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GUM Flashcards

1
Q

What is bacteria vaginosis caused by ?

A
  • Overgrowth of anaerobic bacteria
  • Most commonly : Gardnerella vaginalis
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2
Q

What is the Amsel’s criteria for diagnosing BV?

A

3 of the following :

  • Thin, white homogenous discharge
  • Clue cells on microscopy: stippled vaginal epithelial cells
  • Vaginal pH > 4.5
  • Positive whiff test (addition of potassium hydroxide results in fishy odour)
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3
Q

what swab is required for diagnosing BV

A
  • Charcoal swab for microscopy, either high vaginal or self taken low swab
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4
Q

Treatment of BV

A
  • Symptomatic : oral metronidazole (5-7 days)
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5
Q

What complications in pregnant women is BV associated with ?

A
  • Late miscarriage
  • Preterm delivery
  • Chorioamnionitis
  • Low birth weight
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6
Q

Most common organism seen in vaginal candidiasis

A

Candida albicans (yeast infection)

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7
Q

Symptoms of vaginal candidiasis

A
  • Thick, white discharge that does not typically smell
  • Vulval and vaginal itching, irritation or discomfort
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8
Q

Management of vaginal candidiasis

A
  • oral fluconazole : 150 mg as a single dose
  • 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 = tropical only
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9
Q

What is recurrent vaginal candidiasis and how is it managed ?

A
  • 4 or more episodes a year
  • High vaginal swab for microscopy and culture
  • BM test for DM
  • Induction and maintenance regime : oral fluconazole every 3 days for 3 doses and maintain with oral fluconazole weekly for 6 mnths
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10
Q

what kind of bacteria is chlamydia trachomatis

A

Gram-negative

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11
Q

How is chlamydia diagnosed

A
  • Nucleic acid amplification test (NAATs)
  • Women : vulvovaginal swab first line
  • Men : Urine
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12
Q

If not asymptomatic, how can chlamydia present in women ?

A
  • Abnormal vaginal discharge
  • Abnormal vaginal bleeding (intermenstrual or postcoital)
  • Dysuria
  • Pelvic pain
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13
Q

How does chlamydia present in men ?

A
  • Urethral discharge or discomfort
  • Dysuria
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14
Q

what are the examination findings in chlamydia

A
  • Pelvic or abdominal tenderness
  • Cervical motion tenderness (cervical excitation)
  • Inflamed cervix (cervicitis)
  • Purulent discharge
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15
Q

First line management of uncomplicated chlamydia

A

Doxycycline 100mg twice daily for 7 days

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16
Q

When is doxycycline CI for chlamydia treatment and what can be given ?

A
  • Pregnancy and breastfeeding
  • Azithromycin 1g stat, then 500mg once daily for 2 days
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17
Q

Give 5 pregnancy-related complications with chlamydia

A
  • Preterm delivery
  • Premature rupture of membranes
  • Low birth weight
  • Postpartum endometritis
  • Neonatal infection (conjunctivitis and pneumonia)
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18
Q

Give 8 complications of chlamydia

A
  • PID
  • Chronic pelvic pain
  • Infertility
  • Ectopic pregnancy
  • Epididymo-orchitis
  • Conjunctivitis
  • Lymphogranuloma venereum
  • Reactive arthritis
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19
Q

stage one of lymphogranuloma venereum (LGV)

A

Primary -> painless ulcer. On penis in men, vaginal wall in women or rectum after anal sex

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20
Q

Second stage of LGV

A

Secondary -> lymphadenitis (in guinal or femoral lymph nodes)

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21
Q

Third stage of LGC

A
  • Tertiary -> inflammation of rectum and anus
  • Anal pain, change in bowel habit. tenesmus and discharge
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22
Q

How is LGV managed ?

A

Doxycyline 100mg twice daily for 21 days

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23
Q

what organism causes gonorrhoea

A
  • Neisseria gonorrhoeae = gram negative diplococcus
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24
Q

How does gonorrhoea present in women

A
  • Odourless purulent discharge, possibly green or yellow
  • Dysuria
  • Pelvic pain
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25
Q

How does gonorrhoea present in men ?

A
  • Odourless purulent discharge, possibly green or yellow
  • Dysuria
  • Testicular pain or swelling (epididymo-orchitis)
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26
Q

how is gonorrhoea tested for ?

A
  • Diagnosed : NAAT
  • Charcoal swab for microscopy, culture and sensitivites
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27
Q

How is gonorrhoea managed ?

