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3a > GU > Flashcards

GU Flashcards

1
Q

-Fishy smelling watery grey or white vaginal discharge

A

-Bacterial vaginosis

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2
Q

What causes BV

A

-Overgrowth of anaerobic bacteria in the vagina

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3
Q

Why does BV occur?

A

-Reduced no. of lactobacilli
-Lactobacilli produce lactic acid keeping the pH below 4.5
-Without them, the pH rises allowing anaerobic bacteria to multiply

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4
Q

What is the most common cause of BV?

A

-Gardnerella vaginalis

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5
Q

What is seen on microscopy in BV

A

-‘Clue cells’

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6
Q

What is the antibiotic of choice in BV?

A

-Metronidazole (oral or vaginal gel) -> avoid alcohol when taking
- 5 to 7 days

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7
Q

What are the complications of BV?

A

-Increased risk of catching STI
-Several complications in pregnancy : miscarriage, preterm, PROM, chorioamnitis, low borth weight, postpartum endometritis

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8
Q

-Thick white discharge that does not typically smell
-Vulval and vaginal itching, irritation or discomfort

A

-Thrush

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9
Q

What is the most common cause of vaginal candidiasis (thrush)

A

-Candida albicans

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10
Q

What are the treatment options for thrush ?

A

1st line = oral fluconazole single dose

-Antifungal cream (clotrimazole)
-Antifungal pessary (clotrimazole)
-Oral antifungal tablets (fluconazole)

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11
Q

-Frothy yellow/green vaginal discharge that smells fishy
-Non specific Sx : itching, dysuria, dyspareunia

A

-Trichomoniasis

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12
Q

What is trichomonas vaginalis

A

-Parasite STI

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13
Q

How is trichomoniasis diagnosed

A

-Standard charcoal swab with micoscopy
-Woman : posterior fornix of vagina
-Men : urethral swab or first-catch urine

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14
Q

How is trichomoniasis treated ?

A

-Metronidazole

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15
Q

What 5 things can trichomoniasis increase the risk of ?

A

-Contracting HIV
-Bacterial vaginosis
-Cervical cancer
-PID
-Pregnancy-related complications

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16
Q

What kind of bacteria is chlamydia ?

A

-Chlamydia trachomatis
-Gram negative
-Most common STI

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17
Q

What is the national chlamydia screening programme

A

-> Aims to screen every sexually active person <25 for chlamydia annually or when they change sexual partner

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18
Q

What might the cervix look like on examination in trichomoniasis ?

A

-> Strawberry cervix

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19
Q

What are charcoal swabs used for ?

A

-> They allow microscopy, culture and sensitivities of any bacteria
-> They can be used for endocervical swabs or high vaginal swabs
-They can confirm : BV, thrush, gonorrhoeae, trichomonas vaginalis, GBS

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20
Q

What does NAAT specifically test for?

A

-> DNA or RNA of organism
-> Chlamydia and gonorrhoea
-> Women : vulvovaginal swab, endocervical or first catch urine swab
-> Men : first catch urine

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21
Q

How is chlamydia diagnosed ?

A

-> Nucleic acid amplification test (NAAT)

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22
Q

How is chlamydia treated?

A

-1st line : doxycycline 100mg twice a day for 7 days

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23
Q

What is lymphogranuloma venereum

A

->Condition affecting the lymphoid tissue arund the site of infection with chlamydia

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24
Q

What are the 3 stages of LGV

A
  1. Painless ulcer
  2. Lymphadenitis (inguinal or femoral lymph nodes)
  3. Proctitis and anus inflammation : anal pain, tenesmus, discharge and change in bowel habits
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25
Q

How is LGV treated

A

-> Doxycycline 100mg twice daily for 21 days

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26
Q

What swabs are used to detect chlamydia in the throat or rectum ?

A

-> Rectal and pharyngeal NAAT swabs

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27
Q

What kind of bacteria is Neisseria gonorrhoeae?

A

-Gram negative diplococcus

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28
Q

-Female : odourless purulent discharge (green/yellw), dysurua, pelvic pain
-Male : same discharge, dysuria, epididymo-orchitis

A

-Gonorrhoea

29
Q

What swabs are used in gonorrhoea ?

A

-NAAT to detect
-Charcoal swab for sensitivites and resistance

30
Q

How is gonorrhoea managed?

A

-Refer to GUM
-Single dose of 1g IM ceftriaxone if sensitivities not known
-Single dose of 500mg oral ciprofloxacin if sensitivities know

31
Q

When is a ‘test of cure’ done for gonorrhoea ?

A

-72 hrs after treatment for culture
-7 days after treatment for RNA NAAT
-14 days after treatment for DNA NAAT

(NAAT if asymptomatic, cultures if symptomatic)

32
Q

What is a key complication of gonorrhoea ?

A

-> Gonococcal conjunctivitis
-> In neonates : ophthalmia neonatorum

33
Q

What is a complication of untreated gonorrhoea ?

A

-> Disseminmated gonococcal infection : spreads to skin and joints

34
Q

What causes cold sores and genital herpes and how is it spread ?

A

-HSV
-Direct contact with affected mucous membranes

35
Q

After initial infection, where does HSV become latent ?

