GUM Flashcards
Name infectious causes of urethral discharge and the aetiological agent
- Gonococcal urethritis (Neisseria Gonorhea)
- Non-gonococcal urethritis (no aetiology, Chlamydia trachomatis, Mycoplasma genitalium, Trichomonas vaginalis, Candida albicans)
- Intra-urethral ulcers (HSV)
- Intra-urethral warts (HPV)
Name a non-infectious cause of urethral causes
Physiological trauma
Infectious causes (+ causative organism) of vaginal discharge
Vaginal infections:
* Candida albicans
* Gardnerella vaginalis
* Trichomonas vaginalis
Cervical infections:
* Chlamydia trachomatis
* Neisseria gonorrhoeae
* Herpes simplex virus (HSV)
* Human Papilloma virus (HPV)
* Treponema pallidum
All except candida and gardnerella are sexually transmitted
Non-infectious causes of vaginal discharge
Vaginal:
* Physiological trauma
* FB (retained tampons)
* Retained products
Cervical:
* Carcinoma of the cervix (linked with HPV infection)
Infectious causes of genital ulcers (and causative organism)
Multiple and painful:
* Herpetic (HSV)
* Chancroid (Haemophilus ducreyi)
* Scabies (Sarcopetes scabiei)
Single and painful:
* TB (M. tuberculosis)
* Bacterial infection (Staphylococcus aureus)
Multiple and painless (Treponema pallidum)
Single and painless:
* Primary syphilis (Treponema pallidum)
* Lmphgranuloma venerium (LGV) (Chlamydia trachomatis (LGV serovar))
* Granuloma inguinale (Klebsiella granulomatis (Donovanosis)
Non-infectious diseases of genital ucers
- Behcet’s disease
- Steven Johnson syndrome
- Carcinomas
Causative organism of chlamydia and transmission
Chlamydia Trachomatis (obligate intracellular bacteria)
Transmission = sex + vertical
Risk factors for chlamydia
- Under 25
- New sexual partner
- > 1 sexual partner/year
- No condoms
Clinical features of chlamydia in women and men
Women
* Symptoms: asymptomatic (70%), dysuria, pelvic pain
* Signs: Increased vaginal discharge, post coital/intermenstrual bleeding
Men:
* Symptoms: asymptomatic (50%), dysuria, testicular pain
* Signs: Urethral discharge
Ix and management for chlamydia
Ix:
* Nucleic acid amplification technique (NAAT)
* Test for LGV in MSM with rectal chlamydia
Management:
* Doxycycline 100mg BD for 7 days (NB Doxycycline = contraindicated in pregnancy)
* Alternative: Azithromycin 1G OD day 1, 500mg OD day 2+3
Advice + test of cure in chlamydia
Advice:
* No sexual contact for 1 week
* PIL leaflet on condition
* Health advisor on contact tracing
Test of cure (TOC):
* Retest in 3 months if under 25
* TOC in 6 weeks if pregnant or rectal infection
Complications of chlamydia
Males:
* Epididymo-orchitis (red, swollen, tender hemiscrotum)
* Prostatitis (dysuria, haematuria, haematospermia, urgency)
* Urethral structure (inflammation in the urethra can lead to fibrosis of the lumen)
Females:
* Pelvic inflammatory disease (PID) = infection of the uterus, fallopian tubes, ovaries and inside the pelvis due to bacterial spread
* Peritoneal spread (Fitz-High-Curtis syndrome; inflammation of the liver capsule without parenchymal involvement - presents with RUQ pain)
* Problems in pregnancy (miscarriage, ectopic pregnancies, preterm delivery, congenital infections, vertical transmission - causing chlamydial conjunctivitis + pneumonia in newborn)
* Infertility
General complications:
* Reactive arthritis - an autoimmune arthritis (triad of conjuctivitis, urethritis, arthritis - ‘can’t see, can’t pee, can’t climb a tree’)
* Trachoma (granular conjunctivitis of the inner eyelids resulting in eye discharge, swollen eyelids and trichiasis (misdirected eyelashes))
* Lymphogranuloma venereum (LGV) = infection of the lymphatic vessels + nodes
Causative organism of gonorrhoea and transmission
Neisseria Gonorrhoea (gram-negative diplococcus)
Transmission: Sexual contact, vertical
A 23 y/o male presents to the GP with dysuria and ‘pus coming out of the penis’. His history includes 9 sexual partners in the last 3 months, none of whoch he used a condom with. O/E there is yellow discharge from the urethral meatus. Underlying diagnosis?
