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Reproductive Health Block > GUM > Flashcards

GUM Flashcards

1
Q

How do barrier contraceptives work?

A

They prevent the sperm from coming into contact with the ovum

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2
Q

What is one of the big benefits of most barrier contraceptives?

A

Decreased transmission of STIs

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3
Q

What are the types of barrier contraception?

A

Male condom
Female condom
Diaphragms
Cervical caps

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4
Q

Describe how female condoms work.

A

Tubular shape with inner ring that sits in vagina, and outer ring that sits just outside the vulva.

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5
Q

Describe how a diaphragm works?

A

Rigid metal inner frame spanning the posterior fornix and covering the cervix.

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6
Q

Describe how cervical caps work?

A

Sit directly over the cervix, held on by suction and vaginal tone. Spermicide often added to increase efficacy.

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7
Q

What are the advantages to the male condom?

A

No contraindications (unless latex allergic, but alternate materials can be used)
Responsibility shared between both people.
Widely available, simple to use.
Protect against STIs.

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8
Q

What are the benefits of female condom?

A

No contraindications
Less likely to tear than male condom
Protects against some STIs
Can be inserted up to 8 hours before intercourse

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9
Q

What are the benefits of the diaphragm and the cervical cap?

A

Can be inserted up to 3 hours before intercourse.

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10
Q

What are the disadvantages of the male condom?

A

User dependant, and perfect use is rarely achieved.

Can reduce sensitivity/arousal.

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11
Q

What are the disadvantages of the female condom?

A

Perfect use is rarely achieved
Penis can be inserted outside of the condom
Can be noisy or uncomfortable

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12
Q

What are the disadvantages of diaphragms and cervical caps?

A 
Perfect use is rarely achieved
Require planning and careful insertion
Require measuring and fitting to find the correct size
High rate of UTIs
STI transmission is not reduced
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13
Q

With perfect use, what are the efficacy rates of barrier contraceptions?

A

Male condom 98%
Female condom 95%
Diaphragm 94%
Cervical cap 80-91% depending on parity.

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14
Q

Considering the failure rates of barrier contraception, what should we counsel patients to do if the barrier fails or is omitted?

A

Seek emergency contraception from a pharmacy ASAP

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15
Q

What is the primary action of combined hormonal contraception?

A

Inhibits ovulation by preventing LH surge by negative feedback.

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16
Q

In addition to the primary action of combined hormone contraception, how else does it work?

A

Progesterone inhibits endometrial proliferation and thickens cervical mucus

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17
Q

What forms does combined hormonal contraception come in?

A

COCPs
Transdermal patch
Contraceptive vaginal ring

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18
Q

What kind of COCPs are there, and how do they work?

A

Monophasic pills - same amount of hormones in each pill. 21 day cycle with a 7 day break.
Phasic pills - varying amounts of hormone throughout the cycle. May be biphasic, triphasic, or quadraphasic. Important to take them in the correct order.

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19
Q

Give 2 examples of brands of monophasic COCP.

A

Microgynon 30

Brevinor

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20
Q

Give 2 examples of phasic COCP brands.

A

QIaira

BiNovum

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21
Q

How does the transdermal patch work?

A

Apply and change every 7 days over 3 weeks, with a one week break. Withdrawal bleed usually occurs.

Very sticky, can stay on while bathing or swimming.

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22
Q

How does the contraceptive vaginal ring work?

A

120 micrograms etonogestrel and 15 micrograms ethinyl estradiol per day deposited into vagina.
Sits in place for 21 days, rest for 7 days.

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23
Q

What are the advantages of combined hormonal contraceptives?

A

Non invasive.
If taken correctly, more effective than barrier.
Menses can be regulated and lighter/less painful.
Reduce risk of ovarian, uterine, and colon cancer, and ovarian cysts.
Return to normal fertility immediately after stopping use.

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24
Q

What are the disadvantages of combined hormonal contraception?

A

User dependant
Side effects (headaches, breast tenderness, mood wings)
BP may increase
Breakthrough bleeding may occur
Small risk of VTE, MI/stroke, breast and cervical cancer

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25
Q

What are the contraindications to combined hormonal contraception?

