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Obstetrics and Gynaecology > Genitourinary Medicine (GUM) > Flashcards

Genitourinary Medicine (GUM) Flashcards

1
Q

What are the causes for vaginal discharge?

A

Physiological
Candida

Trichimonas vaginalis
Bacterial vaginosis
Gonorrhoea
Chlamydia
Ectropion
Foreign body
Cervical cancer
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2
Q

What type of discharge is seen in candida infections?

A

Curd like
Non-offensive

White

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3
Q

What type of discharge is seen in trichimonas?

A

Yellow, frothy, offensive

Strawberry cervix

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4
Q

What type of discharge is seen in bacterial vaginosis?

A

Thin
White/grey

Fishy

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5
Q

What type of discharge is seen in gonorrhoea?

A

Thin
Watery

Yellow

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6
Q

What type of discharge is seen in chlamydia?

A

Copious amounts of purulent yellow discharge

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7
Q

What type of discharge is seen in ectropion?

A

Increased amounts of normal discharge

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8
Q

What type of discharge may be seen with foreign bodies?

A

Foul smelling

+ blood

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9
Q

What type of discharge is seen in cervical cancer?

A

Persistent discharge which doesn’t respond to treatment

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10
Q

What are the main risk factors for STIs?

A

Age <25
Sexual partner positive

Recent change in sexual partner
Co-infection with another STI
Non-barrier contraception

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11
Q

How are STIs managed in general?

A

Abstain from sex until both treated
Offer screening for other STI’s

Encourage talking to previous partners
Talk about safe sex in future

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12
Q

What is bacterial vaginosis?

A

Not an STI
Normal vaginal flora disturbed leading to reduced lactobacilli

Other micro-organisms grow - Gardnerella Vaginalis, anaerobes and mycoplasmas

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13
Q

Why do you have a raised pH in bacterial vaginosis?

A

Lactobacilli produce hydrogen peroxide to maintain acidity

Reduced lactobacilli

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14
Q

What are the main risk factors for bacterial vaginosis?

A

Multiple sexual partners
Receptive oral sex

IUD
Concurrent STI
Vaginal douching or soaps
Recent Abx use
Smoking
Copper coil
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15
Q

How does bacterial vaginosis present?

A

Offensive fishy discharge
Thin white/grey discharge

Not normally sore or itchy

Speculum examination can be performed to confirm with high vaginal swab

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16
Q

How is bacterial vaginosis diagnosed?

A

High vaginal swab for microscopy:
- Clue cells (vaginal epithelia studded with coccobacilli)

  • Reduced lactobacilli
  • Absence of pus cells

Vaginal pH >4.5 - 3.5-4.5
Positive whiff test - add alkali to discharge and strong fishy odour smelt

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17
Q

How is bacterial vaginosis managed?

A

Asymptomatic - dont need treating
Oral metronidazole - can be vaginal

Clindamycin second line
Advice regarding risk factors
Consider IUD removal

Assess the risk of chlamydia and gonorrhoea with swabs

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18
Q

What must be avoided during treatment with metronidazole?

A

Alcohol
Alcohol and metronidazole can cause a disulfarim like reaction with n+v, flushing and sometimes symptoms of shock or angioedema.

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19
Q

What is the recurrence rate of bacterial vaginosis and how is it managed?

A

> 50% in 3 months

Oral metronidazole

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20
Q

What is important to know about bacterial vaginosis in pregnancy?

A

Symptomatic BV can increase risks of premature birth, miscarriage and chorioamnionitis

Treat with metronidazole

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21
Q

What are the complications of bacterial vaginosis?

A

Can increase the risk of catching STIs, including chlamydia, gonorrhoea, HIV.

Complications in pregnant women
Miscarriage
Preterm delivery
Preterm rupture of membranes
Chorioamnionitis
Low birth weight 
Postpartum endometritis
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22
Q

What is candidiasis?

