GUM Flashcards
Name common causes of dysuria
UTI, Chlamydia, trochomatis, gonorrhoea, herpes, candidiasis, torchomonas, vaginalis, vulval dermatoses
History questions to ask
Frequency?
Do you they wake up in the night to go?
Blood in pain?
Other pain loin, abdo?
ASS: discharge, bleeding (sex, between peroids)
Lumps, bumps rashes- vagina or elsewhere
Sexual Hx:
Sexually active, new partner, does partner have symptoms
What investigations could you do for dysuria?
Vulvo-vaginal swab: chlamydia + gonorrhoea NAAT
High vaginal swab: candida, BV, Trichomonas Vaginalis
Endocervical swab: gonorrhoea
MSU: UTI
Names cases of vaginal discharge
BV, candidacies, trichomonas vaginalis, gonorrhoea, chlamydia, cervical herpes infection, retained foreign body
Describe clinical presentation of BV, changes on microscopy & TX
watery white discharge + fish smell.
pH > 4.5
Microscopy: loss of lactobacilli replaced with small cocoa-bacilli (Usually G. vaginalis)
Tx: Metronidazole
Risk for thrush.
pregnancy, diabetes, recent abx
Describe clinical presentation of trichomonas vaginalis
Sexual risk (new partner, abroad, partner symptoms) Malodorous green/yellow discharge often frothy Vuval burning & discomfort, external dysuria
trichomonas vaginalis
a) appearance of cervix in 2-5%
b) Microscopy
c) How to investigate
d) Tx
a) strawberry cervix
b) mobile flagellated protozoa
c) high vaginal swab
d) metronidazole
Clinical presentations of gonorrhoea &chlamydia
Sexual risk Usually asymptomatic Abnormal bleeding PCB/IMB Lower abdo pain Dysuria \+/- purulent discharge
What tests for C & G?
How do you treat C or G
What are the transmission rates?
Endocervical & vulvo-vaginal swab: culture & NAAT for N. gonorrhoea
Gonorrhoea:
- cefixime PO or ceftriaxone 500mg IM
- 75% transmission
Chlamydia:
- Azithromycin 1g (single dose)
- 50% tranmission
Infective causes of post-coital bleeding
Chlamydia, gonorrhoea, PID
Hx for PCB
Smear History Sexual history - sexually active? Changed partner? Symptomatic partner? Vaginal discharge Dysuria IMB Abdominal pain
What signs are you looking out for on examination for PCB
Cervical excitation- PID
visible lesions on cervix
vaginal/cervical discharge
Investigations for PCB
Vulvo-vaginal swab: Chlamydia + Gonorrhoea NAAT
Endocervical swab: Gonorrhoea culture
Cervical Assessment: Cytology +/- colposcopy
Causes of male dysuria & discharge
Infective:
chlamydia (50% asympt)
gonorrhoea (10% asympt)
UTI
If <35 assume STI until proven overwise.
Non-gonorrhoea urethritis (NGU)- inflammation of urethra not caused by gonorrhoea
Investigations
Urethral swab: gram stained smear & culture for N. gonorrhoea
First void urine: chlamydia & gonorrhoea NAAT
MID stream urine: test for UTI (e.coli)
Syphilis serology
HIV antibody test
Rectal & pharyngeal swabs: 3 site chlamydia/gonorrhoea testing for MSM
Tx Chlamydia
Azithromycin 1g single dose or doxycycline 100mg bd 7 days
Tx Chlamydia
Ceftriazone 500mg IM + Azithromycin PO single dose (Tx chlamydia as co-infection in 50%)
Complications of chlamydia
Reiter’s syndrome/reactive arthritis
Fitz-hugh curtis syndrome
How does reiters syndrome present? Who is it more common in?
Arthritis (usually in 1 major joint)
Urethritis (or cervicitis in women)
Uveitis/conjunctivitis
What is fitz-hugh curtis syndrome? Who suffers from it?
A rare complication of PID. Occurs almost exclusively in women. Inflammation spreads from pelvis to Glisson’s capsule that results in peri-hepatitis.
Presents with: Pyrexia Guarding RUQ pain Abnormal LFTs
Which HPV subtypes cause condylomata accuminata
6 & 11
What are the usual symptoms of genital warts
Normally asymptomatic.
May cause painless, slow growing papillomatous lessons.
Often catch on clothing and may cause external dyspareunia.
How do you treat genital warts
Aim destroy warts:
- Pharmacological
- Podophyllin paint (weekly)
- Podophyllin Toxin (2 x daily in 3 day cycle, 4 weeks)
- Thrichloroacetic acid
Physical
- Crythotheraoy
- laster therapy
Use condoms, trace sexual contacts
What bacteria cause syphilis. What shape is it?
Treponeumum pallidum
spirochete
Describe the clinical stages of syphilis
Primary syphilis 3 weeks post infection Painless, solitary ulcer (chancre) Chancre often unnoticed Inguinal lymphadenopathy
Secondary syphilis
5 weeks after primary, occurs in first 2 years
Proliferation of spirochetes in skin and mucous membranes
Palms & soles → rash
Most areas (anogenital & axillae)
Mouth, throat vagina
Generalised lymphadenopathy
Genital condyloma lata- Wart like lesions on the genitals
Anterior uveitis
Inflammation of iris
Tertiary syphilis
5 years after initial infection
Tertiary syphilis → 40% ppl infected > 2 years
Neurosyphilis
Dementia
Tabes dorsalis
Cardiosyphilis
syphilitis aortitis
Endarteritis obliterans -> aortic aneurysm formation
Gummata
granuloma-like, most commonly found in liver (gumma hepatis) but can be found in brain, heart, skin, bone & testies.
Describe early and late congenital syphilis
Early: skin rash, hepatomegaly & skeletal problems (sabre shin = anteriorly curved shin)
Late: Hutchinson Triad: Notched central incisors, blindness, deafness from 8th cranial nerve injury
How does syphilis affect the foetus
Crosses placenta
Main clinical infections of PID
Pelvic pain, adnexal tenderness, fever and vaginal discharge
Other cause of PID than ascending STI infection
Childbirth/TOP
