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GUM Flashcards

1
Q

causes of genital ulceration?

A
  • infectious (viral: HCV, varicella, CMV. bcaterial: syphilis, staph/strep, LGV, chancroid, donovanosis. fungal)
  • inflammatory/immune (crohns, blistering skin conditions, aphthous)
  • durg-related (FDE, topical reaction, IVDU)
  • traumatic
  • malignant
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2
Q

What tests are done for herpes?

A
  • take a swab (send for PCR) on a wet blister/ulcer not crusted over

also offer full STI screen, syphilis serology, HIV antibody test

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3
Q

management of herpes?

A
  • course of oral antiviral (e.g. aciclovir) 400mg TDS for 5 days
  • 5% lidocaine ointment
  • rest and analgesia
  • salt watering bathing
  • vaseline
  • avoid sexual contact while symptomatic
  • advise to disclose to partner
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4
Q

complications of herpes?

A
  • urinary retention (due to extreme pain when passing)
  • adhesions
  • meningism
  • emotional distress
  • recurrences
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5
Q

are herpes ulcers painless or painful?

A

painful !

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6
Q

differential diagnose for genital ulcers?

A
  • syphilis
  • herpes simples
  • lymphogranuloma venereum
  • aphthous ulceration
  • trauma
  • Mpox
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7
Q

how do you diagnose syphilis?

A

from lesions:
- dark ground microscopy
- treponemal PCR

in blood:
- treponemal enzyme immunoassay (EIA)
- treponema pallidum particule agglutination assay (TPPA)
- rapid plasma reagin test (RPR)

  • always perform full STI screen including HIV testing
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8
Q

first line treatment for syphilis?

A

early: benzathine pencillin IM one dose
late: benzathine penicillin IM 3 doses

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9
Q

what tests would you do on a symptomatic female?

A
  • high vaginal loop swab fro microscopy and pH testing - TV, BV, candida
  • vulvovaginal swab ‘dual NAAT’ - chlamydia and gonorrhea. may need throat and rectal
  • bloods: HIV.syph +/- Hep B/C

+/-:
- high vaginal charcoal swab
- gonorrhea cultures
- HSV PCR
- urinalysis
- preg test

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10
Q

what tests would you do on a symptomatic male?

A
  • urethral smear - GC/NSU, GC culture
  • first pass urine - GC/CT dual NAATs test
  • bloods HIV/syphilis +/- hep B/C

MSM may need rectal and pharyngeal swabs and culutres
other swabs - MC&S/candida/herpes
other test - urine dip

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11
Q

what tests would you do on a symptomatic male?

A
  • urethral smear - GC/NSU, GC culture
  • first pass urine - GC/CT dual NAATs test
  • bloods HIV/syphilis +/- hep B/C

MSM may need rectal and pharyngeal swabs and culutres
other swabs - MC&S/candida/herpes
other test - urine dip

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12
Q

what tests would you do on a symptomatic male?

A
  • urethral smear - GC/NSU, GC culture
  • first pass urine - GC/CT dual NAATs test
  • bloods HIV/syphilis +/- hep B/C

MSM may need rectal and pharyngeal swabs and culutres
other swabs - MC&S/candida/herpes
other test - urine dip

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13
Q

risk factors for candiasis?

A
  • immunosupression (hiv, steroids, chemo)
  • high oestrogen levels (preg, luteal phase, somes COCPs)
  • recent ABx
  • diabetes
  • mucosal breakdown (sexual contact, dermatitis)
  • recurrent candidiasis
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14
Q

how to treat candidal infection?

A

fluconazole 150mg stat or
clotrimazole 500mg pessary PV stat or
clotrimazole 1% cream for 2 wks

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15
Q

what are some important questions to ask regarding vaginal discharge?

A

colour
consistency
odour

associated symptoms: pain, bleeding, itchy, rash, triggers

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16
Q

what examinatons do you want to do on female patient?

A
  • external + vulval examination
  • speculum examination
  • bimanual examination (if abdo pain/deep dyspareunia )
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17
Q

what swabs are used for different organisms?

A
  • high vaginal swab - trichomonas vaginalis/candida/bacterial vaginosis
  • vulvovaginal swab - N. gonorrhoeae and C.trachomatis
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18
Q

what are the clinical features of vaginal candida?

