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MFSRH > GUM > Flashcards

GUM Flashcards

1
Q

Gonorrhoea symptoms per site

A

Men urethra - ax 90%
Women endocervical - 50%
Rectal - most asymp
Pharyngeal - most asymp

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2
Q

NAAT sampling for GC in women, where from?

A

Vulvovaginal recommended

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3
Q

Where to sample for GC if prev hysterectomy

A

VVS and

Urine

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4
Q

GC testing for trans woman with neovagina

A

Swab neovagina and

FPU

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5
Q

GC first line Rx if sensitivities known at all sites

A

Cipro 500mg PO single dose

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6
Q

Ses of cipro

A

Inflam of tendons, muscled, joints and nervous system

Caution if ckd or >60

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7
Q

GC Rx alternatives for penicillin allergic patients

A

2g azithromycin stat plus either:

Cefixime 400mg stat PO or
Gentamicin 240mg IM
Spectinomycin 2g IM (not for throat)

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8
Q

Disseminated GC infection

Rx

A

Ceftriaxone 1g IV OD or
Cipro 500mg IV BD or
Spectinomycin 2g IM BD

Continue for 7 days totally and switch when 24 hours of improvement to cefixime 400mg BD or cipro 500mg bd

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9
Q

GC Rx options in pregnancy

A

Ceftriaxone 1g IM or
Spectinomycin 2g IM or
Azithromycin 2g stat

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10
Q

GC PN

A

Male symptomatic urethral patients - prev 2 weeks

If other patients or asymp - 3/12

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11
Q

When to push GC TOC

A 
Persistent Sx
Pharyngeal infection 
Rx with alternative to first line
Infection from Asia Pacific region
Pregnancy
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12
Q

When to do TOC for GC

A

If still sx do culture as long as >72 hours from finishing Rx

If asymp - NAAT 14/7 post finishing Rx

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13
Q

When to test for LGV

A

MSM if proctitis
HIV pos MSM who are positive for CT at any other site ( even if asymp)

Women with proctitis

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14
Q

First line Rx for CT

A

Doxycycline 100mg BD for 7 days

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15
Q

Alternative to doxy for CT Rx

A

Erythromycin 500mg BD for 14/7

Ofloxacin 400mg OD for 7 days

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16
Q

HIV positive and CT what is the consideration re RX

A

May have LGV

Test for it but RX for 3/52 of doxy and make sure do TOC

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17
Q

CT Rx in pregnancy

A

Erythromycin 500mg BD for 14/7 or
Amoxicillin 500mg TDS for 7/7

Doxy and oflox contraindicated

TOC 3/52 post Rx

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18
Q

Caution with azithromycin

What is the SE?

A

Prolonged QT

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19
Q

Doxycycline SE

A

Dysphagia- swallow with lots of water

Avoid sunlight

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20
Q

When to do TOC following CT infection?

A

Pregnancy
Poor compliance
Sx persist
MSM with rectal CT if LGV test not done

Perform at least 3/52 post Rx

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21
Q

CT partner notification

A

Men with urethral Sx- 1/12 pre onset

All others 6/12 pre

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22
Q

Hay/ison criteria for BV diagnosis

A

Gram stain
Grade 1 normal lacto
Grade 2 intermediate - mixed with some lacto but gardnerella present
Grade 3 BV- mainly gardnerella, few or absent lacto

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23
Q

Mx options for BV

A

Metronidazole 400mg Bd for 5/7 or
Metronidazole 2g stat
Or
Intravaginal metronidazole gel OD for 5/7 ( good if breastfeeding as taste effects breast milk)

Same Rx in pregnancy

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24
Q

Recurrent Candida definition

A

4 documented episodes annually with at least partial resolution of Sx in between

Pos microscopy or culture on 2 occasions when symptomatic

5%

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25
Q

Rx of Candida

A

Clotrimazole 500mg stat, 200mg for 3 nights, 100mg for 6nights

Nystatin pessary 100,000 units per night for 14 nights

Fluconazole 150mg stat or
Itraconazole 200mg Bd for one day

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26
Q

Causes of recurrent Candida

A

Diabetes- check random blood glucose
HIV or immunosuppressed
HRT/cocp high dose oestrogen
Broad spectrum abx

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27
Q

Rx for recurrent Candida

A

Induction - fluconazole 150mg every 72 hours for 3 doses then
Maintenance- fluconazole 150mg once a week for 6/12

Alt

Clotrimazole pessary 500mg once a week

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28
Q

Describe non albicans species of candida and their Rx plan

A

Candida glabrata- still ok with azoles but higher MIC

Candida krusei- resistant to fluconazole

Need 2 weeks

1st nystatin pessary OD for 14/7

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29
Q

Discuss chancroid

A 
H. Ducreyi
Gram neg coccobacillus
Anogential ulcers and lymphadenitis with bubo formation
Transmits through break in skin
4-7 day incubation
Diagnose with PCR
Common in Africa

Rx azithromycin 1g stat or cef 500mg IM stat

PN - 10/7 pre

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30
Q

Discuss donovanosis

A 
South Africa and papa New Guinea 
Klebsiella granulomatis
Genital ulcer
Raised edge
Necrotic
Lymphadenitis uncommon

Microscopy

Azithromycin weekly 1g weekly

PN 6/12

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31
Q

Sx of HIV seroconversion and how long post infection?