Gonorrhoea
Clinical features of gonorrhoea
Women:
* Symptoms: Asymptomatic (50%), pelvic pain (25%), dysuria (12%)
* Signs: Mucopurulent discharge (50%)
Males:
* Symptoms: Asymptomatic (<10%), dysuria (50%)
* Signs: Mucopurulent discharge (80%)
Ix and management for gonorrhoea
Ix:
* Microscopy (sensitivity 90-95% if discharge present, 50% if not)
* NAAT (sensitivity >96%)
* Culture (important due to increasing antibiotic resistance with GC)
Treatment:
* Ceftriaxone 1g IM (mixed with 3.5msl 1% lidocaine)
* Ciprofloxacin 500mg PO stat FIRST-LINE (where sensitivities available prior to treatment)
Advice and TOC for gonorrhoea
Advice:
* No sexual contact for 1 week after patient and their partner are treated
* PIL leaflet on condition
* Health advisor for contact tracing
TOC: 2 weeks after treatment
Complications of gonorrhoea
Men → epididymo-orchitis; Women → PID
Males:
* Urethral stricture (chronic inflammation leads to fibrosis)
* Infertility (chronic epididymitis can lead to infertility)
Females:
* PID (increases the risk of tubal infertility)
* Fitz-Hugh-Curtis syndrome (peritoneal spread can lead to perihepatitis (inflammation of the liver capsule without parenchymal involvement) which presents with RUQ pain
* Pregnancy issues (risk of miscarriage, congenital malformations, vertical transmission)
Disseminated infection:
* Septic arthritis
* Temosynovitis
* Meningitis
* Infective endocarditis
* Dermatitis (Vesicular, pustular or maculopapular lesions)
* Polyarthalgia
Causative organisms of non-specific urethritis (NSU)/ non-gonococcal urethritis
- No cause found in 50%, chlamydia trachomatis up to 45%
- Mycoplasma genitalium 10-25%
- Trichomonas vaginalis 1-20%
- Ureaplasma urealyticum 5-10%
- UTI <6%, adenoviruses 2-4%
- Herpes Simplex Virus 2-3%
- Candida, trauma, irritation, urethral stricture, lichen sclerosis, urinary calculi
Risk factors and transmission of Non-Specific Urethritis (NSU) / non-gonococcal urethritis
Risk factors:
* Sexually active
* Unprotected sex
* Homo/bisexual
* Aged <35
* Multiple partners
Transmission:
* Sexual
Clinical features and complications of Non-Specific Urethritis (NSU) / non-gonococcal urethritis
Clinical features:
* Asymptomatic
* Urethral discharge
* Dysuria
Complications:
* Epididymo-orchitis
* Sexually acquired reactive arthritis
Ix and management for Non-Specific Urethritis (NSU) / non-gonococcal urethritis
Ix:
* Microscopy: gram stained urethral smear (diagnose if >5 pus cells per film)
* Culture
* First pass urine (FPU) to test for gonorrhoea/chlamydia and mycoplasma
* Urinalysis
* MSU
Management:
Doxycycline 100mg BD 7 days
What is the causative organisma and transmission of Trichomonas vaginalis
Flagellated protozoon
Transmission: sexual contact
A 19-year-old female presents to the GUM clinic with a three-day history of foul-smelling, green, frothy discharge from her vagina. She has had 9 sexual partners in the last 3 months. Underlying diagnosis?
Trichomoniasis
Clinical features of trichomoniasis in men and women
Men:
* Symptoms: Asymptomatic (15-50%), thin white urethral discharge, dysuria, frequency
Women:
* Symptoms: Asymptomatic (15-50%), yellow frothy discharge, vulval itching, dysuria, pelvic pain, dyspareunia
* Signs: Yellow-green discharge coating the vaginal walls, particularly the posterior fornix, ‘strawberry cervix’
“Strawberry” cervix : pathognomonic but only seen in 2% of cases
Which STI involves yellow-green frothy discharge from the vagina and a ‘strawberry cervix’?
