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Phase 3a > Genitourinary > Flashcards

Genitourinary Flashcards

1
Q

what is chlamydia?

A

Urogenital chlamydia infection is a common sexually transmitted infection
The causative organism is Chlamydia trachomatis. Infection is usually asymptomatic in both men and women

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2
Q

what are the symptoms of chlamydia?

A

often asymptomatic

can have cervical discharge, friable cervix, abnormal vaginal bleeding, penile discharge, vaginal discharge

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3
Q

what are the investigations for chlamydia?

A

nucleic acid amplification test (NAAT) - non invasive sampling (urine or vaginal) is as effective as invasive sampling (vaginal, endocervical or penile urethral swab)

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4
Q

how is chlamydia treated?

A

azithromycin
or
doxycycline (should not be used in pregnant women)

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5
Q

what are the complications of chlamydia?

A 
epididymitis 
reactive arthritis 
ophthalmia neonatorum 
chlamydia pneumonia 
ectopic pregnancy 
infertility 
cervical cancer 
PID
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6
Q

what is the screening programme for chlamydia?

A

in England the National Chlamydia Screening Programme is open to all men and women aged 15-24 years
the 2009 SIGN guidelines support this approach, suggesting screening all sexually active patients aged 15-24 years
relies heavily on opportunistic testing

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7
Q

what is bacterial vaginosis?

A

Bacterial vaginosis (BV) describes an overgrowth of predominately anaerobic organisms such as Gardnerella vaginalis. This leads to a consequent fall in lactic acid producing aerobic lactobacilli resulting in a raised vaginal pH.

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8
Q

is BV an STI?

A

Whilst BV is not a sexually transmitted infection it is seen almost exclusively in sexually active women.

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9
Q

what are the clinical features of BV?

A

vaginal discharge - fishy and offensive

asymptomatic in half

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10
Q

what is the criteria for diagnosis BV?

A

Amsel’s criteria
3 of the following 4 points should be present
- thin, white homogenous discharge
- clue cells on microscopy - stippled vaginal epithelial cells
- vaginal pH >4.5
- positive whiff test (addition of potassium hydroxide results in fishy odour)

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11
Q

how is BV managed?

A

oral metronidazole for 5-7 days
70-80% initial cure rate
relapse rate >50% within 3 months

clindamycin intravaginal cream can be used

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12
Q

what are the problems of BV in pregnancy ?

A

results in an increased risk of preterm labour, low birth weight and chorioamnionitis, late miscarriage

it was previously taught that oral metronidazole should be avoided in the first trimester and topical clindamycin used instead. Recent guidelines however recommend that oral metronidazole is used throughout pregnancy. The BNF still advises against the use of high dose metronidazole regimes

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13
Q

what is candidiasis?

A

thrush
a type of vaginitis
caused by a yeast like fungus
very common

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14
Q

what are some predisposing factors to thrush?

A 
immunosuppression 
antibiotics 
pregnancy 
DM
anaemia
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15
Q

what are the symptoms of thrush?

A

may be asymptomatic but usually presents with

  • vulval itching and soreness
  • thick, curd like white vaginal discharge
  • dysuria
  • superficial dyspareunia
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16
Q

how is thrush diagnosed?

A

characteristic appearance of: vulval and vaginal erythema, vulval fissuring, typical whit plaques adherent to the vaginal wall.
Culture from HVS or LVS
microscopic detection of spores and pseudohypae on wet slides

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17
Q

how is thrush treated?

A

should only be treated if symptomatic
clotrimazole pessary
Fluconazole oral

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18
Q

what are some risk factors for STIs

A

multiple partners (two or more in the last year)
concurrent partners
recent partner change
non-use of barrier protection
STI in partner
younger age particularly <25
involvement in the commercial sex industry

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19
Q

what is genital herpes?

A

Genital herpes is caused by infection with either HSV-1 or HSV-2
Sexual contact passes infection to the patient
third most common STI in England

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20
Q

what are the symptoms of herpes simplex virus?

A

prodrome (tingle/itching of the skin in affected area)
flu-like illness +/= inguinal lymphadenopathy
vulvitis and pain
small characteristic vesicles on the vulva, but can be atypical with fissures, erosions, erythema of the skin

recurrent attacks are thought to result from reactivation of the latent virus in the sacral ganglia and are normally shorter and less severe

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21
Q

what can recurrent herpes attacks be triggered by?

A

stress
sexual intercourse
menstruation

22
Q

what are the complications of HSV infection?

A

usually complications are of primary infection

  • meningitis
  • sacral radiculopathy - causing urinary retention and constipation
  • transverse myelitis
  • disseminated infection
23
Q

how is herpes diagnosed?

A

usually from the appearance of a typical rash

PCR testing of vesicular fluid viral culture

24
Q

how do you treat herpes?

A

no cure
symptomatic relief with simple analgesia
oral acyclovir

suppressive treatment if >6 recurrences in a year

25
Q

what is gonorrhoea?

A

A common STI caused by Neisseria gonorrhoeae, a gram-negative diplococcus bacterium that is closely related to other human Neisseria species.

26
Q

what are the symptoms of gonorrhoea?

A

usually asymptomatic
men may get urethral discharge and they may get dysuria
they may present with vaginal discharge, low abdominal pain, IMB or PCB

27
Q

what investigations would you perform for gonorrhoea?