A

80% seroconvert within 2-4 weeks

Sx- headache, rash, fever, myalgia, pharyngitis

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32
Q

If on ART which contraceptives are ok?

A

Dmpa

IUC

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33
Q

Man HIV positive and conception plan

A

If HIV viral load less than 50 for 6/12 and on ART - UPSI at ovulation

Otherwise sperm washing and IUI for 3-6/12

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34
Q

Woman HIV positive and fertility options

A

If failure to conceive - full fertility screen pre conception

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35
Q

If HIV positive which contraceptive method not ok?

A

Diaphragm as need to use with N9 which damages condoms and causes ulcers of genitals

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36
Q

If HIV positive and on ART when to check CD4 count during pregnancy?

A

On booking and at delivery

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37
Q

If commencing ART in pregnancy which criteria need to be met?

A

Ideally don’t commence in 1st trimester unless viral load over 100,000 or CD4 less than 200

Wait until second trimester

Viral load check 4 weeks post starting ART, once every trimester, 36/40 and at delivery

38
Q

Untreated HIV pos woman presenting in labour at term, Mx

A

Stay nevirapine 200mg

IV zidovudine for duration of labour

39
Q

Screening in pregnancy for HIV pos women

A

Be aware that bhcg raises by HIV so possible combined test false positive

Invasive prenatal testing - if viral load less than 50

Can have ECV if low viral load

40
Q

Mode of delivery for woman with HIV

A

Viral load at 36 weeks:

If <50 - vag del and less than 0.5
% transmission risk

If 50-399 - consider c/s

If over 400 - fed c/s

C/s at 38/40

41
Q

HIV transmission risk as per site

A

Receptive anal 1 in 90
Insertive anal 1 in 666
Receptive vaginal 1 in 1000
Needle stick 1 in 333

Never give for oral sex/ semen in eye <1 in 10,000

Needle sharing equipment - 1 in 150

42
Q

Factors increasing risk of transmission of HIV

A

Ejaculation
High plasma load (seroconverting)
Non circumcision
Breaches in mucosa in mouth anus or vagina
Sexual assault
Menses or other bleeding - theoretical risk
Stis in hiv positive or genital ulcers in HIV neg

43
Q

If had UPSI with HIV positive on ART what are the criteria for not needing pepse?

A

On ART and adherent
Viral load less than 200
For total of 6/12 at least

44
Q

Pepse regime

A

Truvada (tenofovir and emtricitabine)

Plus

Raltegrivir

Ideally within 24 hours but up to 72 hours and for 28 days

45
Q

Missed pepse rules

A

< 24 hours - take missed dose and usual dose at same time
24-48 hours - continue
> 48 hours - stop pepse

46
Q

MSM criteria to give pepse

A

Offer daily or on demand to:
MSM at high risk with condomless anal sez in prev 6/12 and ongoing

Or

Condomless anal sex with HIV pos partner who isn’t virally suppressed

47
Q

Heterosexual prep who to consider it for

A

Daily oral prep for men and women if condomless sex with hiv pos partners and not suppressed

Women on dmpa

Trans woman - offer daily dosing if condomless anal sex

48
Q

How to take prep depending on site

A

If anal sex - double dose of truvada (2-24hours pre sex) then one a day for 48hours post last UPSI

If less than 7 days since last dose- single dose to start

If vaginal sex - daily regimen and start 7 days pre risk and at least 7 days post. Start with double dose

If IVDU plus anal sex - 7/7 pre and post (daily dosing ideally)

49
Q

When to give pepse if on prep

A

If 3 doses in prev week and MSM then can just take further dose and no need for pepse (at least 4 doses needed per week)

If fewer than 3 tablets in prev 7 days or last dose > 7 days ago - pepse

50
Q

M gen symptoms in men and women

A

Men - NGU , d/c and dysuria

Women- PID, endometritis, PCB

51
Q

Who to test for M Gen

A

PID
NGU

Partners of people infected with MGen

52
Q

Rx of M gen for uncomplicated cervicitis or urethritis

A 
Doxy 100mg bd for 7/7
Then
Azithromycin 1g stat
Then
Azithromycin 500mg OD for 2 days