Trichomoniasis
(Trichomonas vaginalis)
Ix and management for trichomonas vaginalis
Ix
Women:
* Wet slide from posterior fornix
* High vaginal swab → bacterial culture, PCR
Males:
* Urethral/ first pass urine culture in males
Treatment:
* Metronidazole 400mg PO BID x 7 days
Microbiology of bacterial vaginosis and transmission
Microbiology:
* Vaginal pH>4.5 (alkaline)
* Normal vaginal flora (lactobacilli) = dominated by anaerobes e.g. gardnerella vaginalis → causing symptoms of BV
Transmission: Not sexually transmitted
A 23-year-old female sex worker presents to the GUM clinic with a 5-day history of fishy-smelling vaginal discharge. She uses vaginal douches regularly. Vaginal examination reveals a thin, white discharge on the vaginal walls. Diagnosis?
Bacterial vaginosis
Clinical features and complicatiosn of bacterial vaginosis
Clinical features:
* 50% asymptomatic
* Foul-smelling ‘fishy’ vaginal odour
* Greyish-white discharge
* Sign: Vagina will NOT appear inflamed or irritated
Complications:
* Increased risk of other STIs (2x HIV)
* In pregnancy → associated with miscarriage, preterm birth/PROM, postpartum endometritis
Ix and management for bacterial vaginosis
Ix:
* Vaginal pH test: >4.5
* High vaginal swab (from prosterior fornix) → cultured and gram-stained
Management:
* Metronidazole 2g STAT
* Metronidazole 400mg PO BID for 7 days
Advice:
* Written and verbal information on prevention e.g. washing only with water, avoiding soaps/shower gels/bubble bath, avoiding washing hair in bath
Microbiology and transmission of thrush
Microbiology: Candida albicans (80-92%) + some other non-albican species
Transmission: Not sexually transmitted
Risk factors for thrush
- Uncontrolled diabtes mellitus
- Immunosuppression
- Hyperoestrogenaemia (including HRT and the COCP)
- Broad-spectrum antibiotics
Clinical features of thrush in men and women
Women:
* Vulval itch + soreness
* Vaginal discharge (curdy, non-offensive)
* Superficial dyspareunia
* External dysuria, erythema, fissurig, excoriation
Men:
* Red skin, swelling, irritation
* Soreness + itchness
* Phimosis
* Dysuria
* Dyspareunia
Complications: Chronic/recurrent infection in men → leads to phimosis
Phimosis = inability to retract foreskin
Ix and treatment of thrush
Ix:
* Routine microscopy
* MCS (black charcoal swab)
Treatment:
* Clotrimazole pessary 500mg stat
* Clotrimazole 10% vaginal swab
Advice:
* Washing only with water, avoid soaps/shower gels/bubble bath, wearing cotton underwear, avoid thongs
What virus causes genital herpes?
Herpes simplex virus (HSV)
- HSV type 1- the usual cause of oral herpes (cold sores)
- HSV type 2- historically associated with sexual transmission
- (note either type can cause both oral and genital herpes)
What is the natural history of herpes simplex virus?
Primary infection → virus = becomes latent in sensory ganglia → periodically reactivating to cause symptomatic lesions or asymptomatic viral shedding
Clinical features of genital herpes
- Asymptomatic (80%)
- Painful blisters + ulcers, dysuria, tender inguinal lymphadentitis, discharge, fever myalgia
Complications of genital herpes
- Urinary retention
- Aseptic meningitis
- Adhesions
Ix for genital herpes
HSV DNA detection by PCR - from base of ulcer
Treatment of genital herpes
ACICLOVIR
- Primary herpes → Aciclovir 400mg TDS (5 days); topical anaesthetic agents
- Recurrences of herpes → Aciclovir 800mg TDS (2 days)
Advice:
* Saline bathing, regular analgesia, advice try urinating in the bath
* PIL on condition
* Does not need partner notification
What is the causative organism and transmission route for genital warts
- Genital warts → Human papillomavirus (HPV)
- Transmission → skin-to-skin contact
Clinical features of genital warts
- Most asymptomatic
- Can appear from 3 weeks to years after exposure to the virus
- More common in pregnancy due to immune suppression
- Fleshy lumps, itching, distorted flow of urine if present in urethra
Management for genital warts
**First line: Creams (stimulate local immune response) **
* Warticon (podophyllotoxin) topical on 3 consecutive days
* S/Es skin irritation and ulceration
Cryotherapy: 3 freeze thaw cycles weekly
* S/Es: Painful, hypooigmentation/scarring
Advice: PIL, explain very common infection, not harmful, not the same as cervical cancer strains , treated for cosmetic reasons
A 21-year-old woman presents to her GP with a 2-day history of bilateral lower abdominal pain, deep discomfort during intercourse and thick yellow vaginal discharge. She has recently started a new relationship and has been having unprotected sexual intercourse. Possible diagnosis?
