GUM

Question 1

What causes genital chylamia

UK epidemiology

Answer 1

chlamydia trachomatis bacterium, an obligate intracellular G+ bacterium

most common bacterially sexually transmitted infection in the UK

prevalence highest in young sexually active adults (15-24 year olds)

responsible for infection of 1/10 women in the UK

Question 2

Clinical features of chlamydia

men, women, neonates

Answer 2

asymptomatic infection common

men

• urethral discharge
• dysuria

women

• dysuria
• intermenstrual bleeding
• vaginal discharge

neonates

• pneumonia
• conjunctivitis

Question 3

How do we diagnose chlamydia?

Answer 3

Women

• endo-cervicsal swab -> NAAT

Men

• urine and urthral swabs

Question 4

How do we manage chlamydia?

Answer 4

Doxycycline BD 7 days (MRSA, G+ and limited G-, atypicals)

or

Azithromycin 1g single dose (G+ and limited G-, atypicals)

Question 5

complications of chlamydia

Answer 5

pelvic inflammatory disease

epididymo-orchitis

sero-negative reactive arthritis

Question 6

Gold standard diagnosis of HIV

Answer 6

HIV antibody and HIV antigen test

• HIV antibody test is ‘point of care test’ = finger prick, antibodies detected 21-25 days after infection
• HIV antigen test detects the p24 antigen and can be detected 6 days earlier than antibodies

Question 7

How soon after infection can HIV be detected?

window period

Answer 7

window period = time between HIV transmission and ability to detect infection in the blood testing

• 4 weeks long
• if infection less than 4 weeks ago -> patient needs retesting
• test at 4 weeks and 3 months, regardless of calculated window period

Question 8

Ellaone use

when to take

physiology

contraindications

breastfeeding

side effects

good to know: vomit and other contraceptives

Answer 8

for emergency contraceptive (e.g. for UPSI)

• take within 5 days of UPSI
• if more than 3 days -> ella one
• if less than 3 days -> levonelle

inhibits ovulation (SPRM like miepristone, small progesterons antagonist effect) other name is ullipristal acetate

contraindicated in liver disease and asthma

avoid breastfeeding for 1 week after taking medication

can cause painful periods, mood swings and back pain

if patient vomits within 3 hours, she will need to see the doctor again as the pill will not have been absorbed

ellaOne reduces effectiveness of progesterone-contianing contraceptives

• women should use condoms or avoid UPSI until the next peiod

Question 9

Who is likely to get PCP

what causes it

Answer 9

common presentation in individuals non-compliant with cART regimens or antibiotic prophylaxis (for HIV)

fungus Pneumocystis Jiroveci

Question 10

Clinical features of PCP (3)

chest exam?

Answer 10

• fever
• non-productive cough (can have superimposed bacterial infection)
• exertional breathlessness associated with onset of infection -> specific sign for PCP so used to stratify severity

O/E chest = often clear, sometimes end inspiratory crackles present

Question 11

Ix in PCP

radiology and definitive diagnostic ix

Answer 11

CXR = bilaterial bihilar interstitial infiltrates, 10% normal CXR

High-res CT = if CXR normal but PCP suspected, to look for cysts and nodules

DEFINITIVE IX:

• bronchoscopy with BAL (induced sputum samples can be used but less specific)

Question 12

What stain do we use for PCP samples and what appearance does it show

Answer 12

Grocott’s stain

‘Mexican hats’ appearance aka crushed ping pong balls

Question 13

How do we manage PCP

Answer 13

Tx based on clinical/radiological evidence of infection or clinical indicators of general immune deficiency

first choice agent = Co-trimoxazole aka Septra/Bactrim/TMP-SMX (MRSA, G+, G-)

• if not = clindamycin-primaquine (MRSA, G+), dapsone, IV pentamidine

if patient p02 <9.3 kPa, and arterial alveolar 02 gradient >4.7kPa aka evidence of hypoxaemia e.g. sats <92%

• adjuvant corticosteroids

Question 14

Bacterial vaginosis definition (most common bacteria)

features

associations

Answer 14

bacterial overgrowth

• gardnerella vaginalis = anaerobic organism overproduction, reduction of lactobacilli in the vaginal flora

leading to vaginal discharge with an associated fishy odour

This is associated with UPSI and menstruation

Question 15

Bacterial vaginosis epidemiology

Answer 15

most common cause of abnormal vaginal discharge in women of childbearing age, with prevalence as high as 50% in some communities

Question 16

What criteria do we use to diagnose bacterial vaginosis

Answer 16

Amstel criteria: 3 of 4 features needed

• vaginal pH >4.5 (normal is 3.8-4.5)
• homogenous grey discharge
• whiff test = 10% potassium hydroxide produces fishy odour
• clue cells present on wet mount

Question 17

how do we manage bacterial vaginosis

Answer 17

metronidazole (anaerobes) = can be used in pregnancy too

clindamycin (MRSA, G+, anaerobes)