A

endocervical or vulvovaginal swab with nucleic acid amplification test. If in contact with gonorrhoea - urethral, pharyngeal and rectal swabs should be done
culture - there will be a positive chocolate agar culture

28
Q

what are the complications of gonorrhoea?

A 
pelvic inflammatory disease 
Bartholin's or Skene's abscess 
disseminated gonorrhoea may cause - fever, pustular rash , migratory polyarthralgia, septic arthritis 
tubal infertility 
risk of ectopic pregnancy
29
Q

how is gonorrhoea managed?

A

ceftriaxone IM plus azithromycin

if history of sexual abuse add metronidazole

30
Q

what are the problems of gonorrhoea in pregnancy?

A

PPROM
chorioamnionitis
the risks to the baby are of opthalmia neonatarum

31
Q

what is trichomonas vaginalis?

A

Trichomonas vaginalis is a highly motile, flagellated protozoan parasite. Trichomoniasis is a sexually transmitted infection (STI).

32
Q

what are the features of trichomonas?

A

vaginal discharge: offensive, yellow/green, frothy
vulvovaginitis
strawberry cervix
pH > 4.5
in men is usually asymptomatic but may cause urethritis
dysuria

33
Q

how do you diagnose trichomonas?

A

direct observation of motile trophozoites of the organism by a wet smear or acridine orange stained slide from the posterior vaginal fornix
culture and media
NAATs

34
Q

what are the complications of trichomonas?

A

there is some evidence that trichomonal infection may enhance HIV transmission

35
Q

how is trichomonas managed?

A

metronidazole

36
Q

what are the complications of trichomonas in pregnancy?

A

preterm delivery

low birth weight

37
Q

what is syphilis?

A

Syphilis is a sexually transmitted infection caused by the spirochaete Treponema pallidum. Infection is characterised by primary, secondary and tertiary stages. The incubation period is between 9-90 days

38
Q

what are the primary features of syphilis?

A

chancre - painless ulcer at the site of sexual contact
local non-tender lymphadenopathy
often not seen in women (the lesion may be on the cervix)

39
Q

what are the secondary features syphilis?

A

occurs within the first 2 years of infection
generalised polymorphic rash affecting palms and soles
generalised lymphadenopathy
genital condyloma lata (painless, warty lesions on the genitalia)
anterior uvitis

40
Q

what are the tertiary symptoms of syphilis?

A

presents in up to 40% of people infected for at least 2 years, but may take 4+ years to develop
neurosyphilis - tabes dorsalis and dementia
CV syphilis - commonly affecting the aortic root - ascending aortic aneurysm
Gummata - inflammatory plaques or nodes of the skin and bones

41
Q

what are the features of congenital syphilis?

A

blunted upper incisor teeth (Hutchinson’s teeth), ‘mulberry’ molars
rhagades (linear scars at the angle of the mouth)
keratitis
saber shins
saddle nose
deafness

42
Q

how would you diagnose syphilis?

A

Treponema pallidum is a very sensitive organism and cannot be grown on artificial media. The diagnosis is therefore usually based on clinical features, serology and microscopic examination of infected tissue

  • dark field microscopy of swab from lesion
  • specific serum treponemal enzyme immunoassay
    cardiolipin test - rapid plasma regain (RPR), serum venereal disease research laboratory test (VDRL)
43
Q

what can cause false positive cardiolipin tests?

A 
pregnancy
SLE, anti-phospholipid syndrome
TB
leprosy
malaria
HIV
44
Q

how is syphilis managed?

A

IM benzathine benzylpenicillin

alternative is doxycycline

45
Q

what is the Jarisch-Herxheimer reaction

A

seen following syphilis treatment
fever, rash, tachycardia after the first dose of antibiotic
in contrast to anaphylaxis, there is no wheeze or hypotension
it is thought to be due to the release of endotoxins following bacterial death and typically occurs within a few hours of treatment
No treatment is needed other than antipyretics if required

46
Q

what are the problems of syphilis in pregnancy?

A

preterm delivery
still birth
congenital syphilis
miscarriage

47
Q

what are genital warts?

A

Genital warts are the most prevalent form of viral genital mucosal lesions and are caused by infection with several types of human papillomavirus (HPV). The infection manifests as verrucous fleshy papules that may coalesce into plaques. Lesion size ranges from a few millimetres to several centimetres. The warts may be located anywhere in the anogenital or genital area, including on mucosal surfaces

48
Q

what types of the HPV virus cause genital warts?

A

6 and 11

49
Q

what are the symptoms of genital warts?

A

majority are asymptomatic
painless lumps anywhere is the genitoanal area
(senssile exophytic papilloma’s - usually 1-3mm, discrete, sessile, smooth surfaced exophytic papilloma’s or they may coalesce into larger plaques

50
Q

how are genital warts diagnosed?

A

mainly a clinical diagnosis

51
Q

how is genital warts treated?

A

removal of the visible warts - high rate of recurrence due to the latent virus in the surrounding epithelial cells
clinic treatment: cryotherapy, trichloroacetic acid

home treatment - both contraindicated if there is a risk of pregnancy

  • podophyllotoxin cream/solution
  • imiquimod cream

** the HPV vaccine now protects against strains 6 and 11

52
Q

what are the problems of genital wards in pregnancy?

A

genital warts tend to grow rapidly in pregnancy but usually regress after delivery
very rarely, babies are exposed perinatally and may develop laryngeal or genital warts
it is not an indication for c section

Phase 3a (41 decks)

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