Pelvic inflammatory disease (PID)
Define pelvic inflammatory disease?
PID = infection + inflammation of the organs of the pelvis → caused by infection spreading up through the cervix
What are the two main complications of PID?
- Tubular infertility
- Chronic pelvic pain
Definitions
(of affected organs of PID)
- Endometritis = inflammation of the endometrium
- Salpingitis = inflammation of the fallopian tubes
- Oophoritis = inflammation of the ovaries
- Parametritis = inflammation of the parametrium, which is the connective tissue around the uterus
- Peritonitis = inflammation of the peritoneal membrane
Causes of pelvic inflammatory disease
Most PID is caused by an STI:
* Neisseria gonorrhoeae (more severe PID)
* Chlamydia trachomatis
* Mycoplasma genitalium
Less commonly, not a STI:
* Gardnerella vaginalis (associated with BV)
* Haemophilus influenzae (a bacteria often associated with respiratory infections)
* Escherichia coli (an enteric bacteria commonly associated with UTIs)
Risk factors for pelvic inflammatory disease
Risk factors for PID = same as STIs
* Not using barrier contraception
* Multiple sexual partners
* Younger age
* Existing sexually transmitted infections
* Previous pelvic inflammatory disease
* Intrauterine device (e.g. copper coil)
Signs and symptoms for PID
Symptoms:
* Lower abdominal pain (typically bilateral)
* Deep dyspareunia
* Abnormal vaginal discharge (may be purulent)
* Abnormal vaginal bleeding (intermenstrual, postcoital bleeding, menorrhagia)
Signs on Examination:
* Pelvic tenderness
* Adnexal tenderness or cervical motion tenderness (on bimanual examination)
* Inflamed cervix (cervicitis)
* Mucopurulent vaginal or cervical discharge
* Fever > 38C (may be normal) + other signs of sepsis
Ix for Pelvic Inflammatory Disease (PID)
Causative organisms:
* NAAT swabs (gonorrhoea, chlamydia, Mycoplasma)
* HIV, Syphilis test
* High vaginal swab: BV, candidiasis, trichomoniasis
Microscope: Look for pus cells on microscope (absence excludes PID)
- Inflammatory markers (CRP, ESR) (raised in PID)
- Pregnancy test (exclude ectopic)
Management for pelvic inflammatory disease
- A single dose of intramuscular ceftriaxone 1g → gonorrhoea
- Doxycycline 100mg BD for 14 days → chlamydia + Mycoplasma genitalium
- Metronidazole 400mg BD for 14 days → anaerobes such as Gardnerella vaginalis
Ceftriaxone + doxycycline = will cover other bacterias e.g. **H. influenze + E. coli **#
If patient presenting septic → Admission + IV antibiotics
If pelvic absecess develops → may need interventional radiology or surgery
Complications of pelvic inflammatory disease (PID)
- Sepsis
- Abscess
- Infertility
- Chronic pelvic pain
- Ectopic pregnancy
- Fitz-Hugh-Curtis syndrome
What is Fitz-Hugh-Curtiz syndrome?
- Fitz-Hugh-Curtiz syndrome = complication of PID
- Caused by infection + inflammation of the liver capsule (Glisson’s capsule) → leading to adhesions between the liver + peritoneum
- Bacteria may spread from the pelvis via peritoneal cavity, lympathic system or blood
How does Fitz-Hugh-Curtiz syndrome present and treated?
