gynae Flashcards
fibroid tumours are benign tumours of the
smooth muscle
fibroids are sensitive to which hormone?
oestrogen
common presentation for a fibroid
menorrhagia, prolonged menstruation, abdominal pain, bloating, urinary/bowel symptoms, deep dyspareunia and reduced fertility.
the initial investigation for submucosal fibroid with menorrhagia should be
hysteroscopy
what imaging may be considered and why for fibroids?
US - larger fibroids
MRI - surgical options
for fibroids less than 3cms first line tx
mirena coil
alt. Tx for fibroids less than 3cms
symptomatic (NSAIDS + Tranexamic acid), COCP, cyclical oral progestogens
surgical options for fibroids that cause menorrhagia
endometrial ablation, resection and hysterectomy
surgical options for large fibroids include
uterine artery embolisation, myomectomy, hysterectomy
why may GnRH agonists be used for treatment of fibroids
reduce the size of the fibroids by inducing a menopausal state usually for prior to surgery
what diagnosis would you consider in a pregnant women with a history of fibroids presenting with severe abdominal pain and low grade fever
red degeneration of fibroids
red degeneration of fibroids refer to
ischaemia, infarction and necrosis of fibroids commonly larger than 5cm.
management of red degeneration of a fibroid includes
supportive; rest, fluid and analgesia.
hypogonadotropic hypogonadism refers to
deficiency of LH and FSH
hypergonadotropic hypogonadism refers too
lack of response by the gonads
causes of hypogonadotropic hypogonadism includes
hormonal (pituitary or endocrine), inflammation (pituitary, hypothalamus, chronic conditions), constitutional (diet, delay, exercise), or kallman syndrome
causes of hypergonadotropic hypogonadism
gonad damage, absence of gonads or turner syndrome
congenital adrenal hyperplasia is caused by
congenital deficiency of 21-hydroxylase enzyme resulting in underproduction of cortisol and aldosterone and overproduction of androgens from birth
genetic inheritance of congenital adrenal hyperplasia
autosomal recessive
symptoms acutely for congenital adrenal hyperplasia
electrolyte disturbances and hypoglycaemia
later typical features of congenital adrenal hyperplasia
tall for age, facial hair, absent periods, deep voice, early puberty
androgen insensitivity syndrome results in
female phenotype but absent uterus, female sex organs and the presence of internal testes
initial investigations for primary amenorrhoea
FBC, ferritin, U+E’s, Anti-TTG and Anti ENA for coeliac disease
hormonal blood tests for primary amenorrhoea
FSH, LH, Thyroid function tests, insulin like growth factor 1 for GH deficiency, prolactin and testosterone (PCOS)
use of imaging for primary amenorrhoea
X-ray of wrist for constitutional delay, pelvic US, MRI for kallman or pituitary pathology.
TX for primary amenorrhoea
replacement hormones, reduction in stress, weight gain, CBT and COCP
TX for kallman syndrome or hypogonadotrophic hypogonadism
pulsatile GnRH
secondary amenorrhoea is defined as
no menstruation for more than three months or 3-6 months if prior evidence of irregular periods
causes of secondary amenorrhoea
Pregnancy Menopause Hormonal contraception Hypothalamic or pituitary PCOS Uterine pathology such as Asherman’s syndrome Thyroid pathology Hyperprolactinaemiq
treatment for hyperprolactinaemia
bromocriptine and cabergoline
assessment of secondary amenorrhoea
history and examination, hormonal blood tests and US (PCOS)
hormonal tests for secondary amenorrhoea
FSH, LH, prolactin, TSH, and testosterone
secondary amonerrhoea high FSH suggests
primary ovarian failure
secondary amonerrhoea high LH suggests
PCOS
when secondary amenorrhoea lasts for longer than 12 months women are at risk for
osteoporosis
Tx for physical symptoms of premenstrual cycle
spironolactone
cyclical breast pain treatment
danazole and tamoxifen
Tx for PMS
lifestyle changes, COCP, SSRI’s, CBT
with severe symptoms and failure of medical management for PMS consider
Hysterectomy and bilateral oophorectomy with HRT post-op
gynaecological history questions
age of menarche cycle length intermenstrual and post coital bleeding contraceptive history sexual history pregnancy/plans cervical screening migraines PMH, drug history, smoking, alcohol FH
with heavy menstrual bleeding what examinations should be carried out?
