genitourinary medicine and sexual health

Question 1

presentation of herpes

Answer 1

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

Question 2

complications of herpes

Answer 2

autonomic neuropathy (urinary retention)
neonatal infection

Question 3

investigation and management of herpes

Answer 3

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

Question 4

chlamydia presentation

Answer 4

men usually asymptomatic, women sometimes

urethral discharge
dysuria
intermenstural/post coital bleeding
dyspareunia
conjunctivits

Question 5

chlamydia causative organism

Answer 5

Chlamydia trachomatis

Question 6

complications of chlamydia

Answer 6

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

Question 7

investigations and managment chlamydia

Answer 7

NAAT- vulvovaginal swab, first catch urine

doxycycline
azithromycin if pregnant
test reinfection at 3-12 months

Question 8

gonorrhea presentation

Answer 8

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

Question 9

complications gonorrhea

Answer 9

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

Question 10

investigations and managment gonorrhea

Answer 10

• 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

Question 11

trichomoniasis everything debrief

Answer 11

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

Question 12

anogenital warts causative organism

Answer 12

HPV type 6 and 11

Question 13

anogenital warts investigations and management

Answer 13

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

Question 14

syphilis presentation

Answer 14

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

Question 15

syphilis causative organism

Answer 15

treponema pallidum

Question 16

congenital syphilis

Answer 16

• Shows ≥ 2yrs of age

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

Question 17

diagnosis and management of syphilis

Answer 17

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)

Question 18

risk factors for candidiasis

Answer 18

• Immunosuppression
  
  • Diabetes
  • HIV
• Pregnancy

Question 19

investigations of vulvovaginal candidosis

Answer 19

• 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).

Question 21

treatment candidasis

Answer 21

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

Question 22

causative organism BV

Answer 22

Increased gardnerella vaginalis
enterococcus faecalis
actinomyces neuii
Reduced lactobacilli

Question 23

complications of BV

Answer 23

• Endometritis if uterine instrumentation
• Preterm labour
• Increase risk of HIV

Question 24

presentation BV

Answer 24

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

Question 25

investigations and managament BV

Answer 25

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

Question 26

pelvic inflammatory disease

Answer 26

inflammation and infection of organs of the pelvis from spread through cervix pain purulent discharge abnormal bleeding dyspareunia fever dysuria cervical motion tenderness

Question 27

causative organisms of PID

Answer 27

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

Question 28

complications of PID

Answer 28

- Sepsis - Abscess - Infertility - Chronic pelvic pain - Ectopic pregnancy - Fitz-Hugh-Curtis syndrome

Question 29

investigations and management of PID

Answer 29

- Rule out pregnancy - Nucleic Acid Amplification Test (NAAT) swabs for gonorrhoea and chlamydia - 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

Question 30

what does combined contraception do mechanism

Answer 30

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

Question 31

how ofteh is ring changed

Answer 31

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

Question 32

how often do you chnage the patch

Answer 32

weekly

Question 33

contraindications of combined contracpetion

Answer 33

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

Question 34

how often do you get injection progesterone only

Answer 34

every 13 weeks medroxyprogesterone

Question 35

how long does implant last

Answer 35

3 years

Question 36

options for emergency contraception

Answer 36

- Levonorgestrel can be taken within 72 hours of UPSI - Ulipristal can be taken within 120 hours of UPSI - Copper Coil can be inserted within 5 days of UPSI