A
  • A single dose of IM ceftriaxone 1g if the sensitivities are NOT known
  • A single dose of oral ciprofloxacin 500mg if the sensitivities ARE known and the organism is sensitive to cipro
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28
Q

Should patients treated for gonorrhoea have a ‘test of cure’

A

Yes : NAAT if asymptomatic, cultures if symptomatic

72 hours after treatment for culture
7 days after treatment for RNA NAAT
14 days after treatment for DNA NAAT

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29
Q

What are the complications of gonorrhoea

A
  • PID -> Fitz-Hugh-Curtis syndrome
  • Disseminated gonococcal infection
  • Epididymo-orchitis
  • Prostatitis
  • Conjunctivits
  • Urethral strictures
  • Septic arthritis
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30
Q

What is disseminated gonococcal infection

A
  • When bacteria from untreated gonococcal infection, spreads to the skin and joints
  • Causes : tenosynovitis, migratory polyarthritis and dermatitis
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31
Q

what is a key complication of gonorrhoea in pregnancy ?

A
  • Gonococcal conjunctivitis in a neonate -> opthalmia neonatorum
32
Q

Give the 3 most common causes of PID

A
  • Chlamydia trachomatis
  • Neisseria gonorrhoeae
  • Mycoplasma genitalium
33
Q

What symptoms does PID cause?

A
  • Pelvic or lower abdominal pain
  • Abnormal vaginal discharge
  • Abnormal bleeding (intermenstrual or postcoital)
  • Deep dyspareunia
  • Fever
  • Dysuria
34
Q

What may be seen on examination in PID ?

A
  • Pelvic tenderness
  • Cervical motion tenderness (cervical excitation)
  • Inflamed cervix (cervicitis)
  • Purulent discharge
35
Q

what investigations should be done if PID is suspected ?

A
  • Pregnancy test
  • Full STI screen (high vaginal, urethral, endocervical)
  • Inflammatory markers (CRP)
  • Transvaginal / pelvic USS
36
Q

What will be seen under a microscope in PID?

A

Pus cells

37
Q

What is an example management regime of PID

A
  • A single dose of intramuscular ceftriaxone 1g (to cover gonorrhoea)
  • Doxycycline 100mg twice daily for 14 days (to cover chlamydia and Mycoplasma genitalium)
  • Metronidazole 400mg twice daily for 14 days (to cover anaerobes such as Gardnerella vaginalis)
38
Q

Give 6 complications of PID

A
  • Sepsis
  • Abscess
  • Infertility
  • Chronic pelvic pain
  • Ectopic pregnancy
  • Fitz-Hugh-Curtis syndrome
39
Q

What is Fitz-Hugh-Curtis Syndrome ?

A
  • Complication of PID
  • Inflammation and infection of liver capsule (Glisson’s capsule)
  • Causes adhesions between the liver and the peritoneum
40
Q

What does Fitz-Hugh-Curtis Syndrome cause ?

A
  • RUQ pain, referred to right shoulder tip
41
Q

What kind of STI is trichomoniasis

A
  • Parasite
  • Protozoan -> single-celled organism with flagella
42
Q

If not asymptomatic, how does trichomoniasis present ?

A
  • Vaginal discharge : frothy and yellow/green.
  • Itching
  • Dysuria
  • Dyspareunia
  • Balanitis (inflammation to the glans penis
43
Q

What is seen on examination of the cervix in trichomoniasis ?

A

Strawberry cervix

44
Q

How is trichomoniasis diagnosed ?

A
  • Charcoal swab with microscopy
  • Posterior fornix of vagina in a woman
  • Urethral swab or first-catch urine in a man
45
Q

How is trichomoniasis managed ?

A
  • Oral metronidazole (5-7 days)
46
Q

what can trichomoniasis increase the risk of ?

A
  • Contracting HIV by damaging the vaginal mucosa
  • BV
  • Cervical cancer
  • PID
  • Pregnancy-related complications such as preterm delivery
47
Q

What is herpes simplex virus (HSV) associated with

A
  • HSV-1 = cold sores
  • HSV-2 = genital herpes
48
Q

If not asymptomatic, how does HSV present ?

A
  • Painful genital ulceration
  • Neuropathic type pain (tingling, burning or shooting)
  • Flu-like symptoms (e.g. fatigue and headaches)
  • Dysuria (painful urination)
  • Inguinal lymphadenopathy
49
Q

How is HSV diagnosed ?

A
  • Can be made clinically
  • Viral PCR swab from the lesion to confirm
50
Q

How is genital herpes treated ?

A
  • Oral aciclovir
51
Q

How is a primary genital herpes infection contracted before 28 weeks gestation managed ?

