GUM Flashcards
organism: chlamydia
chlamydia trachomatis
gram-ve
most common STI in UK and causes infertility
GUM STI screening
HIV
syphilis
chlamydia
gonorrhoea
testing: chlamydia and gonorrhoea
NAAT
high vaginal swab: tests for
- BV
- candidiasis
- trichomonas vaginalis
- group B strep
- gonorrhoea
presentation: chlamydia
- mainly asymptomatic
- yellow-green ischarge
- pelvic pain
- abnormal vaginal bleeding
- dyspareunia
ix: chlamydia
NAAT vulvovaginal swab
yellow endocervical high vagianl swab for MC&S
rx: chlamydia
doxycycline 100mg BD 7 days
doxcycline - chlamydia
(not in pregnancy/BF - azythromycin 1g stat and 2 days 500mg/erythromycin 500mg QID 7 days)
complications: chlamydia
- PID
- chronic pelvic pain
- infertility
- ectopic pregnancy
- conjunctivitis
- reactive arthritis
organism: gonorrhoea
gram -ve diplococcus
presemntation: gonorrohoea
more likely to be symptomatic than chlamydia
* odourless, perulent dishcarge (can be green-yello)
* dysuria
* pelvic pain
ix: gonorrohoea
NAAT
charcoal swab for MC&S
rx: gonorrhoea
IM ceftriaxone 1g single dose if senstivities unknown
single dose PO ciprofloxacin 500mg is sensitivities known
presentation: BV
fishy smelling watery grey/white discharge
no itch/pain
ix: BV
- high vaginal swab
- vaginal high pH
- CLUE CELLS on MC&S
key word: clue cells
BV
rx: BV
asymptomatic = no treatment
symptomatic = metronidazole 7 days
key words: metronidazole treatment advice
avoid alcohol
complications: BV
miscarriage
preterm delivery
PROM
chorioamnionitis
LBW
postpartum endometritis
presentation: candidiasis
thick white cottage cheese like discharge
no smeel
itchy/painful
ix: candidiasis
charcoal swab for MC7S
rx: candidiasis
clotrimazole cream/pessary
PO fluconazole
canesten due (tablet and cream)
presentation: trichomonas
asymptomatic
frothy yellow-green fishy discharge
itching
ix: trichomonas
ph >4.5
strawberry cervix on speculum
HV swab for MC&S
rx: trichomonas
metronidazole
presentation: mycoplasma genitalium
urethritis
similar to chlamydia
ix: mycolplasma genitalium
NAAT swab
test cure after
rx: mycoplasma genitalium
doxycycline BD 7 days THEN azithromycin 1g stat THEN 500mg OD for 2 days
organism: syphilus
- treponema pallidum
- spirochete with spiral shaped bacteria
stages: syphillis
primary - painless ulcer “chancre”
secondary - systemic symptoms (skin and mucmous membranes - can resolve after 3-12 weeks and enter latent stage)
latent - symptoms disappear but still infected (early up to 2 years, late - after 2 years)
tertiary - gummas and CV/neuro complications
presentation: neurosyphilis
argyll-robertson ppil - constricted pupil that occomodates focusing on nera object but not reacting to light
diagnosis: syphilis
antibody testing - PCR
dark field microscopy
rx: syphilis
IM benzathine benzylpenicillin
presenation: HSV2 herpes
- ulcers/blistering lesions
- neuropathic pain
- flu-like symptoms
- dysuria
- inguinal lymphadenopathy
- symptoms ca last 3 weeks in primary infection
rx: genital herpes
aciclovir
paracetamol
instilagel
wear loose clothing
def: PID
pelvic inflammatory disease
inflammation and infection of pelvic organs
cause of tubular infertility and chronic pelvic pain
causes: PID
chlamydia
gonorrhoea
mycoplasma
presentation: PID
- pelvic pain
- abnormal vaginal dishcharge
- abnormal bleeding
- dyspareunia
- fever/signs of sepsis
- dysuria
ix: pID
- NAAT swabs
- HV swab
- HIV ad syphilis test
rx: PID
- IM ceftriaxone 1g to cover gonorrhoea
- doxycyline to cover chlamydia 100mg 14 days
- metronidazole 400mg 14 days for anaerobes
complications: PID
- sepsis
- abscess
- infertility
- chronic pelvic pain
- ectoic pregnancy
- Fitz-High-Curtis syndrome
def: Fitz-Hugh-Curtis syndrome
- inflammation and infection of liver capsul
- causes adhesions between liver and peritoneum
- causes RUQ pain
- tx: ahesiolysis via laparoscopy
most common cause: PID
chlamydia
MOA: COCP
- stops ovulation
- thickens cervical mucous
- thins endometrium
contraindications: COCP
- uncontrolled hypertension
- > 35 and >15 cigarettes/day
- migraine with aura
- previous VTE
- vascular disease/stroke
- liver irrhosis/tumours
- IHD/AF/cardiomyopathy
- SLE and APL syndrome
instructions for taking: COCP
- start pill ay any time in cycle
- day 1-5 protected immediately
- otherwise use 7 days additional contraception
missed pill rules: COCP
missing 1 pill:
* take missed pil straight away
* continue taking pack as normal
* emergency contraception not required
missing 2+ pills:
* take most recent pill missed straight away
* use condoms/abstain from sex 7 daysa
* emergency contraception if day 1-7 cycle
MOA: POP
stops ovulation
thickens cervical mucous
thins endometrium
contraindications: POP
- active breast cancer
- severe liver cirrhosis
- liver tumour
starinstructions for taking: POP
- can start any time in cycle
- if day 1-5 preotected immediately
- otherwise use additional conraception for 2 days after starting
missed pill rules: POP
<12 hours:
take missd pill straight away and continue taking pack as normal
> 12 hours:
take missed pill straight away - if missed more than 1 only take 1
use condoms for next 2 days
if you had sex within time of missed pill = emergency contraception
emergency contaception: Levonogestrel (Levonelle)
- taken within72 hours UPSI
- unlikely effective after ovulation (day 14+)
- 1.5mg single dose
- 3mg single dose if BMI>26
- BF ok
- start COCP immediately
emergency contraception: ullipristal acetate (ellaone)
- taken within 120h of UPSI
- unlikely to be effective after ovulation (day 14+)
- more effective than levonelle
- wait 5 days before COCP or POP
- single 30mg dose
- BF avoided
- avoided in severe asthma
emergency contraception: copper coil
can be inserted within 5 days of UPSI/within 5 days og estimated date of ovulation
most effective
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