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GUM Lectures Flashcards

1
Q

Causes of proctitis

A 
LGV lymphomagranuoma venerum
Gonorrhoea
non-LGV chlamydia
herpes 
shigella
Hep A

Other: IBS, haemorrhoids,/polyps, malignancy

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2
Q

What causes LGV

A

1/3 invasive servers of chlamydia trachomatis. L1,L2, L3. Rectal chlamydia, seen most commonly in homosexual men

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3
Q

Classical presentation of LGV

A

proctitis
ulceration
inguinal lymphadenopathy
buboes

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4
Q

D.D testicular pain

A

infections
trauma
torsion
tumours (rare)

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5
Q

investigations for testicular pain

A

infection:

  • first void urine (chlamydia & gonnorhea)- more likely
  • mid-stream (urinary pathogens)
  • swabs
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6
Q

what is acute epididymis-orchitis

what must u exclude

A

Clinical syndrome of pain, swelling and inflammation of the epididymis +/- testes (MUST EXCLUDE TORSION)

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7
Q

Where does the infections come from?

A
  • local from utethra (STI or enteric organism)
  • bladder (urinary)
  • MUMPS orchitis & TB (high risk groups)
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8
Q

Signs of acute epididymis-orchitis on examination

A

Tenderness on affected side, may be bilat
Palpable swelling of epididymis (tail to head)
There may also be:
o urethral discharge
o secondary hydrocele
o erythema and/or oedema of the scrotum on the affected side
o pyrexia

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9
Q

Investigation for acute epididymo-orchitis

A

Microscopy: urethral or FPU
Urethral culture
NAATs (FPU)
Dipstick & MSU

Other: consider MUMPS & TB

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10
Q

Treatment

A

Abstain

Ceftriaxone + prolonged course of doxycycline

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11
Q

What skins/musuc membranes and STIs spread to

A

Eye: bacterial conjunctivitis (chlamydia & gonorrhoea)

Sexually acquired reactive arthritis: <1% chlamydia

Disseminated gonococcal infection

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12
Q

What is reiter’s syndrome?

A

triad of urethritis, arthritis, conjunctivitis

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13
Q

complication of chlamydia in pregnancy

A

Associations with IUGR, Premature rupture of membranes, pre-term delivery, low birth weight

Need to treat quickly to prevent complications to baby & prevent reinfection.

Risk already have complications

(azythromycin + follow up)

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14
Q

complication of gonoorhoea in pregnancy

A

Low birth weight, preterm birth

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15
Q

complications in neonatal period?

A

ophthalmia neonatorum: presents 1-2 weeks due to chlamydia = conjunctivitis & purulent discharge

neonatal pneumonitis due to chlamydia

both need systemic antibiotics (erythromycin)

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16
Q

Causes of ulcers on foreskin

A

Herpes simplex
Genital warts (HPV)
syphilius

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17
Q

What investigations would you do?

A

Swab from ulcer

Blood test:
HIV/Syphilis

Urine test: chlamydia & gonorrhoea

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18
Q

Describe the two types of herpes

Median recurrence rates after primary for each?

A

HSV1: oral & genital (more common), recurrent 1 x year

HSV2: recurrent anogenital symtoms, approx 4 x year

Very painful

Outbreaks tend to be in same dermatome

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19
Q

Are reactivations always symptomatic?

A

No: can be asymptomatic (20%): viral shielding (still infectious)

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20
Q

Treatment of herpes simplex.

A
  1. Treat the pain!
  • Salt water bathing + urinate in the shower
  • Topical anaesthetic/oral analgesia.
  • Aciclovir 400mg 3 x a day for 5 days.
21
Q

Patient info:
1) How is HSV spread?

2) is it going to come back?
3) Can I pass it on to someone else?
4) Can they have sex?

A

1) Direct contact with mucous membrane or skin

2) This was probably a primary episode
Frequency of recurrence depends on type
HSV 1 (orolabial and genital)	~1 / year
HSV 2 (genital)		~4 / year
Recurrence rates usually decrease over time
Asymptomatic in 20%

3) Virus now latent in local sensory ganglia. Most infectious during a recurrence.
Asymptomatic viral shedding occurs

4)
- Acknowledge distress
- Condoms reduce transmission
- Avoid sex during recurrences
- Disclosure is advised and should be documented

22
Q

Single, non tender ulcer on penis.

MSM/homosexual

Likely cause?
Tests?

Discussion?

A

Syphilis, cancer

Blood test
Swab: Dark ground microscopy (diplococci & pus cells: urithtitis) & PCR

  • Heb B vaccine (accelerated) course.
  • Partner notification
  • HIV risk
  • Safer sex
  • Repeat ‘window period’ bloods
23
Q

Single, non tender ulcer on penis. MSM/homosexual

Likely cause?

Tests?

Discussion?

