GUM Flashcards
What is the organism involved in BV?
Gardnerella Vaginalis
What is Chancroid caused by?
Tropical disease caused by Haemophilus Ducreyi
What does Chancroid cause?
Painful genital ulcers associated with unilateral, painful, inguinal lymph node enlargement
Symptoms of Chlamydia?
Asymptomatic in around 70% of women and 50% of men
Women: Cervicitis (discharge, bleeding) dysuria
Men: Urethral discharge, dysuria
What is the investigation of choice for Chlamydia?
Nuclear acid amplification testing (NAATs)
Women: Vulvovaginal is first line
Men: urine
What is the first line management of Chlamydia?
Doxycycline 7-day course
If pregnant then Azithromycin, Erythromycin or Amoxicillin may be used
What is the management of genital warts?
- Topical Podophyllum or cryotherapy are first line
- Imiquimod is second line
What is the incubation period for gonorrhoea?
2-5 days
What are the symptoms of Gonorrhoea?
Males: urethral discharge, dysuria
Females: cervicitis e.g. leading to vaginal discharge
Rectal and pharyngeal infection is usually asymptomatic
What is Lymphogranuloma venereum?
Chlamydia trachomatis serovars L1, L2 and L3
What are the three stages of Lymphogranuloma venereum?
Stage 1: Small painless pustule which later forms an ulcer
Stage 2: Painful inguinal lymphadenopathy
Stage 3: Proctocolitis
How do you treat LGV?
Doxycycline 100mg twice daily for 21 days
What is bacterial vaginosis?
Refers to an overgrowth of bacteria in the vagina, specifically anaerobic bacteria.
It is caused by a loss of the lactobacilli “friendly bacteria” in the vagina.
What are some risk factors for BV?
- Multiple sexual partners
- Excessive vaginal cleaning (douching, cleaning products, vaginal washing)
- Recent antibiotics
- Smoking
- Copper coil
What is the standard presenting feature of BV?
Fishy-smelling discharge
What would you see on microscopy in BV?
Clue cells
What are some complications of BV?
BV can increase the risk of STIs, including chlamydia, gonorrhoea and HIV
Also associated with issues in pregnancy such as
- Miscarriage
- Preterm deliery
- Premature rupture of membranes
- Chorioamnionitis
- Low birth weight
- Postpartum endometritis
What should you warn women about when using antifungal creams and pessaries?
They can damage latex condoms and prevent spermicides from working so alternative contraceptive is required for at least 5 days after use
What examination findings would you expect with Chlamydia?
- Pelvic or abdominal tenderness
- Cervical motion tenderness
- Inflamed cervix
- Purulent discharge
What symptoms could you expect with Disseminated Gonococcal infection?
- Various non-specific skin lesions
- Polyarthralgia
- Migratory polyarthritis
- Tenosynovitis
- Systemic symptoms such as fever and fatigue
What is the treatment of Mycoplasma genitalium?
Doxycycline 100mg daily 7 days then
Azithromycin 1g stat then 500mg once a day for 2 days
UNLESS known to be resistance to macrolides
What cells would you be looking for in PID?
Pus cells on swabs from the vagina or endocervix. Absence of pus cells is useful for excluding PID
What does Trichomoniasis increase your risk of?
- Contracting HIV by damaging the vaginal mucosa
- Bacterial vaginosis
- Cervical cancer
- Pelvic inflammatory disease
- Pregnancy-related complications such as preterm delivery
What is the typical presentation of Trichomoniasis?
50% of cases are asymptomatic, when symptoms occur they are often non specific:
- vaginal discharge
- Itching
- Dysuria
- Dyspareunia
- Balanitis
The typical description of the vaginal discharge is frothy and yellow green
What is the treatment for trichomoniasis?
Metronidazole
What typically causes genital herpes?
HSV-2
How do you treat Primary genital herpes in pregnancy if contracted before 28 weeks of gestation?
Aciclovir during the initial infection. Followed by prophylactic aciclovir starting from 36 weeks.
Women that are asymptomatic at delivery can have a normal vaginal delivery.
How do you treat Primary genital herpes contracted after 28 weeks of gestation?
Aciclovir for the initial infection then imediate regular prophylactic aciclovir. C-Section is recommended.
What is HIV?
An RNA retrovirus. HIV-1 is the most common type and HIV-2 is rare outside West Africa.
What are AIDS-defining illnesses?
- Kaposi’s Sarcoma
- Pneumocystis jirovecii pneumonia
- Cytomegalovirus infection
- Candidiasis
- Lymphomas
- Tuberculosis
What tests can be used to monitor HIV?
CD4 Count
Viral load
What is the CD4 count?
The CD4 count is the number of CD4 cells in the blood. These are the cells that are destroyed by the virus.
The lower the count the higher the risk of opportunistic infections
500-1200cells/mm3 is the normal range
<200 cells/mm3 is considered end stage HIV and puts the patient at risk of opportunistic infections
What is the Viral load?
