GUM

Question 1

How do you investigate BV

Answer 1

microscopy of vaginal discharge

Amsel’s criteria

Question 2

How do you investigate candidiaseis

Answer 2

Microscopy of vaginal discharge +- culture

Question 3

What STIs can you diagnose on NAAT

Answer 3

Trichomoniasis
Chlamydia
GonorrhoEA

Question 4

Explain what triple swab is for and where you take it from

Answer 4

2 endocervical - for chlamydia, gonorrhoea

1 high vaginal - for everything else, from posterior fornix

Question 5

How do you investigate syphilis

Answer 5

Swab of ulcer: Dark ground microscopy

Secondary: Serology for treponema (EIA)

Question 6

Explain pathophys of BV

Answer 6

depletiono of lactobacilli in vaginal flora + aalkaline vaginal pH (>4.5)

Question 7

What are RF for BV

Answer 7

new sexual partner
douching
receiving oral sex

Question 8

How do you manage BV

Answer 8

metronidazole

Question 9

How do you manage candidiasis

Answer 9

intravaginal cream/pessary clotrimazole

OR

PO fluconazole/itraconazole

Question 10

What advice do you give for candidiasis

Answer 10

Return in 1-2 weeks if not resolved
Avoid washing and cleaning with soaps
Avoid washing vulval area more than once daily
Avoid vaginal douching
Avoid washing underwear in biological washing power
Avoid tight fitting clothes

Consider probiotics to relieve sxz

Question 11

Explain trichomoniasis

Answer 11

Vaginal and urethral infection

Caused by trichomonas vaginalis

Question 12

What are symptoms of trichomoniasis

Answer 12

may be asymptomatic 50% of cases
green/yellow offensive frothy discharge
strawberry cervix on examination

Question 13

How do you manage trichomoniasis

Answer 13

metronidazole

Question 14

What are symptoms of gonorrhoe

Answer 14

asymptomatic 50%
altered vaginal discharge
lower bilat abdo pain
rectal infection / pharyngeal infection

Question 15

How d you manage gonorrhoea

Answer 15

IM ceftriaxone 250mg

OR

PO Cefixime 400mg

Question 16

What is the most common bacterial STI

Answer 16

chlamydia

Question 17

How does chlamydia present

Answer 17

asymptomatic
altered vag discharge
lower abdo pain
PCB/IMB

Question 18

How do you manage chlamydiA

Answer 18

PO Doxycycline 100mg BD 7/7
OR
PO Azithromycin 1g STAT

Question 19

What are top three criminals for PID

Answer 19

chlamydia
gonorrhoea
mycoplasma genitalum

Question 20

what are complications of PID

Answer 20

endometrial / fallopian tube damage > INFERTLITITY

Ectopic pregnancy 
Chronic pelvic pain 
Fitz hugh curtis syndrome 
Tubo ovarian abscess 
Adheesions 
PPyosalpinx 
Hydrosalpinx

Question 21

How do you manage PID

Answer 21

Consider IUD removal (unless risk of pregnancy)
Macrolide/tetracycline + METRONIDAZOLE + CEPHALOSPORIN

IMMEDIATE - before swab results

Question 22

What pathogen causes syphilis

Answer 22

Treponema pallidum

Question 23

Explain syphilis progression of infection

Answer 23

primary: chacre (single indurated genital ulcer at site of exposure) - painless, exhudes fluid
+ regional lymphadenopathy

secondary: widespread erythematous rash on palm and soles, condylomata lata
tertiary: neurosyphilis, cardiosyphilis, uveitis, meningitis gumma

Question 24

How do you investigate syphilis

Answer 24

swab of ulcer - dark field microscopy
serology

non-treponemal serological tests: RPR, VDLR

Question 25

How do you manage syphilis

Answer 25

benzathine penicillin IM
single dose

repeat dose if third trimester pregnant/latent infection