A

Not an STI

Also called thrush

Overgrown of Candida albicans

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23
Q

What is the peak incidence of candidiasis?

A

20-40yo

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24
Q

What are the main risk factors for thrush?

A

Pregnancy
Diabetes

Recent abx use
Corticosteroid use
Immunocompromised

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25
Q

How does thrush present?

A

Vulval itching
White curd like discharge - non-offensive

Dysuria

On examination:

  • erythematous vulva
  • satellite lesions - red pustular lesions with superficial white pseudomembranous plaques that can be scraped off

Can have fissures, dyspareunia, excoriation, oedema

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26
Q

What are the investigations for thrush?

A

Often treatment is started empirically
Test vaginal pH using swab and pH paper to differentiate between BV and trichomonas and candidiasis pH <4.5

Charcoal swab with microscopy can confirm diagnosis

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27
Q

What are the management options for thrush?

A

Antifungal medications
Cream - clotrimazole inserted into the vagina with an applicator
Antifungal pessary - clotrimazole
Antifungal tablets - fluconazole

For initial uncomplicated cases options are:
Single dose of cream at night
Single dose of pessary at night
Three doses of pessaries over three nights
Single dose of oral fluconazole

Canesten Duo available over the counter containing single fluconazole tablet and clotrimazole cream

Antifungal creams and pessaries can damage latex condoms
Alternative contraception needed 5 days after use

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28
Q

What should you do if thrush management fails?

A

Measure vaginal pH (<4.5 in thrush) and swab for microscopy

Address risk factors

Treat for longer period

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29
Q

Why is thrush more likely in pregnancy? How is it managed?

A

Oestrogen levels - increased glycogen create favourable environment. Promote growth and sticks it to walls

Treat with intravaginal not oral meds

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30
Q

What organism causes chlamydia and how long is the incubation period?

A

Chlamydia trachomatis
Intracellular gram -ve cocci/rod shaped

7-21 day incubation

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31
Q

How is chlamydia transmitted?

A

Vaginal, oral or anal sex
Skin-skin genital contact

Can infect eye, pharynx and rectum

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32
Q

How does chlamydia present in women?

A

70% asymptomatic
Cervicitis - discharge and bleeding

Dysuria
Pelvic pain
Cervical excitation
Painful urination and sex

Consider rectal chlamydia and lymphogranuloma venereum in patients presenting with anorectal symptoms e.g. discomfort, discharge, bleeding or change in bowel habits after anal sex.

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33
Q

How does chlamydia present in males?

A

50% asymptomatic
Dysuria

Discharge
Urethral discomfort
Testicular pain
Reactive arthritis

Consider rectal chlamydia and lymphogranuloma venereum in patients presenting with anorectal symptoms e.g. discomfort, discharge, bleeding or change in bowel habits after anal sex.

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34
Q

How is chlamydia investigated?

A

NAAT technique on:

Vulvo-vaginal swab
First void urine

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35
Q

What swabs are used in sexual health testing?

A

Charcoal swabs
Nucleic acid amplification test

Charcoal swabs allow for microscopy, culture and sensitivities.
Allows for gram staining for endocervical swabs and high vaginal swabs - confirms BV, candidiasis, gonorrhoea, trichomonas, GBS

NAAT checks DNA or RNA of organism, used specifically for chlamydia and gonorrhoea.
Vulvovaginal swab (self taken) endocervical swab or first catch urine. In men, first catch or urethral swab.

Rectal or oral NAAT swabs for chlamydia in rectum or mouth.

If gonorrhoea on NAAT, then endocervical charcoal swab for MCS.

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36
Q

What are the examination findings in chlamydia?

A

Pelvic or abdominal tenderness
Cervical motion tenderness - cervical excitation
Inflamed cervix - cervicitis
Purulent discharge

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37
Q

How is chlamydia diagnosed?

A

NAAT
Nucleic acid amplification tests

Vulvovaginal swab
Endocervical swab
First catch urine sample
Urethral swab in men
Rectal swab - after anal sex
Pharyngeal swab after oral sex
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38
Q

What is the management of chlamydia?

