GUM

Question 1

Bacterial vaginosis Ix:

Answer 1

pH
Whiff
Gram stain
HIV
NAAT
VDRL (syphilis)

Question 2

Bacterial vaginosis Rx

Answer 2

PO/PV Metronidazole 5-7d
or
Topical clindamycin
Avoid douching and washing

Question 3

Risks of bacterial vaginosis in pregnancy

Answer 3

preterm labour

chorioamonitits

Question 4

Vulvovaginal Candidiasis most women

Answer 4

PV antifungal (clotrimazole, econazole, miconazole)
PO antifungal (fluconazole, itraconazole)

Question 5

VV Candidiasis >60 yo

Answer 5

Oral more acceptable for eae

Question 6

VV candidiasis 12-15yo

Answer 6

topical 1% clotrimazole 2-3/daily

NOT intravaginal

Question 7

Pregnanct VV candidiasis

Answer 7

intravaginal clotrimazole (NOT oral antifungals)

Question 8

Vulval symptoms of candidiasis

Answer 8

Topical imidazole + oral/intravaginal

Question 9

Canesten

Answer 9

intravaginal clotrimazole or oral fluconazole can be purchased OTC

Question 10

Recurrent VV candidiasis

Answer 10

> 4/yr
check compliance
Confirm diagnosis (high vaginal swab)
Exclude predisposing (eg DM)

Question 11

Advise VV Candidiasis

Answer 11

Return if not resolved 7-14d
Avoid: excess cleaning, biological washing powder, non absorbant clothing
DO NOT treat male partner if asymptomatic

Question 12

VV candidiasis Rx and dose

Answer 12

Local: clotrimazole pessary/cream e.g. PV 500mg stat
Oral: itraconazle 200mg PO BD 1 day or fluconazle 150mg PO stat
Pregnancy: only local rx

Question 13

PACES counselling VV candiasis

Answer 13

RF: recent ABx, oral contraceptive, DM, washing
Explain is a yeast naturally occuring
Explain PV/PO rx
Explain hygiene measures (douching, clothing, washing powder)

Question 14

Trichomoniasis Vaginalis

Answer 14

Ix: pH, whiff, gram-stain, HIV, NAAT

Metronidazole 2g stat

Question 15

Chlamydia Ix

Answer 15

Ix: NAAT and swab

Question 16

Chlamydia Rx

Answer 16

1st line: Doxycycline 100mg BD 7d
2nd line (or pregnancy): azithromycin 3d, erythromycin 10-14d

Recommend STI screen
Refer GUM for partner notif.
FU by 5wks to confirm cure

Question 17

Gonorrhoea

Answer 17

-NAAT and swab
1st line: Ceftriaxone 1g (IM) + Azithromyin 1g (PO)
- safe in pregnancy
alternative = doxy replaces azithromycin

Question 18

Pelvic Inflammatory Disease Ix

Answer 18

1. FBC + CRP (+culture if febrile)
2. Endocervical swab - chlamydia and gonorrohea
3. High vag, swab - anaerobes (BV)
4. Speculum (inflam./damage)
5. Bimanual (mass/cervical excitation
6. Detailed Sexual Hx

Question 19

PID Mx

Answer 19

1. Consider removing IUS/D in situ (if not responsive after 72hr)
2. OutPt ABx if suitable:
   - ceftriaxone 500mg IM (stat)
   - Doxycycline 100mg BD PO 14d
   - Metronidazole 400mg BD PO 14d
   - alternative: ofloxacin PO and metro PO
3. STI screen and contact trace
   - contacts get 1g azithromycin

Question 20

PID: ABx if pyrexial or oral management fails

Answer 20

1st line: IV cefoxitin + doxycycline

2nd line: IV clindamycin and gentamicin

Question 21

PID fertility?

Answer 21

Slightly reduced due to possible tubal damage

Question 22

PID follow up

Answer 22

If OutPt Abx: 72hr to check response
If no improvment admit for IV
2-4 wks after this ensure resolution
Reassure if compliant fertility unlikely to be affected

Question 23

PID Cx

Answer 23

Infertility
Ectopic
Chronic pain
up to 30% require admission at some point

Question 24

PACES counselling of PID

Answer 24

RF: <25, STI, multiple partners
ASSESS if needs admission
Explain is inf. -> womb
Risks:infertility, ectopic, pain
Rx: 1 inj + 2 tablets 14d
NO sex until Rx complete
Recommend STI screen and tracing
Discuss contraception
FU: 3d and 2-4wks

Question 25

Genital Herpes

Answer 25

Ix: clinical, PCR Rx: aciclovir, symptomatic (simple analgesia)

Question 26

Genital Warts

Answer 26

Lesions benign - Rx optional Cryopathy if single + large Topical podophyllotocin if mulitple and non-keratinised Alternative: imiquimod, sinecatechins

Question 27

Syphilis Ix

Answer 27

1. Serology 2. Detection (dark field microscopy/PCR) 3. non-treponemal - RPR - VDRL titre (false -ve early infection, false +ve in rheum disease) 4. ELISA 5. TPPA 4 and 5 will be -ve early in dx repeat in 6wks if suspected

Question 28

Syphilis organism

Answer 28

Treponema pallidum

Question 29

Syphilis Mx

Answer 29

``` IM benzathinepencillin Not available routinely at GP Refer GUM 2nd line: doxycycline warning: Jarisch-Herxheimer so oral pred for preventative Contract tracing ```