Genito-Urinary Medicine Flashcards
what is candidiasis?
yeast infection of the lower female reproductive tract
aetiology of candidiasis
hypersensitivity to commensal organisms- typically candida albicans
risk factors for candidiasis
pregnancy DM use of broad-spec ABx chemotherapy foreign bodies in the vagina
how does candidiasis present clinically?
- pruritis vulae
- vulval soreness/ erythema/ oedema
- white ‘cottage cheese’ discharge (non-offensive)
- dysparaeunia
- dysuria
give some differentials for candidiasis
- bacterial vaginosis
- trichomonas vaginalis
- STI
- atrophic vaginitis
- lichen sclerosis
how is candidiasis managed and treated?
- use a soap substitute to clean vulval area
- emolient to moisturise vulval skin
- antifungal agentts- clotrimazole cream, fluconizole tablets
risk factors for chlamydia
- age <25
- sexual partner positive for chlamydia
- multiple sexual partners/ recent change in sexual partner
- another STI
how does chlamydia present clinically (in females and males)?
- 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
differential diagnosis for chlamydia
- gonorrhoea
- prostatitis
- trichomonas vaginalis infection
- bacterial vaginosis
- endometriosis
how is chlamydia diagnosed and how is this test performed in men and women?
- sample taken for nucleic acid amplification tests (NAATs)
- women- vulvovaginal swab
- men- first catch urine specimen
how is chlamydia managed and treated?
doxycycline and azithromycin
contact tracing and contraceptive advice
what medications are given if doxycycline and azithromycin are contraindicted in chlamydia?
erythromycin 500mg BD for 10-14 days
ofloxacin 200mg BD/ 400mg OD for 7 days
what medications used in the treatment of chlamydia are contraindicated in pregnancy?
doxycycline and oflaxacin
where can chlamydia infections occur in adults?
urethra endocervical canal rectum pharynx conjuctiva
what are some complications of chlamydia infection?
- PID- infertility, ectopic pregnancy, chronic pelvic pain
- neonatal- opthlamic neonatorum, atypical pneumonia
- Fitz Hugh Curtis syndrome
what is the national chlamydia screening programme?
aims to detect undiagnosed chlamydia through proactively offering screening to all sexually active young people under the age of 25
what is gonorrhoea?
Neisseria Gonorrhoea is a gram-negative diplococcus infecting mucous membranes of the urethra, endocervix, rectum pharynx and conjuntiva
how does gonorrhoea present in men?
discharge
peri-anal pain
pruritis
how does gonorrhoea present in women?
green/yellow discharge
lower abdo pain
dysuria
how is gonnorhoea diagnosed?
same as chlamydia
- sample taken for nucleic acid amplification tests (NAATs)
- women- vulvovaginal swab
- men- first catch urine
how is gonnorhoea treated?
ceftriaxone IM and Azithromycin oral
contact tracing, contraceptive advice
what is PID?
pelvic inflammatory disease- upper female reproductive tract infection, ascending from the cervix
what organisms can cause PID?
- neisseria gonorrhoeae
- chamydia trachomatis
clinical features of PID
- lower abdominal pain and tenderness
- dyspareunia
- fever
- discharge
- abnormal bleeding
- cervical motion excitation
how is PID diagnosed?
- pregnancy tests
- cervical swabs
- elevated ESR and CRP
- endometrial biopsy
- USS
differential diagnosis of PID
- appendicitis
- ectopic pregnancy
risk factors for the development of PID
- young
- new sexual partner
- multiple sexual partners
- lack of barrier contraception
- low socio-economic group
- IUD
- TOP
how is PID treated?
- mild-moderate- managed in primary care
- clinical severe- hospital admission and IV:
- ceftriaxone 500mg
- doxycycline
- metronidazole
what is Syphillis?
systemic STI characterised by primary, secondary and tertiary stages
what organism causes syphillis?
treponema pallidum
what is the difference between primary and secondary syphillis?
primary- incubation of 2-3 weeks, local infection
secondary- incubation of 6-12 weeks, generalised infection
how does primary syphilis present clinically?
- 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
in heterosexual men with syphilis, were are Chancre typically found?
coronary sulcus
glans and inner surface fo the prepuce
how does secondary syphilis present clinically?
- 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)
how does latent syphilis present clinically?
positive serological tests for syphilis with no clinical evidence of treponemal infection
how does tertiary syphilis present neurologically?
- can by asymptomatic
- dorsal column loss
- dementia
- meningovascular involvement
how does tertiary syphilis affect the cardiovascular system?
