GUM Flashcards
test for thrush
Often treatment for candidiasis is started empirically, based on the presentation.
Testing the vaginal pH using a swab and pH paper can be helpful in differentiating between bacterial vaginosis and trichomonas (pH > 4.5) and candidiasis (pH < 4.5).
A high vaginal charcoal swab with microscopy can confirm the diagnosis.
management thrush
- oral fluconazole 150 mg as a single dose first-line
clotrimazole 500 mg intravaginal pessary as a single dose if oral therapy is contraindicated
If there are vulval symptoms, consider adding a topical imidazole in addition to an oral or intravaginal antifungal
- if pregnant then only local treatments (e.g. cream or pessaries) may be used - oral treatments are contraindicated
diagnosis gonnorrhoea
NAAT
A standard charcoal endocervical swab should be taken for microscopy, culture and antibiotic sensitivities before initiating antibiotics. This is particularly important given the high rates of antibiotic resistance.
Management gonorrhoea
A single dose of intramuscular ceftriaxone 1g if the sensitivities are NOT known
A single dose of oral ciprofloxacin 500mg if the sensitivities ARE known
test of cure gonorrhoea
This is with NAAT testing if they are asymptomatic, or cultures where they are symptomatic. BASHH recommend a test of cure at least:
72 hours after treatment for culture
7 days after treatment for RNA NATT
14 days after treatment for DNA NATT
Disseminated Gonococcal Infection
Various non-specific skin lesions
Polyarthralgia (joint aches and pains)
Migratory polyarthritis (arthritis that moves between joints)
Tenosynovitis
Systemic symptoms such as fever and fatigue
septic arthritis
test for chlamydia
NAAT
management of chlamydia
First-line for uncomplicated chlamydia infection is doxycycline 100mg twice a day for 7 days.
The guidelines previously recommended a single dose of azithromycin 1g orally as an alternative.
management of chlamydia in pregnancy and breast feeding
Azithromycin 1g stat then 500mg once a day for 2 days
Lymphogranuloma Venereum
Lymphogranuloma venereum (LGV) is a condition affecting the lymphoid tissue around the site of infection with chlamydia. It most commonly occurs in men who have sex with men (MSM). LGV occurs in three stages:
The primary stage involves a painless ulcer (primary lesion). This typically occurs on the penis in men, vaginal wall in women or rectum after anal sex.
The secondary stage involves lymphadenitis. This is swelling, inflammation and pain in the lymph nodes infected with the bacteria. The inguinal or femoral lymph nodes may be affected.
The tertiary stage involves inflammation of the rectum (proctitis) and anus. Proctocolitis leads to anal pain, change in bowel habit, tenesmus and discharge. Tenesmus is a feeling of needing to empty the bowels, even after completing a bowel motion.
Doxycycline 100mg twice daily for 21 days is the first-line treatment for LGV recommended by BASHH
unilateral conjunctivitis
Chlamydial conjunctivitis
what is trichomonas
Trichomonas vaginalis is a type of parasite spread through sexual intercourse. Trichomonas is classed as a protozoan, and is a single-celled organism with flagella.
complications of chlamydia?
Pelvic inflammatory disease
Chronic pelvic pain
Infertility
Ectopic pregnancy
Epididymo-orchitis
Conjunctivitis
Lymphogranuloma venereum
Reactive arthritis
trichomonas complications
Contracting HIV by damaging the vaginal mucosa
Bacterial vaginosis
Cervical cancer
Pelvic inflammatory disease
Pregnancy-related complications such as preterm delivery.
pregnancy complications chlamydia
Preterm delivery
Premature rupture of membranes
Low birth weight
Postpartum endometritis
Neonatal infection (conjunctivitis and pneumonia)
investigation trichomonas
high vaginal charcoal swab with microscopy
management trichomonas
metronidazole
raised vaginal pH - value? indicate?
> 4.5
- BV
- trichomonas
investigation genital herpes
clinical but can do:
Viral PCR swab from a lesion can confirm the diagnosis and causative organism.
management genital herpes
Aciclovir
additional measures:
Paracetamol
Topical lidocaine 2% gel (e.g. Instillagel)
Cleaning with warm salt water
Topical vaseline
Additional oral fluids
Wear loose clothing
Avoid intercourse with symptoms
genital herpes and pregnancy
Primary HSV-2 <28 weeks gestation
- aciclovir during the initial infection
- regular prophylactic aciclovir starting from 36 weeks gestation
- if asymptomatic at delivery can have a vaginal delivery (provided it is more than six weeks after the initial infection)
Primary HSV-2 >28 weeks gestation
- aciclovir during the initial infection followed immediately by regular prophylactic aciclovir.
- Caesarean section
Recurrent HSV-2
carries a low risk of neonatal infection (0-3%), even if the lesions are present during delivery. Regular prophylactic aciclovir is considered from 36 weeks gestation to reduce the risk of symptoms at the time of delivery.
tests for syphillis
Antibody testing for antibodies to the T. pallidum bacteria can be used as a screening test for syphilis.
Patients with suspected syphilis or positive antibodies should be referred to a specialist GUM centre for further testing.
Samples from sites of infection can be tested to confirm the presence of T. pallidum with:
Dark field microscopy
Polymerase chain reaction (PCR)
The rapid plasma reagin (RPR) and venereal disease research laboratory (VDRL) tests (assessing for active infection) 2481632 thing
treatment syphillis
deep intramuscular dose of benzathine benzylpenicillin (penicillin)
Mycoplasma genitalium (MG)
bacteria that causes non-gonococcal urethritis
investigation mycoplasma genitalium
Nucleic acid amplification tests (NAAT)
management mycoplasma genitalium
Course of doxycycline followed by azithromycin for uncomplicated genital infections:
Doxycycline 100mg twice daily for 7 days then;
Azithromycin 1g stat then 500mg once a day for 2 days (unless it is known to be resistant to macrolides)
Moxifloxacin is used as an alternative or in complicated infections. Azithromycin alone is used in pregnancy and breastfeeding (remember doxycycline is contraindicated).
testing for HIV
Antibody testing for screening (blood test) - needs 3 months to show up
Testing for the p24 antigen. This can give a positive result earlier in the infection compared with the antibody test.
PCR testing for the HIV RNA levels tests directly for the number of viral copies in the blood, giving a viral load.
CD4 count
500-1200 cells/mm3 is the normal range
Under 200 cells/mm3 is considered end-stage HIV (AIDS) and puts the patient at high risk of opportunistic infections