A

-Cold sores : trigeminal nerve ganglion
-Genital herpes : sacral nerve ganglia

36
Q
  • Initial severe gingivostomatitis
  • cold sores
  • Painful genital ulceration
A

-HSV : cold sores / genital herpes
-Initial infection usually lasts 3 weeks and is more severe
-Can have recurrent episodes

37
Q

How is HSV diagnosed ?

A

-Usually clinical, can be confirmed with viral PCR swab

38
Q

How is genital herpes treated?

A
  • Oral aciclovir
39
Q

What is the risk of genital herpes in pregnancy ?

A

-> Neonatal herpes simplex infection contracted during labour and delivery

40
Q

What causes syphillis and how is it transmitted ?

A

-> Treponema pallidum
-> STI
-> vertical transmission
-> IVDU
-> Blood transfusion and other transplants

41
Q

Explain the 4 possible stages of syphillis

A

1 : Primary : painless ulcer (chancre)
2 : Secondary : systemic sx (3-12 wks) -> skin and mucus membranes
3 : Latent : become asymptomatic despite still infected. Early latent : within 2 yrs. Late latent : > 2yrs.
4 : Tertiary : gummas, cardiac and neuro complications

42
Q

-Painless genital ucler, resolving after 3-8 wks
-Local lymphadenopathy

A

Primary syphillis

43
Q
  • Healed genital lesion
  • Macropapular rash on trunk, hands and soles
  • Condylomata lata : painless, warty lesions on genitalia
  • Fever
  • Lymphadenopathy
  • Alopecia
  • Ulcers
A

Secondary syphillis

44
Q

How can neurosyphillis present ?

A

Headache
Altered behavipur
Dementia
Tabes dorsalis
Ocular syphilis
Paralysis
Sesonry impairment

45
Q

What is a specific finding in neurosyphilis ?

A

-> Argyll-Robertson pupil
-> Constricted pupil that accommodates when focusing on near object but does not react to light
-> ‘Prostitutes pupil’ : accommodates but does not react

46
Q

How is syphilis diagnosed if there is an active lesion (e.g. primary syphilis)

A

-Sample from site of infection with dark field microscopy or PCR

47
Q

How is syphilis treated ?

A

-Deep IM dose of benzathine benzylpenicillin

48
Q

What STI can cause non-gonococcal urethritis ?

A

-Mycoplasma genitalium

49
Q

How is mycoplasma genitalium diagnosed ?

A

-NAAT using first urine sample in men and vaginal swabs in women

50
Q

How is mycoplasma genitalium managed ?

A

-> Doxycycline 100mg twice daily for 7 days THEN :
-> Azithromycin 1g stat then 500mg once a day for 2 days (this alone in pregnancy, doxy is CI)
-> Moxifloxacin in complicated infections

51
Q

What is contact tracing in STI’s

A

-Involves contacting previous partenrs to attend clinics to be tested and/or receive treatment

52
Q

What is HIV and how does it affect the body?

A

-RNA retrovirus
-Destroys CD4 T-helper cells
-Initial seroconversion flu like illness
-Asymptomatic until the condition progresses to immunodeficiency and causes AIDS-defining illness an d opportunistic infections

53
Q

How is HIV screened for and diagnosed ?

A

-Screening : antibody testing
-Diagnosis : testing for p24 antigen
-PCR testing HIV RNA tests directly for viral copies in the blood giving viral load.

54
Q

How is HIV monitored

A

-> CD4 count
-> Viral load

55
Q

-Women : abnormal vaginal discharge and bleeding, pelvic pain, dyspareunia, dysuria
-Men : urethral discharge, dysuria, epididymo-orchitis and reactive arthritis

A

-Chlamydia

56
Q

what is seen on examination in chlamydia

A

Pelvic/abdo tenderness
Cervical excitation
Inflamed cervix
Purulent discharge

57
Q

Gummatous lesions
Aortic aneurysm
Neurosyphilis

A

Tertiary syphillis

58
Q

What investigations indicate a person has been previously treated for syphilis

A

-VDRL negatiive and TPHA positive

-VDRL = active disease
-TPHA = treated = IgG antibodiers

59
Q

Give 6 pregnancy related complications of chlamydia

A

Preterm delivery
premature rupture of membranes
Low birth weight
Postpartum endometritis
Neonatal conjunctivits and pneumonia
Chorioamnionitis

60
Q

give 4 features of congenital syphilis

A

Generalised lymphadenopathy
Hepatosplenomegaly
Rash
Skeletal malformations

61
Q

What can you be more susceptible to after antibiotics

A

Thrush

62
Q

How often is cervical cytology offered in HIV +ve patients

A

-> Annual

63
Q

what is advised for birth if a primary attack of herpes occurs during pregnancy at greater than 28 wks gestation

A

Elective c section at 28 wks

64
Q

what main strands cause genital warts

A

HPV 6 and 11

65
Q

what is used 1st and 2nd line for genital warts

A
  • 1st : Topical podophyllum or cryotherapy
  • 2nd : imiquimod
66
Q

what 2 tests are done for syphilis with no primary lesion

A
  1. Non-treponemal tests : RPR and VDRL and assess antibodies produced.
  2. Treponemal-specific tests : TPHA
67
Q

what syphilis tests results would suggests active syphilis

A
  • Non treponema (VDRL) +ve
  • Treponemal (TPHA) +ve
68
Q

what syphilis tests result would suggest treated syphilis

A
  • Non treponemal (VDRL) -ve
  • Treponemal (TPHA) +ve

3a (45 decks)

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