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NP- Phase 3a Medicine > Genito-Urinary Medicine > Flashcards

Genito-Urinary Medicine Flashcards

1
Q

what is candidiasis?

A

yeast infection of the lower female reproductive tract

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2
Q

aetiology of candidiasis

A

hypersensitivity to commensal organisms- typically candida albicans

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3
Q

risk factors for candidiasis

A 
pregnancy
DM
use of broad-spec ABx
chemotherapy 
foreign bodies in the vagina
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4
Q

how does candidiasis present clinically?

A
  • pruritis vulae
  • vulval soreness/ erythema/ oedema
  • white ‘cottage cheese’ discharge (non-offensive)
  • dysparaeunia
  • dysuria
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5
Q

give some differentials for candidiasis

A
  • bacterial vaginosis
  • trichomonas vaginalis
  • STI
  • atrophic vaginitis
  • lichen sclerosis
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6
Q

how is candidiasis managed and treated?

A
  • use a soap substitute to clean vulval area
  • emolient to moisturise vulval skin
  • antifungal agentts- clotrimazole cream, fluconizole tablets
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7
Q

risk factors for chlamydia

A
  • age <25
  • sexual partner positive for chlamydia
  • multiple sexual partners/ recent change in sexual partner
  • another STI
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8
Q

how does chlamydia present clinically (in females and males)?

A
  • 50% men and 75% women are asymptomatic
  • female- vaginal discharge, dysuria, instrumental/ post-coital bleeding, ascending infection (acute salpingitis, PID)
  • male- urethritis, dysuria, urethral discharge, fever, epididymo-orchitis w/ unilateral testicular pain and swelling
  • BOTH- reactive arthritis and upper abdo pain
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9
Q

differential diagnosis for chlamydia

A
  • gonorrhoea
  • prostatitis
  • trichomonas vaginalis infection
  • bacterial vaginosis
  • endometriosis
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10
Q

how is chlamydia diagnosed and how is this test performed in men and women?

A
  • sample taken for nucleic acid amplification tests (NAATs)
  • women- vulvovaginal swab
  • men- first catch urine specimen
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11
Q

how is chlamydia managed and treated?

A

doxycycline and azithromycin

contact tracing and contraceptive advice

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12
Q

what medications are given if doxycycline and azithromycin are contraindicted in chlamydia?

A

erythromycin 500mg BD for 10-14 days

ofloxacin 200mg BD/ 400mg OD for 7 days

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13
Q

what medications used in the treatment of chlamydia are contraindicated in pregnancy?

A

doxycycline and oflaxacin

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14
Q

where can chlamydia infections occur in adults?

A 
urethra 
endocervical canal
rectum 
pharynx 
conjuctiva
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15
Q

what are some complications of chlamydia infection?

A
  • PID- infertility, ectopic pregnancy, chronic pelvic pain
  • neonatal- opthlamic neonatorum, atypical pneumonia
  • Fitz Hugh Curtis syndrome
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16
Q

what is the national chlamydia screening programme?

A

aims to detect undiagnosed chlamydia through proactively offering screening to all sexually active young people under the age of 25

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17
Q

what is gonorrhoea?

A

Neisseria Gonorrhoea is a gram-negative diplococcus infecting mucous membranes of the urethra, endocervix, rectum pharynx and conjuntiva

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18
Q

how does gonorrhoea present in men?

A

discharge
peri-anal pain
pruritis

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19
Q

how does gonorrhoea present in women?

A

green/yellow discharge
lower abdo pain
dysuria

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20
Q

how is gonnorhoea diagnosed?

A

same as chlamydia

  • sample taken for nucleic acid amplification tests (NAATs)
  • women- vulvovaginal swab
  • men- first catch urine
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21
Q

how is gonnorhoea treated?

A

ceftriaxone IM and Azithromycin oral

contact tracing, contraceptive advice

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22
Q

what is PID?

A

pelvic inflammatory disease- upper female reproductive tract infection, ascending from the cervix

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23
Q

what organisms can cause PID?

