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Obstetrics & Gynaecology > Genital Infections > Flashcards

Genital Infections Flashcards

1
Q

Definition of recurrent vulvovaginal candidiasis

A

At least 4 episodes of infection per year and/or a positive microscopy of moderate to heavy growth of C. albicans

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2
Q

Prevalence of C. albicans in asymptomatic women

A

30-40%

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3
Q

Indications for treatment of vulvovaginal candidiasis

A

Only if symptomatic
Pregnancy is not an indication for treatment - no evidence of adverse outcomes and oral imidazoles are contraindicated in pregnancy

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4
Q

Causes of vulvovaginal candidiasis

A 
80-90% C. albicans
Non-albican species (tend to have similar symptoms but more severe and/or recurrent)
- C. tropicalis
- C. glabrata
- C. krusei
- C. parapsilosis
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5
Q

Factors pre-disposing to vulvovaginal candidiasis

A 
Pregnancy
High-dose COCP
Immunosuppression
Broad spectrum antibiotics
Diabetes
Hormone Replacement Therapy
HIV
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6
Q

Microbiology of C. albicans

A

Diploid fungus
Gram positive spores + long pseudohyphae
Common commensal in gut flora

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7
Q

Diagnosis of C. albicans

A

Vaginal swab Gram stain:
Gram +ve spores and long pseudohyphae
Numerous polymorphs
Abnormal bacterial flora (resembling bacterial vaginosis)

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8
Q

Management of uncomplicated vulvovaginal candidiasis

A

Avoid soaps, perfumes, synthetic underwear
Change from high to low dose COCP or to progesterone only if recurrent
Either a single treatment or a course of several applications/pessaries
Local topical azole
Oral: fluconazole 150mg single dose
OR clotrimazole single 500mg pessary or 100mg pessaries over 6 days

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9
Q

Maintenance treatment for recurrent vulvovaginal candidias

A

150mg Fluconazole weekly for 6 months
OR
weekly topical clotrimazole 500mg for 6-8 weeks

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10
Q

Evidence for use of oral or vaginal lactobacillus or yeasts for vulvovaginal candidiasis

A

NO EVIDENCE. not recommended

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11
Q

Definition of trichomonas vaginalis

A

A severe vulvovaginitis caused by the protozoan trichomonas that is usually sexually transmitted and commonly recurs if male partner is not treated

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12
Q

Clinical features of trichomonas vaginalis

A

Vulval soreness and itching
Foul smelling frothy yellowish green discharge
Dysuria
Abdominal discomfort
Strawberry cervix - punctate haemorrhages
May be asymptomatic carrier

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13
Q

Confirming diagnosis of trichomonas vaginalis

A

MCS of vaginal swab:

  • cone-shaped, flagellated organism with terminal spike
  • motile protozoa - i.e. amoeboid motion with flagella waving if looking at under microscope
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14
Q

Management of trichomonas vaginalis

A

Metronidazole - 2g single oral dose

Ensure screening and treatment of partners too

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15
Q

Normal vaginal pH

A

4.5 i.e. slightly acidic environment

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16
Q

Definition of bacterial vaginosis

A

A common condition of the vagina characterised by the presence of foul-smelling vaginal discharge in the absence of obvious inflammation. It is caused by an increase in the vaginal pH secondary to a change in the flora of the vagina from normal lactobacilli to predominantly anaerobes

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17
Q

Risk factors for bacterial vaginosis

A 
Sexual activity
Woman-woman sexual intercourse
HSV-2 infection
HIV infection
Vaginal douching
Cigarette smoking
18
Q

Common species involved in bacterial vaginosis

A

Gardnerella vaginalis
Mobilinicus spp.

Mycoplasma hominis
Bacteroides spp.

19
Q

Clinical features of bacterial vaginosis

A

Fishy malodorous vaginal discharge
More prominent during and following menstruation
Creamy or greyish-white vaginal discharge adherent to vaginal wall
May be asymptomatic carrier

20
Q

Diagnostic criteria for bacterial vaginosis

A

Amsel criteria:

  1. Presence of clue cells on microscopic examination of vaginal swab
  2. creamy greyish white discharge seen on naked eye examination
  3. Vaginal pH >4.5
  4. Positive whiff amine test (release of characteristic fishy odour on addition of alkali: 10% potassium hydroxide)

at least 3 of the 4 to make a diagnosis

21
Q

What is a clue cell

A

An epithelial cell studded with adherent coccobacilli that gives the cell a stipple appearance - indicator of bacterial vaginosis

22
Q

Management of bacterial vaginosis

A 
ORAL
400mg metronidazole BD 5 days
2g metronidazole single dose
300mg clindamycin BD 7 days (preferred in pregnancy)
Tinidazole 2g orally single dose
OR TOPICAL METRONIDAZOLE OR CLINDAMYCIN
23
Q

