GUM Flashcards
BACTERIAL VAGINOSIS
i) what is it? which bacteria are implicated? is it an STI? what is it caused by? what is the most common causative
ii) name five RF? what is the standard presenting feature? is there usually itching, irritation, pain?
iii) name two investigations that can be done? what is seen on microscopy?
iv) does it always need tx? what is the abx of choice? what is another abx used? what other infections should also be tested for?
v) what can BV increase the risk of? name three complications in pregnancy?
i) overgrowth of bacteria in the vagina - anaerobic bac
not caused by an STI but can increase the risk of dev one
gardanerella vaginalis most common
ii) RF - multiple sexual partners, excess vaginal cleaning, recent abx, smoking, copper coil
px feature - fish smelling watery grey discharge
no itch, irritation or pain
iii) speculum exam and high vaginal swab
vaginal pH > BV pH >4.5
microscopy - clue cells (ep cells from cervix that have bacteria stuck inside)
iv) asymp may not need tx
metronidazole is 1st line for anerobics (oral or gel) - AVOID ETOH N+V
can also give clindamycin
also test for risk of additional pelvic infec eg chlamid and gonnorea
v) BV can increase risk of STIs
complications - miscarriage, preterm delivery, PROM, chorioamiotis, LBW, postpartum endometritis
CANDIDIASIS
i) what is it? name four RF
ii) name two px features? name two things severe infection can lead to
iii) what will vaginal pH be? what can confirm the dx
iv) name three mx options
i) vaginal infection with candida yeast
RF increased oestrogen, poorly controlled diabetes, immunosupp, broad spec abx
ii) thick white non smell discharge, vulval and vaginal itching
severe > erythema, fissures, oedema, dysparunia, dysuria
iii) vaginal pH will be <4.5 (in BV and tich will be >4.5)
charcoal swab with microscopy can confirm dx
iv) antifungal cream (clotrimozale), antifungal pessary (clotrimazole), oral antifungal tablet (fluconazole)
PELVIC INFLAMMATORY DISEASE
i) what is it? where does it originate from? name two things it can cause?
ii) what are they usually caused by? (3) name three other causes
iii) name four RF? name three ways it may px? name three things seen on exam
iv) what should be investigated for first? what type of swab can be done? what cells can be seen on microscopy
v) what should be done on all sexual active women with lower abdo pain? which two blood markers may be raised in PID?
i) infection of organs of pelvis caused by infection spreading up through cervix
can cause tubular infertility and chronic pelvic pain
ii) usually caused by STIs eg neiss gonorrea, chlamid trachmoatic, mycoplas genitalium
can also be caused by non STIs eg garnerella vaginalise, haemoph influ, e coli
iii) RF - no barrier contraception, multiple partners, younger age, previous PID, STI, IUD
px with pelvic or lower abdo pain, abnormal dc, abnormal bleeding, dysparuniea, fever, dysuria
on exam - pelvic tenderness, cervival motion tenderness, inflammed cervix, purulent dc
iv) investigate for causatives eg STIs - NAAT swabs for gon and chlam, mucoplas, HIV test, syphylis test
high vaginal swab for BV, candida, trich
microscopy = pus cells
v) do preg test
inflam markers eg CRP and ESR may be raised
PID MX
i) who should pts be referred to? what should be started quickly?
ii) name three abx that ay be given?
iii) name three complications
iv) what is fitz hugh curtis syndrome?
i) refer to GUM and start empirical abx also contact trace
ii) ceftriaxone to cover gonnorea, doyxcycline for chlam and mycoplas, metronidazole for anerobes eg garnerella vag
iii) sepsis, abscess, infert, chronic pelvic pain, ectopic
iv) FHC - inflam and infec of liver capsule > adhestions between liver and peritoneum > RUQ pain > laparoscopy and remove adhesions
TRICHOMONIASIS
i) what is it? how is it spread? where does it reside in the body? name four things it can increase the risk of when contracted
ii) what % are asymp? name three non spec symptoms? how does vaginal discharge appear? how may it smell?
iii) what charac is seen on exam? what causes this? what vaginal pH will be measured?
iv) how is it diagnosed? where should swabs be taken from? what is used in men?
v) who should pt be referred to? what is tx?
i) parasite (protozoan) spread through sexual intercourse - has flagella appendages
resides in urethra of men and vagina of women
inc risk of contracting HIV, bac bag, cervical cancer, PID, pregnancy complicat eg preterm delivery
ii) 50% are asymp
non spec - discharge, itching, dysuria, dysparunia, balnitis
vaginal dc is yellow green and frothy may smell fishy
iii) on exam see strawberry cervix due to inflam (tiny haemmorhages > strawberry appearance)
iv) dx with charcoal swab with microscopy
swabs from posterior fornix of vagina and urethral swab in men
v) refer to GUM
tx is metronidazole
GONORRHOEA
i) what type of bacteria is it? which part of the body does it infect? name three areas? how does it spread?
