GU Medicine Flashcards
What is chlamydia caused by?
Chlamydia trachomatis
What are the features of chlamydia?
Women: increased vaginal discharge, dysuria, pelvic pain, post coital/ intermenstrual bleeding
Men: Urethral discharge, dysuria, testicular pain
What are the complications of chlamydia?
Epididymitis
Pelvic inflammatory disease
Endometritis
Ectopic pregnancies
Infertility
Reactive arthritis
What are the investigations for chlamydia?
Nuclear acid amplification tests (NAATs) investigation of choice
For NAAT-
First void urine sample for men
Vulvovaginal swab for women
Should be carried out 2 weeks after exposure
What age is screened for chlamydia?
15-24
What is the management of chlamydia?
Doxycycline 7 day course (contraindicated in pregnancy)
If pregnant or doxy contraindicated use azithromycin
Who should be notified from chlamydia infections?
Men with urethral symptoms- anyone 4 weeks prior to symptoms and after symptoms
Women and asymptomatic men- all partners from the last 6 months
Treat then test in partners
Extra information chlamydia?
No sexual contact for 1 week after treatment
Test of cure- 3 months later if under 25
In 6 weeks if pregnant
What causes gonorrhoea?
Neisseria gonorrhoeae
What are the features of gonorrhoea?
Males- purulent urethral discharge, dysuria
Women- cervitis- purulent discharge, pelvic pain
What are the investigations for gonorrhoea?
Microscopy
NAAT
Culture (for antibiotic resistance)
What is the treatment for gonorrhoea?
Ceftriaxone stat
If found to be sensitive before treatment- ciprofloxacillin stat
What type of bacteria is gonorrhoea?
Gram negative diplococci
What is non-specific urethritis?
Urethritis without a clear cause on microscope
What could be the cause of non-specific urethritis?
No cause found
Chlamydia trachomatis
Mycoplasma genitalium
What is the management of non-specific urethritis?
Doxycycline 7 day course
What type of organism if trichomonas vaginalis?
Flagellated protozoon
What are the features of trichomonas vaginalis?
Women- vaginal discharge- offensive, yellow/green, frothy
Itching
Dysuria
Pelvic pain
Strawberry cervix
pH >4.5
Men- usually asymptomatic but urethritis- discharge, dysuria, frequency
What is the investigation for trichomonas vaginalis?
Microscopy of wet mount shows motile trophozoites
What is the management of trichomonas vaginalis?
Oral metronidazole for 5-7 days
Difference between trichomonas and bacterial vaginosis?
BV- thin white discharge, microscopy shows clue cells
monas- frothy yellow-green discharge, vulvovaginitis, strawberry cervix, wet mount- motile trophozoites
Both- offensive vaginal smell, vaginal pH >4.5, treated with metronidazole
What causes bacterial vaginosis?
Gardnerella vaginalis
pH>4.5, normal vaginal flora dominated by anaeriobic
What are the features of bacterial vaginosis?
Offensive smelling fishy vaginal discharge (no soreness, itching etc)
Risks of bacterial vaginosis in pregnancy?
Increased risk of preterm labour, low birth weight and miscarrige
Four criteria for bacterial vaginosis diagnosis?
(Amsel’s criteria)
Thin, white discharge
Clue cells on microscopy
Vaginal pH >4.5
Positive whiff test
What is the management of bacterial vaginosis?
If women asymptomatic no treatment required
If symptomatic- oral metronidazole 5-7 days, stat if adherence an issue
Prevention information- wash with only water etc
If pregnant offer only metronidazole 5-7 days
What causes vaginal candidiasis?
Candida albicans
What are the risk factors for candida albicans?
Diabetes mellitus
Antibiotics
Hyperoestrogenaemia (including HRT and the COCP)
Pregnancy
Immunosuppression: HIV
What are the features of vaginal candidiasis?
Cottage cheese, non offensive discharge
Vulvitis- superficial dyspareunia, dysuria
Itch
Vulval erythema
What are the investigations for vaginal candidiasis?
Clinical
Could do a high vaginal swab if unsure
What is the management of vaginal candidiasis?
Oral fluconazole
Clotrimazole pessary
Topical imidazole
If pregnant only local treatments
Advice- only wash with water
What are the two types of gential herpes?
HSV-1- cold sores
HSV-2- genital herpes
Either can cause cold sore or genital herpes
What causes herpes?
