GUM Flashcards
What is bacterial vaginosis?
- overgrowth of anaerobic bacteria in vagina
- loss of lactobacilli
What are lactobacilli?
- healthy vaginal bacterial flora
- produce lactic acid keeping ph <4.5
- stops other bacteria overgrowing
- alkaline environment > allows anaerobic to multiply
What are risk factors for BV?
- multiple sexual partners
- excessive vaginal cleaning
- recent Abx
- smoking
- copper coil
How does BV present?
- fish smelling discharge
- watery grey or white
How is BV investigated?
- swab and pH paper
- charcoal HVS
- or self low VS
What type of cells are seen on microscopy in BV?
- clue cells
- epithelial cells from cervix with bacteria inside
- usually Gardnerella vaginalis
How is BV managed?
- asymptomatic: none
- metronidazole orally or gel (avoid alcohol)
- clindamycin alternative
- lifestyle advice
What are complications of BV?
- inc risk of STIs
- preterm delivery
- PROM
- low birth weight
- chorioamnionitis
What is thrush?
- vaginal infection of Candida family
- MC is Candida albicans
What are risk factors for thrush?
- inc oestrogen
- poorly controlled diabetes
- immunosuppression
- broad-spectrum Abx
How does thrush present?
- thick white discharge that doesn’t smell
- cottage cheese
- vulva/vaginal itching/discomfort
How does thrush cause infection?
- candida can colonise vagina without causing symptoms
- progresses to infection with right environment
- e.g. during pregnancy
- after Abx treatment altering flora
What are the complications of a severe thrush infection?
- erythema
- fissures
- oedema
- dyspareunia
- dysuria
- excoriation
How is thrush investigated?
- testing pH
- charcoal swab with microscopy
Which infections are indicated by pH >4.5?
- bacterial vaginosis
- trichomonas
How is thrush managed?
- antifungals
- oral fluconazole 1st line
- clotrimazole pessary if CI - pregnancy/breastfeeding
How is recurrent thrush managed?
- 4+ infections per year
- induction and maintenance over 6 months
What methods of delivery are there for thrush medication?
- clotrimazole cream
- clotrimazole pessary (500mg intravaginally)
- fluconazole orally (single dose 150mg)
What is chlamydia?
- chlamydia trachomatis
- gram-negative bacteria
- intracellular organism
What are risk factors for chlamydia?
- young
- sexually active
- multiple partners
What is the National Chlamydia Screening Programme?
- covers every sexually active person 15-24 25 annually or when they change sexual partner
- positive > retest 3mo after
What is the order of preference for NAAT swabs?
- women: endocervical > vulvovaginal > urine
- men: first-catch > urethral
How does chlamydia present in women?
- abnormal vaginal discharge
- pelvic pain
- IMB or PCB
- dyspareunia
- dysuria
How does chlamydia present in men?
- urethral discharge or discomfort
- dysuria
- epididymo-orchitis
- reactive arthritis
What is seen on examination for chlamydia?
- pelvic/abdo tenderness
- cervical motion tenderness
- cervicitis
- purulent discharge
How is chlamydia managed?
- uncomplicated: doxycycline 100mg BD for 7 days
What are the complications of chlamydia?
- PID
- infertility
- ectopic
- lymphogranuloma venereum
How is chlamydia managed in pregnancy?
- azithromycin 1g orally single dose > 500mg OD for 2 days
- erythromycin 500mg QDS for 7 days
What are the complications of chlamydia in pregnancy?
- preterm delivery
- premature ROM
- low birth weight
- neonatal infection
What type of bacteria is neisseria gonorrhoeae?
- gram negative diplococcus
What are risk factors for gonorrhoea?
- young
- sexually active
- multiple partners
- other STIs
What is the pathophysiology of gonorrhoea?
- infects mucous membranes in columnar epithelium
- endocervix, urethra, rectum, conjunctiva, pharynx
- spreads via contact with mucous secretions in infected areas
How does gonorrhoea present?
