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DrFeelGood Stuffs > Genito-Urinary Medicine > Flashcards

Genito-Urinary Medicine Flashcards

1
Q

What are the key features of chancroid?

A

painful genital ulcer, tender inguinal lymphadenopathy

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2
Q

What organism causes chancroid?

A

Haemophilus ducreyi

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3
Q

What are the features of lymphogranuloma venereum?

A

painless genital ulceration, painful lymphadenopathy ‘buboes’ or abscesses

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4
Q

What organism causes lymphogranuloma venereum?

A

Chlamydia trachomatis

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5
Q

What is cryptococcosis?

A

opportunistic fungal infection causes by Cryptococcus species; lungs usually primary locus, with extrapulmonary dissemination; meningoencephalitis is common presentation in HIV

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6
Q

What are the treatment options for cryptococcosis?

A
  • asymptomatic + mild/moderate + no CNS involvement: fluconazole
  • severe / CNS involved: amphotericin B + flucocytosine; then fluconazole
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7
Q

What is cryptosporidiosis?

A

protozoan parasite; causes watery diarrhoea, abdo cramps, appetite loss, fever, nausea/vomiting
can be life-threatening in patients with HIV

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8
Q

What are the treatment options for cryptosporidiosis-induced GI disease?

A
  • immunocompetent + age >1y: nitazoxanide
  • immunosuppression: antiretroviral therapy + restore CD4 count >100
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9
Q

When do symptoms of genito-urinary TB usually develop?

A

10-15 years after primary infection

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10
Q

What are 10 possible symptoms of genito-urinary TB?

A
  1. repeated UTIs, poor response abx
  2. increased frequency of urination
  3. dysuria
  4. suprapubic pain
  5. blood / pus in urine (sterile pyruria)
  6. fever
  7. painful testicular swelling
  8. perianal sinus
  9. genital ulcer
  10. unexplained infertility
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11
Q

What is the classic finding on urine dip in GU TB?

A

sterile pyuria

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12
Q

What is the management of vulvovaginal candidiasis in non-pregnant patients?

A
  • oral fluconazole first line (150mg stat)
  • clotrimazole 500mg pessary as single dose (if PO CI)
  • +- topical imidazole if vulval sx
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13
Q

What is the management of vulvovaginal candidiasis in pregnant patients?

A

local treatments only (cream or pessaries)

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14
Q

What is the definition of recurrent vaginal candidiasis?

A

4 or more episodes / year

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15
Q

What are 4 aspects of the management of recurrent vulvovaginal candidiasis?

A
  1. confirm diagnosis - high vaginal swab
  2. consider blood glucose / HbA1c
  3. exclude differentials e.g. lichen sclerosus
  4. consider induction-maintenance regime
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16
Q

What does an induction-maintenance regime for recurrent vaginal candidiasis involve?

A
  • INDUCTION: oral fluconazole every 3 days for 3 doses
  • MAINTENANCE: oral fluconazole weekly for 6 months
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17
Q

What causes bacterial vaginosis?

A

Overgrowth of Gardnerella vaginalis most commonly; gram positive and negative bacteria may be seen on gram stain

replace normal Lactobacilli

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18
Q

What are the clinical features of bacterial vaginosis?

A
  • Fishy malodorous discharge.
  • Lack of itch
  • Increased vaginal pH
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19
Q

What are the criteria for diagnosis of bacterial vaginosis?

A

Amsel’s criteria - 3 of the following 4 points:
- thin, white, homogenous discharge
- clue cells on microscopy - stippled vaginal epithelial cells
- vaginal pH > 4.5
- positive whiff test (addition of potassium hydroxide results in fishy odour)
-

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20
Q

What is the management of bacterial vaginosis?

A
  • if asymptomatic - may not require treatment (unless undergoing TOP)
  • if symptomatic - oral metronidazole 5-7 days
  • if adherence likely to be an issue - stat metronidazole 2g
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21
Q

What is the management of bacterial vaginosis in pregnancy?

A

If symptomatic oral metronidazole can be used (PO 5-7 days), if asymptomatic discuss with woman’s obstetrician if treatment is indicated (avoid stat dose)

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22
Q

What are the risks of bacterial vaginosis in pregnancy? Give 4

A
  1. Preterm labour
  2. Low birth weight
  3. Chorioamnionitis
  4. Late miscarriage
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23
Q

What are 5 key features of trichomoniasis?

A
  1. Frothy, offensive yellow-green discharge
  2. Vulvovaginitis
  3. Strawberry cervix
  4. pH > 4.5
  5. Wet mount: motile trophozoites
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24
Q

What is the management of suspected epididymo-orchitis when the organism is unknown?

A
  • ceftriaxone 500mg IM STAT
  • doxycycline 100mg BD PO 10-14days

+ refer urgently to local GUM clinic

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25
Q

What are most commonly the organisms causing epididymo-orchitis?

A
  • Chlamydia trachomatis + Neisseria gonorrhoeae
  • OR
  • organisms from bladder- E. coli
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26
Q

What guides the investigations for suspected epididymo-orchitis?

A
  • younger adults - assess for STI
  • older adults + low-risk sexual history: MSU for microscopy + culture
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27
Q

What is the management if enteric organisms are the most likely cause of epididymo-orchitis?

A

treat empirically with oral quinolone for 2 weeks e.g. ofloxacin

28
Q

How many trichomoniasis present in men?

