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Repro > genitourinary medicine and sexual health > Flashcards

genitourinary medicine and sexual health Flashcards

1
Q

presentation of herpes

A

80% asymptomatic
painful ulcers
burning/itching and blistering
inguinal lymphadenopathy
flu like symptoms
dysuria
neuralgic pain in back pelvis legs

incubation period of about 5 days to months

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2
Q

complications of herpes

A

autonomic neuropathy (urinary retention)
neonatal infection

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3
Q

investigation and management of herpes

A

clinical, swab from lesion anf PCR
primary- aciclovir 400mg for 5 days, lidocaine ointment
recurrence >6 cases- suppressive aciclovir 400mg long term

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4
Q

chlamydia presentation

A

men usually asymptomatic, women sometimes

urethral discharge
dysuria
intermenstural/post coital bleeding
dyspareunia
conjunctivits

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5
Q

chlamydia causative organism

A

Chlamydia trachomatis

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6
Q

complications of chlamydia

A

epidydymits (M)
pelvic inflammatory disease (F)
reactive arthritis (see,pee,tree)

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7
Q

investigations and managment chlamydia

A

NAAT- vulvovaginal swab, first catch urine

doxycycline
azithromycin if pregnant
test reinfection at 3-12 months

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8
Q

gonorrhea presentation

A

men- thick, profuse yellow discharge, dysuria, urethral irritation 10%asymptomatic

women- 50% asymptomatic, vaginal discharge, dysuria, bleeding intermenstrual postcoital

incubation period of 2 days to 2 weeks

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9
Q

complications gonorrhea

A
  • Male
    • Epididymitis
  • Female
    • Pelvic inflammatory disease
    • Bartholin’s abscess
  • Both
    • Acute monoarthritis elbow or shoulder
    • Skin lesions, pustular with halo
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10
Q

investigations and managment gonorrhea

A
  • Nucleic Acid Amplification Test (NAAT) on urine or swab
    • Urethral, endocervical, or rectal swabs
  • Culture for sensitivity testing

1g I/M Ceftriaxone
test of cure at 2 weeks
test of reinfection at 3 months

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11
Q

trichomoniasis everything debrief

A

uncommon
usually asymptomatic but women more likely symptoms - Profuse thin vaginal discharge: greenish, frothy, foul-smelling
- Vulval itching

trichomonas vaginalis

can cause miscarriage or preterm labour

vaginal swab and NAAT and treat with metronidazole 400mg for 5 days or 2g single dose

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12
Q

anogenital warts causative organism

A

HPV type 6 and 11

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13
Q

anogenital warts investigations and management

A

clinical
biopsy if unusual
podophyllotoxin or imiqimod
cyrotherapy
diarthermy or scissor removal if bulky

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14
Q

syphilis presentation

A

9-90 day incubation period

often asymptomatic

primary- local ulcer

secondary- widespread mucocutaneous rash, hepatitis, meningitis

Early latent no symptoms but < 2 years since caught
Late Latent: no symptoms but ≥2 years since caught
Tertiary: neurosyphilis and cardiosyphilis, paralysis, and gummatous skin lesions

can get congenital syphilis

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15
Q

syphilis causative organism

A

treponema pallidum

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16
Q

congenital syphilis

A
  • Shows ≥ 2yrs of age

Hutchinson’s Triad
- Deafness
- Interstitial keratitis
- Hutchinson’s teeth — widely spaced, peg-like

17
Q

diagnosis and management of syphilis

A

serology for
Treponema pallidum IgG enzyme immunoassay (TP IgG EIA)
Treponema pallidum particle agglutination assay (TPPA)
Rapid plasma reagin (RPR)

PCR on sample from ulcer

early managment <2 years
- Benzathine penicillin 2.4 MU IM once
- Doxycycline 100mg bd po 2 weeks (if penicillin allergic)

late
- Benzathine penicillin 2.4MU IM weekly for 3 doses
- Doxycycline 100mg bd po 28 days (if penicillin allergic)

18
Q

risk factors for candidiasis

A
  • Immunosuppression
    • Diabetes
    • HIV
  • Pregnancy
19
Q

investigations of vulvovaginal candidosis

A
  • Microscopy from a high vaginal swab
  • Culture e.g. Sabouraud’s medium
  • PCR (Highest sensitivity)

pH - helpful in differentiating betweenbacterial vaginosis andtrichomonas (pH > 4.5) andcandidiasis (pH < 4.5).

20
Q
A
21
Q

treatment candidasis

A

mild- self limiting
azole antifungals cream pessary or tablets- clotrimazole or fluconazole
pregnant- clotrimazole pessary for 7 nights
recurrent- fluconazole over 6 months

22
Q

causative organism BV

A

Increased gardnerella vaginalis
enterococcus faecalis
actinomyces neuii
Reduced lactobacilli

23
Q

complications of BV

A
  • Endometritis if uterine instrumentation
  • Preterm labour
  • Increase risk of HIV
24
Q

presentation BV

A
  • Asymptomatic
  • Watery grey/yellow fishy-smelling discharge
  • May be worse after period/sex
  • Soreness or itchness from dampness
25
Q

investigations and managament BV

A

pH above 4.5
gram stained smear of vaginal discharge- clue cells on microscopy

avoid soap and shower gel in genital area
metronidazole or clindamycin

26
Q

pelvic inflammatory disease

A

inflammation and infection of organs of the pelvis from spread through cervix

pain
purulent discharge
abnormal bleeding
dyspareunia
fever
dysuria
cervical motion tenderness

27
Q

causative organisms of PID

A

Chlamydia trachomatis 14-35%
Neisseria gonorrhoeae 2-3%

28
Q

complications of PID

A
  • Sepsis
  • Abscess
  • Infertility
  • Chronic pelvic pain
  • Ectopic pregnancy
  • Fitz-Hugh-Curtis syndrome
29
Q

investigations and management of PID

A
  • Rule out pregnancy
  • Nucleic Acid Amplification Test (NAAT) swabsforgonorrhoeaandchlamydia
  • Inflammatory markers(CRP and ESR) are raised in PID and can help support the diagnosis.
  • Antibiotics are usually started empirically prior to swab results to avoid complications
  • If patient is stable: Ceftriaxone, Doxycycline and Metronidazole
  • If patient is unstable: IV Ceftriaxone and Doxycycline
    • unstable i.e. fever, evidence of abscess or peritonitis
30
Q

what does combined contraception do mechanism

A

prevents ovulation- oestrogen and progesterone have a negative feedback effect on the hypothalamus and anterior pituitary suppressing release of GnRH, LH and FSH

ovulation cannot occur without LH and FSH

progesterone thickens cervical mucus and inhibits proliferation of endometrium. withdrawal bleed occures when pill stopped and lining of uterus breaks down

31
Q

how ofteh is ring changed

A

every 3 weeks. can be taken out for 3 hours for sex

32
Q

how often do you chnage the patch

A

weekly

33
Q

contraindications of combined contracpetion

A

uncontrolled hypertension
migraine with aura
history of VTE
over 35 smoking more than 15 a day
vascular disease or stroke
previous breast cancer
ischaemic heart disease
AF
liver cirrhosis or tumour
SLE and antiphospholipid

34
Q

how often do you get injection progesterone only

A

every 13 weeks medroxyprogesterone

35
Q

how long does implant last

A

3 years

36
Q

options for emergency contraception

A
  • Levonorgestrelcan be taken within 72 hours of UPSI
  • Ulipristalcan be taken within 120 hours of UPSI
  • Copper Coilcan be inserted within 5 days of UPSI

Repro (21 decks)

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