Presentations:
* RUQ pain
* + Right shoulder tip pain (if diaphragm is irritated)
Mx: **Laproscopic adhesiolysis **
A 22 year old female patient presents with pain in her right upper quadrant, she also has abnormal vaginal discharge, postcoital bleeding and pain in her pelvis. Possible diagnosis?
Fitz-Hugh-Curtiz syndrome
What is syphilis caused by?
Treponema pallidum
(spiral-shaped bacteria (spirochete)
The bacteria gets in through skin or mucous membranes → replicates + disseminates throughout the body
- Incubation period between the initial infection and symptoms = 21 days on average.
Transmission routes for syphilis
- Oral, vaginal or anal sex involving direct contact with an infected area
- Vertical transmission: from mother to baby during pregnancy
- Intravenous drug use
- Blood transfusions and other transplants (although this is rare due to screening of blood products)
What are stages of syphilis?
- Primary syphilis: Painless ulcer (chancre) at the orignal site of infection (usually genitals)
- Secondary syphilis: systemic symptoms (particulary skin + mucous membranes): These symptoms can resolve after 3 – 12 weeks and the patient can enter the latent stage.
- Latent stage: symptoms disappear and the patient becomes asymptomatic despite still being infected
- Early latent syphilis = occurs within 2 years of initial infection
- Late latent syphilis = occurs from 2 years after the infection onwards
- Tertiary syphilis (years after infection): Affects many organs, development of gummas, cardiovascular + neurological complications
- Neurosyphilis: infection reaches the central nervous system - presenting with neurological symptoms
A gumma is caused by the bacteria that cause syphilis. It appears during late-stage tertiary syphilis. It most often contains a mass of dead and swollen fiber-like tissue. It is most often seen in the liver.
How does primary syphilis present?
- Painless genital ulcer (chancre) (tends to resolve over 3-8 weeks)
- Local lymphadenopathy
How does secondary syphilis present?
Secondary syphilis = typically starts after the chancre has healed, with symptoms of:
- Maculopapular rash
- Condylomata lata (grey wart-like lesions around the genitals and anus)
- Low-grade fever
- Lymphadenopathy
- Alopecia (localised hair loss)
- Oral lesions
How does tertiary syphilis present?
Tertiary syphilis = can present with several symptoms (depending on the affected organs). Key features:
- Gummatous lesions (gummas = granulomatous lesions that can affect the skin, organs and bones)
- Aortic aneurysms
- Neurosyphilis
How can neurosyphilis present?
Neurosyphilis = can present at any stage if the infection reaches the CNS. Neurosyphilis presents with symptoms of:
* Headache
* Altered behaviour
* Dementia
* Tabes dorsalis (demyelination affecting the spinal cord posterior columns)
* Ocular syphilis (affecting the eyes)
* Paralysis
* Sensory impairment
What is Argyll-Robertson pupil / ‘Prostitutes pupil’
Argyll-Robertson pupil = specific finding in neurosyphilis
* Its a constricted pupil that accommodates when focusing on a near object - but does not react to light → they’re often irregulary shaped
Argyll-Robertson pupil = ‘prostitute pupil’ → because it ‘it accommodates but does not react’
A patient with tertiary syphilis presents with irregularly shaped pupils, what is this key neurological finding called?
Argyll-Robertson pupil
(‘Prostitute pupil’)
What are the investigations for syphilis?
Screening for syphilis = T. pallidum antibody testing
If suspected syphilis or positive antibodies:
Swab samples from sites of infection can be tested to confirm T. pallidum with:
* **Dark field microscopy ** (characteristic spiral-shaped rods)
* Polymerase chain reaction (PCR)
Other investigations:
* HIV test: as syphilis enhances the transmission of HIV
* Screening for other STIs
* MRI/CT brain and lumbar puncture: if neurosyphilis is suspected
* ECG and echocardiogram: if cardiovascular syphilis is suspected
Management of syphilis
Single deep IM dose of benzathine benzylpenicillin (penicillin)
(Second line/alternative: doxycycline)
- Partner notification
- Contact tracing
(Unless late latent and gummatous syphilis : 3 doses of IM benzathine penicillin)
What is lymphogranuloma venereum (LGV)?
