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3a Women's Health > GUM > Flashcards

GUM Flashcards

1
Q

Name infectious causes of urethral discharge and the aetiological agent

A
  • 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)
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2
Q

Name a non-infectious cause of urethral causes

A

Physiological trauma

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3
Q

Infectious causes (+ causative organism) of vaginal discharge

A

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

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4
Q

Non-infectious causes of vaginal discharge

A

Vaginal:
* Physiological trauma
* FB (retained tampons)
* Retained products

Cervical:
* Carcinoma of the cervix (linked with HPV infection)

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5
Q

Infectious causes of genital ulcers (and causative organism)

A

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)

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6
Q

Non-infectious diseases of genital ucers

A
  • Behcet’s disease
  • Steven Johnson syndrome
  • Carcinomas
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7
Q

Causative organism of chlamydia and transmission

A

Chlamydia Trachomatis (obligate intracellular bacteria)

Transmission = sex + vertical

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8
Q

Risk factors for chlamydia

A
  • Under 25
  • New sexual partner
  • > 1 sexual partner/year
  • No condoms
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9
Q

Clinical features of chlamydia in women and men

A

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

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10
Q

Ix and management for chlamydia

A

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

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11
Q

Advice + test of cure in chlamydia

A

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

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12
Q

Complications of chlamydia

A

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

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13
Q

Causative organism of gonorrhoea and transmission

A

Neisseria Gonorrhoea (gram-negative diplococcus)

Transmission: Sexual contact, vertical

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14
Q

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?

A

Gonorrhoea

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15
Q

Clinical features of gonorrhoea

A

Women:
* Symptoms: Asymptomatic (50%), pelvic pain (25%), dysuria (12%)
* Signs: Mucopurulent discharge (50%)

Males:
* Symptoms: Asymptomatic (<10%), dysuria (50%)
* Signs: Mucopurulent discharge (80%)

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16
Q

Ix and management for gonorrhoea

A

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)

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17
Q

Advice and TOC for gonorrhoea

A

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

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18
Q

Complications of gonorrhoea

A

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

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19
Q

Causative organisms of non-specific urethritis (NSU)/ non-gonococcal urethritis

A
  • 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
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20
Q

Risk factors and transmission of Non-Specific Urethritis (NSU) / non-gonococcal urethritis

A

Risk factors:
* Sexually active
* Unprotected sex
* Homo/bisexual
* Aged <35
* Multiple partners

Transmission:
* Sexual

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21
Q

Clinical features and complications of Non-Specific Urethritis (NSU) / non-gonococcal urethritis

A

Clinical features:
* Asymptomatic
* Urethral discharge
* Dysuria

Complications:
* Epididymo-orchitis
* Sexually acquired reactive arthritis

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22
Q

Ix and management for Non-Specific Urethritis (NSU) / non-gonococcal urethritis

A

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

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23
Q

What is the causative organisma and transmission of Trichomonas vaginalis

A

Flagellated protozoon
Transmission: sexual contact

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24
Q

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?

A

Trichomoniasis

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25
Q

Clinical features of trichomoniasis in men and women

A

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

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26
Q

Which STI involves yellow-green frothy discharge from the vagina and a ‘strawberry cervix’?

A

Trichomoniasis
(Trichomonas vaginalis)

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27
Q

Ix and management for trichomonas vaginalis

A

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

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28
Q

Microbiology of bacterial vaginosis and transmission

A

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

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29
Q

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?

A

Bacterial vaginosis

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30
Q

Clinical features and complicatiosn of bacterial vaginosis

A

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

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31
Q

Ix and management for bacterial vaginosis

A

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

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32
Q

Microbiology and transmission of thrush

A

Microbiology: Candida albicans (80-92%) + some other non-albican species
Transmission: Not sexually transmitted

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33
Q

Risk factors for thrush

A
  • Uncontrolled diabtes mellitus
  • Immunosuppression
  • Hyperoestrogenaemia (including HRT and the COCP)
  • Broad-spectrum antibiotics
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34
Q

Clinical features of thrush in men and women

A

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

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35
Q

Ix and treatment of thrush

A

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

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36
Q

What virus causes genital herpes?

A

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)
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37
Q

What is the natural history of herpes simplex virus?

