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Osha 3a > GUM > Flashcards

GUM Flashcards

1
Q

What is bacterial vaginosis?

A
  • overgrowth of anaerobic bacteria in vagina
  • loss of lactobacilli
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2
Q

What are lactobacilli?

A
  • healthy vaginal bacterial flora
  • produce lactic acid keeping ph <4.5
  • stops other bacteria overgrowing
  • alkaline environment > allows anaerobic to multiply
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3
Q

What are risk factors for BV?

A
  • multiple sexual partners
  • excessive vaginal cleaning
  • recent Abx
  • smoking
  • copper coil
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4
Q

How does BV present?

A
  • fish smelling discharge
  • watery grey or white
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5
Q

How is BV investigated?

A
  • swab and pH paper
  • charcoal HVS
  • or self low VS
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6
Q

What type of cells are seen on microscopy in BV?

A
  • clue cells
  • epithelial cells from cervix with bacteria inside
  • usually Gardnerella vaginalis
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7
Q

How is BV managed?

A
  • asymptomatic: none
  • metronidazole orally or gel (avoid alcohol)
  • clindamycin alternative
  • lifestyle advice
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8
Q

What are complications of BV?

A
  • inc risk of STIs
  • preterm delivery
  • PROM
  • low birth weight
  • chorioamnionitis
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9
Q

What is thrush?

A
  • vaginal infection of Candida family
  • MC is Candida albicans
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10
Q

What are risk factors for thrush?

A
  • inc oestrogen
  • poorly controlled diabetes
  • immunosuppression
  • broad-spectrum Abx
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11
Q

How does thrush present?

A
  • thick white discharge that doesn’t smell
  • cottage cheese
  • vulva/vaginal itching/discomfort
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12
Q

How does thrush cause infection?

A
  • candida can colonise vagina without causing symptoms
  • progresses to infection with right environment
  • e.g. during pregnancy
  • after Abx treatment altering flora
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13
Q

What are the complications of a severe thrush infection?

A
  • erythema
  • fissures
  • oedema
  • dyspareunia
  • dysuria
  • excoriation
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14
Q

How is thrush investigated?

A
  • testing pH
  • charcoal swab with microscopy
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15
Q

Which infections are indicated by pH >4.5?

A
  • bacterial vaginosis
  • trichomonas
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16
Q

How is thrush managed?

A
  • antifungals
  • oral fluconazole 1st line
  • clotrimazole pessary if CI - pregnancy/breastfeeding
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17
Q

How is recurrent thrush managed?

A
  • 4+ infections per year
  • induction and maintenance over 6 months
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18
Q

What methods of delivery are there for thrush medication?

A
  • clotrimazole cream
  • clotrimazole pessary (500mg intravaginally)
  • fluconazole orally (single dose 150mg)
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19
Q

What is chlamydia?

A
  • chlamydia trachomatis
  • gram-negative bacteria
  • intracellular organism
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20
Q

What are risk factors for chlamydia?

A
  • young
  • sexually active
  • multiple partners
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21
Q

What is the National Chlamydia Screening Programme?

A
  • covers every sexually active person 15-24 25 annually or when they change sexual partner
  • positive > retest 3mo after
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22
Q

What is the order of preference for NAAT swabs?

A
  • women: endocervical > vulvovaginal > urine
  • men: first-catch > urethral
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23
Q

How does chlamydia present in women?

A
  • abnormal vaginal discharge
  • pelvic pain
  • IMB or PCB
  • dyspareunia
  • dysuria
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24
Q

How does chlamydia present in men?

A
  • urethral discharge or discomfort
  • dysuria
  • epididymo-orchitis
  • reactive arthritis
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25
Q

What is seen on examination for chlamydia?

A
  • pelvic/abdo tenderness
  • cervical motion tenderness
  • cervicitis
  • purulent discharge
26
Q

How is chlamydia managed?

A
  • uncomplicated: doxycycline 100mg BD for 7 days
27
Q

What are the complications of chlamydia?

A
  • PID
  • infertility
  • ectopic
  • lymphogranuloma venereum
28
Q

How is chlamydia managed in pregnancy?

A
  • azithromycin 1g orally single dose > 500mg OD for 2 days
  • erythromycin 500mg QDS for 7 days
29
Q

What are the complications of chlamydia in pregnancy?

A
  • preterm delivery
  • premature ROM
  • low birth weight
  • neonatal infection
30
Q

What type of bacteria is neisseria gonorrhoeae?

A
  • gram negative diplococcus
31
Q

What are risk factors for gonorrhoea?

