GUM Flashcards
what is pid?
infection or inflammation of upper reproductive tract
pathophysiology of PID?
inflammation of cervix following infection affects mucus plug and allow infection to ascend
what symptoms are seen with PID?
lower abdominal or pelvic pain (usually bilateral), deep dyspareunia, abnormal vaginal bleeding, secondary dysmennorhoea, abnormal PV discharge (often purulent)
if severe can have fever, rigors, chills, night sweats
what are some intra-abdominal complications of PID?
what are other complications of PID?
infertility, ectopicpregnancy, tubo-ovarian abscess, chronci pelvic pain, fitz-hugh curtis syndrome
whatis Fitz-hugh curtis syndrome?
peri-hepatitis, RUQ pain, morecommonly associated with PID secondary to chlamydia.
what is a sign of fitz-hugh curtis syndrome?
adhesions, violin string like around liver capsule??? double check
what can cause PID?
usually polymicrobial
STIs: gonorrhoea, chlamydia, mycoplasma genitalium
non STI: introduction of vaginal flora with intrauterine coil, anaerobes (prevotella, atopobium), gardnerella vaginalis
Who is at higher risk of developing PID?
low economic status, multiple sexual partners young age <25, TOP/miscarriage, coil insertion, appendicitis
what signs are seen with PID?
lower abdominal tenderness, uterine/adnexal tenderness, cervical motion tenderness, adnexal mass, mucopurulent vaginaldischarge, contact bleeding, fever, RUQ tenderness
what conditions can cause pelvic pain?
UTI, ectopic pregnancy, ovarian torsion, endometriosis, appendicitis, bowel inflammation, degenerative fibroids
what investigations can be done for PID?
endocervical/vaginal swabs
urine dipstick
pregnancy test (rule out ectopic pregnancy)
bedside microscopy of vaginal/cervical discharge
how is PID diagnosed?
clinical diagnosis but investigations can help support diagnosis
what can be seen on imaging or laproscopy in PID (usually more severe)?
free fluid in endometrium swollen fallopian tubes or ovaries, abscesses, peri-hepatic adhesions,
management of PID?
mutliple antibiotic course for 2 weeks, analgesia, rest, abstain from sex until patient and partner completed antibiotic treatment
which PID patients will be treated as inpatient?
severe symptoms (nausea, vomiting, pyrexia), signs of peritionitis, not responding to oral antibiotics, pregnancy (higher risk of complication)
what is most common causative organism of PID?
chlamydia
is PID more common in pregnancy?
no it is uncommon in pregnancy
is PID a cause of tubal factor infertility?
yes
what are features of advanced HIV?
CD4<200, opportunistic infections like PCP or crytococcal meningtitis, HIV associated malignancies like Kaposi sarcoma
patients on PrEP and PEPSE may
have delayed or unusual seroconversion
due to very early ART- seek expert advice.
what are some infectious causes of gential sores?
what are non-infectious causes of genital sores?
what associated symptoms are good to ask about with genital sores?
fever, flu like symptoms rashes, any problems with eyes/mouth/joints, urinary symptoms, discharge
what is commonest cause of genital ulceration?
herpes simplex
how can genital herpes affect a pregnancy?
if this is the first case then mum wont have antibodies to pass onto baby so may require C section
what is asymptomatic shedding?
when a patient does not have any symptoms but they are able to transmit the virus
what is another viral differential for herpes simplex infection?
herpes zoster infection
what is a key distinguishing factor between typical presentation of syphilis and herpes simplex infection?
syphilis- painless ulcer
herpes- painful, usually numerous
how do we diagnose syphilis from genital ulcer?
treponemal PCR from ulcer base
treponemal enzyme immunoassay, rapid plasma reagin test, treponema pallidum particle agglutination assay
what is the hallmark sign of primary syphilis?
chancre lesion
what is the management of syphilis?
benzathine penicillin (longer course if more advanced)
what examination should all women with external genital warts have?