A
  • thick, white discharge (cottage cheese like)
  • itching
  • soreness
  • vulval erythema +/- fissures, pH 4
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19
Q

what investigations need to be done when suspecting candida?

A
  • swabs taken from high vaginal walls
    (- culture may grow candida but doesn’t distinguish colonisation)
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20
Q

risk factors for candida infection

A
  • immunouspression
  • high oestrogen levels
  • recent ABx (up to 3 months before)
  • diabetes mellitus
  • mucosal breakdown (sexual contact, mucosal breakdown)
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21
Q

Tx for candida?

A
  • fluconazole 150mg PO STAT or clotrimazole 500mg pessary PV stat
    PLUS clotrimazole 1% cream top BD for 2 wks
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22
Q

what is the treatment fro recurrent candidiasis?

A

recurrent = > 4 times a yr

induction followed by maintenance:
- fluconazole 150mg every 72 hrs for 3 doses
- then fluconazole 150mg x1 a week for 6 months
- clotrimazole pessaries can be used if flucon. contraind.

(+ advice on douching, remove oestrogen e.g. POP)

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23
Q

what is bacterial vaginosis + how is it caused?

A
  • imbalance of vaginal flora
    loss of lactobacilli that maintain pH of vagina
    = overgrowth of normal, commensal, anaerobic and facultative bacteria
    rise in vaginal pH
    NOT AN STI
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24
Q

triggers for bacterial vaginosis?

A
  • sex
  • menses
  • receptive oral SI
  • vaginal douching
  • perfumed bath product
    s- change in sexual partners
  • presence of STI
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25
Q

Tx of bacterial vaginosis?

A

metronidazole 400mg BD for 5 days

26
Q

clincial features of trichonmonas vaginalis?

A
  • frothy vaginal discharge
  • dysuria
  • vulval soreness/itching -> vulvitis, vaginitis
  • strawberry cervix seen in 2%
27
Q

how to diagnose trichomonas vaginalis

A

swab posterior fornix (HVS) - microscopy, culture, NAATs

28
Q

Tx of trichomonas vaginalis?

A
  • metronidazole 400mg PO BD 5-7 days
29
Q

what investigations need to be doen in men who have genital diascharge ?

A
  • urine NAATs for gonnorrhea and chlamydia
  • swab from urethra (having held urine) - gram stained smear
  • gonorrhoea culture (if clinical suspicion high)
    (- MSU/urinalysis)
30
Q

what is non specific urethritis (NSU) ?

A

inflammation of the urethra in the absence of a diagnosis of chlamydia or gonorrhoea

31
Q

what are the clincial features os NSU?

A

urethral diacharge
dysuria
penile irritation

32
Q

how woudl you diahnose NSU?

A

gram stain and microscopy of urethral sample

33
Q

Tx of NSU?

A
  • send STI screening
  • treat with 1/52 of doxycycline 100mg PO BD
  • abstain during treatment and treat partners
34
Q

clicncial features of chlamydia in men and women ?

A

men:
- discharge
- dysuria
- testicular pain

women:
- discharge
- post coital bleeding
- intermenstrual bleeding
- lower abdo pain/ PID
- dysuria

50% asymptomatic in MEN and 70% asymptomatic in WOMEN !!!

35
Q

Tx of chlamydia?

A
  • doxycycline 100mg PO BD 7 days (azithromycin in pregnancy)

no test of cure needed

36
Q

clincial features fo gonorrhea?

A

men: - purulent dscharge or epididymoorchitis, proctitis

women: - purulent dishcarge, IMB or PCB, PID, proctitis

37
Q

how to diagnose gonorrhoea?

A

NAAT testing - vulvovaginal, urine, rectal, pharyngeal (dependign on expsosure)
culture - alwasy require prior to treatment for ABx sensitivities

test of cure required !!!! @ 2 wks

38
Q

Tx for gonorrhoea?

A

ceftriaxone 1g STAT IM, single dose
- if sensitivities back back consider ciprofloxacin 500mg PO STAT

39
Q

what are genital warts

A

condyloma acuminata (genital warts) are benign lesiosn caused by HPV (mostly 6 and 11) - sexually transmitted
small skin coloured or pink growths on genital skin

40
Q

symptoms of genital warts

A

warty growths in genital skin, painless and often asymptomatic
little discomfort (sometimes itchy)
distorted urinary stream with urethral lesions
bleeding from cervical/urethral/anal lesions
rarely - secondary infection

41
Q

name some lesions that can be mistaken for genital warts

A
  • skin tags
  • pearly penile papules
  • fordyce spots
  • molluscum contagiosum
  • condylomata lata (occur in secondary syphilis)
  • malignant or pre malignant conditions
42
Q

Mx for genital warts?