A
  1. Syphilis.

shingles, apthous ulcers, lichen sclerosus/planus/ malignancy (PIN,VIN). severe eczema, Crohns, moon’s blaanitis/

Blood test
Swab: Dark ground microscopy (diplococci & pus cells: urithtitis) & PCR
Urine

  • Heb B vaccine (accelerated) course.
  • Partner notification
  • HIV risk
  • Safer sex
  • Repeat ‘window period’ bloods
24
Q

What bacteria causes syphilis & appearance on dark-field microscopy

A

Treponema pallidum

spirochaete bacterium

25
Q

What are the early stages & signs of syphilis

A

Primary: chancre (site of inoculation)

Secondary: systemic signs: rash (maculo, papula), alopecia, hepatitis, neurological, condyloma lata

Signs last up to 3 months.

Then become asymptomatic and becomes latent.

26
Q

How to know if its early latent

A

Confirmed negative test in last 20 years

27
Q

How to know if its early latent

A

Confirmed negative test in last 2 years

28
Q

What are the late stages & signs of syphilis

A

1st asymptomatic then….
CV: aortic root involvement
Gummatous nodules
Neurological problems

29
Q

How to treat late syphilis

A

3 injections

Do full CV, neuro exam

30
Q

What is coronal papilli

A

normal variant, small pearly papule around edge of glans of penis

Also can get vulval

31
Q

epidermal cyst?

A

lumps on penis, normal variant, may get bigger or shrink

32
Q

How to diagnose warts?

D.D

A

Clinical: small fleshy growths, bumps or skin changes that appear on or around the genital or anal area.

Molluscum contangiosum

33
Q

What causes warts?

Transmission

A

HPV: 6,11 >90% genital warts

Cancer: 16&18: unlikely to cause warts

Skin to skin contact during sexual contact

34
Q

When did I get them?

A

Incubation period: average 3 months
3 weeks-2yrs

often from asymptomatic partner. Most infectious when visible warts

35
Q

how long will i have them?

A
  • usually resolve in 3 months
  • median duration of HPV : 1 yr
  • often reoccur
36
Q

Do condoms eliminate risk of transmission?

A

No, only reduce it. Still advised.

37
Q

Treatment

A

“Ablative” therapies
Cryotherapy
Podophyllotoxin cream/solution
Electrocautery

Immune modulation
Imiquimod 5% cream: keratinised warts, persistent or recurrent warts
Lower recurrence rate (30%)

Surgical
Curettage
Excision
Debulking

38
Q

Will my girlfriend get cervical cancer?

A

Low risk HPV subtypes (6,11) exceptionally unlikely to cause pre-malignant change

High risk HPV subtypes (16,18) unlikely to cause visible warts
Girlfriend should attend for cervical screening as normal

HPV vaccination for girls since 2008 (initially 16/18 only, quadrivalent vaccine since 2012) – MSM vaccination pilot started

Universal vaccination advocated

39
Q

What are fordyce spots

A

are visible sebaceous glands that are present in most individuals. They appear on the genitals and/or on the face and in the mouth.

40
Q

Man detected with gonorrhoea, has pregnant wife & multiple males partners.

He refuses to tell wife/partners and does not come to appoitment.

What should u do? Can you break confidentiality?

A

Can break confidentiality:
-To protect individuals or society from risk of serious harm e.g. serious communicable diseases or serious crime

  • Always seek patient’s consent if practicable
  • Consider any reasons for refusal of consent
41
Q

Teenager comes with friend/person to GU clinic? What do u want to know

A

Name of teenager, school attending.

Who is the friend, sex, relationship, age.

42
Q

What are the Fraser guidelines?

Who do they apply to?

A

young person will

  • understand advice
  • cannot be persuaded to inform parents
  • likely to begin, or continue having sex with or without contraceptive treatment
  • w/o contraceptive - physical, mental or both health will suffer
  • best interest

13-16 sexually active

43
Q

what if under 13?

A

legally rape- requires investigation. Incapable of consenting.

44
Q

Is there a legal obligation to report sex aged 13-16?

A

Not unless exploitation is suspected.

45
Q

0-18 when can info be disclosed?

A
  • risk of neglect or sexual, physical or emotional abuse
  • information would help in the prevention, detection or prosecution of serious crime
  • child saviour at risk of others- serious harm: addiction, self-harm, joy-riding?
46
Q

3 top counselling priorities for underage sex?

A
  • Contraception
  • STI screening
  • She should Inform parents
47
Q

What is the Swiss Statement 2008

A

Described the HIV transmission risk for someone on stable ARV therapy with (VL < 50) as “negligible” and “similar to risks of daily life”

  • Has an undetectable viral load for at least 6 months
  • Has excellent adherence
  • Has no other STIs

Partner should still be informed & it should be their decision to have unprotected sex- the risk is not 0

48
Q

Can you disclose HIV status to a partner?

A

Yes (but encourage her first)

49
Q

Break confidentiality

A

HIV/AIDs
Gon
Syphilis

GOSH (13 decks)

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