Genital Infection Flashcards
What are the most common causes of genital ulcers?
1) Herpes
2) Syphilis
Also chancroid, lymphogranuloma, donovanosis.
How does Herpes present?
Painful ulcers: confluent vesicles lose their tops and become ulcers.
Dyspareunia.
Altered discharge.
Constitutional symptoms - myalgia, fatigue, fevers.
Also recurrences in 75%.
How do you investigate Herpes?
Swab + PCR.
How do you treat Herpes?
Primary infection: acyclovir 200mg 5 times a day, + saline baths, topical lignocaine, analgesia.
Recurrences: don’t treat unless lots of recurrences.
What is the causative organism in syphilis?
Treponema pallidem (a spirochete)
What is the incubation period of syphilis?
10-30d
How does primary syphilis present?
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.
What investigations would you do in syphilis?
Serology for treponemal Ab and cardiolipin Ab.
Dark ground microscopy for treponemes.
How does secondary syphilis present?
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.
How would you treat syphilis?
Procaine penicillin G, daily for 10d or Benzathine penicillin single dose of depot.
How would you treat genital warts?
Podophylotoxin or imiquimod.
Or clinically if not responsive (cryotherapy, hyfrecation etc.)
How do you treat candida?
Clotrimazole (cream) or fluconazole (tablet).
What causes candida to recur?
Pregnancy, diabetes, thyroid disease, iron deficiency, immunosuppression, Abx.
What causes strawberry cervix?
Trichomonas.
How does trichomonas present?
Offensive grey-green discharge, vulval irritation and superficial dyspareunia.
How would you treat a trichomonal infection?
Metronidazole.
How would you treat bacterial vaginosis?
Metronidazole - local or systemic.
How do you diagnose bacterial vaginosis? What criteria is used?
Symptomatic discharge.
pH >4.5.
Clue cells (salt and pepper) on gram stain).
Positive amine test.
Criteria = hay/ison criteria for microflora.
What medical problems are asociated with bacterial vaginosis?
Preterm labour and late miscarriage.
What would you see on microscopy for gonorrhoea?
Gram negative diplococci.
How would you treat gonorrhoea?
Cephalosporins.
How does chlamydia normally present?
Normally asymptomatic!
But presents with urethritis and discharge if anything.
What is the main complication of chlamydia infection? What are its consequences?
What is the other main complication of chlamydia?
1) PID, infertility.
2) Reiter’s syndrome.
How do you investigate chlamydia?
Urine PCR.
