Genitourinary tract infections Flashcards
Pelvic inflammatory disease : definition
- Ascending infection from the endocervix
- Infection and inflammation of the pelvic organs including; Uterus, Fallopian tube, ovaries and surrounding pertoneus
Pelvic inflammatory disease : Most common causes
- Chlamydia Trachomatis
- Neisseria Gonorrohea
Pelvic inflammatory disease : Clinical features
- Lower abdominal pain
- Fever
- Deep dyspareunia
- Vaginal and cervical discharge
Pelvic inflammatory disease : Clinical signs
Cervical excitation
Pelvic inflammatory disease : Investigation
- Pregnancy test } exclude Ectopic pregnancy
- High vaginal swab
- Screen for Chlamydia and Gonorrhea
Pelvic inflammatory disease : Management
Oral : Ofloxacin + Metronidazole
IM : Ceftriaxone + Doxycycline + Metronidazole
Pelvic inflammatory disease : Complication
Inflammation causes adhesions and stricture to form leading to;
1. Ectopic pregnancy
2. Infertility
3. Fitz- Hugh- curtis syndrome : inflammation of the liver capsule with adhesions forming
Bacterial vaginosis : definition
Overgrowth of anaerobic Gardnerella vaginalis in the vagina.
Bacterial vaginosis : pathophysiology
- Normal vaginal flora has lactobacillus species which produce lactic acid and maintain acidic PH
- In BV there is decrease in lactobacilli
- Leading to more alkaline environment which can cause colonisation of other bacteria
- Raising vaginal PH and leading to infection
Bacterial vaginosis : Clinical features
‘Fishy’ - Offensive vaginal discharge
Bacterial vaginosis : Diagnosis
Amsel’s criteria for diagnosis of BV - 3 of the following 4 points should be present
1. thin, white homogenous discharge
2. clue cells on microscopy: stippled vaginal epithelial cells
3. vaginal pH > 4.5
4. positive whiff test (addition of potassium hydroxide results in fishy odour)
Bacterial vaginosis : Management - If asymptomatic
Treatment not required
Bacterial vaginosis : Management - If symptomatic
- Oral metronidazole 5-7 days
- 2nd line : Topical metronidazole or clindamycin
Bacterial vaginosis : Management - If Pregnant
- if asymptomatic: discuss with the woman’s obstetrician if treatment is indicated
- if symptomatic: either oral metronidazole for 5-7 days or topical treatment
Bacterial vaginosis : Risks in pregnancy
- Increased risk of preterm labour,
- Low birth weight
- Chorioamnionitis
- late miscarriage
Vaginal candidiasis : Causative organism
Candida albicans
Vaginal candidiasis : Risk factors
- diabetes mellitus
- drugs: antibiotics, steroids
- pregnancy
- immunosuppression: HIV
Vaginal candidiasis : Discharge + Clinical features
- ‘Cottage cheese’, non-offensive discharge
- vulvitis: superficial dyspareunia, dysuria
- Itch
Vaginal candidiasis : Investigations
High vaginal swab and microscopy
Vaginal candidiasis : Management
First line : PO Fluconazole 150mg
Second line: 500mg Clotrimazole pessary
Vaginal candidiasis : Management - If pregnant
500mg Clotrimazole pessary
Trichomonas Vaginalis : Definition
- Sexually transmitted infection
- Flagellated protozoan parasite
Trichomonas Vaginalis : Vaginal discharge
- Offensive
- yellow/green, frothy discharge
Trichomonas Vaginalis : Clinical features
- Vulvovaginitis
- Strawberry cervix
- Urethritis in men
Trichomonas Vaginalis : investigations
Microscopy of a wet mount ; shows motile trophozoites
Trichomonas Vaginalis : Management
Oral metronidazole for 5-7 days
Chlamydia : Clinical features
Mainly asymptomatic
-
Women:
* Cervicitis (discharge, bleeding),
* Dysuria -
Men:
* Urethral discharge, dysuria
Chlamydia : Complications
- Epididymitis
- Pelvic inflammatory disease
- Increased incidence of ectopic pregnancies
- Infertility
Chlamydia : Investigations
- NAAT tests
Women : Vulvovaginal swab
Men : First void urine
Chlamydia : Management
- First line : Doxycycline } 7 days
- Second line : Azithromycin stat dose
(1g, 500mg,500mg } 3 day course) - Pregnancy : 1g stat Azithromycin
Chlamydia : Partner notification
- Symptomatic men } 4 weeks prior
- Women/Asymptomatic men } 6 months prior
Gonorrhoea : causative organism
Gram-negative diplococcus /Neisseria gonorrhoeae/
Gonorrhoea : Clinical features
- males: urethral discharge, dysuria
- females: cervicitis e.g. leading to vaginal discharge
Gonorrhoea : Management
First line : IM Ceftriazone
Gential herpes : Causative organisms
- HSV-2
(HSV1 : oral lesions/cold sores)
Gential herpes : Clinical features
- Systemic features in primary infection:
-Headache, fever, malaise - Painful genital ulceration :
* Dysuria - Tender inguinal lymphadenopathy
Gential herpes : Investigation
NAAT culture : swab genital ulcer
Gential herpes : Management
- Oral aciclovir
Genital warts : Causative organisms
HPV type 6 and 11
Genital warts : Management
- First line
1. Topical Podophyllum
2. Cryotherapy - Second line
1. Imiquimod cream