( if already had doxy in 2 weeks of m gen diagnosis- just give azith course

53
Q

M gen Rx if organism know to be macrolide resistant or where azith has failed

A

Moxifloxacin 400mg OD for 10/7

54
Q

M gen complicated infection Rx ( PID, epididymorchitis)

A

Moxifloxacin 400mg OD for 14 days

55
Q

M Gen Rx in pregnancy

A

If uncomplicated azithromycin for 3/7

If complicated - as per PID

56
Q

When to do TOC for M Gen and when can have sex

A

5/52 post but no sooner than 3/52

Nil sex for 14:7 post Rx

57
Q

transmission of syphilis

A 
Contact with genital lesion
IVDU
Blood transfusion 
Placenta - highest risk in early disease
STS massively increases the risk of HIV transmission
58
Q

Describe primary syphilis

A

Primary - chancre and lymphadenopathy. Typically 9-90 days incubation. Chancre painless, indurated, single, not pussy
25% go to secondary syphilis

59
Q

Presentation of secondary syphilis

A 
6 weeks to 6/12
Widespread mucocutaneous rash
Lymphadenopathy
Palms and soles rash
Alopecia
Mucous patches (buccal) 
Condylomata lata

Can also cause glomerulonephritis, hepatitis, splenomegaly

Some get neurological complications meningitis. 8th nerve palsy with hearing loss or optic neuropathy

60
Q

Tertiary disease of syphilis discuss presentation

A

20-40 years post initial infection

Gummatous - most common, noses falling off, granulomas lesions with central necrosis, holes in bones and soft tissue - responds well to Rx

CV - 10% - ascending aorta arteritis, dilatation and aortic regurgitation. Saccular aneurysms, MI

Neurological - general paresis of the insane ( cortical neuronal loss can give seizures and hemiparesis), arteritis giving ischaemic stroke
Tabes dorsalis- peripheral neuropathy sensory ataxia due to dorsal column loss and absent reflexes and joint position and vibration sense

61
Q

Pupil defect that can be found in tertiary syphilis

A

Argyll Robinson pupil

Is like a prozzie as it accommodates but doesn’t react

62
Q

Name the other treponemal infections other than palladium

A

Yaws
Pinta
Bejel

Childhood infections

Yaws - Endemic in Africa, Asia, Pacific
Bejel - Sahel region of Africa
Pinta - American region

63
Q

Tests to diagnose syphilis

A

Dark ground microscopy
PCR

Serology - 
EIA - total antibody igG and igM
TPPA - pos for life
RPR
igM antitreponemal antibody test ( usually pos for 2 years)

Always do second treponemal test to confirm diagnosis. If this doesn’t confirm then do IgG immunoblot

Always repeat RPR on day giving RX

64
Q

Causes of false positive STS test

A

Old age
Autoimmune disease
IVDU

65
Q

When to do an LP in STS

A

In late syphilis if clinical suspicion of neurological involvement or Rx failure

If RPR hasn’t fallen four fold by 1 year then do LP

66
Q

Rx for early syphilis

Primary secondary or early latent

A

Benzathine penicillin 2.4 MU IM

Or

Doxycycline 100mg Po Bd for 14/7

Nil sex for 2/52 post Rx

67
Q

Late syphilis mx

Late latent, gummatous or CV tertiary disease

A

Benzathine penicillin 2.4 MU IM weekly for 3 weeks

Or

Doxycycline 100mg BD for 28 days

If cardiac - 24 hours pre and 48hours post of daily pred 40-60mg

68
Q

Rx of neurosyphilis

A

Procaine penicillin 2.4 MU IM OD

Plus

Probenecid 500mg PO QDS
( stops urine excretion)

For 14/7

Also give steroids for 24 hrs pre and 48 hours post

If pen allergic - doxy 200mg bd for 28 days

69
Q

Blood testing post Rx of syphilis

A

Want to see a four fold drop in RPR

Repeat RPR at 3,6 and 12/12 then 6 monthly until neg

Serofast if 2 readings the same over 6/12

70
Q

Mx of syphilis in pregnancy

A

As per normal regime accept if :

In third trimester - give two benzathines within a week of each other

If late syphilis also give steroids if pregnant

71
Q

Different types of HSV

A

Type 1 - used to be oral herpes but no most common cause of genital herpes (1 x year)
Type 2 - used to be most common but not now. More likely to cause recurrence (4x a year)

72
Q

Considerations with HSV serology

When indicated

A

Useful for recurrent disease of unknown cause
Counselling on initial episodes as to likelihood of recurrence
Pregnant women

Can get false negatives as several weeks to develop type specific igG response

73
Q

Mx of HSV

First episode

Recurrence

HIV pos

A

Saline
Analgesia
Topical LA 5% lidocaine ointment
Aciclovir 400mg TDS for 5/7 which reduces duration and severity by 1-2/7

