Genitourinary Flashcards
Bacteria associated with bacterial vaginosis?
Gardnerella vaginalis
mycoplasma hominis
prevotella species
RFs for bacterial vaginosis?
multiple sexual partners (not STI)
excessive vaginal cleaning
recent antibiotics
smoking
copper coil
Presentation of bacterial vaginosis?
fishy-smelling watery grey or white vaginal discharge
(not typical to have itching or pain -> alt diagnosis)
Investigations of bacterial vaginosis?
vaginal pH >4.5
vaginal swab (‘clue cells’ on microscopy)
Mx of bacterial vaginosis?
no treatment if asymptomatic (self-resolves)
metronidazole (oral or topical)
check for chlamydia or gonorrhoea where appropriate
Metronidazole interacts with?
alcohol
disulfiram-like reaction
Complications of bacterial vaginosis?
incr. risk of STIs
in pregnant women:
miscarriage
preterm delivery
PROM
chorioamnionitis
low birth weight
postpartum endometritis
What is bacterial vaginsosis?
overgrowth or bacteria in the vagina caused by a loss of friendly lactoballi
RFs for candidiasis?
incr. oestrogen
poorly controlled DM
immunosuppression
ABx
Presentation of thrush?
thick, white discharge that does not smell
vulval and vaginal itching, irritation or discomfort
Investigations for candidiasis?
not always necessary
vaginal pH <4.5
charcoal swab with microscopy
Mx of candidiasis?
antifungals
topical cream, pessary or oral
fluconazole oral
clotrimazole topically
pregnant women: topical only, fluconazole C/I
What is chlamydia trachomatis?
gram-negative bacteria
most common STI
cause of infertility
Presentation of chlamydia?
women asymptomatic
abnormal discharge
pelvic pain
abnormal vaginal bleeding
dyspareunia
dysuria
on exam:
pelvic or abdo tenderness
cervical excitation
cervicitis
purulent discharge
Diagnosis of chlamydia?
nucleic-acid amplification test
endocervical swab preferred
Mx of chlamydia?
oral doxycycline 100mg BD for 7 days
refer to GUM
notify sexual partners
abstain from sex for duration of treatment
Complications of chlamydia?
PID
chronic pelvic pain
infertility
ectopic pregnancy
conjunctivitis
reactive arthritis
pregnant:
preterm
PROM
low birth weight
postpartum endometritis
neonatal infection
Presentation of gonorrhoea?
50% women symptomatic
odourless purulent discharge
dysuria
pelvic pain
Diagnosis of gonorrhoea?
NAAT for presence
charcoal swab with microscopy for antibiotic sensitivity as high rates or resistance
Mx of gonorrhoea?
refer to GUM
IM ceftriaxone 1g if sensitivities unknown
oral cipro 500mg if sensitivities known
test of cure
Complications of gonorrhoea?
PID
chronic pelvic pain
infertility
conjunctivitis
urethral strictures
disseminated gonococcal infection
skin lesions
Fitz-Hugh-Curtis syndrome
septic arthritis
endocarditis
Causes of PID?
gonorrhoea
chlamydia
mycoplasma genitalium
Gardnerella vaginalis
haemophilus influenzae
E coli
RFs for PID?
UPSI
multiple sexual partners
younger age
existing STIs
previous PID
IUD
Presentation of PID?
pelvic or lower abdo pain
abnormal vaginal discharge
abnormal bleeding
dyspareunia
fever
dysuria
exam:
pelvic or abdo tenderness
cervical excitation
cervicitis
purulent discharge
Investigations for PID?
NAAT swabs
HIV test
syphilis test
high vaginal swab
pregnancy test
inflammatory markers
Mx of PID?
IM 1g ceftriaxone (gonorrhoea)
doxycycline 100mg BD (chlamydia, mycoplasma)
metronidazole 400mg BD (bacterial vaginosis)
Complications of PID?
sepsis
abscess
infertility
chronic pelvic pain
ectopic pregnancy
Fitz-Hugh-Curtis syndrome
What is Fitz-Hugh-Curtis syndrome?
adhesions form between the liver and the peritoneum
RUQ pain
Complications of trichomoniasis?
incr. risk of:
HIV
bacterial vaginosis
cervical ca
PID
pregnancy-related complications
Presentation of trichomoniasis?
discharge
itching
dysuria
dyspareunia
‘strawberry cervix’
vaginal pH >4.5
Diagnosis of trichomoniasis?
charcoal swab from the posterior fornix of the vagina
Mx of trichomoniasis?
metronidazole