A
  • screen for other STIs
  • encourgae condom use
  • reassure that HPV is common and will resolve sponteneously
  • or can discuss through Tx options
43
Q

Tx for genital warts?

A
  • destruction (cryotherapy)
  • anti-mitotic agents (podophyllotoxin)
  • immune modifiers (imiquimod cream)
  • surgery
44
Q

what is teh Tx/Mx for genital warts in pregnancy

A
  • watch and wait, resolve post partum
  • topical cream treatments contraindicated
  • cryoablation is safe
  • surgical removal possible in extreme cases
45
Q

nmae some infective cuases of genital ulcers/sores

A

herpes simplex
herpes zoster
syphilis
topcial diseases: LGV, granuloma inguinale, chancroid

46
Q

name the derm condition that can cause genital sorenss?

A
  • fixed drug reactions
  • bechets
  • apthosis
  • lichen planus
  • pemphigus
  • malignancy
47
Q

4 stages of herpes simplex virus ulcers?

A
  1. painful tingly red macular lesions
  2. fluid filled ulcers
  3. burst and become painful ulcers
  4. heal forming fry cakey lesion
48
Q

how long is the incubation period for HSV?

A

3-14 days

49
Q

what can HSV look like on the cervix?

A

confluent necrotic type lesions

50
Q

how can HSV interfer with pregnancy?

A

if recurrent episode then low risk
if primary infection !! in last trimester! then c section required
occasional use of prophylactic aciclovir in last trimester

51
Q

cliincial featuyres of syphilis?

A

single, painless, undurated ulcer known as chancre
lymphadenopathy near lesion

52
Q

what commonly causes PID?

A
  • chlamydia and gonorrhoea
  • gardnerella vaginalis / anaerobes
  • mycoplasma genitalium
53
Q

long term effects of PID?

A
  • ifnertility
  • increased risk of ectopic pregnancy
  • chronic pelvic pain
  • tuboovarian abscess
  • fitz hugh curtis syndrome - RUQ pain, perihepatitis (= violin strign adhesions in peritoneal cavity attached to liver)
54
Q

risk factors for PID?

A
  • Hx of multiple partners
  • Coil insertion
  • chlamydia, gonorrhoea
  • young age < 25
  • previous PID
  • TOP/miscarriage
  • douching/BV
  • new sexual partner
  • instrumentation of uterus
55
Q

symptoms/signs of PID?

A
  • lower abdo pain
  • deep dyspareunia
  • abnormal PV discharge, often purulent
  • PCB, IMB
  • fever, chills
    **can be aysmptomatic
  • cervical motion tenderness
  • adnexal tenderness
  • adnexal mass (if tuboovarian abscess)
  • contact bleeding from cervix
56
Q

hwo to diagnose PID?

A
  • very difficult !! based on clinical features of infection on examination
  • preggo test - to rule out ectopic
  • test for chlam + gonorr
  • dont wait for test results to come back to start Tx
  • elevated ESR/WCC/CRP
  • gram stained microscopy - look for endocervical pus cells
  • USS may show hydrosalpinx/free fluid/ abscess
  • MRI/CT may exclude/confirm other DDs
    (- laparoscopy if still unknown)
57
Q

Mx of PID?

A
  • rest
  • analgesia
  • broad spec ABx (500mg IM ceftrixone + 100mg doxy BD for 2 wks + 400mg metronidazole BD for 2 wks)
  • admit for obs if severe disease, pregnant, suspected tubo-ovarian abscess
  • abstain sex
58
Q

what is the reasonign for partners notification?

A
  • break the chain of transmission
  • prevent re-infection of the index patient
  • prevent complications of untreated infection
  • moral duty/ethics to inform
59
Q

what are the partner notification methods?

A
  • pt referral
  • provider referral
  • conditional or contract referral
60
Q

Tx for trichomonas?

A

Metronidazole 2g PO STAT

Y4 medicine (18 decks)

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