genitourinary problems

Question 1

What are the causes of infective vaginal discharge

Answer 1

Bacterial vaginosis
Candidiasis
trichomonas

Question 2

What conditions is BV associated with (both gynaecological and obstetric)

Answer 2

PID
Pregnancy: ROM, chorioamnionitis, premature birth, miscarriage
Increased risk of HIV infection

Question 3

Management of BV

Answer 3

Metronidazole (or clindamycin)

Question 4

Mx thrush

Answer 4

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

Question 5

Advice for thrush

Answer 5

If symptoms haven’t gone in 7-14 days come back
All the washing stuff
Don’t treat asymptomatic sexual partners

Question 6

Mx trichomonas vaginalis

Answer 6

Metronidazole

It’s sexually transmitted so treat sexual partner simulatneously

Question 7

Dx trichmonas

Answer 7

Test if symptomatic

NAAT on vaginal or endocervical swab

Question 8

Causes of cervicitis and PID

Answer 8

neisseria gonorrhoae

Chlamydia trachomatis

Question 9

symptoms of PID

Answer 9

Mainly changed discharge
endocervical INF which can be asymptomatic in 50% of cases
Can get rectal or pharyngeal (received oral sex) infection

Question 10

What if gonorrhea infection spreads

Answer 10

PID
Disseminated gonoccocal infection can lead to purpuric non-blanching rash w/ arthralgia
ophthalmic infection from secretions
neonatal infection

Question 11

Dx of n.gonorrhoea

Answer 11

NAAT is gold standard

Also look for chlamydia and other STIs as dual infection is common

Question 12

Mx of gonorrhoea

Answer 12

IM ceftriaxone

Question 13

Mx of dual infection

Answer 13

IV ceftriaxone and azithromycin

Question 14

Indications for testing for chlamydia

Answer 14

new sexual partner
change in discharge
post-coital and/or intermenstrual bleeding
abdo pain

Question 15

Mx chlamydia

Answer 15

azithromycin or doxycycline

Question 16

Signs and symptoms of PID

Answer 16

Bilateral abdo pain
discharge
dyspareunia
intermenstrual/post-coital bleeding

Cervical motion tenderness
Cervicits

Question 17

complications of PID

Answer 17

Endometrial/fallopian damage leading to subfertility (may see hydrosalpinx)
increased risk of ectopic
chronic pelvic pain
FtizHugh-Curtis syndrome - get RUQ cause of perihepatits

Question 18

Mx PID

Answer 18

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

Question 19

Dx of herpes

Answer 19

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

Question 20

Which HPV cause genital warts

Answer 20

6 + 11

Question 21

What do HPV 16 and 18 cause

Answer 21

anogenital dysplasia and cancer

Question 22

What happens in syphilis infection

Answer 22

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

Question 23

Mx for syphilis

Answer 23

penicillin

Question 24

Gynae complications of HIV

Answer 24

at higher risk of HPV 16+18 and therefore CIN and

Question 25

Contraception counselling in HIV

Answer 25

Most antiretrovirals interact with hormonal contraceptives

Question 26

What factors can increase risk of vertical HIV transmission

Answer 26

breastfeeding
PROM
break in baby’s skin
lots of maternal blood

Question 27

Ix for BV

Answer 27

vaginal pH
whiff test
gram-stain
HIV-test (have increased risk of HIV infection
NAAT