Suppressive HSV MX - aciclovir 400mg BD try for max 1 year and then reassess frequency

Recurrence HSV- over 6 per year

HIV pos - aciclovir 400mg five times daily for 7/7

74
Q

Risks for transmission of HSV in pregnancy

A

Risk greatest in third trimester and primary infection, particularly within 6 weeks of delivery

FSE
Vaginal delivery
PROM

75
Q

Hepatitis A

A 
RNA virus
Poor sanitation
MSM oral anal or digital rectal
Group sex
Incubation 28 days
Infectious 2 weeks pre and one week post jaundice 
Sx , promdrome flu illness with RUQ pain then icteric illness with jaundice, nausea
< 1% acute liver failure 
Pos hep a igM. Raised LFTs
Mx - rest and oral rehydration 
Hep A vaccine up to 14/7 post exposure 0,6,12/12 vaccine schedule
Usually lifelong immunity post infection
76
Q

Who to give hep a vaccine to

A

All MSM single dose
IVDU
Chronic hep b and c

77
Q

Hep B

A

DNA virus
Risks MSM IVDU blood donor tattoos sex workers
Most asymp
Same signs and prodrome as hep A
Chronic infection possible uss for fibrosis
Rx if fibrosis and high dna load - tenofovir
High risk of vertical transmission
PN for 2 weeks ore jaundice

78
Q

Hepatitis B vaccine

A

Can give within 6 weeks after first exposure

0,7,21

Or

0,1,2/12

Or

0,1,6/12

With booster at 12/12 for both

Test for response 1/12 post last dose
Should be antiHBs antibodies

79
Q

Hepatitis C

A 
RNA virus
Shared needles snorting drugs 
Also MSM with fisting etc
Sex workers prisoners alcoholics 
Most asymp
Chronic hep c - usually asymp worse if other refs for liver disease
Mx - fibro scan 
HCV rna positive - acute infection unless over 6/12 in which case chronic 
Anti HCV neg- acute
HCV core antigen - replication marker
80
Q

EIA pos
IgM pos
TPPA 1:1280
RPR 1:128

A

Defo syphilis
IgM pos so prob within past two years
RPR v high - recent infection and prob v infectious

81
Q

EIA pos
IgM neg
TPPA 1:640
RPR neg

A 
Prev treated an successful
Late latent (>2 years ago)
Prev exposes to yaws/ pinta or bejel
82
Q

Hep b serology

A 
HBsAg infection
HBeAg marker of replication
IgG HBsAg - immune from vaccination
IgM HBsAg acute infection
IgG HBsAg chronic infection 
IgG - HBcAg cured prev infection
83
Q

TV Mx

A

Metronidazole 2g stat

Or

Metronidazole 400mg BD for 5/7

Nil alcohol for 48 hours afterwards
No sex for 1 week post Rx

Treat partners in prev 4weeks

84
Q

Mx genital warts

A

PIL
Condoms
Latex weakened by imiquimod

Soft non keratinised - podophyllotoxin 0.15% cream bd for 3 days then 4 days rest. Avoid in pregnancy

Keratinised - Cryo

Both imiquimod 5% cream - apply 3 x weekly and wash off in 6-10 hours for up to 4/12

Only cryo can be used in pregnancy

85
Q

Rx of scabies

A

Premethrin 5% apply to whole body and wash off 8-12 hours later then reapply 1 week later

Or

Malathion 0.5% lotion wash off after 24hours

86
Q

PID standard Rx

3 alternatives

A

Ceftriaxone 1g stat IM plus doxy 100mg BD for 14/7 and metronidazole 400mg BD for 14/7

Ofloxacin 400mg BD plus metronidazole 400mg BD for 14/7

Moxifloxacin 400mg Od for 14/7

87
Q

PID Rx with pregnancy

A

Ceftriaxone 1g IM then

Azithromycin 1g stat each week for 2 weeks

But Rx as IP for actual pregnant rather than PT risk and give
IV cef plus IV erythromycin plus IV metronidazole

88
Q

PN for PID

A

Male partners in prev 6/12 screen

Test current partners if MGen pos and give doxy 100mg BF for 7/7

89
Q

Rx for LGV

A

Doxycycline 100mg BD for 3/52

Or

Erythromycin 500mg qds for 3/52 if preggers

90
Q

Mx of epididymorchitis

A

Ceftriaxone 500mg stat plus doxy 100mg BD for 14/7

91
Q

NGU how to diagnose and Rx

A

Doxycycline 100mg bd for 7/7

Urethral smear

5 or more PMNLs

If smear neg- do early morning smear

Rx partners

92
Q

Rx of persistent NGU

A

Recurrence within 1-3/12 of Rx

Azithromycin 500mg stat then 250mg for 4/7 plus metronidazole 400mg BD for 5/7

MFSRH (8 decks)

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