Lymphogranuloma venereum = a curable STI - affecting the lymphatic vessels + nodes - caused by chlamydia trachomatis
How can lymphogranuloma venereum (LGV) be transmitted?
Unprotected sex:
* Anal
* Vaginal
* Oral
The risk of catching LVG is increased by having high-risk sex, such as group sex and fisting, as well as using recreational drugs. The risk may further be increased if HIV positive
What is lymphogranuloma venereum (LGV) caused by?
LGV = caused by one of the 3 serovars of Chlamydia trachomatis
(L2 = most common; L1 and L3 less common)
What are the clinical features of lymphogranuloma venereum?
Small painless pustule/papile + acute onset of tender, enlarged lymph nodes (?in groin)
- Stage 1 : small painless pustule which later forms an ulcer (on penis, vulva, vagina, cervix)
- Stage 2 : painful inguinal lymphadenopathy; usually 10-30 days after the primary lesion
- Stage 3 : proctocolitis (most commonly seen in men who have sex with men); may mimic Crohn’s disease
(Pharyngeal symptoms = rare)
The first symptom is usually a painless papule, pustule or ulcer on the penis, vulva, vagina or cervix
A 22-year-old sexually active homosexual male presents with a small painless penile papule. A swab of the lesion suggests Chlamydia trachomatis and he is treated with 100mg oral doxycycline bd for 7 days. Diagnosis?
Lymphogranuloma venereum (LGV)
Ix for lymphogranuloma venereum
- Swab taken (from rectum, vagina, throat, or an ulcer (if present))
- NAATs: high sensitivity and specificity and, if positive for C.trachomatis, DNA may be tested for LGV-specific DNA
Management for lymphogranuloma venereum (LGV)?
100mg oral doxycycline BD for 21 days
A 28-year-old man presents with a painful ulcer on his penis which started as a small tender papule. He also reports painful swelling in his groin. His sexual history reveals recent unprotected intercourse with a new partner. Possible diagnosis?
Chancroid
What is chancroid caused by?
Chancroid = an STI caused by the bacterium Haemophilus ducreyi
Haemophilis ducreyi = invade the epithelium of the genital region → resulting in inflammation, necrosis, ulceration
Where is chancroid most common?
Chancroid is rare in the UK and is more common in Africa and Southeast Asia
Risk factors:
* Unprotected sexual intercourse
* Multiple sexual partners
* Men are affected more often than women
Signs and symptoms of chancroid
Signs:
* Painful solitary ulcers on the penis or vulva
* Tender unilateral inguinal lymphadenopathy: fluctuant lymphadenitis (bubo formation)
* Painful groin swelling
Symptoms:
* Genital pain
Basically, unilateral painful groin swelling + soiltary ulcers
Ix for chancroid
- Swab of ulcer base: to collect material for culture + PCR testing for H. ducreyi
- HIV serology : co-infection is common
Ix to consider:
* Bubo aspirates: fluid may be collected from fluctuant buboes
Management for chancroid
First-line:
* Antibiotics: Single dose PO azithromycin (alternatives: ceftriaxone, erythromycin)
* Partner notification + treatment
Second-line:
* Abscess drainage: If buboes (swollen lymph nodes) are fluctuant, needle aspiration can provide symptomatic relief
Complications of chancroid
- Genital scarring + stricture
- Abscess formation in inguinal lymph node (buboes)
- Spread of the infection to other area of the body (rare)
What is balanitis?
Balanitis = inflammation of the glans penis
(Sometimes extends to the underside of the foreskin = balanoposthitis)
What are the causes of balanitis?
Categories: Inflammatory, infective (bacterial + fungi), precancerous:
- Candidiasis
- Dermatitis (contact or allergic)
- Dermatitis (eczema or psoriasis)
- Bacterial
- Anaerobic
- Lichen planus
- Lichen sclerosus
Ix for balanitis
- Swab for microbiology (gram stain + culture) and Nucleic acid amplification test (NAAT)
- Swab for virology (PCR)
- Dark-field microscopy (for syphilis)
How can balanitis present?