A 
BMI over 35
Breast feeding
Smoking over age 35
HTN
Personal or FHx of VTE
Prolonged immobility
Diabetes mellitus with complications
Migraine with aura
Breast cancer or primary liver tumours
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26
Q

How effective are combined hormonal contraceptives when used perfectly?

A

99.7% effective

91% with typical use

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27
Q

What is something key to consider with hormonal contraceptives?

A

There is no protection against STIs.

It is also important to counsel them on what to do if they miss a pill.

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28
Q

What is the mechanism of action of the POP?

A

Thicken cervical mucus primarily.

Suppresses ovulation to varying degrees also, depending on the type of pill.

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29
Q

What are the 5 POPs licensed in the UK?

A 
Femulen
Norgeston
Noriday
Micronor
Cerazette
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30
Q

What are the advantages of the POP?

A

More effective than barrier when taken correctly.
No need to interrupt intercourse.
Used when COCP is contraindicated.
May reduce risk of endometrial cancer.

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31
Q

What are the disadvantages of the POP?

A 
User dependant
Have to be taken at the same time every day
Can deregulate menses
Some adverse effects
30% increased risk in ovarian cysts
Small increased risk of breast cancer
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32
Q

When is the POP contraindicated?

A

Current or PMHx of breast cancer
Liver cirrhosis or tumours
Weight over 70kg lowers efficacy
Stroke or coronary heart disease

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33
Q

What is the UK licensed progesterone only implant? How does it work?

A

Nexplanon - 40mm long plastic tube inserted into upper arm.

Releases 68mg of etonogestrel over 3 years.

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34
Q

How does the progesterone implant work?

A

Primarily inhibits ovulation and thickens cervical mucus, and thins endometrium.

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35
Q

What are the advantages of the progesterone implant?

A

Extremely effective - one of the smallest failure rates.
Can be used where COCP contraindicated.
In situ for 3 years
Can use during breast feeding
Normal fertility returns quickly after removal
Effective in women of all BMIs

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36
Q

What are the disadvantages of the progesterone implant?

A

50% of women experience change to menstrual cycle, irregular patterns common.
Fitting/removal can be painful, bleed, and cause irritation.
Small risk increase for breast cancer.
Can bend or break in situ.

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37
Q

When is the progesterone implant contraindicated?

A 
Pregnancy
Unexplained vaginal bleeding
Liver cirrhosis or tumours
Hx of breast cancer
Stroke or TIA with implant in situ
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38
Q

How many injectable progesterone contraceptives are there available in the UK?

A

3:
Depo-Provera
SAYANA PRESS
Noristerat

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39
Q

How frequently are the injectable contraceptives given?

A

Every 8-13 weeks depending on brand.

Depo-Provera = most common = given every 12 weeks IM.

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40
Q

How does the progesterone injection work?

A

Inhibits ovulation

Thickens cervical mucus

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41
Q

What are the advantages of the progesterone injection?

A

Very effective.
Long term - don’t have to worry about contraception.
No known drug interactions.
Can be used when COCP is contraindicated.
Can be used in women BMI over 35

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42
Q

What are the disadvantages of the progesterone injection?

A

Not rapidly reversible - can take up to a year to return to normal fertility.
Altered bleeding patterns inc. persistent bleeding
Weight gain
Slight increase in breast cancer
Loss of bone mineral density if used over a year

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43
Q

What are the contraindications to the progesterone injection?

A 
Current breast cancer
Hx of severe arterial disease
Pregnancy
Diabetes with complications
Those who want quick return to fertility
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44
Q

How effective is the progesterone injection with perfect use?

A

99.8% effective

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45
Q

How long does an IUD/IUS stay in situ?

A

It can stay in for up to 5 years

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46
Q

What is the IUD?

A

Copper coil which is toxic to sperm and inhibits implantation

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47
Q

What is the IUS?

A

Levonorgestrel-releasing coil which thins endometrium and thickens cervical mucus.

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48
Q

How effective is the IUD/IUS?

A

Over 99% effective but do not offer any protection against STIs

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49
Q

When can an IUD/IUS be inserted?

A

At any point in the menstrual cycle

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50
Q

What would you tell a patient who wants an IUD/IUS inserting about the procedure?

