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3- Reproduction > Genitourinary > Flashcards

Genitourinary Flashcards

1
Q

Bacterial vaginosis

A

overgrowth of bacteria in the vagina, specifically anaerobic bacteria

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2
Q

BV anaerobic bacteria

A

Gardenella vaginali (most common)
Mycoplasma hominid
prevotella

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3
Q

BV presentation

A

fishy-smelling watery grey discharge

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4
Q

BV investigations

A

vaginal pH
- BV occurs with pH >4.5

Standard charcoal vaginal swab
-‘clue cells’ on microscopy

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5
Q

BV management

A

metronidazole

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6
Q

candidiasis

A

thrush

vaginal infection with yeast of candida family

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7
Q

candidiasis presentation

A

thick, white discharge

Vulval and vaginal itching, irritation or discomfort

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8
Q

Candidiasis management

A

Antifungal medications

  • clotrimazole (cream or pessary)
  • fluconazole (tablets)
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9
Q

Chlamydia aetiology

A

chlamydia trachomatis: gram-negative bacteria

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10
Q

Chlamydia screening swabs

A

Charcoal swab
- microscopy, culture and sensitivities

NAAT swabs
- check directly for DNA or RNA of organism

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11
Q

Chlamydia presentation

A

asymptomatic

women

  • abnormal vaginal discharge
  • pelvic pain
  • abnormal vaginal bleeding
  • painful sex
  • painful urination

men-urethral discharge/ discomfort

  • painful urination
  • epididymo-orchitis
  • reactive arthritis
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12
Q

Chlamydia exam findings

A

pelvic/ abdo tenderness
cervical motion tenderness
inflamed cervix
purulent discharge

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13
Q

chlamydi management

A

doxycycline 100mg twice a day for 7 days
(contraindicated in pregnancy and breastfeeding)

Alternative: Azithromycin

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14
Q

genital herpes

A

HSV type 1 and 2

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15
Q

HSV-1

A

associated with cold sores

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16
Q

HSV-2

A

associated with genital herpes

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17
Q

Management of genital herpers

A

Aciclovir

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18
Q

Pregnancy and genital herpes management

A

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
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19
Q

gonorrhoea aetiology

A

gram-negative diplococcus bacterium

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20
Q

gonorrhoea presentation

A

Female

  • odourless purulent discharge
  • dysuria
  • pelvic pain

Male

  • odourless purulent discharge
  • dysuria
  • testicular pain/ swelling
21
Q

Gonorrhoea diagnosis

A

NAAT

Genital infection

  • swabs
  • first catch urine sample in males

Standard charcoal Endocervical swab
- for antibiotic sensitivities

22
Q

gonorrhoea management

A 
IM ceftriaxone  (sensitivities not known) 
Oral ciprofloxacin (known senitivities)

Follow up: Test of cure

23
Q

AIDS-Defining illness

A

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
24
Q

Monitoring HIV

A

CD4 count

Virl lod

25
Q

HIV treatment

A

Combination of antiretroviral therapy

yearly cervical smears for women with HIV

Vaccinations

  • avoid live vaccines
  • influenza, pneumococcal, hep A&B, tetanus, diphtheria, polio
26
Q

HIV and pregnancy / breastfeeding

A

Mother’s viral load will determine mode of delivery

breastfeeding: Not recommended.
HIV can be transmitted during breastfeeding, even if mother’ viral load undetectable

27
Q

mycoplasma genitalium

A

Bacteria that causes non-gonococcal urethritis

28
Q

mycoplasma genitalium investigations

A

often asymptomatic.
Urethritis key feature

NAT

  • first urine sample men
  • vaginal swabs
29
Q

mycoplasma genitalium management

A

Doxycycline followed by azithromycin

Pregnancy & breastfeeding; Azithromycin alone

30
Q

pelvic inflammatory disease

A

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

31
Q

PID aetiology

A

Neisseria gonorrrhoea
Chlamydia trachomatis
Mycoplasma genitalium

+ less common by non-STIs

  • gardenella vaginalis
  • h.influenzae
  • e.coli
32
Q

PID risk factors

A 
no barrier contraception 
multiple sexual partners
younger age
existing STI
Previous PID
IUD
33
Q

Presentation of PID

A 
Pelvic or lower abdo pain 
Abnormal vaginal discharge
Abnormal bleeding 
Pain during sex
Fever
Dysuria
34
Q

PID exam findings

A 
pelvic tenderness
cervical motion tenderness
inflamed cervix
prulent discharge
Possible fever
35
Q

PID investigations

A

NAAT swabs: chlamydia & gonorrhoea
NAAT: mycoplasma genitalium if available
HIV test
Syphilis test.

Raised inflammatory markers (CRP & ESR)

36
Q

PID management

A

Antibiotic regime
IM ceftriaxone
Doxycycline 100mg 2x day for 14 days
metronidazole 400mg 2x daily for 14 days

37
Q

Fitz-Hugh-Curtis Syndrome

A

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

38
Q

Syphilis

A

bacteria: treponema pallidum (spirochete bacteria)

Incubation period: 21 dys

39
Q

Syphilis stages

A 
primary
Secondary 
latent
tertiary
neuro
40
Q

Presentation of syphilis

A

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
41
Q

Argyll-Robertson pupil

A

Specific finding in neurosyphilis
Constricted pupil accommodates when focusing on a near object but does not react to light
Often irregularly shaped

42
Q

Syphilis diagnosis

A

Antibody test

COnfirm presence of T.pallidum

  • dark field microscopy
  • PCR
43
Q

Syphilis management

A

IM benzathine benzylpenicillin

44
Q

trichomoniasis

A

trichomonad vaginalis- parasite

protozoan. Single-celled organism with flagella

45
Q

Trichominiasis cervix exam

A

Strawberry cervix

- inflammation. tiny haemorrhages across surface of cervix

46
Q

trichomoniasis presentation

A 
asymptomatic 
vaginal discharge;frother & yellow-green 
itching 
dysuria 
dyspareunia 
balanitis
47
Q

diagnosis of trichomoniasis

A

standard charcoal swab with microscopy

  • posterior fornix of vagina
  • urethral swab or first-catch urine in men
48
Q

Trichomoniasis management

A

metronidazole

3- Reproduction (15 decks)

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