genitourinary problems Flashcards
What are the causes of infective vaginal discharge
Bacterial vaginosis
Candidiasis
trichomonas
What conditions is BV associated with (both gynaecological and obstetric)
PID
Pregnancy: ROM, chorioamnionitis, premature birth, miscarriage
Increased risk of HIV infection
Management of BV
Metronidazole (or clindamycin)
Mx thrush
Most women:
Topical (clotrimazole) or oral (fluconazole)
Girls 12-15:
topical clotrimazole (don’t give intra vaginal or oral)
Pregnant women:
intra vaginal clotrimazole (don’t give oral)
>60:
give fluconazole
If vulval symptoms give imidazole (clotrimazole and ketoconazole) AND oral/intra vaginal antifungal
Advice for thrush
If symptoms haven’t gone in 7-14 days come back
All the washing stuff
Don’t treat asymptomatic sexual partners
Mx trichomonas vaginalis
Metronidazole
It’s sexually transmitted so treat sexual partner simulatneously
Dx trichmonas
Test if symptomatic
NAAT on vaginal or endocervical swab
Causes of cervicitis and PID
neisseria gonorrhoae
Chlamydia trachomatis
symptoms of PID
Mainly changed discharge
endocervical INF which can be asymptomatic in 50% of cases
Can get rectal or pharyngeal (received oral sex) infection
What if gonorrhea infection spreads
PID
Disseminated gonoccocal infection can lead to purpuric non-blanching rash w/ arthralgia
ophthalmic infection from secretions
neonatal infection
Dx of n.gonorrhoea
NAAT is gold standard
Also look for chlamydia and other STIs as dual infection is common
Mx of gonorrhoea
IM ceftriaxone
Mx of dual infection
IV ceftriaxone and azithromycin
Indications for testing for chlamydia
new sexual partner
change in discharge
post-coital and/or intermenstrual bleeding
abdo pain
Mx chlamydia
azithromycin or doxycycline
Signs and symptoms of PID
Bilateral abdo pain
discharge
dyspareunia
intermenstrual/post-coital bleeding
Cervical motion tenderness
Cervicits
complications of PID
Endometrial/fallopian damage leading to subfertility (may see hydrosalpinx)
increased risk of ectopic
chronic pelvic pain
FtizHugh-Curtis syndrome - get RUQ cause of perihepatits
Mx PID
Remove IUD (but consider risk of pregnancy if unprotected sex)
outpatient abx:
ceftriaxone, doxycycline, metronidazole
NB- don’t have sex on Abx
if pyrexial or oral mx failed:
IV cefoxitin + doxycycline
STI screen and contact trace (partners within 6 months)
Follow up:
see within 72 hours
then see at 2-4 weeks
Dx of herpes
swab lesion and run type specific PCR to see which HSV it is
neonatal herpes is life threatening so deliver if first acquisition of genital herpes in 3rd trimester
Which HPV cause genital warts
6 + 11
What do HPV 16 and 18 cause
anogenital dysplasia and cancer
What happens in syphilis infection
Primary - painless chancre at site of infection
Remit for about 2 years
Secondary - erythematous rash on palms and soles
condylomata lata (raised lesions) in anogenital region
Mx for syphilis
penicillin
Gynae complications of HIV
at higher risk of HPV 16+18 and therefore CIN and
Contraception counselling in HIV
Most antiretrovirals interact with hormonal contraceptives
What factors can increase risk of vertical HIV transmission
breastfeeding
PROM
break in baby’s skin
lots of maternal blood
Ix for BV
vaginal pH whiff test gram-stain HIV-test (have increased risk of HIV infection NAAT
