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Medicine > Genitourinary > Flashcards

Genitourinary Flashcards

1
Q

single-celled organism with flagella (protozoan)

A

Trichomonas vaginalis

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2
Q

Trichomoniasis features

A

frothy and yellow-green, fishy smell discharge
associated with vulval itch and soreness, dysuria, abdominal pain and superficial dyspareunia

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3
Q

“strawberry cervix”

A

Trichomoniasis
tiny haemorrhages across the surface of the cervix,

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4
Q

Nucleic acid amplification test is used to diagnose

A

Trichomoniasis
Mycoplasma genitalium
chlamydia
gonorrhoea

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5
Q

Tx Trichomoniasis

A

oral metronidazole

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6
Q

Cause of Genital herpes

A

herpes simplex virus 1 & 2

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7
Q

Epidemiology genital herpes

A

prevalence of both HSV-1 and HSV-2 is higher in women than men
HSV-2 is more likely to cause frequent recurrences than HSV-1.

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8
Q

Features of genital herpes

A

symptoms of an initial infection with genital herpes usually appear within two weeks. multiple, painful, ulcerated genital lesions.small vesicles that progress to pustules, which subsequently ulcerate and crust over.Also tender lymphadenopathy
systemic symptoms, proctitis, urinary retention, dysuria

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9
Q

Viral PCR swab is used to diagnose

A

Genital herpes

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10
Q

Treatment of genital herpes

A

Aciclovir
should be offered to patients who present within 5 days of symptom onset, if new lesions are still appearing or systemic symptoms are ongoing

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11
Q

Pregnancy and Genital Herpes

A

Primary genital herpes contracted after 28w gestation tx with aciclovir followed by regular prophylactic aciclovir to reduce the risk of genital lesions during labour and delivery.
C-section is recommended in all cases to reduce the risk of neonatal infection.
Recurrent genital herpes in pregnancy, Regular prophylactic aciclovir is considered from 36 weeks gestation

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12
Q

Commanest cause of candidiasis

A

C. albicans

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13
Q

RF for candidiasis

A

Increased oestrogen eg ocp
Poorly controlled diabetes
Immunosuppression
Broad-spectrum antibiotics alters the vaginal flora
Local irritants
Sexual activity
HRT

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14
Q

Features of Candidiasis

A

Thick, white discharge ( cottage/cheese like) that does not typically smell
Vulval and vaginal itching,soreness
causes mild dyspareunia and dysuria

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15
Q

Ix for candidiasis

A

hx
vaginal ph - bacterial vaginosis and trichomonas (pH > 4.5) and candidiasis (pH < 4.5)
A charcoal swab with microscopy can confirm the diagnosis

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16
Q

Treatment of candidiasis

A

fluconazole 150 mg oral c
Advise clotrimazole 500 mg intravaginal pessary if oral therapy is contraindicated

Patients with thrush during pregnancy should avoid oral anti-fungal treatment

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17
Q

Mycoplasma genitalium

A

a bacteria that causes non-gonococcal urethritis , sti
presentation is very similar to chlamydia, and patients may be infected with both organisms. Urethritis is a key feature

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18
Q

Symptoms of non-gonococcal urethritis

A

a white or cloudy discharge from penis
dysuria
irritated and sore
Urine frequency
In a small number of cases the infection travels up the tube between the bladder and the end of the penis (the urethra) to the testicles (testes) and causes pain and swelling in one or both testicles. (epididymo-orchitis)
NGU rarely causes any symptoms in women

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19
Q

Treatment for mycoplasma genitalium

A

doxycycline followed by azithromycin

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20
Q

Consider chlamydia in women that are sexually active and present with:

A

Abnormal vaginal discharge
Pelvic pain
Abnormal vaginal bleeding (intermenstrual or postcoital)
Painful sex (deep dyspareunia)
Painful urination (dysuria)

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21
Q

Consider chlamydia in men that are sexually active and present with:

A

Urethral discharge or discomfort
Painful urination (dysuria)
Epididymo-orchitis
Reactive arthritis

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22
Q

when a patient attends a GUM clinic for STI screening, as a minimum, they are tested for:

A

Chlamydia
Gonorrhoea
Syphilis (blood test)
HIV (blood test)

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23
Q

Treatment of chlamydia

A

doxycycline 100mg
contraindicated in pregnancy and breastfeeding

24
Q

Lymphogranuloma Venereum

A

condition affecting the lymphoid tissue around the site of infection with chlamydia. . This is a tropical disease, rare in the UK,most common in MSM

25
Q

Lymphogranuloma Venereum primary stage

A

painless ulcer

26
Q

Lymphogranuloma Venereum secondary stage

A

lymphadenitis. This is swelling, inflammation and pain in the lymph nodes infected with the bacteria.

27
Q

Lymphogranuloma Venereum tertiary stage

A

inflammation of the rectum (proctitis) and anus.