A
  • Oral aciclovir
  • Regular prophylactic aciclovir starting from 26 wks
  • Asymptomatic = vaginal delivery
52
Q

How is primary genital herpes contracted >28 wks gestation managed ?

A
  • Ora aciclovir during the
  • Regular prophylactic aciclovir.
  • C section
53
Q

what causes syphilis ?

A

Spirochaete Treponema pallidum

54
Q

What is the primary stage of syphilis?

A
  • Chancre - painless ulcer at the site of sexual contact
  • Local non-tender lymphadenopathy
  • Often not seen in women (the lesion may be on the cervix)
55
Q

what is secondary syphilis ?

A
  • Systemic symptoms : fever, lymphadenopathy
  • Rash on trunk, palms and soles
  • Condylomata lata
  • Buccal ‘snail track’ ulcer
  • These symptoms can resolve after 3 – 12 weeks and the patient can enter the latent stage.
56
Q

what is latent syphilis ?

A
  • Patient is asymptomatic whilst still being infected
  • Early latent syphilis occurs within two years of the initial infection
  • Late latent syphilis occurs from two years after the initial infection onwards.
57
Q

what is tertiary syphilis

A
  • Gummatous lesions (gummas are granulomatous lesions that can affect the skin, organs and bones)
  • Aortic aneurysms
  • Neurosyphilis
58
Q

What are the signs of neurosyphilis ?

A
  • Headache
  • Altered behaviour
  • Dementia
  • Tabes dorsalis (demyelination affecting the spinal cord posterior columns)
  • Ocular syphilis (affecting the eyes)
  • Paralysis
  • Sensory impairment
59
Q

What is a specific finding in neurosyphilis ?

A
  • Argyll-Roberton pupil : constricted pupil that accomodates when focusing on a near object but does not react to light
60
Q

How is syphilis treated ?

A

IM benzathine benzylpenicilin

61
Q

Explain the different test results obtained when looking at syphilis

A
  • Positive non-treponemal test + positive treponemal test
    = consistent with active syphilis infection
  • Positive non-treponemal test + negative treponemal test =
    consistent with a false-positive syphilis result e.g. due to pregnancy or SLE (see list above)
  • Negative non-treponemal test + positive treponemal test =
    consistent with successfully treated syphilis
62
Q

What kind of virus is HIV and what is it’s effect on the body?

A
  • RNA retrovirus
  • Destroys CD4 T-helper cells.
63
Q

First-line test for HIV screening of asymptomatic individuals or pts with signs and symptoms of chronic infection

A
  • Fourth generation : checks for HIV antibody and P24 antigen. Window period of 45 days.
64
Q

What 2 ways can HIV be monitored ?

A
  • CD4 count
  • Viral load -> HIV RNA per ml of blood.
65
Q

what is given prophylactically to all patients with HIV?

A

-Co trimoxazole (if CD4<200/mm3)
- Protect against pneumocystis jirovecii pneumonia (PCP)

66
Q

How often are women with HIV offered cervical smears ?

A
  • Yearly, due to increased risk of HPV infection and cervical cancer
67
Q

What vaccines are avoided in HIV?

A
  • Live vaccines (e.g. BCG and typhoid)
68
Q

What does mycoplasma genitalium cause ?

A

Non-gonococcal urethritis

69
Q

What is the investigation for mycoplasma genitalium ?

A
  • NAAT
  • First urine sample in the morning for men
  • Vaginal swabs (can be self-taken) for women
  • Check every +ve sample for macrolide resistance and perform a ‘test of cure’
70
Q

How mycoplasma genitalium managed

A
  • 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)
71
Q

How is mycoplasma genitalium treated in pregnancy and breastfeeding ?

A

Azithromycin alone

72
Q

what are the complications of mycoplasma genitalium ?

A
  • Urethritis
  • Epididymitis
  • Cervicitis
  • Endometritis
  • PID
  • Reactive arthritis
  • Preterm delivery in pregnancy
  • Tubal infertility
73
Q

Most appropriate treatment of oral candidiasis in immunocomprimised patients (e.g. HIV)

A

Fluconazole

74
Q

4 RF for vaginal candidiasis

A
  • Diabetes mellitus
  • Drugs: antibiotics, steroids
    pregnancy§- Immunosuppression: HIV
75
Q

Principles of management in PID

A
  1. Analgesia
  2. Antibiotics
  3. Encourage partner notification and treatment
  4. Patient education regarding safe sex
76
Q
A

Finals (92 decks)

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