A

usually asymptomatic but can cause urethritis

29
Q

What does microscopy show in trichomonas vaginalis?

A

motile trophozoites

30
Q

What is the organism that causes trichomonas vaginalis and how is it transmitted?

A

trichomonas vaginalis is a highly motiles, flagellated protozoan parasite - is an STI

31
Q

What is the management of Trichomonas vaginalis?

A

oral metronidazole for 5-7 days (BNF also supports one-off 2g metronidazole)

32
Q

What is recommended first line to treat chlamydia?

A

doxycyline or azithromycin

33
Q

What is recommended first line to treat PID?

A
  • ofloxacin + metronidazole OR
  • IM ceftriaxone + doxycycline + metronidazole
34
Q

What is first line to treat syphilis?

A

benzathine penicillin
or doxycycline or erythromycin

35
Q

What is the management of chlamydia infection in pregnancy?

A

azithromycin, erythromycin or amoxicillin

NOT doxycycline

36
Q

What is the incubation period of chlamydia?

A

7-21 days

37
Q

In what proportion of cases is chlamydia asymptomatic?

A

50& men, 70% women

38
Q

What is the investigation of choice for chlamydia?

A

NAAT using first void urine sample (first line in men), vulvovaginal swab (first line in women) or cervical swab

39
Q

At what time after possible exposure should chlamydia testing be performed?

A

2 weeks after a possible exposure

40
Q

What is the first line treatment for chlamydia?

A

doxycycline - 7 day course

41
Q

Why is doxycycline preferred to azithromycin to treat chlamydia?

A

due to concerns about Mycoplasma genitalium - often coexistant in patients with chlamydia, rising resistance to macrolides

42
Q

Which contacts should be contacted for treatment in men with chlamydia and urethral symptoms?

A

all contacts since and in the 4 weeks prior to the onset of symptoms

43
Q

Which contacts should be treated for chlamydia in women with chlamydia and asymptomatic men?

A

all partners from the last 6 months, or the most recent sexual partner

44
Q

What is the approach to testing/treating contacts of chlamydia?

A

should be offered treatment prior to results of their investigations being known (treat then test)

45
Q

What are 3 causes of painless penile ulcers?

A
  1. lymphogranuloma venereum
  2. syphilis
  3. donavanosis (granuloma inguinale)
46
Q

What are 3 causes of painful penile ulcers?

A
  1. herpes simplex
  2. Behcet’s
  3. chancroid
47
Q

What are 3 stages of lymphogranuloma venereum?

A
  1. stage 1: small painless pustule which later forms an ulcer
  2. stage 2: painful inguinal lymphadenopathy
  3. stage 3: proctolitis
48
Q

What is the treatment of lymphogranuloa venereum?

A

doxycycline

49
Q

What should be monitored iaftern the treatment of syphilis?

A

nontreponemal titres (rapid plasma reagin RPR or venereal disease research laboratory VDRL) - fourfold decilne considered adequate response

50
Q

What reaction is sometimes seen in response to syphilis treatment?

A

Jarisch-Herxheimer reaction - fever/rash/tachycardia (no hypotension or wheeze)

51
Q

What is thought to cause the Jarisch-Herxheimer reaction?

A

release of endotoxins following bacterial death, occurs within a few hours

52
Q

What is the treatment of a Jarish-Herxheimer reaction?

A

no treatment other than antipyretics if required

53
Q

Which types of HPV cause genital warts?

A

6 + 11

54
Q

What is the first line management for single, keratinised genital warts?

A

cryotherapy

55
Q

What is the first line treatment for multiple, non-keratinised genital warts?

A

topical podophyllum (imiquimod second-line)

56
Q

How well do genital warts respond to treatment?

A

often resistant to treatment - recurrence common, but majority of infections clear without intervention within 1-2 years

57
Q

What are 2 symptoms that may appear with painful ulceration in genital herpes?

A
  1. tender inguinal lymphadenopathy
  2. urinary retention
58
Q

What is the investigation of choice in genital herpes?

A

NAAT

59
Q

What are 3 aspects of the management of genital herpes?

A
  1. oral aciclovir (long term in some patients with frequent exacerbations)
  2. saline bathing
  3. analgesia, topical anaesthetic e.g. lidocaine
60
Q

What is advised in pregnancy if a primary attach occurs > 28 weeks?

A

elective caesarean at term

61
Q

What is the risk of transmission to the baby in a patient with recurrent herpes during pregnancy?

A

risk of transmission is low

62
Q

What are the features of secondary syphilis?

A

fever, rash (trunk and palms), lymphadenopathy, buccal ulcers, condylomata

63
Q

What is the management of gonorrhoea?

A
  • IM ceftriaxone (single dose)
  • if sensitivities known + sensitive to ciprofloxacin - single dose cipro 500mg PO

2nd line PO cefixime 400mg (1 dose) + azithromycin 2g (1 dose)

64
Q

What is the commonest cause of septic arthritis in young adults?

A

gonococcal infection

65
Q

What is the classic triad seen in Disseminated gonococcal infection (DGI) ?

A
  1. tenosynovitis
  2. migratory polyarthritis
  3. dermatitis
66
Q

What are 3 late complications in disseminated gonococcal infection (DGI)?

A
  1. septic arthritis
  2. endocarditis
  3. perihepatitis (Fitz-Hugh-Curtis syndrome)

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