Genital Tract Infections Flashcards
How soon after unprotected sexual intercourse are chlamydia, gonorrhoea, HIV, and syphilis identifiable in tests?
- Chlamydia and gonorrhoea - 2-3 weeks
- HIV - 1 month
- Syphilis - 3 months
Which infections does a high vaginal swab detect?
BV, TV, candida
Which infections does an endocervical/vulvo-vaginal swab detect?
Chlamydia, gonorrhoea
What is this a presentation of?
Often asymptomatic. Female, recent unprotected sex, dyspareunia, dysuria, intermittent IMB/PCB, increased vaginal discharge.
Chlamydia trachomatis
What is this a presentation of?
Often asymptomatic. Male, recent unprotected sex, dysuria, urethral discharge.
Chlamydia trachomatis
How is chlamydia diagnosed?
- Female - NAAT on vulvo-vaginal swab
2. Male - first pass urine, then oral/anal swabs if had oral/anal sex.
What is the treatment for chlamydia infection?
- Azithromycin 1g PO single dose
- Or doxycycline 100mg BD for 1 week
- No sex for 1 week
- Contact tracing and treat partners
How is chlamydia treated in pregnancy?
- Erythromycin 500mg BD for 2 weeks
2. Can cause neonatal conjunctivitis
What are the complications of a chlamydia infection?
- PID
- Perihepatitis - Fitz-Hugh-Curtis syndrome
- Tubal infertility
- Increased ectopic pregnancy
What is this a presentation of?
Urethral/vaginal discharge, dysuria, lower abdominal pain, PCB, IMB, recent unprotected sex. Half of females asymptomatic.
Neisseria gonorrhoeae
What type of organism is Neisseria gonorrhoeae?
Gram -ve diplococcus
What are the complications of gonorrhoea infection?
- PID
- Bartholin’s/Skene’s abscess
- Tubal infertility
- Increased ectopic pregnancy
How is gonorrhoea diagnosed?
- Female - NAAT on vaginal swab
- Male - first pass urine
- Culture for sensitivities on chocolate agar if NAAT +ve
What is the management for gonorrhoea infection?
- Ceftriaxone 500mg IM and azithromycin 1g PO
- Contact tracing
- No sex for 1 week
- Treatment the same in pregnancy (can cause neonatal conjunctivitis)
What is this a presentation of?
Female, recent unprotected sex, grey/green frothy vaginal discharge, itch, strawberry cervix.
Trichomonas vaginalis infection
How many men are asymptomatic in trichomonas vaginalis infection?
70%, can have some discharge.
How is trichomonas vaginalis infection investigated?
- Saline drop wet slide microscopy
2. NAAT
What is the treatment for trichomonas vaginalis infection?
- Metronidazole 400mg BD for 5 days
- Contact tracing
- No sex for one week
What is this a presentation of?
Female. Thin, white, fishy smelling vaginal discharge. No itch or soreness. Asymptomatic in half.
Bacterial vaginosis
How is bacterial vaginosis investigated?
- Gram stain to examine vaginal flora
2. Clue cells, lack of lactobacilli, vaginal pH >4.5, mix with KCl = ammonia smell (positive whiff test)
What is the treatment for bacterial vaginosis?
Oral or PV metronidazole
What is this a presentation of?
Genital itch, burning, cottage cheese-like discharge, dyspareunia.
Genital candidiasis
What are the risk factors for genital candidiasis?
Pregnancy, steroids, immunodeficiency, antibiotics, diabetes mellitus.
How is genital candidiasis investigated?
Microscopy and culture for candida.
What is the treatment for genital candidiasis?
- Clotrimazole 500mg pessary PV and cream for vulva and/or PO Fluconazole 150mg.
- Use topical regime alone if pregnant or breastfeeding.
What is this a presentation of?
Flu-like prodrome followed by stinging and itching around genitals, anus and throat. Vesicles bursting and crust over. Local lymphadenopathy and dysuria. Can reoccur.
Genital herpes (HSV 1 and 2)
How is genital herpes investigated?
Clinical investigation and PCR
What is the management of genital herpes?
- Acyclovir 500mg 5 times per day for 5 days
- Lidocaine gel for analgesia
- Suppressive therapy if indicated - Acyclovir 400mg BD for 3 months
What is this a presentation of?
Within 90 days of infection. Macule, papule, typically painless ulcer (chancre). Highly infectious.
Primary syphilis
What is this a presentation of?
4-10 weeks after dissemination. Rash on palms/soles, warty genital/perioral growths, fever, headache, myalgia, lymphadenopathy, hepatitis.
Secondary syphilis
What is this a presentation of?
20-40 years after infection. Focal neurological deficits, seizures, psychiatric problems, aortic regurgitation.
Tertiary syphilis
How is syphilis investigated?
- PCR
- VDRL test +ve
- Congenital syphilis - Hutchinson teeth, deafness, keratitis
What is the treatment for syphilis?
Benzathine penicillin IM
Which organism is responsible for syphilis?
Treponema pallidum
What is this a presentation of?
May be subclinical. External warts affecting vulva, perianus, and cervix. May be itchy.
Genital warts
Which organism is responsible for genital warts?
Condylomata acuminate
How is are genital warts diagnosed?
Clinical diagnosis
What is the treatment for genital warts?
- No treatment is an option - spontaneous regression
- Topical podophyllin or imiquimod and/or cryotherapy
- In pregnancy - only treat with cryotherapy
What is the treatment for mycoplasma genitalium?
- Azithromycin 1g STAT then 500mg OD for 2 days
2. Moxifloxacin
Over what size is abnormal in lymphadenopathy?
> 2cm
What are the most common causes of tender and non-tender lymphadenopathy?
- Tender - HSV
2. Non-tender - syphilis
What is this a presentation of?
Retained tampon, high fever, hypotension, multisystem organ failure.
Toxic shock syndrome
Which organism is responsible for toxic shock syndrome?
Toxin producing staphylococcus aureus