Herpes simplex virus
What are the features of herpes?
Painful genital ulceration (dysuria, pruritis)
Primary infection often more severe than recurrent episodes (systemic features such as headache, fever and malaise)
Tender inguinal lymphadenopathy
Urinary retention may occur
What are the investigations for herpes?
Nucelic acid amplification tests (NAAT)
What is the management of herpes?
General measures: saline bathing, analgesia, topical anaethetic agents
Oral aciclovir
Pregnancy and herpes?
Maybe elective caesarean if primary attack occurs after 28 weeks gestation
What causes genital warts?
HPV (human papillomavirus)- especially 6 and 11
Well established that 16, 18 and 33 cause cervical cancer
What are the features of genital warts?
Small fleshy lumps- may bleed or itch
Could be asymptomatic
What is the management of genital warts?
Topical podophyllum or cryotherapy commonly used first line depending on location and type of lesion
Imiquimod topical cream 2nd line
What causes syphilis?
Treponema pallidum
Gram negative spirochaete
What are the different stages of syphilis infection?
Primary, secondary and tertiary
Neurosyphilis can occur anytime
What are the primary features of syphilis?
Chancre- painless ulcer at the site of sexual contact
What are the secondary features of syphilis (6-10 weeks after primary infection)?
Systemic symptoms- fevers, lymphadenopathy
Rash on trunk, palms and soles
Buccal snail track ulcers
What are the tertiary features of syphilis?
Gummatous (nodules that break down into ulcers and heal slowly)
Aortic aneurysms
What are the investigations for syphilis?
Non-treponemal (not specific):
Rapid plasma reagin (RPR) and Venereal Disease Research Laboratory (VDRL)
Treponemal (specific but can stay positive after treated):
TP-EIA, TPHA
What is the management of syphilis?
Intramuscular benzathine penicillin is first line (benzylpenicillin)
What are the stages of HIV?
- Acute infection
- Seroconversion- myalgia, fever, rash, severe sore throat
- Asymptomatic phase- loss of CD4 cells
- AIDS
What are the investigations of HIV?
HIV antibody- develop antibodies at 4-6 weeks but 99% by 3 months
HIV antibody and HIV antigen p24 (combination tests)- 2-3 weeks after exposure
HIV RNA
What to monitor in HIV?
CD4 count and viral load
What is the management of HIV?
HAART therapies:
NRTIs- nucleoside analogue reverse trascriptase inhibitors
NNRTIs
Protease inhibitors
Integrase inhibitors
What are the AIDS defining illnesses?
Pneumocystis jiroveci- cotrimoxazole- causes pneumonia
Oesophageal candidiasis
What can be used to control HIV?
PEP (post exposure prophylaxis)- soon as possible after exposure- within 7 hours
PrEP (pre exposure prohylaxis)- antiretroviral therapy for MSM at risk of HIV
What are the complications of hepatitis B?
Chronic hepatitis
Fulminant liver failure
Hep B investigations?
Serology
Hep B management?
Rest- notifiable disease
Balanitis?
Infection with bacteria or candida
Wash your bellend
What is
Fitz-Hugh-Curtis syndrome?
Complication of PID
Female hepatic capsulitis
Chlamydia RUQ pain
How long to take retrovirals after HIV exposure?
4 weeks
HIV seroconversion features?
Sore throat
Lymphadenopathy
Malaise, myalgia, arthralgia
Diarrhoea
Maculopapular rash
Mouth ulcers
Rarely meningoencephalitis
What to do if a HIV combined test is positive?
Repeat it
What are disseminated gonococcal infection (DGI) and gonococcal arthritis
Complications of gonnorhoea
Tenosynovitis
Migratory polyarthritis
Dermatitis (lesions can be maculopapular or vesicular)
What type of bacteria causes Chlamydia?
An obligate intracellular pathogen
When is a vaginal delivery reccomended in women with HIV?
Viral load is less than 50 copies/ml at 36 weeks
What shows a previous syphilis infection?
VDRL negative, TPHA positive
Syphilis investigation summary?
Positive non-treponemal test + positive treponemal test
consistent with active syphilis infection
Positive non-treponemal test + negative treponemal test
consistent with a false-positive syphilis result e.g. due to pregnancy or SLE (see list above)
Negative non-treponemal test + positive treponemal test :
consistent with successfully treated syphilis
Genital herpes investigation?
NAAT
HSV serology in recurrent