Viral load is the number of copies of HIV RNA per ml of blood. “Undetectable” refers to a viral load that is below the labs recordable range.
How often should women with HIV have smears?
They are required yearly.
What are the breastfeeding rules for mothers with HIV?
HIV can be transmitted during breastfeeding, even if the mothers viral load is undetectable.
How does primary syphilis present?
- A painless genital ulcer (chancre) which tends to resolve over 3-8 weeks.
- Local lymphadenopathy
How does secondary syphilis present?
- Maculopapular rash
- Condylomata lata (grey wart-like lesions)
- Low-grade fever
- Lymphadenopathy
- Alopecia
- Oral lesions
How does tertiary syphilis present?
Can present with several symptoms depending on the affected organs. Key features to be aware of are
- Gummatous lesions
- Aortic aneurysms
- Neurosyphilis
What is the treatment for Syphilis?
A single deep IM dose of Benzathine Benzylpenicillin
What is the name of the organism causing syphilis?
Treponema palidum - a spirochete bacterium
Who is more at risk of contracting syphilis?
MSM
Sex workers
Individuals with multiple sexual partners
What investigations are available for syphillis?
- Serological testing: Non-treponemal tests for screening and monitoring treatment response and treponemal tests for confirmation of diagnosis
- Dark field microscopy: Can be used to directly observe T.Pallidum in samples from primary lesions or secondary rash
- CSF examination: should be considered in tertiary syphilis
What factors can contribute to pH imbalance in the vagina?
- Having multiple sexual partners or a new sexual partner
- Douching
- Lack of consistent condom use
- Hormonal changes, such as those that occur in pregnancy
How does doxycycline work?
Protein synthesis inhibition by blocking the 30S ribosomal subunit
What is Fitz-Hugh-Curtis syndrome commonly caused by?
It is a post-infectious syndrome that results from:
- Neisseria gonorrhoeae infection (manifests as gram-negative diplococci)
- Chlamydia trachomatis infection (although less common)
How do you diagnose genital herpes?
- Clinical history and examination
- Swabs from the base of the ulcer analysed using NAAT
What findings would you expect on microscopy in Vulvovaginal candidiasis?
- Detection of blastospores, pseudohyphae and neutrophils suggest candida
What is the recommended treatment of vaginal candidiasis in pregnancy?
Intravaginal clotrimazole
What malignancies are associated with HIV infection?
- Kaposi’s Sarcoma
- High-grade B-cell non-Hodgkin’s lymphoma
- Invasive cervical cancer
What is the Jarisch-Herxheimer reaction?
It is a systemic inflammatory response to antibiotic treatment, particularly prevalent in syphilis infection but also seen in other spirochetal diseases.
Thought to be a result from the rapid lysis of the bacteria and the subsequent release of endotoxins
What are the signs and symptoms of Jarisch-Herxheimer reaction?
- Fever
- Rash
- Rigors
- Tachycardia
Other possible symptoms may include - Headache
- Myalgia
- Chills
- Hypotension
What is the management of Jarisch-Herxheimer reaction?
If it results in severe symptoms the management should include:
- Hospital admission and close monitoring
- Hydration to counteract the effects of fever and potential hypotension.
- Symptomatic treatment, including fluids, antipyretics for fever and analgesics for discomfort or pain
How often should the contraceptive injection be given?
- Should be given every 13 weeks
What are some UKMEC 4 conditions for use of CHC?
<6 weeks postpartum and breastfeeding
<3 weeks postpartum, not breastfeeding, with other risk factors for VTE
Age ≥35 and smoking ≥15 cigarettes/day
Consistently elevated blood pressure (systolic ≥160 mmHg or diastolic ≥100 mmHg)
Vascular disease (e.g. coronary heart disease, peripheral vascular disease intermittent claudication, hypertensive retinopathy)
Current or past ischaemic heart disease (including angina)
Current or past stroke (including TIA)
History of VTE (including PE and DVT)
Current VTE (even if on anticoagulation)
Planned major surgery with prolonged immobilisation
Known thrombogenic mutations (e.g. factor V Leiden)
Complicated valvular and congenital heart disease (e.g. with pulmonary hypertension)
Cardiomyopathy with impaired cardiac function
Atrial fibrillation
Migraine with aura, at any age
Current breast cancer
Severe or decompensated liver disease e.g. cirrhosis
Certain liver tumours e.g. hepatocellular adenoma, malignant hepatocellular carcinoma)
Systemic lupus erythematosus (SLE) with positive antiphospholipid antibodies
Any other condition with positive antiphospholipid antibodies
What is Tabes Dorsalis?
It is a form of neurosyphilis
When is the copper intrauterine device licensed for use after unprotected sexual intercourse?
120 hours
When is Ulipristal acetate licensed for used after unprotected sexual intercourse?
120 hours
When is Levonorgestrel licensed for used after unprotected sexual intercourse?
72 hours