speculum exam
what are differentials of genital warts?
fordyce spots, pearly papules, skin tags, syphilis, sebaceous cysts, squamous cells carcinomas or VIN/PIN, haemangiokeratoma, molluscum conagiosum
what is buschke-lowenstein?
giant wart associated with HPV, theyare rare and have higher rate of malignant transformation
how do we manage genital warts?
screen for stis
explain condition, reassure it usually clears itself as bpdy clears virus over time, HPV that causes warts different to those related to cancer
can occur in monogamous relationship due to dormant phase
condoms don’t help wart transmission
cosmetic treatment to remove lesions
what ways can we remove genital warts?
cryotherapy, anti-mitotic agents (podophyllotoxin), immune modifiers (imiquimod), surgery
what is the first line treatment for candidiasis?
oral fluconazole
what are some risk factors for candiasis?
immunosupression, high oestrogen levels, recent anitbiotics, DM, mucosal breakdown
what is amsel criteria which helps us diagnose BV?
characteristic discharge
clue cells on wet mount
raised pH
odour with KOH
what is the treatment of BV?
metronidazole BD for 5 days
how does TV present? it is an STI?
yes it is an STI
presents with off white, putrid,frothy blood stained discharge with vulval soreness/itch, strawberry cervix
how is TV treated?
metronidazole 400mg BD 7 days and treat male partners empirically
whatare likely causes of penile urthral discharge?
gonorrhoea (50%)
chlamydia (25%)
non-specific urethritis
what investigations would you do for penile discharge?
urethral smear, gonorrhoea culture, urine NAAT
consider: MSU, herpes simplex, mycoplasma genitalis
what does gonorrhoea look like on a slide?
gram negative intracellular diplococci
how do we treat gonorrhoea?
ceftriaxone 1g IM stat dose
what percentage of men and women are asymptomatic with chlamydia?
men 50%
women 70%
what treatment is used in chlamydia?
doxycycline for 7 days
or azithromycin/erythromycin
how long does implant last?
3 years
how long do the copper and hormonal coils last?
copper: 5 or 10
hormone: 3, 5, 8
what are differences between implant and injection?
higher failure rate with injection as has toget it done every few months
what are side effects of depo provera?
altered bleeding patterns, weight gain
delay in return of fertility, may slightly reduce bone mineral density
how long after implant removal will fertility return?
over a couple weeks
when are people on contraception not covered?
missed COCP 2 days or more
POP >36 hours
>14 weeks since last depo injection
up til when can you give emergency contraception?
3 days - levonogestrel
5 days- ulipristal
5days after unprotected sex or 5 days after estimated ovulation- IUD
if a patient wanting emergency contraception has had any hormonal meds in the last 5 days, which one can they not have?
EllaOne (ulipristal) which works as anti progesterone
What are non infective causes of abnormal vaginal discharge?
Foreign bodies, fistulae, malignancy, cervical polyps and ectopy, allergic reactions
What are non-STI infective causes of abnormal vaginal discharge?
Bacterial vaginosis, candida
What are STIs that cause abnormal vaginal discharge?
Chlamydia, trichomonas vaginalis, neisseria gonorrhoeae, herpes simplex virus
What questions do you ask about abnormal vaginal discharge?
Change in volume? Colour? Consistency (watery or thickened)? Smell?
Onset, course, exacerbating, relieving factors, previous episodes? Associated symptoms?
What are the 6 Cs important to ask in a sexual history?
Contraception
Cycle- last menstrual period
Children- been pregnant before
Cytology- when was last smear, abnormal results?
Chlamydia- STIs
hepatitis C- blood born virus risk factors
What are questions to asks to assess risks of blood born infections?
- had sex with man that has sex with men?
- IVDU
- had sex under influence of drugs
- had sex with sex worker
- had sex with someone not from UK
- medical procedures/blood transfusions abroad
- tattoos/pericings in non-professional place
- sexually assaulted?
- had Hep B vaccine