A
  • neisseria gonorrhoeae

- chamydia trachomatis

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24
Q

clinical features of PID

A
  • lower abdominal pain and tenderness
  • dyspareunia
  • fever
  • discharge
  • abnormal bleeding
  • cervical motion excitation
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25
Q

how is PID diagnosed?

A
  • pregnancy tests
  • cervical swabs
  • elevated ESR and CRP
  • endometrial biopsy
  • USS
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26
Q

differential diagnosis of PID

A
  • appendicitis

- ectopic pregnancy

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27
Q

risk factors for the development of PID

A
  • young
  • new sexual partner
  • multiple sexual partners
  • lack of barrier contraception
  • low socio-economic group
  • IUD
  • TOP
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28
Q

how is PID treated?

A
  • mild-moderate- managed in primary care
  • clinical severe- hospital admission and IV:
  • ceftriaxone 500mg
  • doxycycline
  • metronidazole
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29
Q

what is Syphillis?

A

systemic STI characterised by primary, secondary and tertiary stages

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30
Q

what organism causes syphillis?

A

treponema pallidum

31
Q

what is the difference between primary and secondary syphillis?

A

primary- incubation of 2-3 weeks, local infection

secondary- incubation of 6-12 weeks, generalised infection

32
Q

how does primary syphilis present clinically?

A
  • primary lesion at site- heals in 2-6 weeks
  • small painless papule forms and ulcer (Chancre)- round/oval, painless, bright red margin, clear serum
  • enlarged regional lymph ndoes
33
Q

in heterosexual men with syphilis, were are Chancre typically found?

A

coronary sulcus

glans and inner surface fo the prepuce

34
Q

how does secondary syphilis present clinically?

A
  • 6 weeks after beginning of primary lesion
  • multi system involvement occurring within 2 years of infection
  • night headaches, malaise, fever, aches
  • polymorphic rash on palms, soles and face (non-itchy)
35
Q

how does latent syphilis present clinically?

A

positive serological tests for syphilis with no clinical evidence of treponemal infection

36
Q

how does tertiary syphilis present neurologically?

A
  • can by asymptomatic
  • dorsal column loss
  • dementia
  • meningovascular involvement
37
Q

how does tertiary syphilis affect the cardiovascular system?

A
  • aortitis
  • aortic regurgitation
  • aortic aneurysm
  • angina
38
Q

what are Gummata?

A
  • occur in tertiary syphilis
  • inflammatory fibrous nodules/ plaques which can be locally destructive
  • can occur in any organ- but usually bone and skin
39
Q

give 1 possible differential for syphilis

A

herpetic ulcers

40
Q

how is syphilis diagnosed?

A

Treponemal enzyme immunoassay

IgM= early infection

IgG= later

41
Q

how is syphilis treated?

A
  • 1st line- Benzathine penicillin 2.4 mega units IM

- 2nd line- single dose Oral azithromycin

42
Q

what is bacterial vaginosis?

A

overgrowth on anaerobic organisms, which leads to a fall in lactic acid producing lactobacilli, resulting in a raised pH (>4.5)

43
Q

what organism typically cause bacterial vaginosis?

A
  • gardnerella vaginalis
44
Q

risk factors for the development of bacterial vaginosis

A
  • sexual activity
  • new sexual partner
  • other STI’s
  • afro-carribean
  • vaginal douching
  • receptive oral sex
  • smoking
45
Q

clinical presentation of bacterial vaginosis

A
  • offensive, fishy-smelling vaginal discharge
  • no soreness or irritation
  • can be asymptomatic
  • thin layer of white discharge covering vaginal wall
46
Q

differential diagnosis for bacterial vaginosis

A
  • other infections- candida, trichomoniasis
  • physioloigcal discharge
  • tumours of vulvula, vagina, cervix or endometrium
  • atrophic vaginitis
47
Q

how is bacterial vaginosis diagnosed?

A
  • increased vaginal pH (>4.5)

- microscopy

48
Q

how is bacterial vaginosis managed and treated?

