GUM Flashcards
How is the vaginal pH kept low?
Lactobacilli are the main component of healthy vaginal bacterial flora. They produce lactic acid which keeps the pH under 4.5
Which bacteria are most associated with BV?
Gardnerella vaginalis
What are the risk factors for BV?
Multiple sexy partners Excessive vaginal cleaning Recent abx Smoking Copper coil
How does BV present?
Watery grey or white fishy smelling discharge
Which investigations should be done for BV?
Assess vaginal pH using swab and paper. Usually 3.5-4.5 but in BV it is >7
Standard charcoal vaginal swab
BV shows clue cells on microscopy
What is the management of BV?
Metronidazole
Education about how to clean your fanny
What are the risk factors for vaginal candidiasis?
Increased oestrogen (pregnancy)
Poorly controlled diabetes
Immunosupression
Broad spectrum antibiotics
How does vaginal candidiasis present?
Thick, white discharge which doesn’t typically smell
What are the investigations for vaginal candidiasis?
Test the vaginal pH using a swab and pH paper. Will be <4.5. This means you can differentiate between this and BV. Bacterial vaginosis and trichomonas (pH > 4.5) and candidiasis (pH < 4.5).
Charcoal swab with microscopy can confirm the diagnosis
What are the management options for vaginal candidiasis?
Clotrimazole cream or pessary
Oral fluconazole
What should people be warned about when commencing candidiasis treatment?
Antifungal creams and pessaries can damage condoms and prevent spermacides from working
Is chlamydia gram positive or negative?
negative
When should people who have had chlamydia be re-tested?
3 months after treatment
What are charcoal swabs used for?
Microscopy, culture and sensitivities
They can be used for endocervical swabs and high vaginal swabs
What are NAAT swabs used for?
Nucleic acid amplification test swabs are used to check for DNA or RNA. They can test for chlamydia or gonorrhoea
Which samples can a NAAT test be performed on?
In vaginas= endocervical, first catch urine
Willies= first catch urine, urethral swabs
and: rectal, pharyngeal
How can chlamydia present?
Fannies= vaginal discharge, pelvic pain, abnormal vaginal bleeding, dypareunia, dysuria
Willies= urethral discharge, dysuria, epididymo-orchitis, reactive arthritis
How can chlamydia be diagnosed?
NAAT test on swab or urine
What is the management of chlamydia?
Doxycycline PO 100mg twice a day for 7 days
Contact tracing and notification
What is lymphogranuloma venereum?
Affects the lymphoid tissue around the site of chlamydia infection
How does lymphogranuloma venereum present?
Primary stage= painless ulcer
Secondary stage= lymphadenitis
Tertiary stage= inflammation of the rectum
What is the management of lymphogranuloma venereum?
Doxycycline 100mg twice a day
What type of bacteria is neisseria gonorrhoeae?
Gram negative diplococcus
How does gonorrhoea present?
Odourless purulent discharge
Dysuria
Testicular pain
Pelvic pain
How is gonorrhoea diagnosed?
NAAT to detect RNA or DNA
Do a pharyngeal and rectal swab in MSM
Charcoal swab should also be taken before antibiotic therapy
How should gonorrhoea be managed?
IM ceftriaxone 1g
Single dose of oral ciprofloxacin if sensitivities are known
All patients should have a ‘test of cure’ due to high levels of resistance
What is disseminated gonococcal infection?
Complication of untreated gonococcal infection where the bacteria spreads to the skin and joints. Leads to skin lesions, polyartralgia, tenosynovitis
What is the presentation of mycoplasma genitalium?
Non-gonococcal urethritis
How is mycoplasma genitalium managed?
Doxycycline 100mg BD for 7 days followed by azithromycin 1g stat and the 500mg OD for 2 days
Which bacteria are the common causes of infection in pelvic inflammatory disease?
Neisseria gonorrhoeae
Chlamydia trachomatis
Mycoplasma genitalium
What are risk factors for PID?
Not using barrier contraception
Multiple sexual partners
Young age
Intrauterine device
How may PID present?
Pelvic pain Abnormal vaginal discharge pain during sex fever dysuria
How can PID be diagnosed?
NAAT swabs for gonorrhoea and chlamydia
HIV and syphillis test
Microscopy for pus cells
Inflammatory markers raised
How is PID managed?
IM ceftriaxone
Doxycycline 100mg BD for 14 days
Metronidazole 400mg for 14 days
What is Fitz-Hugh-Curtis syndrome?
Complication of PID. Causes inflammation and infection of the liver capsule
Results in RUQ pain
management is adhesiolysis
What type of micro-organism is trichomonas vaginalis?
A parasite
Protozoan with flagella
What are the complications of trichomonas?
Increases the risk of contracting HIV
Bacterial vaginosis
Cervical cancer
PID
How does trichomonas present?
Vaginal discharge which is frothy, green and has a fishy smell
Strawberry cervix
Raised vaginal pH
How is trichomonas diagnosed?
Standard charcoal swab with microscopy
What is the management of trichomonas?
Metronidazole
Which strain of herpes is most associated with cold sores?
HS-1
Which strain of herpes is most associated with genital herpes?
HS-2
When do symptoms of herpes usually present?
2 weeks after infection
What is the presentation of herpes?
Ulcers Neuropathic pain Flu like symptoms Dysuria Inguinal lympahdenopathy
How can genital herpes be diagnosed?
Viral PCR and clinically
What is the management of genital herpes?
Aciclovir
Is herpes ok during pregnancy?
Genital herpes is not known to cause pregnancy related complications or congenital abnormalities.
Herpes can be passed on during delivery causing neornatal herpes simplex infection. This has high mortality and morbidity
Treat with aciclovir and then do a caesarean section to reduce the risk of transmission
Which bacteria causes syphillis?
Treponema pallidum
How can syphillis be contracted?
Oral, vaginal, anal sex
Vertical transmission
IVDU
Blood transfusions
What is the presentation of primary syphillis?
Painless ulcer (chancre) at the original site of infection
What is the presentation of secondary syphillis?
Involves systemic symptoms, particularly of the skin and mucous membranes. Symptoms resolve after 3-12 weeks
Symptoms: maculopapular rash, condylomata lata, low grade fever
What is the latent stage of syphillis?
Patient is asymptomatic after the secondary stage of syphilis
Early latent syphilis occurs within 2 years of the initial infection. Late latent syphilis is after 2 years.
What is the tertiary stage of syphilis?
Presents with the development of gummas and CV and neuro complications
Gummas are granulomatous lesions which affect the skin
What is the name of the specific finding in neurosyphillis? What does this mean?
Argyll-Robertson pupil
Constricted pupil that accommodates when focusing on near object but does not react to light
How can syphilis be diagnosed?
Antibody testing for antibodies to the T.palladium bacteria which can be used as a screening test for syphilis.
Dark field microscopy
Polymerase chain reacrion (PCR)
Rapid plasma reagin (RPR)
Veneral disease reasearch lab (VDRL)
How is syphilis managed?
Single deep IM dose of benzathine benzylpencillin