A

First line for uncomplicated - doxycycline 100mg twice a day for 7 days
Erythromycin if CI

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39
Q

When is doxycycline contraindicated in treatment for chlamydia?

A

In pregnancy and breastfeeding

Alternatives include
Azithromycin 1mg stat, then 500mg once a day for 2 days
Erythromycin 500mg four times daily for 7 days
Erythromycin 500mg twice daily for 14 days
Amoxicillin 500mg three times daily for 7 days

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40
Q

What are important factors to consider during the treatment of chlamydia?

A

Test of cure not usually routinely recommended.
Abstain from sex for seven days of treatment of all partners
refer to GUM for contact Tracing and notification of sexual partners
Test for and treat any other sexually transmitted infections
Provide advice about how to prevent future infections
Consider safeguarding and sexual abuse in young people

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41
Q

What are the complications of chlamydia?

A 
Pelvic inflammatory disease
Chronic pelvic pain
Infertility
Ectopic pregnancy
Epididymo-orchitis
Conjunctivitis
Lymphogranuloma venereum
Reactive arthritis
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42
Q

What are the pregnancy related complications of chlamydia?

A 
Preterm delivery
Premature rupture of membranes
Low birth weight
Postpartum endometritis
Neonatal infection - conjunctivitis and pneumonia
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43
Q

What is lymphogranuloma venereum?

A

Condition affecting the lymphoid tissue around the site of infection with chlamydia.

Primary stage - painless ulcer, primary lesion - on penis in men, vaginal wall or rectum.

Secondary stage - lymphadenitis; swelling, inflammation and pain in lymph nodes infected with bacteria - inguinal or femoral lymph nodes.

Tertiary - inflammation of the rectum and anus, proctitis leads to anal pain, changes in bowel habits, tenesmus.

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44
Q

What is the treatment of lymphogranuloma venereum?

A

Doxycycline 100mg twice daily for 21 days

Erythromycin or azithromycin are second line options

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45
Q

What is chlamydial conjunctivitis?

A

When genital fluid comes into contact with the eye e.g. hand to eye spread.
Presents with chronic erythema, irritation and discharge lasting more than two weeks.

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46
Q

What organism causes gonorrhoea? how long is the incubation period?

A

Neisseria gonorrhoea - gram -ve cocci

2-5 day incubation

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47
Q

How is gonorrhoea transmitted?

A

Vaginal, oral or anal sex
Vertical transmission - mother to child

Can infect rectum and pharynx

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48
Q

What is the main additional risk factor for gonorrhoea?

A

MSM

49
Q

How does gonorrhoea present in women?

A

50% asymptomatic
Cervicitis - thin watery yellow discharge

Dysuria
Pelvic pain
Easily induced cevical bleeding

50
Q

How does gonorrhoea present in men?

A

Purulent discharge
Dysuria

Epididymal tenderness
Testicular pain or swelling

Rectal infection may cause anal or rectal discomfort and discharge, often asymptomatic

Pharyngeal infection - sore throat
Prostatitis
Conjunctivitis - erythema, purulent discharge

51
Q

How is gonorrhoea investigated?

A

NAAT technique - endocervical/vaginal swab or first pass urine

Microscopy and culture - endocervical/urethral swabs

NATT does not provide info on specific bacteria, sensitivities and resistance hence microscopy is needed.

52
Q

How is gonorrhoea managed?

A

Referred to GUM for coordinate testing, treatment and contact tracing.
If uncomplicated - single dose of intramuscular ceftriaxone 1g if the sensitivities not known
Single dose of oral ciprofloxacin 500mg if sensitivities are known

53
Q

How is gonorrhoea followed up?

A

TOC
With NAAT testing if asymptomatic or cultures if symptomatic
at least 72 hours after treatment for culture
7 days after treatment RNA NATT
14 days after treatment for DNA NATT

54
Q

What are the main complications associated with gonorrhoea?