A

Takes about 20 minutes.
Bimanual examination then speculum examination to visualise cervix.
Insertion of a cervical dilator or sizer.
Small plastic T shaped device is inserted into uterus via cervix and remains there. Strings are cut to suit patient so the coil can be removed.

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51
Q

Should an STI screen be performed before insertion of a coil?

A

It is usually performed 2 weeks before insertion as recent STI exposure is an absolute contraindication for the coil.

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52
Q

Which coil can be used as emergency contraception?

A

The copper coil if inserted within 5 days of UPSI

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53
Q

What are the indications for the IUS other than contraception?

A

First line for treatment of heavy menstrual bleeding.

Second line for dysmenorrhoeaa

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54
Q

When are coils contraindicated?

A 
Infection -hx of PID, STI, or infection of the uterus.
Pregnancy/up to 4 weeks post partum
Abnormal structure of uterus
Gynae malignancy
Current unexplained vaginal bleeding
Copper allergy
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55
Q

What specific contraindications are there for the IUS?

A

Current DVT or PE
Current liver disease
History of breast cancer

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56
Q

What are the advantages of the coil?

A

Over 99% successful
Quick return to normal fertility after removal
Can be fitted at any time of cycle and during breastfeeding
Good when COCP contraindicated
Mirena helps with heavy/painful periods
Copper coil has no hormones

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57
Q

What are the disadvantages of the coil?

A

No protection against STIs
Risk of ascending or iatrogenic infection
Risk of uterine perforation when inserted
Risk of body expelling the coil
Irregular bleeding for up to 6 months after insertion
Can be painful
Higher risk of ectopic pregnancy
Cervical dilation increases risk of seizures in epileptics

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58
Q

What can be used as emergency contraception?

A

IUD/Copper coil
Levonorgestrel morning after pill (Levonele One Step)
Ulipristal acetate morning after pill (EllaOne)

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59
Q

When is emergency contraception indicated?

A

UPSI or contraception method has failed.

Missed pills may require emergency contraception depending on how many have been missed.

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60
Q

How does the levonorgestrel morning after pill work?

A

Synthetic progesterone that delays ovulation for 5-7 days until the sperm is no longer viable.

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61
Q

When can someone take the levonorgestrel pill?

A

Within 72 hours of unprotected sex

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62
Q

When can someone take the ulipristal acetate/ellaone pill?

A

Within 120 hours of unprotected sex

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63
Q

How does the ulipristal acetate pill work?

A

Progesterone receptor modulator that delays ovulation by 5-7 days by which time the sperm have become non-viable.

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64
Q

Why might someone choose the copper IUD over a pill as emergency contraception?

A

It can provide contraceptive cover for 5-10 years after insertion!

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65
Q

When would the levonorgestrel morning after pill be contraindicated?

A

There are no absolute contraindications.

May have reduced efficacy in diseases of malabsorption, or when they are taking enzyme-induing drugs e.g. rifampicin.

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66
Q

When would the ulipristal acetate morning after pill be contraindicated?

A 
May have reduced efficacy in diseases of malabsorption
Severe hepatic dysfunction
Enzyme inducing drugs
Breast feeding
Asthma controlled by steroids
Drugs increasing gastric pH
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67
Q

When is the copper IUD contraindicated for emergency contraception?

A

Uterine fibroids causing cavity distortion
PID (diagnosed or suspected)
STI (documented or suspected)

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68
Q

What safety-netting/aftercare advice do you need to give to someone who has taken a morning after pill?

A

Verbal and written.
Seek help if vomiting occurs within 2 hours (levonorgestrel) or 3 hours (ulipristal).
If UPSI occurs again, the pill only covers the original episode.
ADRs inc. nausea, dizziness, menstrual disturbance, and abdominal pain.

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69
Q

Can levonorgestrel be used more than once in a cycle?

A

Yes

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70
Q

Can ulipristal acetate be used more that once in a cycle?

A

It didn’t used to be recommended, but now it can be.

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71
Q

What is PID?

A

Pelvic inflammatory disease is an infection of the upper genital tract in females, affecting the uterus, fallopian tubes, and ovaries.

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72
Q

What age group is PID most common in?

A

Ages 15-24

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73
Q

Where does the infection come from in PID?

A

Lower genital tract e.g. vagina or cervix

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74
Q

What are the common causes of PID?

