GUM

Question 1

Name common causes of dysuria

Answer 1

UTI, Chlamydia, trochomatis, gonorrhoea, herpes, candidiasis, torchomonas, vaginalis, vulval dermatoses

Question 2

History questions to ask

Answer 2

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

Question 3

What investigations could you do for dysuria?

Answer 3

Vulvo-vaginal swab: chlamydia + gonorrhoea NAAT
High vaginal swab: candida, BV, Trichomonas Vaginalis
Endocervical swab: gonorrhoea
MSU: UTI

Question 4

Names cases of vaginal discharge

Answer 4

BV, candidacies, trichomonas vaginalis, gonorrhoea, chlamydia, cervical herpes infection, retained foreign body

Question 5

Describe clinical presentation of BV, changes on microscopy & TX

Answer 5

watery white discharge + fish smell.
pH > 4.5
Microscopy: loss of lactobacilli replaced with small cocoa-bacilli (Usually G. vaginalis)
Tx: Metronidazole

Question 6

Risk for thrush.

Answer 6

pregnancy, diabetes, recent abx

Question 7

Describe clinical presentation of trichomonas vaginalis

Answer 7

Sexual risk (new partner, abroad, partner symptoms)
Malodorous green/yellow discharge often frothy
Vuval burning & discomfort, external dysuria

Question 8

trichomonas vaginalis

a) appearance of cervix in 2-5%
b) Microscopy
c) How to investigate
d) Tx

Answer 8

a) strawberry cervix
b) mobile flagellated protozoa
c) high vaginal swab
d) metronidazole

Question 9

Clinical presentations of gonorrhoea &chlamydia

Answer 9

Sexual risk
Usually asymptomatic 
Abnormal bleeding PCB/IMB
Lower abdo pain
Dysuria 
\+/- purulent discharge

Question 10

What tests for C & G?
How do you treat C or G
What are the transmission rates?

Answer 10

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

Question 11

Infective causes of post-coital bleeding

Answer 11

Chlamydia, gonorrhoea, PID

Question 12

Hx for PCB

Answer 12

Smear History 
Sexual history - sexually active? Changed partner? Symptomatic partner?
Vaginal discharge 
Dysuria 
IMB
Abdominal pain

Question 13

What signs are you looking out for on examination for PCB

Answer 13

Cervical excitation- PID
visible lesions on cervix
vaginal/cervical discharge

Question 14

Investigations for PCB

Answer 14

Vulvo-vaginal swab: Chlamydia + Gonorrhoea NAAT
Endocervical swab: Gonorrhoea culture
Cervical Assessment: Cytology +/- colposcopy

Question 15

Causes of male dysuria & discharge

Answer 15

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

Question 16

Investigations

Answer 16

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

Question 17

Tx Chlamydia

Answer 17

Azithromycin 1g single dose or doxycycline 100mg bd 7 days

Question 18

Tx Chlamydia

Answer 18

Ceftriazone 500mg IM + Azithromycin PO single dose (Tx chlamydia as co-infection in 50%)

Question 19

Complications of chlamydia

Answer 19

Reiter’s syndrome/reactive arthritis

Fitz-hugh curtis syndrome

Question 20

How does reiters syndrome present? Who is it more common in?

Answer 20

Arthritis (usually in 1 major joint)
Urethritis (or cervicitis in women)
Uveitis/conjunctivitis

Question 21

What is fitz-hugh curtis syndrome? Who suffers from it?

Answer 21

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

Question 22

Which HPV subtypes cause condylomata accuminata

Answer 22

6 & 11

Question 23

What are the usual symptoms of genital warts

Answer 23

Normally asymptomatic.
May cause painless, slow growing papillomatous lessons.
Often catch on clothing and may cause external dyspareunia.

Question 24

How do you treat genital warts

Answer 24

Aim destroy warts:

1. 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

Question 25

What bacteria cause syphilis. What shape is it?

Answer 25

Treponeumum pallidum

spirochete

Question 26

Describe the clinical stages of syphilis

Answer 26

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.

Question 27

Describe early and late congenital syphilis

Answer 27

Early: skin rash, hepatomegaly & skeletal problems (sabre shin = anteriorly curved shin)
Late: Hutchinson Triad: Notched central incisors, blindness, deafness from 8th cranial nerve injury

Question 28

How does syphilis affect the foetus

Answer 28

Crosses placenta

Question 29

Main clinical infections of PID

Answer 29

Pelvic pain, adnexal tenderness, fever and vaginal discharge

Question 30

Other cause of PID than ascending STI infection

Answer 30

Childbirth/TOP