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Y4 Obs & Gyn > Discharge > Flashcards

Discharge Flashcards

1
Q

What causes cottage cheese discharge?

A

vaginal candidiasis

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2
Q

how would vaginal candidiasis present?

A

itching
white, cottage cheese discharge
pruritus
tenderness and burning sensation

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3
Q

how does penile candidiasis present?

A

soreness, pruritus
redness
dull, dry and glazed plaques and papules
vulvitis: superficial dyspareunia, dysuria

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4
Q

what is the pathophysiology candidiasis?

A
  • fungal: Candida albicans
  • transmission non-sexual
  • caused by overgrowth despite being part of normal commensal flora
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5
Q

what are some risk factors for candida?

A

immunosuppression, endogenous oestrogen, recent Abx, DM, mucosal breakdown, recurrent candidiasis

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6
Q

how is candida investigated?

A

microscopy - detection of blastospores, pseudohyphae and neutrophils
high vaginal swab - charcoal not routine if clinical strong

*recurrent investigate for immunosuppressive conditions

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7
Q

what is the management for candida?

A
  • first line fluconazole
  • second line clotrimazole pessary
  • pregnancy → cream or pessaries
  • recurrent → induction with fluconazole
  • general skin care

*compliance for medication, abstinence till complete, no use of soaps, tight underwear and douching

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8
Q

what causes grey-white discharge?

A

Bacterial vaginosis

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9
Q

what is the pathophysiology of BV?

A

bacterial imbalance of the vagina caused by an overgrowth of anaerobic bacteria, such as Gardnerella vaginalis, and a loss of lactobacilli, the dominant bacterial species responsible for maintaining an acidic vaginal pH

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10
Q

what factors could cause a pH imbalance which leads to BV?

A
  • Having multiple sexual partners or a new sexual partner
  • Douching
  • Lack of consistent condom use
  • Hormonal changes, such as those that occur in pregnancy
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11
Q

what are some risk factors for BV?

A

douching, perfumed products, cunnilingus, black race, recent change in partner, smoking, presence of an STI

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12
Q

how does is BV diagnosed?

A

Amsel’s criteria for diagnosis of BV - 3 of the following 4

  • thin, white homogenous discharge
  • clue cells on microscopy: stippled vaginal epithelial cells
    vaginal pH > 4.5
  • positive whiff test (addition of potassium hydroxide results in fishy odour)
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13
Q

how is BV investigated?

A
  • microscopy: no lactobacilli
  • pH: alkali
  • high vaginal swab
  • whiff test
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14
Q

how is BV managed?

A
  • Metronidazole or Clindamycin, which can be administered orally or intravaginally
    • Sex partners do not typically require treatment
    • can have a gel if cannot keep off alcohol
  • washing advice - no douching, no use of soaps
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15
Q

when might BV cause life threatening complications?

A

*if pregnant

  • results in an increased risk of preterm labour, low birth weight and chorioamnionitis, late miscarriage
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16
Q

What causes Offensive, yellow/green, frothy discharge?

A

Trichomonas vaginalis

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17
Q

what is the pathophysiology of trichomonas?

A
  • Flagellate protozoan
  • transmission: sex
18
Q

how might trichomonas present?

A
  • Vaginal discharge (thin, frothy yellow coloured)
  • Strawberry cervix on speculum examination
  • Vulval pruritus
  • Vulvovaginitis
  • Dysuria
  • Dyspareunia
19
Q

how might trichomonas present in men?

A
  • Urethral discharge
  • Urethral irritation/itching
  • Dysuria
  • Balanitis
20
Q

how is trichomonas investigated?

A
  • pH >4.5
  • microscopy of a wet mount shows motile trophozoites
21
Q

how is trichomonas managed?

A

oral metronidazole for 5-7 days, although the BNF also supports the use of a one-off dose of 2g metronidazole
- avoid alcohol during tx and 72h afterwards
- - full sexual health screen
- contact tracing and partner notifications
- avoid sex until tx
- test of cure not routine

22
Q

what are some complications of trichomonas?

A
  • Pelvic inflammatory disease: increases the risk of ectopic pregnancy and infertility
  • Altered vaginal flora
  • Prostatitis
  • In pregnancy, there is an increased risk of premature rupture of membranes and preterm birth
23
Q

what presents as Copious, mucopurulent discharge, dysuria, sx 3 days after new sexual contact?