A
  • avoid vaginal douching
  • Metronidazole 400-500mg BD for 5-7 days
  • can give clindamycin as an alternative
49
Q

what triad is typically seen in trichomonas vaginalis?

A

vaginitis

cervicitis

urethritis

50
Q

what type of organism causes trichomonas vaginalis?

A

flagellated protozoan

51
Q

how does trichomonas vaginalis present in women?

A
  • frothy green vaginal discharge
  • strawberry cervix
  • offensive smell
  • dysuria
  • lower abdo discomfort
52
Q

how does trichomonas vaginalis present in men?

A
  • usually asymptomatic

- can have urethritis, dysuria and urethral discharge

53
Q

how is trichomonas vaginalis diagnosed?

A
  • high vaginal swab

- NAATS- nucleic acid amplification test

54
Q

how is trichomonas vaginalis managed and treated?

A
  • treat both sexual partners at same time
  • avoid intercourse for 1 week following treatment
  • Metronidazole- either a 2g single dose or 400-500mg BD for 5-7 days
55
Q

what is Lichen sclerosis?

A

chronic inflammatory dermatosis that affects the skin of the anogenital region in women or glans penis and foreskin in men

56
Q

describe the aetiology of lichen sclerosis

A
  • auto-immune induced in genetically predisposed patients

- preceding infections may play part also

57
Q

how does Lichen sclerosis present (generally- i.e. in both men and women)?

A

white thickened patches- with ecchymosis, hyperkeratosis/ bullae

58
Q

how does Lichen Sclerosis present in women?

A
  • itch- worse at night
  • pain
  • perianal lesions- constipation
  • white lesions ‘figure of 8’ around vulva and anus
  • shrinking of labia, clitoral adhesions
59
Q

how does Lichen sclerosis present in men?

A
  • soreness and haemorrhagic blisters
  • dyspareunia
  • painful erections due to phimosis
  • poor urine stream/ dysuria
  • white patches
60
Q

differential diagnosis of Lichen sclerosis

A
  • vitiligo
  • scleroderma
  • lichen planus
  • leukoplakia
61
Q

how is Lichen sclerosis diagnosed?

A
  • clinically

- can biopsy if uncertain

62
Q

how is Lichen sclerosis treated?

A

topical steroids- e.g. clobetasol propionate

63
Q

describe the epidemiology of the herpes simplex virus

A
  • spread by sexual contact

- incubation period of 2-7 days

64
Q

symptoms of herpes simplex

A
  • mild flu-like illness
  • inguinal lymphadenopathy
  • vulvitis
  • small, characteristic vesicles on vulva
65
Q

how is herpes simplex diagnosed?

A
  • history/ appearance of typical rash

- gold standard- viral culture of vesicle fluid

66
Q

what are the maternal risks of contracting herpes simplex whilst pregnant?

A
  • meningitis
  • sacral radiculopathy
  • transverse myelitis
  • disseminated infection
67
Q

what are the foetal risks of herpes simplex?

A

no congenital defects

miscarriage/ preterm

68
Q

neonatal risks of herpes simplex

A
  • transmission rate from vaginal delivery around 50%
  • some cases limited to eyes and mouth only
  • if widely disseminated (75% of cases) 70% will die, survivors will have long term problems such as mental retardation
69
Q

how is herpes simplex managed in pregnancy?

A
  • acyclovir can decrease severity and duration of attack if given within 5 days of symptom onset
  • if labour is within 6 weeks of primary infection- delivery by Caesarian recommended
70
Q

what are the symptoms of genital warts?

A

painless lumps found anywhere in the genitoanal area

71
Q

what subtypes of human pappilomavirus cause genital warts?

A

6 and 11

72
Q

what are subtypes 16 and 18 of human papillomavirus associated with?

A

CIN and cervical neoplasia

73
Q

how are genital warts treated?

A

cryotherapy- removal of visible wart

treatment contraindicated if pregnancy risk !

74
Q

what cells does HIV target?

A

CD4- resulting in immunodeficiency

NP- Phase 3a Medicine (22 decks)

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