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GU Medicine Flashcards

1
Q

What is chlamydia caused by?

A

Chlamydia trachomatis

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2
Q

What are the features of chlamydia?

A

Women: increased vaginal discharge, dysuria, pelvic pain, post coital/ intermenstrual bleeding

Men: Urethral discharge, dysuria, testicular pain

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3
Q

What are the complications of chlamydia?

A

Epididymitis

Pelvic inflammatory disease

Endometritis

Ectopic pregnancies

Infertility

Reactive arthritis

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4
Q

What are the investigations for chlamydia?

A

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

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5
Q

What age is screened for chlamydia?

A

15-24

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6
Q

What is the management of chlamydia?

A

Doxycycline 7 day course (contraindicated in pregnancy)

If pregnant or doxy contraindicated use azithromycin

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7
Q

Who should be notified from chlamydia infections?

A

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

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8
Q

Extra information chlamydia?

A

No sexual contact for 1 week after treatment

Test of cure- 3 months later if under 25

In 6 weeks if pregnant

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9
Q

What causes gonorrhoea?

A

Neisseria gonorrhoeae

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10
Q

What are the features of gonorrhoea?

A

Males- purulent urethral discharge, dysuria

Women- cervitis- purulent discharge, pelvic pain

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11
Q

What are the investigations for gonorrhoea?

A

Microscopy

NAAT

Culture (for antibiotic resistance)

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12
Q

What is the treatment for gonorrhoea?

A

Ceftriaxone stat

If found to be sensitive before treatment- ciprofloxacillin stat

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13
Q

What type of bacteria is gonorrhoea?

A

Gram negative diplococci

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14
Q

What is non-specific urethritis?

A

Urethritis without a clear cause on microscope

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15
Q

What could be the cause of non-specific urethritis?

A

No cause found

Chlamydia trachomatis

Mycoplasma genitalium

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16
Q

What is the management of non-specific urethritis?

A

Doxycycline 7 day course

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17
Q

What type of organism if trichomonas vaginalis?

A

Flagellated protozoon

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18
Q

What are the features of trichomonas vaginalis?

A

Women- vaginal discharge- offensive, yellow/green, frothy
Itching
Dysuria
Pelvic pain
Strawberry cervix
pH >4.5

Men- usually asymptomatic but urethritis- discharge, dysuria, frequency

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19
Q

What is the investigation for trichomonas vaginalis?

A

Microscopy of wet mount shows motile trophozoites

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20
Q

What is the management of trichomonas vaginalis?

A

Oral metronidazole for 5-7 days

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21
Q

Difference between trichomonas and bacterial vaginosis?

A

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

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22
Q

What causes bacterial vaginosis?

A

Gardnerella vaginalis
pH>4.5, normal vaginal flora dominated by anaeriobic

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23
Q

What are the features of bacterial vaginosis?

A

Offensive smelling fishy vaginal discharge (no soreness, itching etc)

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24
Q

Risks of bacterial vaginosis in pregnancy?

A

Increased risk of preterm labour, low birth weight and miscarrige

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25
Four criteria for bacterial vaginosis diagnosis?
(Amsel's criteria) Thin, white discharge Clue cells on microscopy Vaginal pH >4.5 Positive whiff test
26
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
27
What causes vaginal candidiasis?
Candida albicans
28
What are the risk factors for candida albicans?
Diabetes mellitus Antibiotics Hyperoestrogenaemia (including HRT and the COCP) Pregnancy Immunosuppression: HIV
29
What are the features of vaginal candidiasis?
Cottage cheese, non offensive discharge Vulvitis- superficial dyspareunia, dysuria Itch Vulval erythema
30
What are the investigations for vaginal candidiasis?
Clinical Could do a high vaginal swab if unsure
31
What is the management of vaginal candidiasis?
Oral fluconazole Clotrimazole pessary Topical imidazole If pregnant only local treatments Advice- only wash with water
32
What are the two types of gential herpes?
HSV-1- cold sores HSV-2- genital herpes Either can cause cold sore or genital herpes
33
What causes herpes?
Herpes simplex virus
34
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
35
What are the investigations for herpes?
Nucelic acid amplification tests (NAAT)
36
What is the management of herpes?
General measures: saline bathing, analgesia, topical anaethetic agents Oral aciclovir
37
Pregnancy and herpes?
Maybe elective caesarean if primary attack occurs after 28 weeks gestation
38
What causes genital warts?
HPV (human papillomavirus)- especially 6 and 11 Well established that 16, 18 and 33 cause cervical cancer
39
What are the features of genital warts?
Small fleshy lumps- may bleed or itch Could be asymptomatic
40
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
41
What causes syphilis?
Treponema pallidum Gram negative spirochaete
42
What are the different stages of syphilis infection?
Primary, secondary and tertiary Neurosyphilis can occur anytime
43
What are the primary features of syphilis?
Chancre- painless ulcer at the site of sexual contact
44
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
45
What are the tertiary features of syphilis?
Gummatous (nodules that break down into ulcers and heal slowly) Aortic aneurysms
46
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
47
What is the management of syphilis?
Intramuscular benzathine penicillin is first line (benzylpenicillin)
48
What are the stages of HIV?
1. Acute infection 2. Seroconversion- myalgia, fever, rash, severe sore throat 3. Asymptomatic phase- loss of CD4 cells 4. AIDS
49
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
50
What to monitor in HIV?
CD4 count and viral load
51
What is the management of HIV?
HAART therapies: NRTIs- nucleoside analogue reverse trascriptase inhibitors NNRTIs Protease inhibitors Integrase inhibitors
52
What are the AIDS defining illnesses?
Pneumocystis jiroveci- cotrimoxazole- causes pneumonia Oesophageal candidiasis
53
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
54
What are the complications of hepatitis B?
Chronic hepatitis Fulminant liver failure
55
Hep B investigations?
Serology
56
Hep B management?
Rest- notifiable disease
57
Balanitis?
Infection with bacteria or candida Wash your bellend
58
What is Fitz-Hugh-Curtis syndrome?
Complication of PID Female hepatic capsulitis Chlamydia RUQ pain
59
How long to take retrovirals after HIV exposure?
4 weeks
60
HIV seroconversion features?
Sore throat Lymphadenopathy Malaise, myalgia, arthralgia Diarrhoea Maculopapular rash Mouth ulcers Rarely meningoencephalitis
61
What to do if a HIV combined test is positive?
Repeat it
62
What are disseminated gonococcal infection (DGI) and gonococcal arthritis
Complications of gonnorhoea Tenosynovitis Migratory polyarthritis Dermatitis (lesions can be maculopapular or vesicular)
63
What type of bacteria causes Chlamydia?
An obligate intracellular pathogen
64
When is a vaginal delivery reccomended in women with HIV?
Viral load is less than 50 copies/ml at 36 weeks
65
What shows a previous syphilis infection?
VDRL negative, TPHA positive
66
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
67
Genital herpes investigation?
NAAT HSV serology in recurrent

Phase 3a (17 decks)

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