A

PID
Epididymo-orchitis

Prostatits
Salpingitis –> infertility
Disseminated gonococcal infection

55
Q

How would you contact trace for gonorrhoea?

A

Symptomatic men - all partners 2 weeks

Women and asymptomatic men - all partners 3 months

56
Q

What is important to know about gonorrhoea in pregnancy?

A

Risk of spontaneous abortion, premature labour and early rupture of membranes

IM ceftriaxone and oral azithromycin

57
Q

How does a disseminated gonococcal infection present and how is it managed?

A

Skin lesions and joint pain

Admit to hospital for management - can lead to sepsis

58
Q

What are other factors is it important to consider during treatment for gonorrhoea?

A

Abstain from sex for 7 days of treatment of all partners
Test for and treat any other STIs
Provide advice about ways to prevent future infection
Consider safeguarding

59
Q

What are the complications of gonorrhoea?

A 
Pelvic inflammatory disease
Chronic pelvic pain
Infertility 
Epididymo-orchitis
Prostatitis
Conjunctivities
Urethral strictures
Disseminated gonococcal infection
Skin lesions
Fitz-Hugh curtis syndrome
Septic arthritis
Endocarditis
60
Q

What is disseminated gonococcal infection?

A

Complication of untreated gonococcal infection
Bacteria spreads to skin and joints
Skin lesions
Polyarthralgia - joint aches and pains
Migratory polyarthritis
Tenosynovitis
Systemic symptoms e.g. fever and fatigue.

61
Q

What is mycoplasma genitalium?

A

Bacteria that causes non gonococcal urethritis

62
Q

What may a MG infection lead to?

A 
Urethritis
Epididymitis
Cervicitis
Endometritis
PID
Reactive arthritis
Preterm delivery in pregnancy
Tubal infertility
63
Q

What are the investigations for MG?

A

NAAT testing as traditional cultures not helpful in isolating MG as it is a slow growing organism.

First urine sample in the morning for men.
Vaginal swabs for women

Check every positive sample for macrolide resistance and perform a test of cure after treatment.

64
Q

What is the management of MG?

A

Doxycycline 100mg twice daily for 7 days then
Azithromycin 1g stat, then 500mg once a day for 2 days unless there is known to be resistance.

Moxifloxacin can be used as an alternative.
Azithromycin alone in pregnancy.

65
Q

What is pelvic inflammatory disease?

A

Inflammation and infection of the organs of the pelvis caused by infection spreading up through the cervix.

66
Q

What are the common causes of PID?

A

Neisseria gonorrhoea - produces most severe PID
Chlamydia trachomatis
Mycoplasma genitalium

Can also be caused less commonly by non sexually transmitted infections e.g. Gardnerella, haemophils influenzae, e. coli

67
Q

What are the risk factors for PID?

A 
Not using barrier contraception
Multiple sexual partners
Younger age
Existing sexually transmitted infections
Previous PID
Intrauterine device e.g. copper coil
68
Q

What is the presentation of PID?

A 
Pelvic or lower abdominal pain
Abnormal vaginal discharge
Abnormal bleeding - intermenstrual or postcoital
Pain during sex - dyspareunia
Fever
Dysuria
69
Q

What may be findings on examination in PID?

A

Pelvic tenderness
Cervical motion tenderness
Inflamed cervix - cervicitis
Purulent discharge

70
Q

What are the investigations for PID?

A

NAAT swabs for gonorrhoea and chlamydia
NAAT swabs for MG if available
HIV test
Syphilis test

A high vaginal swab for BV, candidiasis, trichomoniasis
Microscope to look for pus cells
Pregnancy test if presenting with lower abdominal pain to rule out ectopic pregnancy.
Inflammatory markers CRP and ESR

71
Q

What is the management of PID?