- Red scaly patches
- Pruritus
- Erosion
- Post-inflammatory hypo- or hyper-inflammation
Patient may present:
* Multiple sexual partners or high-risk sexual behaviours
* Uncircumcised
Risk factors for balanitis
- Congenital or acquried dysfunctional foreskin
- Uncircumcised state
- Poor hygiene; urinary dribbling or leakage
- Over-washing
- Human papillomavirus (HPV) infection
Management for balanitis
- Atopic eczema → hydrocortisone topical (topical corticosteroid)
- Irritant contact dermitis → irritant avoidance + topical corticosteroid
- Lichen scleroisus → topical corticosteroid ± antifungal (clobetasol topical)
- Gonorrhoea → antibiotic
- Psoriasis → topical corticosteroid
- Candidiasis → ketaconazole topical (anti-fungal)
What is sexual dysfunction in women?
Women’s sexual dysfunctions include a spectrum of disorders that are typically multi-factorial in aetiology and include:
* Sexual interest/arousal disorder (SIAD)
* Female orgasmic disorder (FOD)
* Genito-pelvic penetration pain disorder (GPPPD) - which combines the frequently overlapping diagnoses of vaginismus + dyspareunia
What is the 3 criteria for diagnosing a sexual disorder in women?
Symptoms need to:
* Persisted for min 6 months
* Have to be** experienced in all or almost all** (75% to 100%) sexual encounters
* Caused clinically significant distress
What are the strong correlations (causes) with sexual dysfunction in women?
- Poor mental health
- Stress
- Low levels of emotional intimacy between partners
SERUM LEVELS OF SEX HORMONES = DO NOT
Risk factors of sexual dysfunction in women
- Depression
- Antidepressant use
- Comorbid anxiety disorder
- Psychological aspects of cancer
- Endometriosis
- Neurological disease (can interrupt sexual response)
Ix for sexual dysfunction in women
All expected to be normal, only do these if suspect underlying diseases:
- FBC
- Serum glucose level
- Renal function
- Thyroid function tests
- Serum prolactin level
Basically ignore
Management of sexual dysfunction in women
- Psycohological therapy
- Oestrogen (for vaginal atrophy)
- Vibrostimulation
- Review antidepressant therapy
What are the complications of chlamydia in pregnancy?
Increased risk of:
* Premature delivery with low birth weight
* Miscarriage
* Still birth
What antibiotics are contraindicated in pregnancy?
Doxycycline + ofloxacin
What is the treatment for the mother if infected with chlamydia?
Azithromycin + erythromycin
(Doxycycline = contraindicated in pregnancy)
How may a baby present if they contract chlamydia from the mother?
- Neonatal chlamydial conjunctivitis (5-12 days after birth): inflammation + discharge in eyes
- Pneumonia (1-3 months after birth)
What are the Ix and management for chlamydia in neonates?
- Ix: Swabs from eyelid or nasopharynx
- Management: Oral erythromycin
Complications of gonorrhoea in pregnancy
- Perinatal mortality
- Spontaneous abortion
- Preamature labour
- Early fetal membrane rupture
If there vertical transmission of gonorrhoea in a neonate, what is the major clinical feature?
Gonococcal conjunctivitis
Neonate will experience:
* Eye pain
* Redness
* Discharge
If untreated - can lead to long term damage + blindness
Is the treatment for gonorrhoea in pregnancy the same as uncomplicated gonorrhoea?
Yes!
Single dose of IM ceftriaxone 1g
Can syphilis (T. pallidum) cross the placenta to a fetus?
Yes!
(Pregnant women are screened for syphilis, HIV and Hepatitis B)
If syphilis is left untreated in pregnancy, what can it lead to?
- Miscarriage
- Stillbirth
- Pre-term labour
- Congenital syphilis
How might congenital syphilis present?
Congenital syphilis = severe + debilitating
- Saddle nose
- Rashes
- Fever
- Failure to gain weight
What are the complications of trichomonas vaginalis in pregnancy?
- Premature labour
- Low birth weight
- TV infection = may also predispose to maternal postpartum sepsis
How is trichomonas vaginalis treatment in pregnancy?
Same as uncomplicated (Metronidazole 400-500mg twice daily for 5-7 days)
High dose regimes = not tolerated
Metronidazole = may affect the taste of the breast milk (so don’t breastfeed for 12-24 if a single dose is used)