A

Primary infection → virus = becomes latent in sensory ganglia → periodically reactivating to cause symptomatic lesions or asymptomatic viral shedding

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38
Q

Clinical features of genital herpes

A
  • Asymptomatic (80%)
  • Painful blisters + ulcers, dysuria, tender inguinal lymphadentitis, discharge, fever myalgia
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39
Q

Complications of genital herpes

A
  • Urinary retention
  • Aseptic meningitis
  • Adhesions
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40
Q

Ix for genital herpes

A

HSV DNA detection by PCR - from base of ulcer

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41
Q

Treatment of genital herpes

A

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

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42
Q

What is the causative organism and transmission route for genital warts

A
  • Genital warts → Human papillomavirus (HPV)
  • Transmission → skin-to-skin contact
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43
Q

Clinical features of genital warts

A
  • 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
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44
Q

Management for genital warts

A

**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

45
Q

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?

A

Pelvic inflammatory disease (PID)

46
Q

Define pelvic inflammatory disease?

A

PID = infection + inflammation of the organs of the pelvis → caused by infection spreading up through the cervix

47
Q

What are the two main complications of PID?

A
  • Tubular infertility
  • Chronic pelvic pain
48
Q

Definitions
(of affected organs of PID)

A
  • 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
49
Q

Causes of pelvic inflammatory disease

A

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)

50
Q

Risk factors for pelvic inflammatory disease

A

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)

51
Q

Signs and symptoms for PID

A

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

52
Q

Ix for Pelvic Inflammatory Disease (PID)

A

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)
53
Q

Management for pelvic inflammatory disease

A
  • 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

54
Q

Complications of pelvic inflammatory disease (PID)

A
  • Sepsis
  • Abscess
  • Infertility
  • Chronic pelvic pain
  • Ectopic pregnancy
  • Fitz-Hugh-Curtis syndrome
55
Q

What is Fitz-Hugh-Curtiz syndrome?

A
  • 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
56
Q

How does Fitz-Hugh-Curtiz syndrome present and treated?

A

Presentations:
* RUQ pain
* + Right shoulder tip pain (if diaphragm is irritated)

Mx: **Laproscopic adhesiolysis **

57
Q

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?

A

Fitz-Hugh-Curtiz syndrome

58
Q

What is syphilis caused by?

A

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.
59
Q

Transmission routes for syphilis

A
  • 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)
60
Q

What are stages of syphilis?

A
  • 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.

61
Q

How does primary syphilis present?

A
  • Painless genital ulcer (chancre) (tends to resolve over 3-8 weeks)
  • Local lymphadenopathy
62
Q

How does secondary syphilis present?

A

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
63
Q

How does tertiary syphilis present?

A

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
64
Q

How can neurosyphilis present?

A

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

65
Q

What is Argyll-Robertson pupil / ‘Prostitutes pupil’

A

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’

66
Q

A patient with tertiary syphilis presents with irregularly shaped pupils, what is this key neurological finding called?

A

Argyll-Robertson pupil
(‘Prostitute pupil’)

67
Q

What are the investigations for syphilis?

A

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

68
Q

Management of syphilis

A

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)

69
Q

What is lymphogranuloma venereum (LGV)?

A

Lymphogranuloma venereum = a curable STI - affecting the lymphatic vessels + nodes - caused by chlamydia trachomatis

70
Q

How can lymphogranuloma venereum (LGV) be transmitted?

A

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

71
Q

What is lymphogranuloma venereum (LGV) caused by?

A

LGV = caused by one of the 3 serovars of Chlamydia trachomatis
(L2 = most common; L1 and L3 less common)

72
Q

What are the clinical features of lymphogranuloma venereum?

A

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

73
Q

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?

A

Lymphogranuloma venereum (LGV)

74
Q

Ix for lymphogranuloma venereum

A
  • 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
75
Q

Management for lymphogranuloma venereum (LGV)?

A

100mg oral doxycycline BD for 21 days

76
Q
A
77
Q

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?

A

Chancroid

78
Q

What is chancroid caused by?

A

Chancroid = an STI caused by the bacterium Haemophilus ducreyi

Haemophilis ducreyi = invade the epithelium of the genital region → resulting in inflammation, necrosis, ulceration

79
Q

Where is chancroid most common?

A

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

80
Q

Signs and symptoms of chancroid

A

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

81
Q

Ix for chancroid

A
  • 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

82
Q

Management for chancroid

A

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

83
Q

Complications of chancroid

A
  • Genital scarring + stricture
  • Abscess formation in inguinal lymph node (buboes)
  • Spread of the infection to other area of the body (rare)
84
Q

What is balanitis?

