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Genital tract infections Flashcards

1
Q

Normal vagina is colonized by what and what is the pH

A

Lactobacillus, <4.5

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2
Q

What happens to the vagina in prepubertal and post menopausal women

A

No oestrogen= atrophy and pH6.5-7.5 and reduced resistance to infection

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3
Q

What is the most commong cause of vaginal infection

A

Candida albicans 20%

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4
Q

Risk factors for candida

A

Diabetes, pregnancy and use of antibiotics

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5
Q

Symptomatic candida albicans presents as

A

Cottage cheese discharge, vulval irritation , itching, superfical dyspareunia, dysuria, inflamed/red vagina/vulva

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6
Q

How is candida diagnosed

A

culture

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7
Q

How do you treat candida infections

A

Topial imidazole- clotrimazole/oral fluconoazole

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8
Q

How does Bacterial vaginosis occur?

A

Normal lactobacilli overtaken by Gardenerella and mycoplasma hominis.

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9
Q

How does BV present?

A

Grey white discharge, vagina not red or itchy, fishy odour from amines released by bacterial proteolysis

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10
Q

How is BV diagnosed? (4)

A

Raised vaginal pH, typical discharge, whiff test positive and presence of clue cells on microscopy

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11
Q

How would you treat symptomatic BV?

A

Metronidazole or clindamycin cream

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12
Q

Complications of BV?

A

Secondary infection in PID and association with preterm labour.

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13
Q

Infection and discharge in children is usually due to?

A

foreign body/abuse

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14
Q

Retained hyperabsorbable tampons cause

A

Toxic shock syndrome

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15
Q

Principles of management of STIs (6)

A 
Screening
Regular sexual partner
Partner notification
Confidentiality
Education
Barrer method of contraception
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16
Q

Most commn STI in the developed world

A

Chlamydia trachomatis

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17
Q

Chlamydia presents as

A

Asymptomatic, urethritis vaginal discharge

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18
Q

Complication of chlamydia is

A

PID–>tubal damage and subfertility, chonic pelvic pain

Reiter’s syndrome-u,c,a

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19
Q

How do you investigate chlamydia

A

NAATs, PCR of urine

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20
Q

Treatment of chamydia

A

Azithromycin/doxyclycline

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21
Q

Gonorrhoea is caused by, which is

A

Neisseria, gram-ve diplococcous

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22
Q

Gonorrhoea presents in women as

A

asymp or vaginal discharge, urethritis, bartholinitis, cervicitis/ pelvis

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23
Q

Gonnorhoea presents in men as

A

urethritis

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24
Q

What are the systemic complications of Gonorrhoea

A

Bacteraemia/ acute monoarticular septic arthritis

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25
Diagnosis of Gonnorhoea is made by
NAAT, but Endocervical swabs for culture for sensitivities
26
Gonorrhoea is now treated with
IM ceftriaxone, Abx resistance has increased to ciprofloxacin
27
Genital warts has another name
condylomata acuminata
28
Genital warts are caused by
HPV
29
Warts mainly affect the
Cervix, HPV16,18 involved in CIN
30
How do you treat genital warts?
Topical podophyllin or imiquimod cream | Cryotherapy or electocautery for resistant warts
31
Genital herpes is caused by
Herpes simplex type 2
32
What happens in primary genital herpes infection? (4)
Commonly- Multiple small painful vesicles and ulcers aound introitus, local lymphadenopathy, dysuria and systemic symptoms-
33
Genital herpes may complicate. What happens? (2)
Aseptic meningitis or acute urinary retention
34
What happens to HSV2 after primary infection
Dormant in dorsal root gangla- 75% recur
35
Diagnosis is established by
Examination and viral swabs
36
Treated by
Aciclovir (vala/fam)
37
Syphillis is caused by
Spirochete treponema pallidum
38
What are the presenting syndromes of syphillis
Primary, secondary, latent, tertiary
39
How does primary syphillis present?
solitary painless vulval ulcer (chancre)
40
How does secondary syphillis present?
Weeks after secondary with rash, flulike symptoms, warty genital/perioral growth. infitrates other organs and causes disease
41
How does latent syphillis present?
other phases resolve spontaneously, stays in body
42
How does tertiary syphillis present and what are the complications?
Rare, any organ, Aortic regurgitation, Dementia, tabes dorsalis, gummata in skin and bone
43
Diagnostic tests for syphillis
EIA, VDRL
44
Treatment of syphillis
Parenteral penicillin (IM)
45
Trichomoniasis caused by
Trichomonas vaginalis, flagellate protozoan
46
Typical presentation of trichomoniasis
Offensive grey-green discharge, vulval irritation and superficial dyspareunia, Strawberry appearance of cervicitis- punctate erythematous.
47
Diagnosis of trichomoniasis
Wet film microscopy, special staining/culture of vaginal swabs
48
Treatment of trichomoniasis
Metronidazole
49
What other STIs apart from Herpes and syphilis caus genital ulcers?
Chancroid -haemophilus ducreyi LGV- chlamydia trachomatis Donovanosis- Calymatobacterrium granulomatis
50
Endometritis is
Infection confined to the uterine cavity
51
Endometritis is caused by 2 main events
Instrumentation of uterus- illegal termination | Complication of pregnancy-after miscarriage, termination, RPOC
52
Organisms involved with endometritis
Chlamydia/gonococcous hominis and gardenerella Ecoli/staph/clostridia
53
Endometritis presents as
Persistent heavy vaginal bleed with pain. Tender uterus, open cervical os, fever absent but septicaemia can ensue
54
Investigation and treatment of Endometritis
Vaginal and cervical swabs FBC Pelvic ultrasound Rx- Broad spectrum antibiotics
55
Who are at most risk of Acute PID
Young poor sexually active(multiple parrtners) nulliparous women not using barrier method
56
Which agent causes acute presentation of PID
Gonococcous
57
Perihepatitis- adhesions causing RUQ pain in PID is known as
PItz-Hugh-Curtis syndrome
58
how does acute PID present?
Asymp, subfertility/menstrual problems, bilateral lower abdominal pain with deep dyspareunia (hallmark) usually with abnormal vaginal bleeding or discharge. Tacyhcardia, high fever, signs of lower abdominal peritonism with bilateral adnexal tenderness and cervical excitation.
59
What is cervical excitation
Pain on moving the cervix
60
Investigating Acute PID
- Take endocervical swabs for Chlamydia and gonococcous - Blood culture sent if fever - Pelvic US- abscess/ovarian cyst - Gold standard- Lap with fibrial biopsy
61
Treatment for acute PID
``` Analgesia Parenteral cephalosporin IM ceftriaxone followed by metronidazole and doxycyline/ofloxacin Admit febrile patients for IV therapy Perform lap if no improvement Pelvic abscesses may need drainage ```
62
Early complications of acute PID
Abscess or Pyosalpix
63
Late complications of acute PID
Tubal obstruction, subfertility, chronic pelvic infection, chronic pelvic pain, ectopic pregnancy more likely
64
Chronic PID develops
inadequate treatment of acute PID, pelvic adhesions, hydrosalpix/pyosalpinx
65
Chronic PID presents as
Chronic pelvic pain, deep dyspareunia, heavy and irregular periods, chronic vaginal discharge and subfertility
66
Treating chronic PID
antibiotics and analgesia, adhesiolysis, salpingectomy
67
What are the differentials for vaginal discharge?
``` Physiological Ectropion/eversion Bacterial vaginosis Candidiasis Trichomoniasis Malignancy Atrophic ```

Gynaecology (11 decks)

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