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Year 4 Gynae > Genital discharge > Flashcards

Genital discharge Flashcards

1
Q

Questions to ask regarding genital discharge

A 
Consistency
Volume 
Colour 
Blood
Smell 
Duration 
Washing 
Abx use
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2
Q

Differentials for abnormal genital discharge

A 
Chlamydia 
Gonorrhoea 
Trichomoniasis 
Bacterial vaginosis 
Mycoplasma genitalium

Cervical ectropion
Cervical neoplasm
Post menopausal vagintis

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3
Q

Associated female symptoms

A 
Pelvic pain 
PCB 
IMB 
Itchiness 
Dyspareunia 
Rashes
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4
Q

Examination for female genital discharge

A

Inspect genitalia
Speculum
+/- Bimanual exam

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5
Q

When to do a bimanual exam

A

If there is lower abdominal pain or deep dyspareunia

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6
Q

Investigations for abnormal genital discharge

A

High vaginal swab - wet mount and garm stain for microscopy

Vulvovaginal swab - NAAT

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7
Q

What does a high vaginal swab detect

A

Trichomonas vaginalis
Gardenerella vaginalis
Candida

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8
Q

What does a vulvovaginal swab detect

A

Chlamydia trachomatis

Neisseria gonorrhoea

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9
Q

Candidiasis presenting complaint

A

Thick, white, cheese-like discharge

Itching and soreness

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10
Q

Candidiasis history

A 
Antibiotic use 
Washing 
Steroid use 
Chemotherapy 
HIV 
Pregnancy 
DM 
Atopy
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11
Q

Investigations for candidiasis

A

high vaginal swabs - microscopy and culture

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12
Q

Microscopy of candida albicans

A

Spores
Psuedohyphae
Neutrophils

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13
Q

Treatment of candida albicans

A

Fluconazole orally stat

+ clotrimazole cream BDS for 2 weeks

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14
Q

Contrainidcations for fluconazole

A

Pregnancy and breastfeeding

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15
Q

Treatment for recurrent candida albicans

A

Fluconazole every 72 hours for 3 doses

then

Fluconazole once per week for 6 months

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16
Q

Advice for candidiasis

A

Good diabetes control
Avoid perfumed products
Do not over wash
May swap to POP

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17
Q

Bacterial vaginosis presenting complaint

A

Copious discharge
Fishy odour
White

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18
Q

Amsel criteria for bacterial vaginosis

A
  1. Discharge
  2. Clue cells on wet mount
  3. Raised pH
  4. KOH whiff test +ve
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19
Q

Microscopy for Gardenerella vaginalis

A

Gram positive cocci

20
Q

Hay Ison criteria for bacterial vaginalis

A

Gram stain of posterior fornix

21
Q

Bacterial vaginalis history

A 
Antibiotic use 
Washing 
Steroid use 
Chemotherapy 
HIV 
Pregnancy
22
Q

Treatment of bacterial vaginalis

A

Metronidazole BDS 5 days

23
Q

Bacterial vaginalis

A

Treat even if asymptomatic

Avoid high dose metronidazole

24
Q

Trichomonas vaginalis presenting complaint in females

A

Frothy discharge
Dysuria
Vulval soreness
Itching

25
Q

Sign of trichomoniasis

A

Strawberry cervix

26
Q

Trichomonas vaginalis presenting complaint in males

A

Non-specific urethritis

27
Q

Complications of trichomoniasis

A

Pre term
Low birth weight
Enhanced HIV transmission

28
Q

Investigations for trichomoniasis

A

High vaginal swab - wet mount, gram stain microscopy and culture

Speculum

NAAT from first void urine sample

29
Q

Treatment of trichomoniasis

A

Metronidazole BD 5 - 7 days - first line

Metronidazole 2g PO stat - 2nd line

30
Q

Associated male symptoms

A 
Testicular pain 
Anal pain 
Swellings 
Lumps 
Dysuria 
Urinary symptoms
31
Q

What does polymorphonuclear leucocytes indicate

A

Urethritis

32
Q

How to treat non-specific urethritis

A

Doxycycline bds oral - 7 days

33
Q

Non specific urethritis

A

Inflammation of the urethra that is not due to chlamydia or Neisseria gonorrhoea

34
Q

Presenting complaint for chlamydia

A 
Urethritis - dysuria 
Cervicitis - clear, thin discharge 
PMB
IMB 
Lower abdominal pain
35
Q

Complications of chlamydia

A 
PID
Epididymo - orchitis 
SARA - arthritis 
Tubal infertility 
Increased risk of ectopics
36
Q

Extra-genital symptoms of chlamydia

A

Conjunctivitis
Pharyngitis
SARA
Proctitis

37
Q

Treatment for chlamydia

A

Doxycycline PO BDS 7 days

Azithromycin if allergic

38
Q

Contraindications of doxycycline

A

Pregnancy

39
Q

When to retest for chlamydia

A

12 weeks

40
Q

Neisseria gonorrhoea on microscopy

A

Gram negative diplococci

41
Q

Presenting complaint of gonorrhoea

A

Purulent discharge

IMB or PCB

42
Q

Complications of gonorrhoea

A

PID
epididymo-orchitis
Proctitis

43
Q

Disseminated gonorrhoea

A

Rash
Joint pain
Erythema

44
Q

Investigations for gonorrhoea

A

Vulvovaginal swab - gram stain and microscopy and culture and sensitivity
First void urine - NAAT

45
Q

Treatment for gonorrhoea

A

Ceftriaxone IM single dose

46
Q

Mycoplasma genitalium treatment

A

1 week doxycycline + 3 days azithromycin

Year 4 Gynae (35 decks)

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