A

Balanitis = inflammation of the glans penis
(Sometimes extends to the underside of the foreskin = balanoposthitis)

85
Q

What are the causes of balanitis?

A

Categories: Inflammatory, infective (bacterial + fungi), precancerous:

  • Candidiasis
  • Dermatitis (contact or allergic)
  • Dermatitis (eczema or psoriasis)
  • Bacterial
  • Anaerobic
  • Lichen planus
  • Lichen sclerosus
86
Q

Ix for balanitis

A
  • Swab for microbiology (gram stain + culture) and Nucleic acid amplification test (NAAT)
  • Swab for virology (PCR)
  • Dark-field microscopy (for syphilis)
87
Q

How can balanitis present?

A
  • Red scaly patches
  • Pruritus
  • Erosion
  • Post-inflammatory hypo- or hyper-inflammation

Patient may present:
* Multiple sexual partners or high-risk sexual behaviours
* Uncircumcised

88
Q

Risk factors for balanitis

A
  • Congenital or acquried dysfunctional foreskin
  • Uncircumcised state
  • Poor hygiene; urinary dribbling or leakage
  • Over-washing
  • Human papillomavirus (HPV) infection
89
Q

Management for balanitis

A
  • 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)
90
Q

What is sexual dysfunction in women?

A

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

91
Q

What is the 3 criteria for diagnosing a sexual disorder in women?

A

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

92
Q

What are the strong correlations (causes) with sexual dysfunction in women?

A
  • Poor mental health
  • Stress
  • Low levels of emotional intimacy between partners

SERUM LEVELS OF SEX HORMONES = DO NOT

93
Q

Risk factors of sexual dysfunction in women

A
  • Depression
  • Antidepressant use
  • Comorbid anxiety disorder
  • Psychological aspects of cancer
  • Endometriosis
  • Neurological disease (can interrupt sexual response)
94
Q

Ix for sexual dysfunction in women

A

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

95
Q

Management of sexual dysfunction in women

A
  • Psycohological therapy
  • Oestrogen (for vaginal atrophy)
  • Vibrostimulation
  • Review antidepressant therapy
96
Q

What are the complications of chlamydia in pregnancy?

A

Increased risk of:
* Premature delivery with low birth weight
* Miscarriage
* Still birth

97
Q

What antibiotics are contraindicated in pregnancy?

A

Doxycycline + ofloxacin

98
Q

What is the treatment for the mother if infected with chlamydia?

A

Azithromycin + erythromycin
(Doxycycline = contraindicated in pregnancy)

99
Q

How may a baby present if they contract chlamydia from the mother?

A
  • Neonatal chlamydial conjunctivitis (5-12 days after birth): inflammation + discharge in eyes
  • Pneumonia (1-3 months after birth)
100
Q

What are the Ix and management for chlamydia in neonates?

A
  • Ix: Swabs from eyelid or nasopharynx
  • Management: Oral erythromycin
101
Q

Complications of gonorrhoea in pregnancy

A
  • Perinatal mortality
  • Spontaneous abortion
  • Preamature labour
  • Early fetal membrane rupture
102
Q

If there vertical transmission of gonorrhoea in a neonate, what is the major clinical feature?

A

Gonococcal conjunctivitis

Neonate will experience:
* Eye pain
* Redness
* Discharge

If untreated - can lead to long term damage + blindness

103
Q

Is the treatment for gonorrhoea in pregnancy the same as uncomplicated gonorrhoea?

A

Yes!
Single dose of IM ceftriaxone 1g

104
Q

Can syphilis (T. pallidum) cross the placenta to a fetus?

A

Yes!
(Pregnant women are screened for syphilis, HIV and Hepatitis B)

105
Q

If syphilis is left untreated in pregnancy, what can it lead to?

A
  • Miscarriage
  • Stillbirth
  • Pre-term labour
  • Congenital syphilis
106
Q

How might congenital syphilis present?

A

Congenital syphilis = severe + debilitating

  • Saddle nose
  • Rashes
  • Fever
  • Failure to gain weight
107
Q

What are the complications of trichomonas vaginalis in pregnancy?

A
  • Premature labour
  • Low birth weight
  • TV infection = may also predispose to maternal postpartum sepsis
108
Q

How is trichomonas vaginalis treatment in pregnancy?

A

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)

109
Q
A

3a Women's Health (9 decks)

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