Genitourinary Medicine Flashcards
What are the STD triple swabs?
In a setting outside a sexual health clinic, three swabs (“triple swabs”) are usually taken to screen for infection in symptomatic women
What are the different swabs for the STD triple swab?
Swab 1
- Stuarts Medium
- Posterior Fornix
- “HVS”
- TV, BV (“heavy growth of anaerobes”), Candida (& grp B strep)
Swab 2
- Endocervix
- Stuart’s Medium
- “ECS”
- GC
Swab 3
- Endocervix (cells)
- Chlam swab
- “Chlamydia”
- Chlamydia
What is thrush?
A vaginal yeast infection is a fungal infection that causes irritation, discharge and intense itchiness of the vagina and the vulva — the tissues at the vaginal opening.
Also called vaginal candidiasis
What is the cause of thrush?
Overgrowth of Candida albicans
Overgrowth of yeast can result from:
- Antibiotic use, which causes an imbalance in natural vaginal flora
- Pregnancy
- Uncontrolled diabetes
- An impaired immune system
- Taking oral contraceptives or hormone therapy that increase estrogen levels
What are the symptoms of thursh?
‘Cottage cheese’, non-offensive discharge
Vulvitis: dyspareunia, dysuria
Itch
Vulval erythema, fissuring, satellite lesions may be seen
Watery vaginal discharge
How do you diagnose thrush?
- A high vaginal swab is not routinely indicated if the clinical features are consistent with candidiasis
- HbA1c for recurrent infections should be done
What is the treatment for thrush?
Local treatments include
- Clotrimazole pessary (e.g. clotrimazole 500mg PV stat)
Oral treatments include
- Itraconazole 200mg PO bd for 1 day or fluconazole 150mg PO stat
if pregnant then only local treatments (e.g. cream or pessaries) may be used - oral treatments are contraindicated
What is chlamdyia?
Chlamydia trachomatis is a common sexually transmitted infection (STI) caused by bacteria
What is the cause of chlamydia?
Chlamydia trachomatis
Most commonly spread through vaginal, oral and anal sex
It’s also possible for pregnant women to spread chlamydia to their children during delivery, causing pneumonia or a serious eye infection in the newborns
What are the complications of chlamydia?
- Pelvic inflammatory disease
- Epididymitis
- Prostate gland infection
- Ecotopic pregnancy
What are the symptoms of chlamydia?
- Asymptomatic in around 70% of women and 50% of men
- Women
- Cervicitis (discharge, bleeding)
- Dysuria
Who is screened regularly for chlamydia?
- Sexually active women age 25 or younger
- Pregnant women
- Women and men at high risk
How is chlamydia diagnosed?
- Urine test - first line for men
- Vulvovaginal swab - pap test - first line for women
Investigation of choice - NAAT is done on these swabs
What is the treatment for chlamydia?
First line
- Doxycycline (7 day course)
In women who are breastfeeding or pregnant
- Azithromycin
- Amoxicillin
- Erythromycin
What is bacterial vaginosis?
Bacterial vaginosis is a type of vaginal inflammation caused by the overgrowth of bacteria naturally found in the vagina, which upsets the natural balance.
What is the cause of bacterial vaginosis?
Bacterial vaginosis results from overgrowth of one of several bacteria naturally found in your vagina.
Usually, “good” bacteria (lactobacilli) outnumber “bad” bacteria (anaerobes)
What are the symptoms of bacterial vaginosis?
- Thin, gray, white or green vaginal discharge
- Foul-smelling “fishy” vaginal odor
- Vaginal itching
- Burning during urination
- Many women with bacterial vaginosis have no signs or symptoms.
How do you diagnose bacterial vaginosis?
- Thin, white homogenous discharge
- Clue cells on microscopy: stippled vaginal epithelial cells
- Vaginal pH > 4.5
- Positive whiff/amine test (addition of potassium hydroxide results in fishy odour)
What is the treatment for bacterial vaginosis?
1st line - Metranidazole
2nd Line - Clindamycin
What is Trichomoniasis?
Trichomoniasis is a common sexually transmitted infection caused by a parasite
What is the cause of Trichomoniasis?
Trichomoniasis is caused by a one-celled protozoan, a type of tiny parasite that travels between people during sexual intercourse.
The incubation period between exposure and infection is unknown, but it’s thought to range from four to 28 days.
What are the symptoms of trichomoniasis?
In Women
- Vaginal discharge: offensive, yellow/green, frothy
- Vulvovaginitis
- Strawberry cervix
- pH > 4.5
In men
- Usually asymptomatic but may cause urethritis
What is the difference between bacterial vaginosis and trichomonas?
What is gonorrhea?
Gonorrhea is an infection caused by a sexually transmitted bacterium that infects both males and females.
Gonorrhea most often affects the urethra, rectum or throat. In females, gonorrhea can also infect the cervix.
What is syphilis?
Syphilis is a bacterial infection usually spread by sexual contact
What are the symptoms of syphilis?
Primary syphilis
The first sign of syphilis is a small sore, called a chancre
Secondary syphilis
Within a few weeks of the original chancre healing, you may experience a rash that begins on your trunk but eventually covers your entire body — even the palms of your hands and the soles of your feet. This rash is usually not itchy and may be accompanied by wartlike sores in your mouth or genital area
Latent syphilis
If you aren’t treated for syphilis, the disease moves from the secondary stage to the hidden (latent) stage, when you have no symptoms
Tertiary syphillis
Gummas (granulomatous lesions of the skin and bones)
Ascending aortic aneurysms
General paralysis of the insane
Tabes dorsalis
Argyll-Robertson pupil
What are the symptoms of genital warts?
Small, flesh-colored, brown or pink swellings in your genital area
A cauliflower-like shape caused by several warts close together
Itching or discomfort in your genital area
Bleeding with intercourse