A 
Chlamydia trachomatis
Neisseria gonorrhoea
Streptococcus
Bacteriodes
Anaerobes
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75
Q

What are the risk factors for PID?

A 
Sexually active
Age 15-24
Recent partner change
Intercourse without barrier contraception
Hx of STIs or PID
76
Q

Can PID be iatrogenic?

A

Yes - can be caused by instrumentation of the cervix

77
Q

What are the symptoms of PID?

A 
May be asymptomatic
Lower abdo pain
Deep dyspareunia
Menstrual abnormalities
Post-coital bleeding
Dysuria
Abnormal vaginal discharge
78
Q

If a woman with suspected PID has fever and nausea and vomiting, what might be the problem?

A

Severe PID which may go on to sepsis

79
Q

What signs may a patient with PID have?

A

Adnexal tenderness
Cervical excitation
May have a palpable mass in lower abdomen
Abnormal vaginal discharge

80
Q

What are the differentials for PID?

A

Ectopic pregnancy
Ruptured ovarian cyst
Endometriosis
UTI

81
Q

How is suspected PID investigated?

A 
Urine dip +/- MSU
Pregnancy test
Endocervical swabs and full STI screen
TVUS if severe or diagnosis uncertain 
Laparoscopy if diagnosis uncertain
82
Q

What does Neisseria gonorrhoea look like on microscopy?

A

Diplococci

83
Q

How is PID managed?

A

Antibiotic therapy

84
Q

What antibiotic therapy is used for PID?

A

14 days of broad spectrum antibiotics with good anaerobic coverage. Start immediately, before swab results are available.

85
Q

What are the 2 options for broad spec abx for PID?

A
  1. Doxycycline 100mg BD 14 days + Ceftriaxone 500mg stat + Metronidazole 400mg BD 14 days
  2. Ofloxacin 400mg BD 14 days + Metronidazole 400mg BD 14 days
86
Q

Aside from abx, what other Mx should be considered/advised in PID?

A

Analgesics such as paracetamol
Rest and avoid sexual intercourse
Contact tracing
Admission if severe symptoms/signs of peritonitis/unresponsive to oral meds

87
Q

What are the complications of PID?

A 
Ectopic pregnancy
Infertility
Tubo-ovarian abscess
Chronic pelvic pain
Fitz-Hugh Curtis syndrome
88
Q

How does PID increase the risk of ectopic pregnancy?

A

Infection causing adhesions causing narrowing and scarring of fallopian tubes.

89
Q

How common is infertility as a consequence of PID?

A

Affects 1 in 10 women with PID

90
Q

What is Fitz-Hugh Curtis syndrome?

A

Perihepatitis that usually causes right upper quadrant pain

91
Q

What is the causative organism in chlamydia?

A

Chlamydia trachomatis bacterium - intracellular gram negative bacterium with different serotypes

92
Q

What is the most commonly reported bacterial STI in the UK?

A

Chlamydia - 46% of all STI diagnoses

93
Q

Which Chlamydia serotypes cause GU infections

A

Serotypes D-K

94
Q

How is a chlamydia infection transmitted?

A

Unprotected vaginal, anal , or oral sex, or direct skin-to-skin contact of the genitals.

95
Q

Where can a chlamydia infection occur outside of the genitals?

A

In the eyes - chlamydial conjuncitivitis.

Rectum

Pharynx

96
Q

How can chlamydial conjuncitivis occur?

A

Infected semen or vaginal fluid enters the eye.

97
Q

Can chlamydia be passed vertically?

A

Yes - it can be passed from mother to baby during delivery.

98
Q

How does C. trachomatis infected cells in the body?

A

It entters a host cell in its infectious form. It then changes into non-infective form which is capable of replication. After replication it changes back into its infectious form, causing the cell to reupture and spread the infection to other cells.

99
Q

What are the risk factors of chlamydia?

A
  • Age under 25
  • Sexual partner positive for chlamydia
  • Recent change of sexual partner
  • Co-infection with another STI
  • Use of no or non-barrier contraception
100
Q

Is chlamydia always symptomatic?

A

No - 50% of infected men and 70% of infected women don’t know they have it.

101
Q

How long is the incubation period for chlamydia?

