GU Flashcards
-Fishy smelling watery grey or white vaginal discharge
-Bacterial vaginosis
What causes BV
-Overgrowth of anaerobic bacteria in the vagina
Why does BV occur?
-Reduced no. of lactobacilli
-Lactobacilli produce lactic acid keeping the pH below 4.5
-Without them, the pH rises allowing anaerobic bacteria to multiply
What is the most common cause of BV?
-Gardnerella vaginalis
What is seen on microscopy in BV
-‘Clue cells’
What is the antibiotic of choice in BV?
-Metronidazole (oral or vaginal gel) -> avoid alcohol when taking
- 5 to 7 days
What are the complications of BV?
-Increased risk of catching STI
-Several complications in pregnancy : miscarriage, preterm, PROM, chorioamnitis, low borth weight, postpartum endometritis
-Thick white discharge that does not typically smell
-Vulval and vaginal itching, irritation or discomfort
-Thrush
What is the most common cause of vaginal candidiasis (thrush)
-Candida albicans
What are the treatment options for thrush ?
1st line = oral fluconazole single dose
-Antifungal cream (clotrimazole)
-Antifungal pessary (clotrimazole)
-Oral antifungal tablets (fluconazole)
-Frothy yellow/green vaginal discharge that smells fishy
-Non specific Sx : itching, dysuria, dyspareunia
-Trichomoniasis
What is trichomonas vaginalis
-Parasite STI
How is trichomoniasis diagnosed
-Standard charcoal swab with micoscopy
-Woman : posterior fornix of vagina
-Men : urethral swab or first-catch urine
How is trichomoniasis treated ?
-Metronidazole
What 5 things can trichomoniasis increase the risk of ?
-Contracting HIV
-Bacterial vaginosis
-Cervical cancer
-PID
-Pregnancy-related complications
What kind of bacteria is chlamydia ?
-Chlamydia trachomatis
-Gram negative
-Most common STI
What is the national chlamydia screening programme
-> Aims to screen every sexually active person <25 for chlamydia annually or when they change sexual partner
What might the cervix look like on examination in trichomoniasis ?
-> Strawberry cervix
What are charcoal swabs used for ?
-> 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
What does NAAT specifically test for?
-> DNA or RNA of organism
-> Chlamydia and gonorrhoea
-> Women : vulvovaginal swab, endocervical or first catch urine swab
-> Men : first catch urine
How is chlamydia diagnosed ?
-> Nucleic acid amplification test (NAAT)
How is chlamydia treated?
-1st line : doxycycline 100mg twice a day for 7 days
What is lymphogranuloma venereum
->Condition affecting the lymphoid tissue arund the site of infection with chlamydia
What are the 3 stages of LGV
- Painless ulcer
- Lymphadenitis (inguinal or femoral lymph nodes)
- Proctitis and anus inflammation : anal pain, tenesmus, discharge and change in bowel habits
How is LGV treated
-> Doxycycline 100mg twice daily for 21 days
What swabs are used to detect chlamydia in the throat or rectum ?
-> Rectal and pharyngeal NAAT swabs
What kind of bacteria is Neisseria gonorrhoeae?
-Gram negative diplococcus
-Female : odourless purulent discharge (green/yellw), dysurua, pelvic pain
-Male : same discharge, dysuria, epididymo-orchitis
-Gonorrhoea
What swabs are used in gonorrhoea ?
-NAAT to detect
-Charcoal swab for sensitivites and resistance
How is gonorrhoea managed?
-Refer to GUM
-Single dose of 1g IM ceftriaxone if sensitivities not known
-Single dose of 500mg oral ciprofloxacin if sensitivities know
When is a ‘test of cure’ done for gonorrhoea ?
-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)
What is a key complication of gonorrhoea ?
-> Gonococcal conjunctivitis
-> In neonates : ophthalmia neonatorum
What is a complication of untreated gonorrhoea ?
-> Disseminmated gonococcal infection : spreads to skin and joints
What causes cold sores and genital herpes and how is it spread ?
-HSV
-Direct contact with affected mucous membranes
After initial infection, where does HSV become latent ?