A

Referral to GUM and contact tracing
Start antibiotics empiricallly
Single dose of IM ceftriaxone to cover gonorrhoea
Doxycycline 100mg twice daily for 14 days to cover chlamydia and MG
Metronidazole 400mg twice daily for 14 days to cover anaerobes e.g. Gardnerella

If signs of sepsis admit to hospital, IV antibiotics
Pelvic abscess may develop

72
Q

What are the complications of PID?

A 
Sepsis
Abscess
Infertility
Chronic pelvic pain
Ectopic pregnancy
Fitz Hugh Curtis syndrome
73
Q

What is Fitz Hugh Curtis syndrome?

A

A complication of PID, due to inflammation and infection of the liver capsule - Glisson’s capsule
Leads to adhesions between the liver and the peritoneum. Bacteria may spread from pelvis via peritoneal cavity, lymphatic system or blood.

Results in RUQ pain, can be referred to shoulder tip.
Laparoscopy needed to visualise and treat adhesions.

74
Q

What is trichomonas vaginalis?

A

A parasite spread through sez

Lives in urethra of men and women, and vagina of women

75
Q

What can trichomoniasis increase the risk of?

A

Contracting HIV by damaging vaginal mucosa
Bacterial vaginosis
Cervical cancer
Pelvic inflammatory disease
Pregnancy related complications e.g. preterm delivery

76
Q

What is the presentation of trichomoniasis?

A 
Up to 50% asymptomatic
Vaginal discharge - frothy, yellow-green, fishy
Itching
Dysuria - painful urination
Dyspareunia
Balanitis - inflammation to glands penis
77
Q

What is seen on examination in trichomoniasis?

A

Strawberry cervix - colpitis macularis
Due to inflammation - cervicitis, tiny haemorrhages across the surface of the cervix making it look like a strawberry.

pH testing - raised pH above 4.5

78
Q

What can be done to confirm the diagnosis of trichomoniasis?

A

Charcoal swab with microscopy
Swabs taken from posterior fornix of vagina, behind the cervix, or self taken swab as alternative
For men - urethral swab or first catch urine.

79
Q

What is the management of trichomoniasis?

A

Referral to GUM clinic, diagnosis, treatment, contact tracing. Treatment with metronidazole

80
Q

What causes trichomonas vaginalis? what is the incubation period?

A

A protozoa

1 month incubation

81
Q

How is trichomonas vaginalis transmitted? what are the additional risk factors?

A 
Vaginal sex (NOT ORAL OR ANAL)
Vertical transmission - mother to child at delivery

Older women

82
Q

What is important to know about trichomonas vaginalis in pregnancy?

A

Risk of premature labour and low birth weight

Metronidazole can be used but affect taste of breast milk

83
Q

What are the similarities between BV and trichomonas?

A

“Offensive” vaginal discharge

Vaginal pH >4.5

Treat with metronidazole

84
Q

How does BV vary from trichomonas?

A

Thin white discharge

Microscopy - clue cells

85
Q

How does trichomonas vary from BV?

A

Frothy yellow green discharge
Vulvovaginitis

Strawberry cervix

Wet mount - motile trophozoites

86
Q

What is the herpes simplex virus?

A

Responsible for cold sores and genital herpes.

Strains HSV-1 and HSV-2.

87
Q

What is the pathophysiology of recurrent infection?

A

After initial infection, virus becomes latent in associated sensory nerve ganglia.
Trigeminal nerve ganglion - cold sores.
Sacral nerve ganglion - genital herpes.

Reactivated, particularly in times of stress.

88
Q

How is herpes spread?

A

Through direct contact with affected mucous membranes or viral shedding in mucous secretions. Can shed even when asymptomatic, more common in first 12 months of infection.

89
Q

What is the presentation of genital herpes?

A

May be asymptomatic, or develop symptoms months or years after an initial infection when latent virus reactivated.

Symptoms appear within two weeks. Initial episode most severe, recurrent episodes more mild.

