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Alice's finals cards > GUM > Flashcards

GUM Flashcards

1
Q

How is the vaginal pH kept low?

A

Lactobacilli are the main component of healthy vaginal bacterial flora. They produce lactic acid which keeps the pH under 4.5

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2
Q

Which bacteria are most associated with BV?

A

Gardnerella vaginalis

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3
Q

What are the risk factors for BV?

A

Multiple sexy partners
Excessive vaginal cleaning
Recent abx
Smoking
Copper coil

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4
Q

How does BV present?

A

Watery grey or white fishy smelling discharge

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5
Q

Which investigations should be done for BV?

A

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

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6
Q

What is the management of BV?

A

Metronidazole

Education about how to clean your fanny

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7
Q

What are the risk factors for vaginal candidiasis?

A

Increased oestrogen (pregnancy)

Poorly controlled diabetes

Immunosupression

Broad spectrum antibiotics

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8
Q

How does vaginal candidiasis present?

A

Thick, white discharge which doesn’t typically smell

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9
Q

What are the investigations for vaginal candidiasis?

A

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

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10
Q

What are the management options for vaginal candidiasis?

A

Clotrimazole cream or pessary

Oral fluconazole

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11
Q

What should people be warned about when commencing candidiasis treatment?

A

Antifungal creams and pessaries can damage condoms and prevent spermacides from working

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12
Q

Is chlamydia gram positive or negative?

A

negative

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13
Q

When should people who have had chlamydia be re-tested?

A

3 months after treatment

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14
Q

What are charcoal swabs used for?

A

Microscopy, culture and sensitivities

They can be used for endocervical swabs and high vaginal swabs

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15
Q

What are NAAT swabs used for?

A

Nucleic acid amplification test swabs are used to check for DNA or RNA. They can test for chlamydia or gonorrhoea

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16
Q

Which samples can a NAAT test be performed on?

A

In vaginas= endocervical, first catch urine

Willies= first catch urine, urethral swabs

and: rectal, pharyngeal

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17
Q

How can chlamydia present?

A

Fannies= vaginal discharge, pelvic pain, abnormal vaginal bleeding, dypareunia, dysuria

Willies= urethral discharge, dysuria, epididymo-orchitis, reactive arthritis

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18
Q

How can chlamydia be diagnosed?

A

NAAT test on swab or urine

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19
Q

What is the management of chlamydia?

A

Doxycycline PO 100mg twice a day for 7 days

Contact tracing and notification

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20
Q

What is lymphogranuloma venereum?

A

Affects the lymphoid tissue around the site of chlamydia infection

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21
Q

How does lymphogranuloma venereum present?

A

Primary stage= painless ulcer

Secondary stage= lymphadenitis

Tertiary stage= inflammation of the rectum

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22
Q

What is the management of lymphogranuloma venereum?

A

Doxycycline 100mg twice a day

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23
Q

What type of bacteria is neisseria gonorrhoeae?

A

Gram negative diplococcus

24
Q

How does gonorrhoea present?

A

Odourless purulent discharge
Dysuria
Testicular pain
Pelvic pain

25
Q

How is gonorrhoea diagnosed?

A

NAAT to detect RNA or DNA

Do a pharyngeal and rectal swab in MSM

Charcoal swab should also be taken before antibiotic therapy

26
Q

How should gonorrhoea be managed?

A

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

27
Q

What is disseminated gonococcal infection?

A

Complication of untreated gonococcal infection where the bacteria spreads to the skin and joints. Leads to skin lesions, polyartralgia, tenosynovitis

28
Q

What is the presentation of mycoplasma genitalium?

A

Non-gonococcal urethritis

29
Q

How is mycoplasma genitalium managed?

A

Doxycycline 100mg BD for 7 days followed by azithromycin 1g stat and the 500mg OD for 2 days

30
Q

Which bacteria are the common causes of infection in pelvic inflammatory disease?

A

Neisseria gonorrhoeae
Chlamydia trachomatis
Mycoplasma genitalium

31
Q

What are risk factors for PID?

A

Not using barrier contraception
Multiple sexual partners
Young age
Intrauterine device

32
Q

How may PID present?

A

Pelvic pain
Abnormal vaginal discharge
pain during sex
fever
dysuria

33
Q

How can PID be diagnosed?

A

NAAT swabs for gonorrhoea and chlamydia

HIV and syphillis test

Microscopy for pus cells

Inflammatory markers raised

34
Q

How is PID managed?

A

IM ceftriaxone
Doxycycline 100mg BD for 14 days
Metronidazole 400mg for 14 days

35
Q

What is Fitz-Hugh-Curtis syndrome?

A

Complication of PID. Causes inflammation and infection of the liver capsule

Results in RUQ pain

management is adhesiolysis

36
Q

What type of micro-organism is trichomonas vaginalis?

A

A parasite

Protozoan with flagella

37
Q

What are the complications of trichomonas?

A

Increases the risk of contracting HIV
Bacterial vaginosis
Cervical cancer
PID

38
Q

How does trichomonas present?

A

Vaginal discharge which is frothy, green and has a fishy smell

Strawberry cervix

Raised vaginal pH

39
Q

How is trichomonas diagnosed?

A

Standard charcoal swab with microscopy

40
Q

What is the management of trichomonas?

A

Metronidazole

41
Q

Which strain of herpes is most associated with cold sores?

A

HS-1

42
Q

Which strain of herpes is most associated with genital herpes?

A

HS-2

43
Q

When do symptoms of herpes usually present?

A

2 weeks after infection

44
Q

What is the presentation of herpes?

A

Ulcers
Neuropathic pain
Flu like symptoms
Dysuria
Inguinal lympahdenopathy

45
Q

How can genital herpes be diagnosed?

A

Viral PCR and clinically

46
Q

What is the management of genital herpes?

A

Aciclovir

47
Q

Is herpes ok during pregnancy?

A

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

48
Q

Which bacteria causes syphillis?

A

Treponema pallidum

49
Q

How can syphillis be contracted?

A

Oral, vaginal, anal sex

Vertical transmission

IVDU

Blood transfusions

50
Q

What is the presentation of primary syphillis?

A

Painless ulcer (chancre) at the original site of infection

51
Q

What is the presentation of secondary syphillis?

A

Involves systemic symptoms, particularly of the skin and mucous membranes. Occur 6-10 weeks after primary infection

Symptoms: maculopapular rash, condylomata lata (lesions on mucous membranes), low grade fever

52
Q

What is the latent stage of syphillis?

A

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.

53
Q

What is the tertiary stage of syphilis?

A

Presents with the development of gummas and CV and neuro complications

Gummas are granulomatous lesions which affect the skin

54
Q

What is the name of the specific finding in neurosyphillis? What does this mean?

A

Argyll-Robertson pupil

Constricted pupil that accommodates when focusing on near object but does not react to light

55
Q

How can syphilis be diagnosed?

A

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)

56
Q

How is syphilis managed?

A

Single deep IM dose of benzathine benzylpencillin

Alice's finals cards (23 decks)

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