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
How do you diagnose Trichomoniasis?
- Sample of vaginal fluid for women
- Urine for men under a microscope
- Shows Trophozoites
What is the treatment for trichomoniasis?
Metronidazole 5-7 days OR 2g single dose
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 the cause of gonorrhea?
Gonorrhea is caused by the bacterium Neisseria gonorrhoeae
What are the complications of gonorrhea?
- PID in women
- Epididymitis in men
What are the symptoms for gonorrhea?
Males:
Urethral discharge, dysuria
Females:
Cervicitis e.g. leading to vaginal discharge
Rectal and pharyngeal infection is usually asymptomatic
How do you diagnose gonorrhea?
-
Microscopic examination of Gram stained smears
- Genital secretions looking for gram negative diplococci within cytoplasm of polymorphs
- Male urethra
- Female endocervix
-
Nucleic acid amplification tests (NAAT)
- Men - First pass utine
- Women - vaginal or endocervical swab
- Culture on selective medium to confirm diagnosis
What is the treatment for gonorrhea?
- IM Cefriaxone 1g - single doese
- If needlephobic - oral ceftriaxone with azithromycin
- If allergic - gentamycin
What is Herpes?
Genital herpes is a common sexually transmitted infection caused by the herpes simplex virus (HSV)
What is the cause of herpes?
HSV-1
This is the type that usually causes cold sores or fever blisters around your mouth. HSV-1 is often spread through skin-to-skin contact, though it can be spread to your genital area during oral sex. Recurrences are much less frequent than they are with HSV-2 infection.
HSV-2
This is the type that commonly causes genital herpes. The virus spreads through sexual contact and skin-to-skin contact. HSV-2 is very common and highly contagious, whether or not you have an open sore.
What are the symptoms of herpes?
Pain or itching
You may experience pain and tenderness in your genital area until the infection clears.
Small red bumps or tiny white blisters
These may appear a few days to a few weeks after infection.
Ulcers
These may form when blisters rupture and ooze or bleed. Ulcers may make it painful to urinate.
Scabs
Skin will crust over and form scabs as ulcers heal.
How do you diagnose herpes?
- Nucleic acid amplification tests (NAAT)
- HSV serology may be useful in certain situations such as recurrent genital ulceration of unknown cause
What is the treatment for herpes?
Acyclovir
Valacyclovir
SAME AS SHINGLES
What is syphilis?
Syphilis is a bacterial infection usually spread by sexual contact
What is the causative orghanism of syphilis?
Treponema pallidum
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
How do you diagnose syphilis?
-
Dark ground microscopy
- Detection of spirochaete in primary and secondary syphilis
-
Serology
- Treponema pallidum Haemagglutination test (TPHA) - Always positive even after treatment
- Venereal Disease Research Laboratory (VDRL Test) - Negative after treatment
What are the results of the VDRL and TPHA after treatment of syphilis?
VDRL (Venereal Disease Research Laboratory) becomes negative
TPHA (Treponema pallidum HaemAgglutination test) remains positive
What is the treatment for syphilis?
- IM benzathine penicillin is the first-line management
- Alternatives: doxycycline
- The Jarisch-Herxheimer reaction is sometimes seen following 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
What is the Jarisch-Herxheimer reaction?
Reaction after taking treatment for syphilis for the first time
Fever, chills, nausea, achy pain and a headache
What is genital warts?
Genital warts are one of the most common types of sexually transmitted infections.
What is the cause of genital warts?
The human papillomavirus (HPV) 6 + 11
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
How do you diagnose genital warts?
Pap tests
HPV test
What is the treatment for genital warts?
FIRST LINE
Topical podophyllin - better for non-keratinised warts
Cryotherapy (freezing) - better for keratinised warts
SECOND LINE
Topical Imiquimod
What is HIV?
Acquired immunodeficiency syndrome (AIDS) is a chronic, potentially life-threatening condition caused by the human immunodeficiency virus (HIV)
What is the cause of HIV?
HIV is caused by a virus.
It can spread through sexual contact or blood, or from mother to child during pregnancy, childbirth or breast-feeding.
What are the symptoms of HIV?
- Fever
- Headache
- Muscle aches and joint pain
- Rash
- Sore throat and painful mouth sores
- Swollen lymph glands, mainly on the neck
- Diarrhea
- Weight loss
- Cough
- Night sweats
How do you diagnose HIV?
Antigen/antibody tests
These tests look for antibodies to HIV in blood or saliva. Most rapid HIV tests, including self-tests done at home, are antibody tests
Nucleic acid tests (NATs)
These tests look for the actual virus in your blood (viral load). They also involve blood drawn from a vein. If you might have been exposed to HIV within the past few weeks
What is the treatment for HIV?
-
Antiretroviral therapy
- Typically two nucleoside reverse transcriptase inhibitors (NRTI) and either a protease inhibitor (PI)
-
Mode of delivery
- Vaginal delivery is recommended if viral load is less than 50 copies/ml at 36 weeks, otherwise caesarian section is recommended
- A zidovudine infusion should be started four hours before beginning the caesarean section
- Neonatal antiretroviral therapy
-
Infant feeding
- In the UK all women should be advised not to breast feed
