Genitourinary Flashcards
ABx for cervicitis
Chlamydia
1- doxycycline 100mg BID 7 days
2- azithromycin 1g PO + 500mg PO OD 2 days
Neiserria
- ceftriaxone 1g IM single dose stat - TOC
Or
- cipro 500mg PO single dose
If genotypes anti microbial data suggests susceptibility to cipro - give cipro only , if unknown give ceftriaxone
PID treatment
Outpatient
Inpatient
Out-
Oral Ofloxacin +oral metronidazole
Or
IM ceftriaxone + oral doxy + oral metronidazole
In- CDM
Ceftriaxone + doxy + metronidazole
Yellow greenish, smelly vaginal discharge + itching
On exam - strawberry cervix
Vaginal pH >4.5
Dx + treatment ?
Trichomoniasis
Oral metronidazole
Grey white fishy vaginal discharge
Positive whiff test
Vaginal pH>4.5
Dx + tx?
Bacterial vaginosis - Gardnerella vaginalis
Metronidazole +clindamycin
Treatment of vulvovaginal candidiasis
Clotrimazole
What is normal vaginal pH
3.8 -4.5
Amsel’s criteria
Diagnosis of bacterial vaginosis 3/4 of : 1. Homogenous grey - white discharge 2. +ve whiff test (fishy smell w/ KOH) 3. Clue cells under microscopy 4.vaginal ph> 4.5
HPV 6 and 11 are responsible for
Genital warts
HPV 16 & 18 are responsible for
Most cervical cancers in UK
Prevention of genital warts
Gardasil
If vaccinated and warts still develop its of no help
Treatment of genital warts
Ablation/ cryotherapy
Multiple painful genital ulcers + dysuria
Dx +Treatment
HSV
Give acyclovir
Single non painful genital ulcer
Dx?
Syphilis - treponema pallium
Chancre
Single painful genital ulcer
Dx>
Haaemophilus Ducreyi (chancroid)
^ can be multiple and painful, like HSV - do PCR or viral culture to differentiate
PCR better **
Motile flagellate on microscopy of vaginal discharge
Dx?
Trichomoniasis vaginalis
Chlamydia presentation in males
Complications
Urethritis
Unilateral testicular pain
- untreated chlamydia - epididymis-orchitis or epididiymitis
Major complication of untreated chlamydia in females
Saplingitis
Most common STI in the UK
Chlamydia
Complications of syphilis
Aortic aneurysm
Granulomatous lesions of skin and bone - 3ry stage syphilis
Treatment of cervical ectropion
Resolves spontaneously
If tx required - cauterise with silver nitrate
Anogenital warts are caused by
HPV 6 & 11
Single best investigation in the case of a 20 YO with a new sexual partner and complaints of yellow green vaginal discharge that is increasing
Endocervical and high vaginal swab
HVS, endocervical, and self collected vulvovaginal swabs uses
self collected - chlamydia, n.gonorrhoea screening
^ suspected case , asymptomatic
Signs and sx of chlamydia or gonorrhoea
- endocervical swab
Suspected trichomoniasis - HVS
To cover all @ once = endocervical + HVS
Most sensitive screening test for chlamydia and gonorrhoea
Self collected vulvovaginal swab for NAAT
HSV investigations
1st line - NAAT testing
Others = viral culture + DNA PCR
If negative and the ulcers are recurrent/atypical - Anti HSV antibody
Treatment of HSV
Oral acyclovir
Rashes on the palms and soles of feet occurs in (3)
- HFMD - coxsackie
- Rocky Mountain spotted fever - rickettsia
- Secondary syphilis - treponema pallidum
Primary stage of syphilis
Chancre - single painless ulcer
2ry stage of syphilis
- when does it occur
Features (3)
6 weeks after chancre
Fever lymphadenopathy malaise - systemic symptoms
Rashes on soles palms and faced
Condyloma lata
3ry stage of syphilis
3
Gumma - granulomatous lesion ; commonly affects skin & bones
Cardiovascular - ascending aortic aneurysm , aortic regurgitation
Neuro - dementia/ tabes dorsalis
Management of syphilis
1st line - IM benzathine penicillin
Alternatively , if allergic
Doxycycline
Investigations of syphilis
Ulcer still present + presents to GU clinic - dark microscopy
Ulcer present + GP clinic - PCR
Healed chancre (disappeared) - syphilis serology
Healed chancre + oral ulcers present - mouth swab for PCR
Investigation after anal intercourse (insertive & receptive )
Receptive = NAAT
Rectal swab for screening of chlamydia and gonorrhoea - NAAT
Insertive
Urethral swab + first void sample urine
*receptive much riskier for getting HIV
Screen fro HIV Hep B chlamydia and gonorrhoea
Treatment of pregnancy woman w/ UTI
Cefalexin
Condyloma accuminatum vs Condyloma latum
Accumiantum - HPV = painless, skin coloured, cauliflower like
Latum - 2ry syphilis = painless hypopigmented , firm moist , pink/reddish , papules containing spirochetes
Chancre vs chancroid
Chancre - T.pallidum (syphilis)
Painless, single , bilateral regional lymphadenopathy
Exude serum
Hard and indurated, sloping edges
Chancroid = H.Ducreyi
Painful, multiple, unilateral regional lymphadenopathy
Purulent exudate
Soft base, undermined edges