- odourless purulent discharge
- green or yellow
- dysuria
- pelvic pain (women)
- testicular pain/swelling (men)
What is the symptomatic percentage for gonorrhoea in men vs women?
- symptomatic percentage:
- 90% of men
- 50% of women
How is gonorrhoea diagnosed?
- NAAT swabs to detect RNA or DNA
- endocervical, vulvovaginal, urethral or first-catch urine
- standard charcoal endocervical swab for MC&S
What other gonorrhoeal swabs should be taken in MSM?
- rectal and pharyngeal
How is gonorrhoea managed?
- single dose IM ceftriaxone 1g if sensitivities unknown
- single dose oral ciprofloxacin 500mg if sensitivities known
When should a test of cure be done in gonorrhoea?
- 72hrs after treatment for culture
- 7 days after treatment for RNA NAAT
- 14 days for DNA NAAT
How to decide which method to use for gonorrhoeal test of cure?
- NAAT if asymptomatic
- cultures if symptomatic
What is disseminated gonococcal infection?
- complication of untreated gonorrhoea
- bacteria spreads to skin and joints
- haematogenous spread from mucosal infection
How does disseminated gonococcal infection present?
- tenosyonvitis
- polyarthralgia
- migratory polyarthritis
What are complications of gonorrhoea?
- PID
- infertility
- epididymo-orchitis
- Fitz-High-Curtis
What is Trichomonas vaginalis?
- parasite
- protozoan
Where does trichomonas live?
- men: urethra
- women: vagina
How does trichomonas present?
- vaginal discharge
- itching
- dysuria and dyspareunia
- balanitis
How is discharge described in trichomonas?
- frothy
- yellow-green
- fishy smell
What is seen on examination of trichomonas?
- strawberry cervix
- vaginal pH >4.5
How is trichomonas diagnosed?
- charcoal swab from posterior fornix of vagina
- self-taken low vaginal swab
- urethral swab or first catch urine in men
How is trichomonas treated?
- metronidazole
What is the pathophysiology of HIV?
- RNA retrovirus
- enters and destroys CD4 T-helper cells
How is HIV transmitted?
- unprotected anal, vaginal or oral sex
- vertical transmission during pregnancy, birth or breastfeeding
- mucous membrane, blood or wound exposure to bodily fluids
How does HIV present initially?
- within 3-12 weeks of infection
- sore throat
- lymphadenopathy
- diarrhoea
- malaise, myalgia, arthralgia
- maculopapular rash
What are some AIDS-defining illnesses?
- lymphomas
- CMV
- TB
- Pneumocystitis pneumonia (PCP)
How does fourth generation HIV testing work?
- 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
How do point-of-care HIV tests work?
- test for HIV antibodies
- give results within minutes
- 90 day window
How is the CD4 count monitored?
- 500-1200 cells/mm3 is normal range
- <200 puts patient at risk of infection
How is HIV managed?
- two NRTIs (tenofovir + emtricitabine) and a PI (indinavir) or NNRTI (nevirapine)
- aim to achieve a normal CD4 count and undetectable viral load
What additional management/screening is given to patients with HIV?
- prophylactic co-trimoxazole to prevent PCP
- CV disease (statins)
- yearly smears
- vaccinations up to date
How is HIV transmission during delivery prevented?
- <50 copies: NVD
- > 50 copies: consider pre-labour C-section
- > 400 copies: pre labour C-section
What prophylaxis is available for HIV?
- PEP: use within 72hrs
- PrEP: take before
- both use emtricitabine/tenofovir
What is lymphogranuloma venereum?
- affects lymphoid tissue around chlamydia infection
- affects MSM
What is the primary stage of lymphogranuloma venereum?
- painless ulcer
- penis in men
- vaginal wall in women
- rectum
What is the secondary stage of lymphogranuloma venereum?
- lymphadenitis
- inguinal or femoral
What is the tertiary stage of lymphogranuloma venereum?
- inflammation of rectum and anus
- anal pain
- change in bowel habit
- tenesmus
What is the treatment for lymphogranuloma venereum?
- doxycycline 100mg BD
- 21 days