-Cold sores : trigeminal nerve ganglion
-Genital herpes : sacral nerve ganglia
- Initial severe gingivostomatitis
- cold sores
- Painful genital ulceration
-HSV : cold sores / genital herpes
-Initial infection usually lasts 3 weeks and is more severe
-Can have recurrent episodes
How is HSV diagnosed ?
-Usually clinical, can be confirmed with viral PCR swab
How is genital herpes treated?
- Oral aciclovir
What is the risk of genital herpes in pregnancy ?
-> Neonatal herpes simplex infection contracted during labour and delivery
What causes syphillis and how is it transmitted ?
-> Treponema pallidum
-> STI
-> vertical transmission
-> IVDU
-> Blood transfusion and other transplants
Explain the 4 possible stages of syphillis
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
-Painless genital ucler, resolving after 3-8 wks
-Local lymphadenopathy
Primary syphillis
- Healed genital lesion
- Macropapular rash on trunk, hands and soles
- Condylomata lata : painless, warty lesions on genitalia
- Fever
- Lymphadenopathy
- Alopecia
- Ulcers
Secondary syphillis
How can neurosyphillis present ?
Headache
Altered behavipur
Dementia
Tabes dorsalis
Ocular syphilis
Paralysis
Sesonry impairment
What is a specific finding in neurosyphilis ?
-> 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
How is syphilis diagnosed if there is an active lesion (e.g. primary syphilis)
-Sample from site of infection with dark field microscopy or PCR
How is syphilis treated ?
-Deep IM dose of benzathine benzylpenicillin
What STI can cause non-gonococcal urethritis ?
-Mycoplasma genitalium
How is mycoplasma genitalium diagnosed ?
-NAAT using first urine sample in men and vaginal swabs in women
How is mycoplasma genitalium managed ?
-> 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
What is contact tracing in STI’s
-Involves contacting previous partenrs to attend clinics to be tested and/or receive treatment
What is HIV and how does it affect the body?
-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
How is HIV screened for and diagnosed ?
-Screening : antibody testing
-Diagnosis : testing for p24 antigen
-PCR testing HIV RNA tests directly for viral copies in the blood giving viral load.
How is HIV monitored
-> CD4 count
-> Viral load
-Women : abnormal vaginal discharge and bleeding, pelvic pain, dyspareunia, dysuria
-Men : urethral discharge, dysuria, epididymo-orchitis and reactive arthritis
-Chlamydia
what is seen on examination in chlamydia
Pelvic/abdo tenderness
Cervical excitation
Inflamed cervix
Purulent discharge
Gummatous lesions
Aortic aneurysm
Neurosyphilis
Tertiary syphillis
What investigations indicate a person has been previously treated for syphilis
-VDRL negatiive and TPHA positive
-VDRL = active disease
-TPHA = treated = IgG antibodiers
Give 6 pregnancy related complications of chlamydia
Preterm delivery
premature rupture of membranes
Low birth weight
Postpartum endometritis
Neonatal conjunctivits and pneumonia
Chorioamnionitis
give 4 features of congenital syphilis
Generalised lymphadenopathy
Hepatosplenomegaly
Rash
Skeletal malformations
What can you be more susceptible to after antibiotics
Thrush
How often is cervical cytology offered in HIV +ve patients
-> Annual
what is advised for birth if a primary attack of herpes occurs during pregnancy at greater than 28 wks gestation
Elective c section at 28 wks
what main strands cause genital warts
HPV 6 and 11
what is used 1st and 2nd line for genital warts
- 1st : Topical podophyllum or cryotherapy
- 2nd : imiquimod
what 2 tests are done for syphilis with no primary lesion
- Non-treponemal tests : RPR and VDRL and assess antibodies produced.
- Treponemal-specific tests : TPHA
what syphilis tests results would suggests active syphilis
- Non treponema (VDRL) +ve
- Treponemal (TPHA) +ve
what syphilis tests result would suggest treated syphilis
- Non treponemal (VDRL) -ve
- Treponemal (TPHA) +ve