28
Q

Lymphogranuloma Venereum tx

A

Doxycycline 100mg twice daily for 21 days

29
Q

chlamydial conjunctivitis

A

chronic erythema, irritation and discharge lasting more than two weeks.
young adults. It can also affect neonates with mothers infected with chlamydia

30
Q

Gonorrhoea causative organism

A

Gram-negative intracellular diplococcus bacteria
Neisseria gonorrhoeae.

31
Q

Gonorrhea epidemiology

A

15-24 y
increasing rates
MSM most common

32
Q

Gonorrhea Female genital infections can present with:

A

Odourless purulent discharge, possibly green or yellow
Dysuria
Lower Pelvic pain (25%),
abnormal bleeding (rare)

33
Q

Gonorrhea Male genital infections can present with:

A

Penile discharge is observed in > 90% of men, Odourless purulent discharge, possibly green or yellow,usually occurs 2-5 days following infection.
Dysuria
Testicular pain or swelling (epididymo-orchitis)

34
Q

Treatment of gonorrhoea

A

single dose of IM ceftriaxone if sensitivities not known, single dose of oral ciprofloxacin 500mg if the sensitivities ARE known

35
Q

gonococcal conjunctivitis in neonate

A

medical emergency and is associated with sepsis, perforation of the eye and blindness.

36
Q

Disseminated Gonococcal Infection

A

bacteria spreads to the skin and joints.

37
Q

Bacterial vaginosis

A

overgrowth of bacteria in the vagina. It is not a sexually transmitted infection. It is caused by a loss of the lactobacilli that normally keep the vaginal pH low , a more alkali environment enables anaerobic bacteria to multiply.

38
Q

Epidemiology Bacterial vaginosis

A

commonest cause of abnormal discharge in women of childbearing age
one third of women between the ages of 14-49 years old have evidence of BV.
highest amongst women who are sexually active.
It estimated to be around 10% in the UK female population
BV is seen more commonly in black women
Women who have sex with women are more at risk due to shared vaginal flora patterns.

39
Q

Features of bacterial vaginosis

A

fishy-smelling watery grey or white homogenous vaginal discharge.
Half of women with BV are asymptomatic.
no pain/irritation

40
Q

diagnosis of BV can be made when three of the four Amsel criteria are met:

A

Vaginal pH > 4.5
Typical discharge: thin, off-white/grey, homogenous and smoothly coats vaginal wall
Positive whiff-amine test: development of fishy odour with addition of 10% potassium hydroxide to vaginal discharge
Clue cells (on gram stain microscopy): vaginal epithelial cells studded with adherent coccobacilli

41
Q

Treatment of bacterial vaginosis

A

Metronidazole- specifically targets anaerobic bacteria

42
Q

HIV

A

RNA retrovirus. HIV-1 is the most common type. HIV-2 is rare outside West Africa.
The virus enters and destroys the CD4 T helper cells.

43
Q

Primary HIV infection features

A

fever and lymphadenopathy.
maculopapular rash
mucosal ulcers

44
Q

PCP

A

commonest opportunistic infection affecting patients with undiagnosed HIV in this country , is a marker of advanced HIV.
Patients will usually present with a CD4 count <200. It is caused by Pneumocysitis jirovecii

45
Q

PCP treatment

A

IV Co-Trimoxazole for 14-21 days (Trimethoprim plus Sulfamethoxazole or “Septrin”).

46
Q

Ix HIV

A

HIV Antibody blood test
Testing for the p24 antigen
PCR testing for the HIV RNA
Monitor viral load and cd4 count

47
Q

Caesarean section should be used in HIV unless the mother has an undetectable viral load:

A

less than 50 copies/ml at 36 weeks.

48
Q

Newborns to HIV positive mothers should receive

A

ART for 4 weeks after birth

49
Q

Post Exposure Prophylaxis HIV

A

must be commenced within a short period (less than 72 hours). current regime is Truvada (emtricitabine / tenofovir) and raltegravir for 28 days.
HIV tests should be done initially but also a minimum of 3 months after exposure to confirm a negative status.

50
Q

Symphilis causative organism

A

Treponema pallidum.
spirochete, a type of spiral-shaped bacteria.

51
Q

Primary syphilis

A

painless ulcer called a chancre at the original site of infection.usually in conjunction with local lympadenopathy.

52
Q

Secondary syphilis

A

systemic symptoms, maculopauplar rash (palms of the hands and soles of the feet), alopecia

53
Q

Tertiary syphilis

A

Gummatous lesions (gummas are granulomatous lesions that can affect the skin, organs and bones)
Aortic aneurysms
Neurosyphilis

54
Q

Argyll-Robertson pupil

A

constricted pupil that accommodates when focusing on a near object but does not react to light. They are often irregularly shaped.specific finding in neurosyphilis

55
Q

Treatment of syphilis.

A

benzathine benzylpenicillin IM

56
Q

Tx for pubic lice

A

malathion lotion and permethrin 5% cream
Permethrin is NOT usually used if you are under 18.
Follow up should be arranged 1 week after completion of treatment to ensure clearance of infestation.

57
Q

Anogenital warts are caused by

A

human papillomavirus (HPV), most commonly low-risk genotypes 6 and 11.

Medicine (72 decks)

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