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Gynaecology > Genital Tract infections > Flashcards

Genital Tract infections Flashcards

1
Q

What is bacterial vaginosis

A

loss of lactobacilli and increase in anaerobic and highly specific BV-associated bacteria in the vagina

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2
Q

what bacteria are commonly associated with bacterial vaginitis

A

G.vaginalis

atrophium vaginae

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3
Q

what are the clinical features of bacterial vaginitis

A

grey-white discharge

fishy odour

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4
Q

how do you diagnose bacterial vaginitis

A

decreased vaginal pH (>4.5, usually around 7)
grey-white discharge
fishy-odour
‘clue cells’ on microscopy

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5
Q

how do you treat bacterial vaginitis

A

metronidazole

clindamycin cream

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6
Q

what is the common patient population for bacterial vaginitis

A

women of reproductive age

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7
Q

what are risk factors for vaginal candidiasis infection

A

pregnancy
diabetes
antibiotic use

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8
Q

what are clinical features of vaginal candidiasis infection

A

lumpy white ‘cottage cheese’ discharge
vulval irritation/itching
superficial dyspareunia
dysuria

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9
Q

how do you diagnose vaginal candidiasis infection

A

cultures

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10
Q

what is the treatment for vaginal candidiasis

A

topical imidazole

oral fluconazole

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11
Q

what is toxic shock syndrome

A

rare complication of keeping a tampon in for too long due to staph aureus toxin release

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12
Q

what are clinical features of toxic shock syndrome

A

high fever
hypertension
multisystem organ failure

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13
Q

how do you treat toxic shock syndrome

A

ICU admission and IV Abx

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14
Q

what are risk factors for STIs

A 
number of partners (>3 within 6 months, or a newpartner in the last 3 months)
concurrent partners 
not using condoms
other STIs
<20
sexual preference
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15
Q

what is the most common sexually transmitted disease in the world

A

Chlamydia

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16
Q

what proportion of women have genital symptoms with a chlamydia infection

A

<30%

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17
Q

what are some symptoms of chlamydia infection

A 
altered vaginal discharge 
intermenstrual bleeding 
post-coital bleeding 
low abdominal pain
dyspareunia
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18
Q

what is the main complication of chlamydia infection

A

pelvic infection leading to infertility

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19
Q

what atypical presentation is chlamydia associated with and what are its clinical features

A

sexually active arthritis, presenting with :

urethritis
conjunctivitis
arthritis

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20
Q

how do you diagnose a chlamydia infection

A

NAATs of vaginal swabs

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21
Q

how do you treat chlamydia

A

azithromyicin or doxycycline

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22
Q

what kind of bacteria is gonorrhea

A

gram negative diplococcus

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23
Q

how does gonorrhea present in men

A

urethritis

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24
Q

how does gonorrhea present in women

A 
vaginal discharge
urethritis
bartholinitis 
cervicitis
pelvic infection
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25
Q

what are the complications of gonorrhea infection (although they are rare)

A

septic arthritis

bacteraemia

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26
Q

how do you diagnose a gonorrhea infection

A

NAATs of vulvovaginal swabs

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27
Q

how do you treat gonorrhea

A

if not quinolone resistant: azithromycin or cefixime

2nd line: IM ceftriaxone

28
Q

what is linked with causing genital warts

A

HPV (6,11,16,18)

29
Q

how do genital warts spread

A

physical contact

30
Q

how do you diagnose genital warts

A

clinical diagnosis

31
Q

how do you treat genital warts

A

chemical application

podophyllin
podophyllotoxin
trichloroacetic acid
imiquimod

or cryotherapy

32
Q

what is the recurrence rate of genital warts

A

25%

33
Q

what causes gentital herpes

A

HSV1 and HSV2 - but more predominantly HSV2

34
Q

which herpes simplex virus is associated with mouth infections (coldsores)

A

HSV1

35
Q

what are common features of symptomatic Herpes infection

A

stinging/itching in affected area
small vesicles which then burst and crust over
dysuria
local lymphadenopathy

36
Q

which herpes infections recur more/less

A

HSV2 + 6 recur more, HSV1 recurs less

37
Q

what is the treatment for herpes infections

A

oral aciclovir for all first indications

IV aciclovir in severe infections

38
Q

what causes syphillis

A

T.pallidum

39
Q

what are the 3 types of syphillis and their clinical features

A

Primary
Only clinical feature is a single ulcer – called a chancre

Secondary  
Occurs only if there is an untreated primary  
Develops week later  
Rash  
Flu-ike illness  
Warty genital/perioral growths  
Systemic vasculitis  
Hepatitis  
Uveritis  
Alopecia

