Genitourinary Flashcards
Bacterial vaginosis
overgrowth of bacteria in the vagina, specifically anaerobic bacteria
BV anaerobic bacteria
Gardenella vaginali (most common)
Mycoplasma hominid
prevotella
BV presentation
fishy-smelling watery grey discharge
BV investigations
vaginal pH
- BV occurs with pH >4.5
Standard charcoal vaginal swab
-‘clue cells’ on microscopy
BV management
metronidazole
candidiasis
thrush
vaginal infection with yeast of candida family
candidiasis presentation
thick, white discharge
Vulval and vaginal itching, irritation or discomfort
Candidiasis management
Antifungal medications
- clotrimazole (cream or pessary)
- fluconazole (tablets)
Chlamydia aetiology
chlamydia trachomatis: gram-negative bacteria
Chlamydia screening swabs
Charcoal swab
- microscopy, culture and sensitivities
NAAT swabs
- check directly for DNA or RNA of organism
Chlamydia presentation
asymptomatic
women
- abnormal vaginal discharge
- pelvic pain
- abnormal vaginal bleeding
- painful sex
- painful urination
men-urethral discharge/ discomfort
- painful urination
- epididymo-orchitis
- reactive arthritis
Chlamydia exam findings
pelvic/ abdo tenderness
cervical motion tenderness
inflamed cervix
purulent discharge
chlamydi management
doxycycline 100mg twice a day for 7 days
(contraindicated in pregnancy and breastfeeding)
Alternative: Azithromycin
genital herpes
HSV type 1 and 2
HSV-1
associated with cold sores
HSV-2
associated with genital herpes
Management of genital herpers
Aciclovir
Pregnancy and genital herpes management
Primary contract before 28 weeks
- acyclovir
- regular prophylactic from 36 weeks
- Asymptomatic: vaginal delivery
- Symptoms: Caesarean section
primary contract after 28 weeks
- acyclovir
- immediate regular prophylactic acyclovir
- recommend c-section
recurrent
- low risk of neonatal infection
- regular prophylactic acyclovir from 36 weeks
gonorrhoea aetiology
gram-negative diplococcus bacterium
gonorrhoea presentation
Female
- odourless purulent discharge
- dysuria
- pelvic pain
Male
- odourless purulent discharge
- dysuria
- testicular pain/ swelling
Gonorrhoea diagnosis
NAAT
Genital infection
- swabs
- first catch urine sample in males
Standard charcoal Endocervical swab
- for antibiotic sensitivities
gonorrhoea management
IM ceftriaxone (sensitivities not known) Oral ciprofloxacin (known senitivities)
Follow up: Test of cure
AIDS-Defining illness
Occur where CD4 count has dropped to a level that allows for unusual opportunistic infection & malignancies
Kaposi's sacroma Pneumocystis Jirovecii Pneumonia Cytomegalovirus infection Candidiasis Lymphomas TB
Monitoring HIV
CD4 count
Virl lod
HIV treatment
Combination of antiretroviral therapy
yearly cervical smears for women with HIV
Vaccinations
- avoid live vaccines
- influenza, pneumococcal, hep A&B, tetanus, diphtheria, polio
HIV and pregnancy / breastfeeding
Mother’s viral load will determine mode of delivery
breastfeeding: Not recommended.
HIV can be transmitted during breastfeeding, even if mother’ viral load undetectable
mycoplasma genitalium
Bacteria that causes non-gonococcal urethritis
mycoplasma genitalium investigations
often asymptomatic.
Urethritis key feature
NAT
- first urine sample men
- vaginal swabs
mycoplasma genitalium management
Doxycycline followed by azithromycin
Pregnancy & breastfeeding; Azithromycin alone
pelvic inflammatory disease
Inflammation and infection of the organs of the pelvis, caused by infection spreading up and through the cervix.
Significant cause of tubular infertility and chronic pelvic pain
PID aetiology
Neisseria gonorrrhoea
Chlamydia trachomatis
Mycoplasma genitalium
+ less common by non-STIs
- gardenella vaginalis
- h.influenzae
- e.coli
PID risk factors
no barrier contraception multiple sexual partners younger age existing STI Previous PID IUD
Presentation of PID
Pelvic or lower abdo pain Abnormal vaginal discharge Abnormal bleeding Pain during sex Fever Dysuria
PID exam findings
pelvic tenderness cervical motion tenderness inflamed cervix prulent discharge Possible fever
PID investigations
NAAT swabs: chlamydia & gonorrhoea
NAAT: mycoplasma genitalium if available
HIV test
Syphilis test.
Raised inflammatory markers (CRP & ESR)
PID management
Antibiotic regime
IM ceftriaxone
Doxycycline 100mg 2x day for 14 days
metronidazole 400mg 2x daily for 14 days
Fitz-Hugh-Curtis Syndrome
Complication of PID
Inflammation and infection of liver capsule, leading to adhesions between liver and peritoneum.
RUQ pain - possibly referred to right shoulder tip if diaphragmatic irritation
Syphilis
bacteria: treponema pallidum (spirochete bacteria)
Incubation period: 21 dys
Syphilis stages
primary Secondary latent tertiary neuro
Presentation of syphilis
Primary
- painless genital ulcer
- local lymphadenopathy
Secondary
- maculopapular rash
- Condylomata lata (grey wart-like lesions)
- Low-grade fever
- lymphadenopathy
- alopecia
- oral lesions
Tertiary
- gummatous lesions
- aortic aneurysm
- neurosyphilis
Neuroyphilis
- headache
- aletered behaviour
- dementia
- tabes dorsalis
- ocular syphilis
- paralysis
- sensory impairment
Argyll-Robertson pupil
Specific finding in neurosyphilis
Constricted pupil accommodates when focusing on a near object but does not react to light
Often irregularly shaped
Syphilis diagnosis
Antibody test
COnfirm presence of T.pallidum
- dark field microscopy
- PCR
Syphilis management
IM benzathine benzylpenicillin
trichomoniasis
trichomonad vaginalis- parasite
protozoan. Single-celled organism with flagella
Trichominiasis cervix exam
Strawberry cervix
- inflammation. tiny haemorrhages across surface of cervix
trichomoniasis presentation
asymptomatic vaginal discharge;frother & yellow-green itching dysuria dyspareunia balanitis
diagnosis of trichomoniasis
standard charcoal swab with microscopy
- posterior fornix of vagina
- urethral swab or first-catch urine in men
Trichomoniasis management
metronidazole
