genital tract infections Flashcards
what is the rx for thrush?
clotrimazole (Canesten) or oral fluconazole
what causes bacterial vaginosis?
lactobacilli overgrown by:
mixed flora including anaerobes
o Gardnerella and Mycoplasma hominis
what are some findings on ivx for BV?
increased pH,
positive ‘whiff’ test (fishy odour when 10% KOH added to secretions),
discharge and
presence of ‘clue cells’ (epithelial cells studded with Gm-variable coccobacilli)
doesnt cause vaginal itch or irritation
what is the rx for BV?
metronidazole or clindamycin cream
complications of bv?
Can cause secondary infection in PID
Association with PTL
What is a rare complication of hyperabsorbable tampon?
toxic shock syndrome
what are the mechanisms of toxic shock syndrome?
S. aureus makes toxins =
o High fever
o Hypotension
o Multisystem failure
-> Tx with abx and intensive care
what are the presenting sx of chlamydia t?
comlications?
Rx?
Usually asymptomatic
o Sx: urethritis and vaginal discharge
complications:
- PID
Tubal damage -> subfertility or chronic pelvic pain
Reiter’s syndrome
o Urethritis, conjunctivitis, arthritis
o Can’t see, can’t pee, can’t climb a tree
rx:
azithromycin or doxycycline
what are the ivx for chlaymydia ?
Urine Nucleic acid amplification tests (NAAT) and polymerase chain reaction (PCR)
go see GUM STI flashcards
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What are the presenting sx of gonnorhea?
Asymptomatic
Vaginal discharge o Urethritis o Bartholinitis o Cervicitis o Pelvis commonly infected
systemic:
Bacteraemia
o Acute, monarticular septic arthritis
ivx and rx for gonnorhea?
ivx:
Endo-cervical swab + NAAT : test abx sensitivities
IM ceftriaxone (or oral cefixime)
what is the rx for genital warts?
complications of contracting warts?
- Topical podophyllin or imiquimod cream (external warts)
- Cryotherapy or electrocautery for resistant warts
- HPV vaccine
complications:
CIN - if HPV 16/18
25% recurrence
which sti presents as follows:
preceded by localised tingling Multiple small painful vesicles and ulcers around intraoitus o Local lymphadenopathy o Dysuria o Systemic symptoms
genital herpes
what is the prognosis and rx of genital herpes?
75% recurrence
can be reduced if treated early with ORAL acyclovir
what are the dangers of syphilis in pregnancy?
Primary or secondary syphilis during pregnancy -> congenital malformation
which sti presents as follows:
Aortic regurgitation
Dementia
Tabes dorsalis (syphilitic myelopathy demyelination of posterior dorsal column
loss of proprioception, vibration and discriminative touch)
Gummata in skin and bone (form of granuloma)
tertiary syphilis - rare
how is syphilis tested for and treated?
Enzyme immunoassay: syphilis EIA
o Veneral disease research laboratories (VDRL) test
o Tx: parenteral (usually IM) penicillin
which sti presents as follows:
Offensive grey-green discharge o Vulval irritation o Superficial dyspareunia o Can be asymptomatic o Cervicitis : ‘strawberry’ appearance (punctate, erythematous)
trichomonas vaginalis
how is trichomonad tested for and treated?
Wet film microscopy
Staining and culture of vaginal swabs
rx: metronidazole
what is the subtype of chlamydia that affects men who sleep with men - MSM?
Lymphogranuloma venerum
what are some complications of PID?
If treated, PID can still cause ectopic pregnancy and SUBfertility as a result of adhesions that may have formed following the infection.
Peri-hepatitis (Fitz–Hugh–Curtis syndrome) - have RUQ pain
what is the gold standrard for diagnosis in PID?
Laparoscopy
A patient has presented, you are suspecting PID as a diagnosis. what do you do next?
- Ivx:
- Endocervical + high vaginal swabs? - test for STIs
- FBC, CRP, pelvic US?
- > MUST RULE OUT pregnancy first - UPT - Commence broad-spectrum antibiotics.
- before results come
- Ceftriaxone + Metronidazole + doxycycline
- PID has such severe consequences if not treated, such as chronic pelvic pain and subfertility, treating before any delay in investigations is the most important step.
- Pain relief
- ibuprofen/paracetamol
WHAT ARE THE OTHER PRINCIPLES OF MX OF PID?
nice cks:
- should ideally be managed in (GUM) clinic
- Her and her partner should refrain from sex until treatment finished - or use condoms
- sexual contact tracing!
in which cases would we consider admission for PID?
Ectopic pregnancy cannot be ruled out.
Symptoms and signs are severe (such as nausea, vomiting, and a fever greater than 38°C).
There are signs of pelvic peritonitis.
A surgical emergency (such as acute appendicitis) cannot be ruled out.
The woman is pregnant.
A tubo-ovarian abscess is suspected.
The woman is unwell and there is diagnostic doubt.
The woman is unable to follow or tolerate an outpatient treatment regimen.
name some risk factors for PID?
Factors related to sexual behaviour, such as:
Young age (younger than 25 years).
Early age of first coitus.
Multiple sexual partners.
Recent new partner (within the previous 3 months).
History of STI in the woman or her partner.
Recent instrumentation of the uterus or interruption of the cervical barrier, such as due to:
Termination of pregnancy.
Insertion of an intrauterine device (within the past 4–6 weeks, especially in women with pre-existing gonorrhoea or C. trachomatis infection).
Hysterosalpingography.
IVF and IUI
what are the presenting sx/signs of PID?
Lower abdominal tenderness (usually bilateral). Adnexal tenderness (with or without a palpable mass), cervical motion tenderness, or uterine tenderness (on bimanual vaginal examination).
Abnormal cervical or vaginal mucopurulent discharge (on speculum examination).
A fever of greater than 38°C, although the temperature is often normal.
what is the INITIAL BROAD SPECTRUM abx course in PID?
- Ceftriaxone + Metronidazole + doxycycline
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