- aortitis
- aortic regurgitation
- aortic aneurysm
- angina
what are Gummata?
- occur in tertiary syphilis
- inflammatory fibrous nodules/ plaques which can be locally destructive
- can occur in any organ- but usually bone and skin
give 1 possible differential for syphilis
herpetic ulcers
how is syphilis diagnosed?
Treponemal enzyme immunoassay
IgM= early infection
IgG= later
how is syphilis treated?
- 1st line- Benzathine penicillin 2.4 mega units IM
- 2nd line- single dose Oral azithromycin
what is bacterial vaginosis?
overgrowth on anaerobic organisms, which leads to a fall in lactic acid producing lactobacilli, resulting in a raised pH (>4.5)
what organism typically cause bacterial vaginosis?
- gardnerella vaginalis
risk factors for the development of bacterial vaginosis
- sexual activity
- new sexual partner
- other STI’s
- afro-carribean
- vaginal douching
- receptive oral sex
- smoking
clinical presentation of bacterial vaginosis
- offensive, fishy-smelling vaginal discharge
- no soreness or irritation
- can be asymptomatic
- thin layer of white discharge covering vaginal wall
differential diagnosis for bacterial vaginosis
- other infections- candida, trichomoniasis
- physioloigcal discharge
- tumours of vulvula, vagina, cervix or endometrium
- atrophic vaginitis
how is bacterial vaginosis diagnosed?
- increased vaginal pH (>4.5)
- microscopy
how is bacterial vaginosis managed and treated?
- avoid vaginal douching
- Metronidazole 400-500mg BD for 5-7 days
- can give clindamycin as an alternative
what triad is typically seen in trichomonas vaginalis?
vaginitis
cervicitis
urethritis
what type of organism causes trichomonas vaginalis?
flagellated protozoan
how does trichomonas vaginalis present in women?
- frothy green vaginal discharge
- strawberry cervix
- offensive smell
- dysuria
- lower abdo discomfort
how does trichomonas vaginalis present in men?
- usually asymptomatic
- can have urethritis, dysuria and urethral discharge
how is trichomonas vaginalis diagnosed?
- high vaginal swab
- NAATS- nucleic acid amplification test
how is trichomonas vaginalis managed and treated?
- 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
what is Lichen sclerosis?
chronic inflammatory dermatosis that affects the skin of the anogenital region in women or glans penis and foreskin in men
describe the aetiology of lichen sclerosis
- auto-immune induced in genetically predisposed patients
- preceding infections may play part also
how does Lichen sclerosis present (generally- i.e. in both men and women)?
white thickened patches- with ecchymosis, hyperkeratosis/ bullae
how does Lichen Sclerosis present in women?
- itch- worse at night
- pain
- perianal lesions- constipation
- white lesions ‘figure of 8’ around vulva and anus
- shrinking of labia, clitoral adhesions
how does Lichen sclerosis present in men?
- soreness and haemorrhagic blisters
- dyspareunia
- painful erections due to phimosis
- poor urine stream/ dysuria
- white patches
differential diagnosis of Lichen sclerosis
- vitiligo
- scleroderma
- lichen planus
- leukoplakia
how is Lichen sclerosis diagnosed?
- clinically
- can biopsy if uncertain
how is Lichen sclerosis treated?
topical steroids- e.g. clobetasol propionate
describe the epidemiology of the herpes simplex virus
- spread by sexual contact
- incubation period of 2-7 days
symptoms of herpes simplex
- mild flu-like illness
- inguinal lymphadenopathy
- vulvitis
- small, characteristic vesicles on vulva
how is herpes simplex diagnosed?
- history/ appearance of typical rash
- gold standard- viral culture of vesicle fluid
what are the maternal risks of contracting herpes simplex whilst pregnant?
- meningitis
- sacral radiculopathy
- transverse myelitis
- disseminated infection
what are the foetal risks of herpes simplex?
no congenital defects
miscarriage/ preterm
neonatal risks of herpes simplex
- 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
how is herpes simplex managed in pregnancy?
- 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
what are the symptoms of genital warts?
painless lumps found anywhere in the genitoanal area
what subtypes of human pappilomavirus cause genital warts?
6 and 11
what are subtypes 16 and 18 of human papillomavirus associated with?
CIN and cervical neoplasia
how are genital warts treated?
cryotherapy- removal of visible wart
treatment contraindicated if pregnancy risk !
what cells does HIV target?
CD4- resulting in immunodeficiency