A
  • young
  • sexually active
  • multiple partners
  • other STIs
32
Q

What is the pathophysiology of gonorrhoea?

A
  • infects mucous membranes in columnar epithelium
  • endocervix, urethra, rectum, conjunctiva, pharynx
  • spreads via contact with mucous secretions in infected areas
33
Q

How does gonorrhoea present?

A
  • odourless purulent discharge
  • green or yellow
  • dysuria
  • pelvic pain (women)
  • testicular pain/swelling (men)
34
Q

What is the epidemiology of gonorrhoea?

A
  • symptomatic percentage:
  • 90% of men
  • 50% of women
35
Q

How is gonorrhoea diagnosed?

A
  • NAAT swabs to detect RNA or DNA
  • endocervical, vulvovaginal, urethral or first-catch urine
  • standard charcoal endocervical swab for MC&S
36
Q

What other gonorrhoeal swabs should be taken in MSM?

A
  • rectal and pharyngeal
37
Q

How is gonorrhoea managed?

A
  • single dose IM ceftriaxone 1g if sensitivities unknown
  • single dose oral ciprofloxacin 500mg if sensitivities known
38
Q

When should a test of cure be done in gonorrhoea?

A
  • 72hrs after treatment for culture
  • 7 days after treatment for RNA NAAT
  • 14 days for DNA NAAT
39
Q

How to decide which method to use for gonorrhoeal test of cure?

A
  • NAAT if asymptomatic
  • cultures if symptomatic
40
Q

What is disseminated gonococcal infection?

A
  • complication of untreated gonorrhoea
  • bacteria spreads to skin and joints
  • haematogenous spread from mucosal infection
41
Q

How does disseminated gonococcal infection present?

A
  • tenosyonvitis
  • polyarthralgia
  • migratory polyarthritis
42
Q

What are complications of gonorrhoea?

A
  • PID
  • infertility
  • epididymo-orchitis
  • Fitz-High-Curtis
43
Q

What is Trichomonas vaginalis?

A
  • parasite
  • protozoan
44
Q

Where does trichomonas live?

A
  • men: urethra
  • women: vagina
45
Q

How does trichomonas present?

A
  • vaginal discharge
  • itching
  • dysuria and dyspareunia
  • balanitis
46
Q

How is discharge described in trichomonas?

A
  • frothy
  • yellow-green
  • fishy smell
47
Q

What is seen on examination of trichomonas?

A
  • strawberry cervix
  • vaginal pH >4.5
48
Q

How is trichomonas diagnosed?

A
  • charcoal swab from posterior fornix of vagina
  • self-taken low vaginal swab
  • urethral swab or first catch urine in men
49
Q

How is trichomonas treated?

A
  • metronidazole
50
Q

What is the pathophysiology of HIV?

A
  • RNA retrovirus
  • enters and destroys CD4 T-helper cells
51
Q

How is HIV transmitted?

A
  • unprotected anal, vaginal or oral sex
  • vertical transmission during pregnancy, birth or breastfeeding
  • mucous membrane, blood or wound exposure to bodily fluids
52
Q

How does HIV present initially?

A
  • within 3-12 weeks of infection
  • sore throat
  • lymphadenopathy
  • diarrhoea
  • malaise, myalgia, arthralgia
  • maculopapular rash
53
Q

What are some AIDS-defining illnesses?

A
  • lymphomas
  • CMV
  • TB
  • PCP
54
Q

How does fourth generation HIV testing work?

A
  • 4th generate tests for antibodies to HIV and p24 antigen.
  • -ve result within 45 days is unreliable.
  • > 45 days after exposure a negative result is reliable
55
Q

How do point-of-care HIV tests work?

A
  • test for HIV antibodies
  • give results within minutes
  • 90 day window
56
Q

How is the CD4 count monitored?

A
  • 500-1200 cells/mm3 is normal range
  • <200 puts patient at risk of infection
57
Q

How is HIV managed?

A
  • two NRTIs (tenofovir + emtricitabine) and a PI (indinavir) or NNRTI (nevirapine)
  • aim to achieve a normal CD4 count and undetectable viral load
58
Q

What additional management is given to patients with HIV?

A
  • prophylactic co-trimoxazole to prevent PCP
  • CV disease (statins)
  • yearly smears
  • vaccinations up to date
59
Q

How is HIV transmission during delivery prevented?

A
  • <50 copies: NVD
  • > 50 copies: consider pre-labour C-section
  • > 400 copies: pre labour C-section
60
Q

What prophylaxis is available for HIV?

A
  • PEP: use within 72hrs
  • PrEP: take before
  • both use emtricitabine/tenofovir

Osha 3a (15 decks)

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