A

7-21 days

102
Q

When chlamydia does cause symptoms in a woman, what symptoms are common?

A
  • Dysuria
  • Abnormal PV discharge
  • Intermenstrual/post-coital bleeding
  • Deep dyspareunia
  • Lower abdominal pain
103
Q

When chlamydia does cause symptoms in a man, what symptoms are common?

A
  • Urethritis - dysuria and urethral discharge

- Epididymo-orchtis and testicular pain

104
Q

What signs of chlamydia can be seen in a woman?

A
  • Cervicitis +/- contact bleeding
  • Mucupurulent endocervical discharge
  • Pelvic tenderness
  • Cervical excitation
105
Q

What signs of chlamydia can be seen in a man?

A

Epididymal tenderness

Mucupurulent discharge

106
Q

If a patient has ?chlamydia, how should they be investiagted?

A

Do a full STI screen as the common presenting symptoms are similar for many STIs and they commonly occur alongside each other.

107
Q

Which STIs are particularly hard to differentiate from each other?

A

Chlamydia and gonorrhoea

108
Q

How does the National Chlamydia screening programme work?

A

Under 25s are offered chlamydia testing as part of routine primary care and sexual health consultations, as well as eductaion about testing which is available from pharmacies, universities, and contraception clinics across the UK.

109
Q

What is NAAT and what does it test for?

A

Nucleic acid amplification test - used to investigate specimens for chlamydia as it is too small to be seen by microscopy.

110
Q

What specimen is taken from women to test for chlamydia?

A

Vulvo-vaginal swab is first choice.

Endocervical swab or first catch urine sample can also be used.

111
Q

What specimen is taken from men to test for chlamydia?

A

First catch urine sample if first choice.

Urethral swab can also be used.

112
Q

Other than swabs, what other investiagtion needs to bedone for chlamydia?

A

Contact tracing and full STI screen.

113
Q

How is uncomplicated chlamydia treated once it has been diagnosed?

A

Antibiotics -combination of:

  • Doxycycline 100mg BD for 7 days
  • Azithromycin 1g stat dose
114
Q

If a pt with chlamydia is allergic to doxycycline or azithromycin, or it is otherwise contraindicated, how can chlamydia be treated?

A

Erythromycin 500mg BD 10-14 days
+
Ofloxacin 200mg BD/400mg OD for 7 days

115
Q

What advice is given to patient’s on treatment for chlamydia?

A

Avoid sexual intercourse/other sexual contact until they +/or partner have completed treatment.

116
Q

When is test of cure required for a chlamydia infection?

A

If the pt is pregnant, symptoms persist, or compliance has been poor.

117
Q

What complications can occur in women following a chlamydia infection?

A

Ascending infection -> salpingitis +/or endometritis

PID

Perihepatitis
Increased risk of ectopic pregnancy
Risk of decreased fertility

118
Q

What complications can occur in men following a chlamydia infection?

A

Epididymitis
Epididymo-orchitis
Risk of decreased fertility.

119
Q

What complications of chlamydia can occur in women and men?

A

Sexually acquired reactive arthritis -> joint, eye, and urethral inflammation.

120
Q

What effect can chlamydia have on pregnancy?

A

Increased risk of:

  • Premature delivery
  • Low birth weight
  • Miscarriage
  • Stillbirth
121
Q

What are the drugs of choice for treating chlamydia in pregnancy? Why?

A

Azithromycin and erythromycin.

Doxycycline and ofloxacin are teratogenic.

122
Q

How does a neonatal chlamydia infection present?

A
  • Inflammation and discharge in eyes 5-12 days after birth

- May develop pneumonia up to 3 months after birth

123
Q

How is neonatal chlamydia treated?

A

Oral erythromycin

124
Q

What is bacterial vaginosis?

A

A non-sexually transmitted infection of the lower genital tract caused by disturbance of the normal vaginal flora.

125
Q

How does the vaginal pH change in bacterial vaginosis?

A

It increases i.e. becomes less acidic.

126
Q

What is the most common cause of abnormal vaginal discharge in women of childbearing age?

A

Bacterial vaginosis?

127
Q

Which bacteria is mainly responsible for maintaining the low pH of the vagina?

A

Lactobacilli bacteria

128
Q

Tell me about lactobacilli bacteria.