ii) name three way female genital infections can px? name three ways male genital infections can px? name three other places it can px
iii) which test is used to dx? name three ways this can be obtained?
iv) what is reccom for MSM? what should be done before starting abx?
i) gram negative diplococcus that infects mucous mems with a columnar ep eg endocervix, urethra, rectum, conjunctiva, pharynx
spreads through mucus secretion contact from infected areas - STI
ii) female - odourless purulent discharge, dysuria, pelvic pain
male - odourless purulent discharge, dysuria, testicular pain or swell
can also px in rectum, pharyngeal, prostatitis, conjunctivitis
iii) nuc acid amplification testing (NAAT) to detect gon RNA or DNA
genital infection by swab or first catch urine
iv) MSM - do rectal/pharyngeal swab
do a standard charcoal endocervical swab for micro/cuture/abx senisitivity before starting abx
GONNORHOEA MX AND COMPLICATIONS
i) what is given if sensitivities are not known? what is given if sens are known?
ii) what follow up test should patients have? what test is done?
iii) name three other advice that should be given
iv) name four complications? what is the key complication in the neonate?
v) what can happen if infection goes untreated? name three symptoms of this
i) sens not known - single IM ceftriaxone
sens known - oral ciprofloxacin
ii) test of cure with NAAT
iii) abstain from sex for 7 days of tx, contact trace, info about preventing future infection, safeguarding
iv) PID, chronic pelvic pain, infertility, epididymoorchities, prostatitis, conjunc, urethral sticture, septic arth
neonate = gonococcal conjunctivitis > medical emergency is assoc with sepsis, perf of eye and blindness
v) untx > disseminated gonococcal infection > spreads to skin and joints
non spec skin lesions, polyarthralgia, migratory polyarthritis, tenosynovitis, systemic symptoms eg fever
CHLAMIDIYA
i) what type of bacteria is it? how often should a sexually active person under 25 be screened?
ii) what do charcoal swabs allow for? what do nucleic acid amplification tests check for?
iii) name four presenting symptoms if symptomatic in women? in men?
iv) name three things found on examination? what test is used to dx?
v) what is first line tx for uncomplicated infection?
i) gram negative intracellular organism > enters cells then ruptures and spreads
screen annually
ii) charcoal swab - microscopy, culure and senstivity inc gram stain
NAAT allows for direct testing of DNA or RNA (endocervical, vulvovaginal or first catch urin)
iii) women - abnormal discharge, pelvic pain, abnormal bleeding, dysparunia, dysuria
men - urethral discharge, painful urination, epididymo-orchitis, reactive arthritis
iv) OE - pelvic/abdo tenderness, cervical motion tender, inflammed cervix, purulent discharge
NAAT test to dx
v) doxycycline 100mg BD for 7 days
CHLAMIDYA COMPLICATIONS
i) name five complications
ii) name three pregnancy related complications
iii) what can affect neonates?
i) PID, chronic pelvic pain, infertility, ectopic pregnancy, eporchitis, conjunctivitis, lymphogranuloma verenum, reactive arth
ii) preg related - preterm delivery, PROM, LBW, post partum endometritis, neonatal infection
iii) chlamidya conjunctivitis - gonnococcal is an important differential
SYPHYLLIS
i) what bacteria causes it? what type of bac is it? what is the incubation period?
ii) name three ways it can be contracted? what are the four stages? which organ can it spread to?
iii) how does primary present? (2) how does secondary px? (3) how does teritiary px? (2)
iv) name three symptoms of neurosyphillis? what is the argyll robertson pupil?
i) caused by treponema pallidum = spirochete
incubation is 21d avg
ii) contracted through oral/vaginal/anal sex, vertical trans, IVDU, blood transfusion
primary = painless ulcer
secondary = systemic sys
teritary = occ years later
neurosyphillis
iii) primary - painless genital ulcer (chancre) 3-8 wks and local LN inflam
secondary - after ulcer has healed - macpap rash, conylomata lata (grey warts), low fever, LNs, alopecia, oral lesions
tertiary - years later - gummatous lesions (granulomatous lesions that aff skin, organs), aortic aneurysms, neurosyph
iv) neurosyph - headahce, alt behavs, tabes dorsalis (demyelination of sp cord posterior columns), ocular symph, paralysis
argyll robertson pupil is specific to neurosyph - constricted pupul that accomodates when focus on a near objecy but doesnt react to light
irregularly shaped
SYPHILLIS DX AND MX
i) which antibodies are tested for as screening? which two methods test for antibodies
ii) name two non specific but sensitive tests used to assess for active infection? what do they test?
iii) name four things all patients need in mx
iv) which abx is given? how is it given?
i) T pallidum antibodies
dark field microscopy and PCR
ii) rapid plasma reagin and venereal disease research lab tests > assess quanity of antibodies
iii) full STI screen, avoid sexual activity until tx, contact tracing
iv) single deep IM dose of bezathine benzylpenicillin