Ulcers, blistering lesions on genital area
Neuropathic type pain - burning, tingling, shooting
Flu like symptoms e.g. fatigue, headache
Dysuria
Inguinal lymphadenopathy

90
Q

How can herpes infection be diagnosed?

A

Ask about sexual contact including those with cold sores
Diagnosis made clinically based on history and exam
Viral PCR swab from lesion can confirm diagnosis

91
Q

What is the management of herpes?

A

Aciclovir

Additional measures:
Paracetamol
Topical lidocaine e.g. Instillagel
Cleaning with warm salt water
Topical vaseline
Additional oral fluids
Wear loose clothing
Avoid intercourse with symptoms
92
Q

What is the risk of pregnancy with genital herpes?

A

Not known to cause any pregnancy related complications

But risk of neonatal herpes simplex infection during labour and delivery.
If develops infection, woman will develop antibodies to the virus which can cross placenta and give the fetus passive immunity.

93
Q

What is the management of genital herpes in pregnancy?

A

Primary herpes before 28 weeks - aciclovir then regular prophylactic aciclovir from 36 weeks.
Asymptomatic can have vaginal otherwise c-section.

Primary genital herpes after 28 weeks treated with aciclovir during initial infection then regular prophylactic aciclovir. C-section in all causes.

Recurrent genital herpes - low risk of infection, known to have genital herpes before becoming pregnant.
Regular prophylactic aciclovir considered from 36 weeks.

94
Q

What is HIV and AIDS?

A

Human immunodeficiency virus
Acquired immunodeficiency syndrome occurs as HIV progresses, leads to opportunistic infections - several AIDS defining illnesses e.g. Karposi’s sarcoma.

95
Q

What sort of virus is HIV?

A

RNA retrovirus
HIV-1 most common type, HIV-2 rare outside west africa
Enters and destroys CD4 T helper cells
Initial seroconversion flu like illness, then asymptomatic until condition progresses to immunodeficiency.

96
Q

How is HIV transmitted?

A

Unprotected anal, vaginal or oral sexual activity
Mother to child at any stage of pregnancy, birth or breastfeeding - vertical transmission
Mucous membrane, blood or open wound exposure to blood or bodily fluids; sharing needles, needle stick injuries, blood splashed in an eye.

97
Q

What are examples of AIDS defining illnesses?

A

Occurs at end stage HIV, where CD4 count very low

Kaposi's sarcoma
Pneumocystis jirovecii pneumonia
Cytomegalovirus infection
Candidiasis - oesophageal or bronchial
Lymphomas
Tuberculosis
98
Q

How long can it take for HIV tests to be positive?

A

Can take up to three months to develop antibodies after infection
Repeat testing necessary if initial test negative within three months of exposure
Verbal consent needed to test for HIV

99
Q

How is HIV tested?

A

Antibody testing with simple blood test, self sampling kit
Tests for p24 antigen in the blood which can give an earlier result than the antibody test.
PCR testing for HIV RNA - detects number of viral copies and viral load.

100
Q

How can HIV be monitored?

A

CD4 count
500-1200 is in normal range, under 200 cells mm3 is considered end stage HIV

Viral load - number of copies of HIV RNA per ml blood
Undetectable usually 50-100 copies

101
Q

What is the treatment of HIV?

A

Antiretroviral therapy medications
Offered to everyone irrespective of viral load or CD4 count
Start on regime of two NRTIs (nucleoside reverse transcriptase inhibitors) r.g. tenofovir and emtricitabine

Aims to achieve normal CD4 count and undetectable viral load, then can treat physical health problems as normal.

102
Q

What are examples of highly active anti-retrovirus therapy HAART medications?

A

Protease inhibitors
Integrase inhibitors
Nucleoside reverse transcriptase inhibitors
Non-nucleoside reverse transcriptase inhibitors
Entry inhibitors

103
Q

What additional management is available for HIV?

A

Prophylactic co trimoxazole given to patients with CD4 count under 200 to protect against pneumocystis.

Close monitoring of CV risk factors and blood lipids, may also need statins, increased risk of CVD.