A

Large, rod-shaped bacteria
Produce hydrogen peroxide
Commonly found in the vagina

129
Q

At what pH is the vagina normally maintained?

A

Under pH 4.5

130
Q

Why does the vagina need to be maintained at a pH under 4.5?

A

To inhibit the growth of abnormal microorganisms

131
Q

What organisms are normally responsible for bacterial vaginosis?

A

Gardnerella vaginalis
Anaerobes
Mycoplasmas

132
Q

What are the risk factors associated with bacterial vaginosis?

A
  • Sexual activity (although not an STI)
  • IUD use
  • Receptive oral sex
  • STI presence
  • Vaginal douching
  • Recent abx use
  • Smoking
  • Ethnicity - more common in black women
133
Q

What is the characteristic smell associated ith bacterial vaginosis?

A

Offensive fishy smelling vaginal discharge

134
Q

How does bacterial vaginosis appear on examination?

A

Offensive fishy smelling vaginal discharge which is thin, white/grey, and homogenous.

135
Q

What are the 3 elements to diagnosing bacterial vaginosis?

A

History
Vaginal examination
Microscopy

136
Q

How is bacterial vaginosis diagnosed microscopically?

A

High vaginal smear

Gram stained and examined for clue cells, reduced no. lactobacilli, and absence of pus cells.

137
Q

Other than microscopy, how can BV be diagnosed?

A

Vaginal pH over 4.5 and KOH whiff test (but this is rarely done in practice)

138
Q

Do all women with BV need treating?

A

No - if they are asymptomatic they may opt for no treatment, and just modify risk factors and wait for resolution.

139
Q

If a woman with BV dose want to take abx, what is given?

A

Metronidazole orally - 400mg BD for 5-7 days

OR

Metro 2g stat dose

OR

Metro gel applied directly to vagina

140
Q

What lifestyle modifications can be done to treat BV?

A
  • Stop vaginal douching
  • Avoid scented shower gels, antiseptic agents, or shampoos in bath.
  • Removal of IUD
141
Q

Is BV in pregnancy significant?

A

Yes - if it is untreated and symptomatic it can increase risk of premature birth, miscarriage, and chorioamnionitis.

142
Q

What is vulvovaginal candidiasis also known as?

A

Thrush or a yeast infection

143
Q

What age group of women is thrush most common in?

A

Women aged 20-40

144
Q

How common is thrush?

A

Very - most women will experience it at some point in their lives.

145
Q

What is the most common cause of candidiasis?

A

Candida albicans, a commensal organism.

146
Q

What are most cases of thrush thought to be?

A

Opportunistic infections

147
Q

What % of women carry candida normally without any problem?

What does this mean practically?

A

Around 20%

A swab won’t necessarily tell us anything.

148
Q

When are women at increased risk of candidiasis?

A
  • During pregnancy
  • If they have diabetes
  • Use of broad spec abx
  • Use of corticosteroids
  • If they are immunosuppressed or have compromised immune system
149
Q

What are the typical symptoms of thrush?

A
  • Vulval pruritis
  • White, curd-like non-offensive vaginal discharge
  • Dysuria (superficial)
150
Q

Which symptom usually dominates in a vulvovaginal candidiasis presentation?

A

Vulval pruritis

151
Q

What signs can be found on examination of a woman with vulvovaginal candidiasis?

A
  • Erythema and swelling of vuvla
  • Satellite lesions
  • Curd-like vaginal discharge
152
Q

What are the common infectious differentials for candidiasis?

A

BV or TV

UTI is also possible

153
Q

What investigations should be done for suspected candidiasis?

A

None - a good history is all that is really needed. A vaginal pH can be done if the pt is examined to rule out BV.

If underlying condiiton suspected e.g. in recurrent cases, can Ix for that.

154
Q

How should uncomplicated vulvovaginal candidiasis be managed?

A

Intravaginal antifungal inserted into vagina
OR
Oral antifungal

alongside topical imidazole for vulval symptoms

155
Q

What topical antifungals are used to treat candidiasis?

A

Clotrimazole or fenticonazole

156
Q

What oral antifungals are used to treat candidiasis?