After this stage it can become latent for years and will progress to tertirary syphillis at some point

Tertiary
Rare
Develops years after the primary infection

Any organ can be affected, leading to  
Dementia 
Aortic regurgitation  
Tabes dorsalis 
Gummatis in the skin and bone
40
Q

how do you diagnose syphillis infection

A

syphilis enzyme immunoassay

VRDL test

41
Q

how do you treat syphillis infection

A

parenteral (IM) penecillin

42
Q

what is trichomonas

A

a protozoa

43
Q

what are the typical symptoms of a trichomonas infection

A 
offensive green-grey discharge (70%) 
vulval irritation
dysuria
superficial dyspareunia 
asymptomatic in 50%
44
Q

how do you diagnose trichomonas infection

A

NAATs

wet film microscopy may identify motile trichomonas in 60% of cases

45
Q

how do you treat trichomonas infection

A

systemic metronidazole

46
Q

what is endometritis

A

isolated infection of the endometrium

47
Q

what commonly causes endometritis

A

birth complications - e.g. some placenta left in the uterus post birth

common orgnanisms are:
e-coli
staph aureus 
chlamydia 
gonorrhea 
clostridia
48
Q

what are the clinical features of endometritis

A

persistent and heavy bleeding/pain
tender uterus
cervical os open

49
Q

what is a complication of endometritis

A

sepsis

50
Q

how do you treat endometritis

A

broad spectrum antibiotics
evacuation of retained products of conception if required
sepsis 6 if required

51
Q

what is another name for pelvic inflammatory disease

A

salpingitis

52
Q

what is the lifetime incidence for pelvic inflammatory disease

A

2%

53
Q

what are risk factors for pelvic inflammatory disease

A 
number of partners (>3 within 6 months, or a newpartner in the last 3 months)
concurrent partners 
not using condoms
other STIs
<20
sexual preference
54
Q

what is protective for pelvic inflammatory disease

A

COCP/IUS

55
Q

what kind of infection causes pelvic inflammatory disease and name some common organisms

A

multimicrobial

chlamydia and gonorrhea

56
Q

what is fitz-hugh-curtis syndrome

A

perihepatitis due to pelvic inflammatory disease

characterised by RUQ pain due to adhesions forming between anterior liver and peritoneal wall

57
Q

what is the clinical presentation of pelvic inflammatory disease

A

deep dyspareunia
bilateral abdominal pain
abnormal bleeding discharge
subfertility if presenting for a long time

some acute cases may present with tachycardia, fever and peritonism with bilateral adnexal tenderness

58
Q

what are differentials for acute pelvic inflammatory disease

A

ovarian torsion
ovarian cyst rupture
appendicit s

59
Q

how should you investigate pelvic inflammatory disease

A

endovervical swab for STIs
WBC
CRP
pelvic USS - excludes abscesses and cysts
laproscopy - gold standard = fimbral biopsy and cultures

60
Q

what is the treatment for pelvic inflammatory disease

A

parenteral cephalosporins (IM ceftriaxone) followed by doxycycline/ofloxacin and metronidazole

IV therapy reserved if patients severely unwelll

abscesses may need draining

61
Q

what are complications of pelvic inflammatory disease

A 
tubal obstruction
infertility
chronic pelvic infection 
chronic pelvic pain 
increased chance of ectopic pregnancy
62
Q

what does chronic PID cause

A

dense pelvic adhesions with severe fallopian tube obstruction +/- fluid/pus retention

63
Q

what are common symptoms of chronic PID

A

Chronic pelvic pain

Dysmenorrhoea

Deep dyspaerunia

Subfertility

Chronic vaginal discharge

Heavy and irregular menstruation

64
Q

what might you find on examination in chronic PID

A

tenderness + fixed uterus

65
Q

how do you investigate chronic PID

A

TV USS may identify any fluid in the tubes

Laporoscopy is best tool

Cultures are often negative

66
Q

how do you treat chronic PID

A

Analgesia and antibiotics if active infection

Adhesion removal

Salpingectomy

Gynaecology (14 decks)

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