” in the vagina
What are lactobacilli?
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
Anaerobic bacteria associated with bacterial vaginosis
Gardnerella vaginalis (most common)
Mycoplasma hominis
Prevotella species
What are the risk factors for BV?
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
How does BV present?
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
What investigations are done on BV?
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
What is seen on microscopy in BV?
Clue cells
Clue cells are epithelial cells from the cervix that have bacteria stuck inside them, usually Gardnerella vaginalis
What is the treatment for BV?
Doesn’t usually require treatment
Metronidazole is abx of choice
What is PID?
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
What causes PID?
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
What are the RF associated with PID? (6)
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)
How does PID present? (6)
Fever
Pelvic or abdominal pain
Discharge
Bleeding (intermenstrual or postcoital)
Dyspareunia
Dysuria
What is found on examination in PID?
Pelvic tenderness
Cervical motion tenderness (cervical excitation)
Inflamed cervix (cervicitis)
Purulent discharge
Patients may have a fever and other signs of sepsis
What investigations are done for PID
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
How is PID managed?
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
Complications of PID (6)
Sepsis
Abscess
Infertility
Chronic pelvic pain
Ectopic pregnancy
Fitz-Hugh-Curtis syndrome
What is Fitz-Hugh-Curtis Syndrome?
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
How does candidiasis present?
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
What investigations are carried out for candidiasis?
Vaginal pH can help differentiate between BV, trichomonas, and candidiasis (pH<4.5)
A charcoal swab with microscopy can confirm the diagnosis
What are the management options for candidiasis?
Antifungal cream (i.e. clotrimazole) inserted into the vagina with an applicator
Antifungal pessary (i.e. clotrimazole)
Oral antifungal tablets (i.e. fluconazole)