A

Fluconazole or itraconazole

157
Q

If a simple case of vulvovaginal candidiasis dose not resolve after 7-14 days following treatment, what should be considered?

A
  • An alternate diagnosis
  • An underlying risk factor
  • Patient not taking medication properly or at all
158
Q

What can be recommended to help avoid candidiasis?

A
  • Use soap substitutes
  • Avoid cleaning vaginal area more than once per day
  • Avoid potential irritants
  • Avoid wearing tight fitting underwear/tights
159
Q

Why is pregnancy is risk factor for candidiasis?

A

Increased oestrogen levels by increasing glycogen production and directly promoting candida growth.

160
Q

How should candidiasis in pregnancy be managed?

A
  • Treat with topical antifungals (intravaginal and vulval)
  • Avoid oral antifungals
  • Insert intravaginal treatment carefully
  • Refer to GUM if STI suspected
161
Q

How long is the treatment period for candidiasis in a pt with immune compromise?

A

7-14 days

162
Q

What organism causes syphilis?

A

Treponema pallidum

163
Q

Is incidence of syphilis on the rise?

A

Yes

164
Q

How can syphilis be transmitted?

A

By sexual contact, vertically from mother to foetus, and through infected blood products.

165
Q

What is a chancre?

A

An infectious hard ulcer caused by Treponema pallidum bacteria.

166
Q

How long after contact with does a chancre form in syphilis?

A

Incubation period is 2-3 weeks.

167
Q

What stage of syphilis is characterised by chancre formation?

A

The first stage aka Primary syphilis

168
Q

How does T. pallidum cause systemic damage?

A

If left untreated it causes obliterating arteritis - endothelial cells of vessels proliferate causing vessels to narrow -> ischaemia.

169
Q

What are the risk factors for syphilis?

A
  • Unprotected sex
  • Multiple sexual partners
  • MSM
  • HIV infection
170
Q

How can acquired syphilis be divided?

A

Primary and Secondary

Early latent, late latent, and late symptomatic

171
Q

What is primary syphilis?

A

Local infection after 2-3 weeks incubation period

172
Q

What is secondary syphilis?

A

Generalised infection after 6-12 weeks incubation

173
Q

What is early latent syphilis?

A

Asymptomatic syphilis of less than two years’ duration.

174
Q

What is late latent syphilis?

A

Asymptomatic syphilis of two years’ duration or longer

175
Q

What is late symptomatic syphilis?

A

AKA tertiary syphilis - Cardiovascular syphilis, neurosyphilis, gummatous syphilis

176
Q

What comes just before a syphilis chancre?

A

A papule

177
Q

Is a chancre a painless or painful ulcer?

A

Painless

178
Q

What are the symptoms of secondary syphilis?

A
  • Rash on hands and soles of feet
  • Fever
  • Malaise
  • Arthralgia
  • Weight loss
  • Headaches
179
Q

What are the signs of secondary syphilis?

A
  • Condylomata lata (elevated plaques on moist areas of skin)
  • Painless lymphadenopathy
  • Silvery-grey mucous membrane lesions
180
Q

How does gummatous syphilis present?

A

As syphilis in the bone, skin, mucous membranes of URT, mouth, viscera or connective tissue. Presentation depends on site.

181
Q

How does neurosyphilis present?

A
  • Dementia
  • Argyll Roberston pupil
  • Meningovascular complications
  • Tabes dorsalis
182
Q

What is Tabes dorsalis?

A

A form of neurosyphilis characterised by:

  • ataxia
  • numb legs
  • absence of deep tendon reflexes
  • lightning pain
  • loss of pain and temperature sensation
  • skin and joint damage.
183
Q

How does cardiovascular syphilis present?

A
  • Aortic regurgitation, aortic valvulitis, aortic root dilation
  • Angina (stenosis of coronary arteries)
  • AA dilation and calcification
184
Q

How should syphilis be investigated?

A
  • Do full STI screen
  • Dark ground microscopy
  • PCR swab from active lesion
  • Serology
185
Q

How should neurosyphilis be investigated?

A

Lumbar puncture for antibody testing of CSF

186
Q

https://teachmeobgyn.com/sexual-health/sexually-transmitted-infections/syphilis/

A

https://patient.info/doctor/syphilis-pro

Reproductive Health Block (10 decks)

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