Genital Infection

Question 1

What are the most common causes of genital ulcers?

Answer 1

1) Herpes
2) Syphilis

Also chancroid, lymphogranuloma, donovanosis.

Question 2

How does Herpes present?

Answer 2

Painful ulcers: confluent vesicles lose their tops and become ulcers.

Dyspareunia.

Altered discharge.

Constitutional symptoms - myalgia, fatigue, fevers.

Also recurrences in 75%.

Question 3

How do you investigate Herpes?

Answer 3

Swab + PCR.

Question 4

How do you treat Herpes?

Answer 4

Primary infection: acyclovir 200mg 5 times a day, + saline baths, topical lignocaine, analgesia.

Recurrences: don’t treat unless lots of recurrences.

Question 5

What is the causative organism in syphilis?

Answer 5

Treponema pallidem (a spirochete)

Question 6

What is the incubation period of syphilis?

Answer 6

10-30d

Question 7

How does primary syphilis present?

Answer 7

Papule that becomes a single painless ulcer. It has a clear base, indurated margin and rolled edge. It is associated with ipsilateral lymphadenopathy and no constitutional change.

Question 8

What investigations would you do in syphilis?

Answer 8

Serology for treponemal Ab and cardiolipin Ab.

Dark ground microscopy for treponemes.

Question 9

How does secondary syphilis present?

Answer 9

Symmetrical papular eruption, non pruritic. Involves soles and palms! Occurs 4-10wks after primary infection. Condylomata lata seen, as well as mucosal erosions and snail track ulcers.

Question 10

How would you treat syphilis?

Answer 10

Procaine penicillin G, daily for 10d or Benzathine penicillin single dose of depot.

Question 11

How would you treat genital warts?

Answer 11

Podophylotoxin or imiquimod.

Or clinically if not responsive (cryotherapy, hyfrecation etc.)

Question 12

How do you treat candida?

Answer 12

Clotrimazole (cream) or fluconazole (tablet).

Question 13

What causes candida to recur?

Answer 13

Pregnancy, diabetes, thyroid disease, iron deficiency, immunosuppression, Abx.

Question 14

What causes strawberry cervix?

Answer 14

Trichomonas.

Question 15

How does trichomonas present?

Answer 15

Offensive grey-green discharge, vulval irritation and superficial dyspareunia.

Question 16

How would you treat a trichomonal infection?

Answer 16

Metronidazole.

Question 17

How would you treat bacterial vaginosis?

Answer 17

Metronidazole - local or systemic.

Question 18

How do you diagnose bacterial vaginosis? What criteria is used?

Answer 18

Symptomatic discharge.

pH >4.5.

Clue cells (salt and pepper) on gram stain).

Positive amine test.

Criteria = hay/ison criteria for microflora.

Question 19

What medical problems are asociated with bacterial vaginosis?

Answer 19

Preterm labour and late miscarriage.

Question 20

What would you see on microscopy for gonorrhoea?

Answer 20

Gram negative diplococci.

Question 21

How would you treat gonorrhoea?

Answer 21

Cephalosporins.

Question 22

How does chlamydia normally present?

Answer 22

Normally asymptomatic!

But presents with urethritis and discharge if anything.

Question 23

What is the main complication of chlamydia infection? What are its consequences?

What is the other main complication of chlamydia?

Answer 23

1) PID, infertility.
2) Reiter’s syndrome.

Question 24

How do you investigate chlamydia?

Answer 24

Urine PCR.

Question 25

How do you treat chlamydia?

Answer 25

Macrolides (e.g. erythromycin 1g stat).

Question 26

What are the causative factors in PID?

Answer 26

Sexual factors: STI in vagina / cervix spontaneously spreading.

Instrumentation of the uterus, complications of childbirth / miscarriage and descending infection can also help spread.

Question 27

What are the most common bacteria in PID?

Answer 27

Chlamydia.

Gonorrhoea: often presents acutely.

Question 28

What is fitz-hugh-curtis syndrome?

Answer 28

Perihepatitis due to PID. Causes RUQ pain due to adhesions between liver and anterior abdo wall.

Question 29

How does PID present?

Answer 29

Often late with subfertility.

Hallmark is bilateral abdo pain with deep dyspareunia +- abnormal bleeding / discharge.