A

Gonorrhoea

24
Q

what is the pathophysiology of gonorrhoea?

A
  • Neisseria gonorrhoea - gram negative intra-cellular diplococci
  • primary sites: columnar epithelium lines mucous membranes
    • urethra, endocervix, rectum, pharynx, conjunctiva
    • urethral - mucopurulent discharge
  • transmitted through sexual contact + direct inoculation of infected secretions, vertical transmission can cause ophthalmia neonatorum
25
Q

how does gonorrhoea present?

A
  • rectal: proctitis leading to pain, bleeding and discharge
    mucopurulent
    dysuria

Upon examination in women, discharge from the cervical os, Skene’s gland or Bartholin’s gland may be observed

26
Q

how is gonorrhoea investigated?

A
  • Self-taken vulvovaginal swab in women or self-obtained first pass urine in men; self-obtained rectal swab; or clinician-obtained endocervical or penile swab
  • Microscopy revealing monomorphic Gram-negative diplococci within polymorphonuclear leukocytes
  • Nucleic acid amplification tests (NAAT)
  • Culture
27
Q

how is gonorrhoea managed?

A

Ceftriaxone as the first-line treatment. Following treatment, a test of cure after 14 days is essential to monitor disease clearance and assess the effectiveness of the chosen antibiotic regimen

  • avoid sex
  • partner notification
  • treat them
28
Q

how does gonorrhoea complicate?

A
  • DIC: pustular lesions, joints, tendon involvement
    *are complication of gonococcal infection leading to systemic features (including arthritis, skin lesions and arthralgia)
  • transluminal spread - PID, epidiymoorchitis, prostatitis
29
Q

what presents as Colourless mucoid, watery urethral discharge, dysuria?

A

Chlamydia

30
Q

what is the pathophysiology of chlamydia?

A
  • Organism: chlamydia trachomatis, obligate intracellular bacteria
  • transmission: sexual contact, peri-natal transmission in vaginal canal → neonatal conjunctivitis and pneumonia
31
Q

how does chlamydia present in women?

A
  • Vaginal discharge
  • Proctitis
  • Post-coital bleeding (may indicate cervicitis)
  • Intermenstrual bleeding
  • Cervicitis on vaginal exam
  • PID
32
Q

how does chlamydia present in men?

A
  • Urethral discharge (usually clear)
  • Dysuria
  • Proctitis
  • scrotal pain → epididymo-orchitis
33
Q

how is chlamydia investigated?

A

For women: a vulvovaginal swab (either self-taken or clinician-taken) or an endocervical swab analysed using NAATs

For men: urine or urethral swab, analysed using the same method

For suspected anal infections: an anal swab, also analysed using NAATs

34
Q

how is chlamydia managed?

A

Treatment involves a course of oral doxycycline, administered twice daily for 7 days

Following treatment of rectal infections, a test of cure is usually recommended

  • contact tracing + partner notification
  • abstinence until completed tx
  • test of cure at 5w in case of rectal infection or pregnancy
35
Q

what are some complications of chlamydia?

A
  • Pelvic inflammatory disease (PID): increases the risk ofectopic pregnancyand infertility
  • Epididmyo-orchitis (leading to scrotal pain and swelling)
  • Prostatitis
  • Reactive arthritis
36
Q

what does vulvovaginal swabs test for?

A
  • NAAT for gonorrhoea and trachomatis
  • PCR for T.vaginalis
37
Q

what does high vaginal swab test for?

A
  • culture - t.vaginalis
  • microscopy with wet mount or gram stain
38
Q

what does endocervical swabs?

A

gonorrhoea

39
Q

what are some differentials for physiological discharge?

A
  • pregnancy
  • sexual arousal
  • cyclical
  • hormonal contraception
40
Q

what may cause pathological vaginal discharge?

A
  • candidiasis
  • TV
  • BV
  • foreign body
  • post-menopausal vaginitis
41
Q

what are some pathological cervical discharge?

A
  • gonorrhoea
  • chlamydia
  • herpes
  • non-specific genital infections
  • cervical ectopy

Y4 Obs & Gyn (16 decks)

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