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Gynaecology > Genital tract infections > Flashcards

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
Q

Diagnosis of Gonnorhoea is made by

A

NAAT, but Endocervical swabs for culture for sensitivities

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26
Q

Gonorrhoea is now treated with

A

IM ceftriaxone, Abx resistance has increased to ciprofloxacin

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27
Q

Genital warts has another name

A

condylomata acuminata

28
Q

Genital warts are caused by

A

HPV

29
Q

Warts mainly affect the

A

Cervix, HPV16,18 involved in CIN

30
Q

How do you treat genital warts?

A

Topical podophyllin or imiquimod cream

Cryotherapy or electocautery for resistant warts

31
Q

Genital herpes is caused by

A

Herpes simplex type 2

32
Q

What happens in primary genital herpes infection? (4)

A

Commonly- Multiple small painful vesicles and ulcers aound introitus, local lymphadenopathy, dysuria and systemic symptoms-

33
Q

Genital herpes may complicate. What happens? (2)

A

Aseptic meningitis or acute urinary retention

34
Q

What happens to HSV2 after primary infection

A

Dormant in dorsal root gangla- 75% recur

35
Q

Diagnosis is established by

A

Examination and viral swabs

36
Q

Treated by

A

Aciclovir (vala/fam)

37
Q

Syphillis is caused by

A

Spirochete treponema pallidum

38
Q

What are the presenting syndromes of syphillis

A

Primary, secondary, latent, tertiary

39
Q

How does primary syphillis present?

A

solitary painless vulval ulcer (chancre)

40
Q

How does secondary syphillis present?

A

Weeks after secondary with rash, flulike symptoms, warty genital/perioral growth. infitrates other organs and causes disease

41
Q

How does latent syphillis present?

A

other phases resolve spontaneously, stays in body

42
Q

How does tertiary syphillis present and what are the complications?

A

Rare, any organ, Aortic regurgitation, Dementia, tabes dorsalis, gummata in skin and bone

43
Q

Diagnostic tests for syphillis

A

EIA, VDRL

44
Q

Treatment of syphillis

A

Parenteral penicillin (IM)

45
Q

Trichomoniasis caused by

A

Trichomonas vaginalis, flagellate protozoan

46
Q

Typical presentation of trichomoniasis

A

Offensive grey-green discharge, vulval irritation and superficial dyspareunia, Strawberry appearance of cervicitis- punctate erythematous.

47
Q

Diagnosis of trichomoniasis

A

Wet film microscopy, special staining/culture of vaginal swabs

48
Q

Treatment of trichomoniasis

A

Metronidazole

49
Q

What other STIs apart from Herpes and syphilis caus genital ulcers?

A

Chancroid -haemophilus ducreyi
LGV- chlamydia trachomatis
Donovanosis- Calymatobacterrium granulomatis

50
Q

Endometritis is

A

Infection confined to the uterine cavity

51
Q

Endometritis is caused by 2 main events

A

Instrumentation of uterus- illegal termination

Complication of pregnancy-after miscarriage, termination, RPOC

52
Q

Organisms involved with endometritis

A

Chlamydia/gonococcous
hominis and gardenerella
Ecoli/staph/clostridia

53
Q

Endometritis presents as

A

Persistent heavy vaginal bleed with pain. Tender uterus, open cervical os, fever absent but septicaemia can ensue

54
Q

Investigation and treatment of Endometritis

A

Vaginal and cervical swabs
FBC
Pelvic ultrasound
Rx- Broad spectrum antibiotics

55
Q

Who are at most risk of Acute PID

A

Young poor sexually active(multiple parrtners) nulliparous women not using barrier method

56
Q

Which agent causes acute presentation of PID

A

Gonococcous

57
Q

Perihepatitis- adhesions causing RUQ pain in PID is known as

A

PItz-Hugh-Curtis syndrome

58
Q

how does acute PID present?

A

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
Q

What is cervical excitation

A

Pain on moving the cervix

60
Q

Investigating Acute PID

A
  • Take endocervical swabs for Chlamydia and gonococcous
  • Blood culture sent if fever
  • Pelvic US- abscess/ovarian cyst
  • Gold standard- Lap with fibrial biopsy
61
Q

Treatment for acute PID

A 
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
Q

Early complications of acute PID

A

Abscess or Pyosalpix

63
Q

Late complications of acute PID

A

Tubal obstruction, subfertility, chronic pelvic infection, chronic pelvic pain, ectopic pregnancy more likely

64
Q

Chronic PID develops

A

inadequate treatment of acute PID, pelvic adhesions, hydrosalpix/pyosalpinx

65
Q

Chronic PID presents as

A

Chronic pelvic pain, deep dyspareunia, heavy and irregular periods, chronic vaginal discharge and subfertility

66
Q

Treating chronic PID

A

antibiotics and analgesia, adhesiolysis, salpingectomy

67
Q

What are the differentials for vaginal discharge?

A 
Physiological
Ectropion/eversion
Bacterial vaginosis
Candidiasis
Trichomoniasis
Malignancy
Atrophic

Gynaecology (11 decks)

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