Genitourinary medicine Flashcards
Most common anaerobic bacteria causing BV
Gardnerella vaginalis
BV risk factors
multiple sexual partners
excessive vaginal cleaning
recent antibiotics
smoking
copper coil
Presentation of BV
fishy-smelling watery grey or white vaginal discharge.
High pH >4.5
Clue cells on microscopy
Treatment of BV
Metronidazole
Common organism causing candidiasis or thrush
Candida albicans
Risk factors for candidiasis
IBOD
Increased oestrogen
Poorly controlled diabetes
Immunosuppression
Broad-spectrum antibiotics
Presentation of thrush
thick, white discharge
Vulval and vaginal itching, irritation or discomfort
Investigations for thrush
vaginal pH <4.5
charcoal swab with microscopy to confirm diagnosis
Management of thrush
Anifungal cream, pessary or fluconazole oral
What is Canister Duo?
Standard over the counter single fluconazole tablet and clotrimazole cream
Chlamydia investigations
NAAT testing is the investigation of choice
For women vulovaginal swab is first-line treatment
For men: urine test is first line
National Chlamydia screening programme
Open to all men and women aged 15-24
Management of chlamydia
Doxycycline for 7 days is first line
If pregnant - azithromycin can be used instead
Chlamydia presentation
Most cases are asymptomatic in women.
Women:
Abnormal vaginal discharge
Pelvic pain
Painful sex
Painful urination
Men: Urethral discharge or discomfort
Painful urination
Reactive arthritis
Main organism causing gonorrhoea
Nisseria gonorrhoea
Presentation of gonorrhoea
Females:
Odourless purulent discharge
Dysuria
Pelvic pain
Males:
Odourless purulent discharge
Dysuria
Testicular pain or swelling
Diagnosis of Gonorrhoea
NAAT testing
Genital infections diagnosed via endocervical, vulvovaginal or urethral swabs or first catch urine.
Rectal and pharyngeal swab recommended for homosexual men
Treatment of gonorrhoea
IM Ceftriaxone if sensitivities are not known
Oral ciprofloxacin if sensitivities are known
All patients should have ‘test of cure’ given high antibiotic resistance.
Complications of gonorrhoea
PID
Chronic pelvic pain
Infertility
Prostatitis
Conjunctivitis
DIC
Endocarditis
Septic arthritis
What organism causes non-gonococcal urethritis?
Mycoplasma genitalium
What are the main features of mycoplasma genitalium?
Urethritis
Epididymitis
Cervicitis
Endometritis
PID
Mycoplasma genitalium investigations?
NAAT testing
First urine sample for men
Vaginal swabs for women
Management of mycoplasma genitalium
Doxycycline for 7 days and then azithromycin for 2 days
PID can lead to?
Tubular infertility and chronic pelvic pain
Most common organisms causing PID
Neisseria gonorrhoea
Chlamydia trachomatis
Mycoplasma genitalium
Risk factors for PID
Not using protection
Multiple sexual partners
Younger age
Existing STI
Previous PID
IUD
Presentation of PID
Pelvic or lower abdominal pain
Abnormal vaginal discharge
Abnormal bleeding
Pain during sex
Fever
Dysuria
Investigations for PID
NAAT testing for gonorrhoea, chlamydia, mycoplasma genitalium, HIV test and syphilis test
High vaginal swab for BV, thrush and trichomonas
Microscope findings - absence of pus cells is useful for excluding PID
Management of PID
Contact tracing
- Single dose of IM ceftriaxone to cover for chlamydia
- Doxycycline for 14 days to cover to chlamydia and mycoplasma genitalium
- Metronidazole to cover for anaerobes such as garnerella vaginalis
Complications of PID
Sepsis
Abscess
Infertility
Chronic pelvic pain
Ectopic pregnancy
What is Fitz-Hugh-Curtis syndrome and how is it treated?
a complication of PID caused by inflammation of the liver capsule -> adhesion formation between the liver and peritoneum.
Laparascopy used to visualise and treat adhesions by adhesiolysis.
What type of organism is Trichomoniasis?
It is a parasite spread through sexual intercourse.
What can trichomonas increase the risk of?
HIV
BV
Cervical cancer
PID
How does trichomonas present?
Vaginal discharge - fishy
Itching
Dysuria
Painful sex
Balantis
Diagnosis of trichomoniasis
Charcoal swab with microscopy
Low vaginal swab for women
First catch urine or urethral swab for men
Trichomoniasis treatment
Metronidazole
