genital tract infections

Question 1

what is the rx for thrush?

Answer 1

clotrimazole (Canesten) or oral fluconazole

Question 2

what causes bacterial vaginosis?

Answer 2

lactobacilli overgrown by:

mixed flora including anaerobes
o Gardnerella and Mycoplasma hominis

Question 3

what are some findings on ivx for BV?

Answer 3

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

Question 4

what is the rx for BV?

Answer 4

metronidazole or clindamycin cream

Question 5

complications of bv?

Answer 5

Can cause secondary infection in PID

 Association with PTL

Question 6

What is a rare complication of hyperabsorbable tampon?

Answer 6

toxic shock syndrome

Question 7

what are the mechanisms of toxic shock syndrome?

Answer 7

S. aureus makes toxins =

o High fever
o Hypotension
o Multisystem failure
-> Tx with abx and intensive care

Question 8

what are the presenting sx of chlamydia t?

comlications?

Rx?

Answer 8

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

Question 9

what are the ivx for chlaymydia ?

Answer 9

Urine Nucleic acid amplification tests (NAAT) and polymerase chain reaction (PCR)

Question 10

go see GUM STI flashcards

Answer 10

ok

Question 11

What are the presenting sx of gonnorhea?

Answer 11

Asymptomatic

Vaginal discharge
o Urethritis
o Bartholinitis
o Cervicitis
o Pelvis commonly infected

systemic:
Bacteraemia
o Acute, monarticular septic arthritis

Question 12

ivx and rx for gonnorhea?

Answer 12

ivx:
Endo-cervical swab + NAAT : test abx sensitivities

IM ceftriaxone (or oral cefixime)

Question 13

what is the rx for genital warts?

complications of contracting warts?

Answer 13

1. Topical podophyllin or imiquimod cream (external warts)
2. Cryotherapy or electrocautery for resistant warts
3. HPV vaccine

complications:
CIN - if HPV 16/18
25% recurrence

Question 14

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

Answer 14

genital herpes

Question 15

what is the prognosis and rx of genital herpes?

Answer 15

75% recurrence

can be reduced if treated early with ORAL acyclovir

Question 16

what are the dangers of syphilis in pregnancy?

Answer 16

Primary or secondary syphilis during pregnancy -> congenital malformation

Question 17

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)

Answer 17

tertiary syphilis - rare

Question 18

how is syphilis tested for and treated?

Answer 18

Enzyme immunoassay: syphilis EIA
o Veneral disease research laboratories (VDRL) test
o Tx: parenteral (usually IM) penicillin

Question 19

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)

Answer 19

trichomonas vaginalis

Question 20

how is trichomonad tested for and treated?

Answer 20

Wet film microscopy

Staining and culture of vaginal swabs

rx: metronidazole

Question 21

what is the subtype of chlamydia that affects men who sleep with men - MSM?

Answer 21

Lymphogranuloma venerum

Question 22

what are some complications of PID?

Answer 22

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

Question 23

what is the gold standrard for diagnosis in PID?

Answer 23

Laparoscopy

Question 24

A patient has presented, you are suspecting PID as a diagnosis. what do you do next?

Answer 24

1. Ivx:
   - Endocervical + high vaginal swabs? - test for STIs
   - FBC, CRP, pelvic US?
   - > MUST RULE OUT pregnancy first - UPT
2. 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.

3. Pain relief
   - ibuprofen/paracetamol

Question 25

WHAT ARE THE OTHER PRINCIPLES OF MX OF PID?

Answer 25

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!

Question 26

in which cases would we consider admission for PID?

Answer 26

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.

Question 27

name some risk factors for PID?

Answer 27

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

Question 28

what are the presenting sx/signs of PID?

Answer 28

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.

Question 29

what is the INITIAL BROAD SPECTRUM abx course in PID?

Answer 29

• Ceftriaxone + Metronidazole + doxycycline

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