Yearly cervical smears as HIV predisposes to developing HPV and cervical cancer.

Vaccinations up to date, including flu, pneumococcal, Hep A and B, tetanus, diptheria, polio. No live vaccines.

104
Q

What is important in HIV and reproductive health?

A 
Advise condoms for vaginal and anal sex
Dams for oral sex
Even when both partners HIV positive
If viral load undetectable - transmission through unprotected sex unlikely, but not impossible.
Partners should be regularly tested.

Possible to conceive safely through e.g. sperm washing and HIV.

105
Q

How can HIV transmission be prevented during birth?

A

Normal vaginal delivery if viral load < 50 copies
Caesarean section considered >50 and all women >400
IV zidovudine given during c-section if viral load unknown or >10,000 copies.

Prophylaxis treatment may be given to baby.
Low risk if copies <50, zidovudine for 4 weeks
High risk copies >50, zidovudine, lamivudine and nevirapine for 4 weeks.

106
Q

Can HIV be transmitted during breastfeeding?

A

Yes, even if mother’s load is undetectable

Not recommended

107
Q

What is PEP for HIV?

A

Post exposure prophylaxis after exposure to reduce risk of transmission. Must be commenced in short window of opportunity - less than 72 hours.

Is a combination of ART therapy, HIV tests done immediately and minimum of three months after exposure to confirm negative status.

Individuals to abstain from unprotected sex for minimum of three months until confirmed as negative.

108
Q

What is syphilis?

A

Caused by bacteria Treponema pallidum

109
Q

What is the incubation period of syphilis?

A

21 days on average

110
Q

How is syphilis transmitted?

A

Oral, vaginal or anal sex involving direct contact with infected area
Vertical transmission from mother to baby in pregnancy
Intravenous drug use
Blood transfusions and other transplants - rare due to screening of blood products

111
Q

What are the stages of syphilis?

A

Primary - painless ulcer/chancre at original site of infection, usually genitals.
Secondary - systemic symptoms, particularly of the skin and mucous membranes, resolves after 3-12 weeks.
Latent - symptoms disappear, patient asymptomatic but still infected, early latent within two years.
Tertiary - occurs many years after initial infection, affects many organs of body, development of gummas.

Neurosyphilis if infection involves CNS, neurological symptoms.

112
Q

What is the presentation of primary syphilis?

A

Painless genital ulcer - chancre, resolves over 3-8 weeks

local lymphadenopathy

113
Q

What is the presentation of secondary syphilis?

A 
Starts after chancre has healed
Maculopapular rash
Condylomata lata - grey, wart like lesions around the genitals and anus
Low grade fever 
Lymphadenopathy
Alopecia
Oral lesions
114
Q

What is the presentation of tertiary syphilis?

A

Depends on affected organs
Gummatous lesions - granulomatous lesions affecting skin, organs and bones
Aortic aneurysms
Neurosyphilis

115
Q

What is the presentation of neurosyphilis?

A 
Headache
Altered behaviour
Dementia
Tabes dorsalis - demyelination affecting spinal cord posterior columns
Ocular syphilis affecting the eyes
Paralysis
Sensory impairment
116
Q

What is an Argyll-Robertson pupil?

A

A specific finding in neurosyphilis
Constricted pupil that accommodates when focusing on near object, but doesn’t react to light.
Irregularly shaped

117
Q

How is syphilis diagnosed?

A

Antibody testing for antibodies to T pallidum

Samples from sights of infection to detect T pallidum with dark field microscopy or PCR.

118
Q

What is the management of syphilis?

A 
GUM referral
Full screening for other STIs
Advice about avoiding sexual activity until treated
Contact tracing
Prevention of future infections

Single deep IM dose of benzathine benzylpenicillin
Alternatives include for e.g. late syphilis or neurosyphilis = ceftriaxone, amoxicillin, doxycycline.

Obstetrics and Gynaecology (11 decks)

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