Microbiology of neisseria gonnorhoea

A

Gram-negative intracellular diplococcus
Has affinity to infect the mucous membranes of the genital tract - columnar and cuboidal epithelium in endocervical and urethral mucosa
Can also infect the rectal and oropharyngeal mucous membrane

24
Q

Clinical features of gonorrhoea in a symptomatic females

A

Increased discharge
Lower abdo/pelvic pain
Dysuria with urethral discharge
Proctitis with rectal bleeding, discharge and pain (if anal sex)
Endovcercvical mucopurulent discharge and contact bleeding
Mucopurulent urethral discharge
Pelvic tenderness with cervical excitation

25
Q

Clinical features of gonorrhoea in symptomatic males

A

Dysuria
white, yellow or green urethral discharge
Painful or swollen testicles (less common)
Rectal infection: discharge, itching, soreness, bleeding, painful bowel movements

26
Q

Diagnosis of gonorrhoea

A

Endocervical swabs/swabs from symptomatic areas
- Gram-negative intracellular dipplococci
OR
nucleic acid amplification tests: can test samples from urine and lower vagina

27
Q

management of gonorrhoea

A

Contact tracing
Antibiotics:
in urban Australia: Ceftriaxone 500mg IV or IM + Azithromycin 1g orally (single doses)

In remote areas (less penicillin resistance):
amoxycillin 3g, probenecid 1g, azithromycin 1g all as single oral doses

28
Q

Groups at highest risk of STIs

A 
Young people under 25
Men who have sex with men
People who inject drugs
Sex industry workers
Known contacts of someone with an STI
29
Q

5 Ps of sexual history taking

A 
Partners
Practices
Protection from STIs
Past history of STIs
Prevention of pregnancy (contraception)
30
Q

Chlamydia trachomitis serotypes responsible for genitourinary infection

A

Serotypes D-K

A-C infect the conjunctiva and cause trachoma

31
Q

Clinical features of chlamydia in women

A 
Majority asyptomatic
Increased vaginal discharge
Lower abdominal pain
Postcoital bleeding
Intermenstrual bleeding
Mucopurulent cervical discharge with contact bleeding
Dysuria with urethral discharge
32
Q

Clinical features of chlamydia in men

A

Mucoid or watery urethral discharge - often clear and only seen upon milking the urethra
Dysuria
Incubation period approx 5-10 days i.e. longer than that of gonorrhoea

33
Q

Gold standard investigation for diagnosis of chlamydia

A

Nucleid acid amplificationt test (NAAT)
- first catch urine sample, low vaginal swab or endocervical swab
Microscopy is not useful for the diagnosis of chlamydia

34
Q

Management of uncomplicated chlamydia in women

A

Azithromycin 1g orally single dose
OR
Doxycycline 100mg orally BD for 7 days

35
Q

Management of chlamydia in men

A

doxycycline 100mg BD for 14-21 days
OR
Azithromycin 1g orally stat, repeated 1 week later if concern of adherence

36
Q

Management of STI suspected epididymo-orchitis without identified organism

A 
Treat for both chlamydia and gonorrhoea:
Ceftriaxone 500mg IM or IV
PLUS
Azithromycin 1g orally stat
PLUS Doxycycline 100mg BD 14 days or Azithromycin 1g 1 week later
37
Q

Factors affecting recurrent infection in genital herpes

A

More likely to occur in HSV2 (4x per year) v HSV1 (1x per year)
Longer duration and greater severity of primary infection

Recurrence rates highly variable

38
Q

Management of genital herpes primary infection

A

Oral Aciclovir, famciclovir of valaciclovir for 5 days
begin treatment as soon as clinical diagnosis is made
up to 10 days of treatment may be needed for severe disease

39
Q

Management of recurrent genital herpes

A

Most patients will not require treatment with mild infrequent recurrences

Episodic treatment if infrequent and moderate severity
Short courses started with onset of prodromal symptoms or with onset of lesions
Aciclovir, famciclovir or valaciclovir for 1-5 days accordingly

Suppressive therapy: indicated for frequent severe recurrences, reduces recurrence by 70-80%
Aciclovir, famciclovir, (BD) valaciclovir (once daily), reassess at 6 months
Can safely be continued long-term

40
Q

Diagnosis of genital herpes

A

Confirm clinical diagnosis with PCR, viral culture of immunofluoresence of vesicular fluid ideally

serology may be useful if repeat swabs negative, patients with partners who have genital herpes, risk of new infection in pregnancy

41
Q

Management of gonorrhoea

A

500mg IM ceftriaxone

42
Q

Gonorrhoea and chlamydia contact tracing

A

Gonorrhoea: sexual partners from past 2 months
Chlamydia: sexual partners in last 6 months

Obstetrics & Gynaecology (22 decks)

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