GUM Flashcards
What is bacterial vaginosis (BV)?
BV is an overgrowth of anaerobic bacteria in the vagina due to a loss of lactobacilli, the “friendly bacteria,” which normally help maintain a low vaginal pH. Not an STI.
The vaginal pH rises above 4.5 due to the reduction of lactobacilli, creating an alkaline environment that promotes the growth of anaerobic bacteria.
What is the role of lactobacilli in the vaginal flora?
Lactobacilli produce lactic acid to keep the vaginal pH low (under 4.5), preventing overgrowth of harmful bacteria.
Name some anaerobic bacteria associated with BV.
Gardnerella vaginalis, Mycoplasma hominis, and Prevotella species.
What are the risk factors for developing bacterial vaginosis?
Risk factors include multiple sexual partners, excessive vaginal cleaning, recent antibiotic use, smoking, and the use of a copper coil.
What is the typical presenting feature of bacterial vaginosis?
A fishy-smelling, watery grey or white vaginal discharge.
NO itching, irritation, or pain (suggest other infection).
What are “clue cells,” and what do they indicate?
Clue cells are cervical epithelial cells coated with bacteria, usually Gardnerella vaginalis, and they indicate bacterial vaginosis.
What is the antibiotic of choice for treating BV?
Metronidazole, given orally or as a vaginal gel, is the first-line antibiotic for BV.
Treatment is not usually necessary for asymptomatic cases, as BV may resolve on its own.
What important advice should be given when prescribing metronidazole?
Patients should avoid alcohol during metronidazole treatment due to the risk of a disulfiram-like reaction (nausea, vomiting, and flushing).
What are some complications of BV in pregnant women?
BV in pregnancy is associated with miscarriage, preterm delivery, premature rupture of membranes, chorioamnionitis, low birth weight, and postpartum endometritis.
Which yeast species is most commonly responsible for vaginal candidiasis?
Candida albicans.
Name some factors that increase the risk of developing vaginal candidiasis.
Increased estrogen levels, poorly controlled diabetes, immunosuppression, and broad-spectrum antibiotic use.
What are the main symptoms of vaginal candidiasis?
Thick, white discharge without odor, along with vulval and vaginal itching, irritation, or discomfort.
What additional symptoms may indicate a more severe vaginal candidiasis infection?
Erythema, fissures, edema, dyspareunia (pain during sex), dysuria, and excoriation.
How can vaginal pH help in diagnosing vaginal candidiasis?
Candidiasis typically has a vaginal pH below 4.5, whereas BV and trichomonas infections present with a pH above 4.5.
What is the main approach to diagnosing vaginal candidiasis?
Often empirically based on symptoms, with confirmation through a charcoal swab and microscopy if needed.
What are the primary treatment options for vaginal candidiasis?
Antifungal medications such as intravaginal clotrimazole cream, clotrimazole pessaries, or oral fluconazole tablets.
What does Canesten Duo contain, and when is it used?
It contains a single dose of fluconazole and clotrimazole cream for external vulval symptoms, and is available over the counter.
How should recurrent vaginal candidiasis (more than 4 infections per year) be managed?
With an induction and maintenance antifungal treatment regime over six months, using oral or vaginal antifungals.
What should patients be cautioned about when using antifungal creams or pessaries?
These can damage latex condoms and interfere with spermicides, so alternative contraception is recommended for at least five days after use.
What type of bacteria is Chlamydia trachomatis, and where does it replicate?
It is a gram-negative, intracellular bacterium, meaning it replicates inside cells.
What factors increase the risk of Chlamydia infection?
Young age, being sexually active, and having multiple sexual partners.
What is the National Chlamydia Screening Programme (NCSP) in the UK?
A program that screens sexually active people under 25 annually or when they change partners. A re-test is recommended three months after treatment for those who test positive.
Which infections are typically screened for during a GUM clinic visit?
Chlamydia, gonorrhea, syphilis (via blood test), and HIV (via blood test).
What types of swabs are used in sexual health screening, and what do they test for?
Charcoal swabs (for microscopy, culture, sensitivities) and NAAT swabs (for DNA/RNA testing, specifically for chlamydia and gonorrhea).
Which NAAT sample methods are used for testing chlamydia in women?
Vulvovaginal swab, endocervical swab, or first-catch urine.
How is a NAAT swab for gonorrhea confirmed?
With a charcoal endocervical swab for microscopy, culture, and sensitivity testing.
What are common symptoms of chlamydia in women?
Abnormal vaginal discharge, pelvic pain, abnormal bleeding, dyspareunia, and dysuria.
What are common symptoms of chlamydia in men?
Urethral discharge, dysuria, epididymo-orchitis, and reactive arthritis.
What additional symptoms may suggest rectal chlamydia or lymphogranuloma venereum?
Anorectal discomfort, discharge, bleeding, and bowel habit changes.
What is the first-line treatment for uncomplicated chlamydia infection?
Doxycycline 100 mg twice daily for 7 days.
Which treatment options are recommended for chlamydia in pregnancy or breastfeeding?
Options include azithromycin, erythromycin, or amoxicillin.
When is a test of cure recommended for chlamydia?
For rectal infections, during pregnancy, or if symptoms persist after treatment.
What advice is given regarding sexual activity during chlamydia treatment?
Abstain from sex for seven days of treatment for both the patient and their partners.
Name complications associated with untreated chlamydia infection.
Pelvic inflammatory disease, chronic pelvic pain, infertility, ectopic pregnancy, and conjunctivitis.
What are pregnancy-related complications of chlamydia?
Preterm delivery, premature rupture of membranes, low birth weight, postpartum endometritis, and neonatal conjunctivitis or pneumonia.
What is lymphogranuloma venereum (LGV), and who is primarily affected?
An infection of lymph tissue by Chlamydia commonly affecting men who have sex with men (MSM).
What is the treatment for lymphogranuloma venereum (LGV)?
Doxycycline 100 mg twice daily for 21 days.
How does chlamydial conjunctivitis present, and who is typically affected?
Presents with chronic redness, irritation, and unilateral discharge, most common in young adults and neonates exposed to infected mothers.
What type of bacteria is Neisseria gonorrhoeae, and where does it infect?
A gram-negative diplococcus that infects mucous membranes with columnar epithelium, such as the endocervix, urethra, rectum, conjunctiva, and pharynx.
How is Neisseria gonorrhoeae transmitted, and what increases the risk of infection?
It is sexually transmitted; risk factors include being young, sexually active, having multiple partners, and having other STIs.
Why is antibiotic resistance significant in gonorrhea, and which antibiotics are commonly ineffective?
High resistance exists, particularly to ciprofloxacin and azithromycin, which were traditionally used but now show reduced efficacy.
What are common symptoms of genital gonorrhea in women?
Purulent discharge (green/yellow, odourless), dysuria, and pelvic pain.
What are common symptoms of genital gonorrhea in men?
Purulent discharge (green/yellow, odourless), dysuria, and testicular pain/swelling (epididymo-orchitis).
What are the symptoms of rectal and pharyngeal gonorrhea infections?
Rectal infection may cause discomfort and discharge (often asymptomatic); pharyngeal infection may cause a sore throat but is often asymptomatic.
Which diagnostic test is used to detect gonorrhea DNA or RNA, and what is its limitation?
Nucleic acid amplification testing (NAAT) detects gonococcal DNA/RNA but does not provide antibiotic sensitivities.