pelvic, speculum and bimanual with FBC
outpatient hysteroscopy should be arranged if
Suspected submucosal fibroids
Suspected endometrial pathology, such as endometrial hyperplasia or cancer
Persistent intermenstrual bleeding
pelvic and transvaginal US should be arranged if
Possible large fibroids (palpable pelvic mass)
Possible adenomyosis (associated pelvic pain or tenderness on examination)
Examination is difficult to interpret (e.g. obesity)
Hysteroscopy is declined
symptomatic relief outwith contraception for heavy menstrual bleeding consider
tranexamic acid and mefenamic acid
contraceptive options for heavy menstrual bleeding
mirena coil, combined COCP, cyclical oral progestogens
final options for heavy menstrual bleeding
endometrial ablation (balloon thermal) or hysterectomy
potential causes of endometriosis
retrograde menstruation, embryonic cells, lymphatic spread and metaplasia
endometriosis adhesions lead to which symptoms
chronic non-cyclical pain and reduced fertility possibly.
presentation of endometriosis
Cyclical abdominal or pelvic pain
Deep dyspareunia (pain on deep sexual intercourse)
Dysmenorrhoea (painful periods)
Infertility
Cyclical bleeding from other sites, such as haematuria
gold standard diagnosis for endometriosis
laparoscopic surgery with biopsy of lesions
Stage 1 endometriosis
small superficial lesion
stage 2 endometriosis
mild, but deeper lesions than stage 1
stage 3 endometriosis
deeper lesions with lesions on the ovaries and mild adhesions
stage 4 endometriosis
deep and large lesions affecting the ovaries with extensive adhesions
hormonal management of endometriosis
COCP, POP, depo-provera, implant, mirena coil, GnRH agonists
surgical management of endometriosis
laparoscopic surgery or hysterectomy with bilateral salpingo-oopherectomy
adenomyosis presents with
painful heavy periods and dyspareunia
1st line investigation for adenomyosis
transvaginal ultrasound
gold standard diagnostic method for adenomyosis is
histological examination after hysterectomy
alternatives for transvaginal US for adenomyosis
MRI and transabdominal US
Tx for adenomyosis that is painless but don’t want contraception
tranexamic acid
Tx for for adenomyosis that is painful but don’t want contraception
mefenamic acid + NSAIDS
management for adenomyosis
mirena coil, COCP, cyclical oral progestogens
specialists options for adenomyosis
GnRH analogues, endometrial ablation, uterine artery embolisation, and hysterectomy
premature ovarian insufficiency is characterised as
hypergonadotropic hypogonadism
hormone analysis of premature ovarian insufficiency shows
raised LH and FSH but low oestradiol levels
hormone analysis of menopause will show
low oestrogen and progesterone but high LH and FSH
after the last menstrual period how long should contraception should be continued
1 year over 50, 2 years under 50
acceptable forms of contraception for menopausal women
Barrier methods Mirena or copper coil Progesterone only pill Progesterone implant Progesterone depot injection (under 45 years) Sterilisation
two key side effects of depo injections
reduced bone mineral density and weight gain
symptom management of perimenopausal symptoms
HRT, clonidine, CBT, SSRI (citalopram or fluoxetine), testosterone, vaginal oestrogen, vaginal moisturisers
the rotterdam criteria is for
PCOS diagnosis and it requires all three criteria to be met for diagnosis
all three points for the rotterdam diagnosis of PCOS
oligoovulation or anovulation, hyperandrogenism, and polycystic ovaries on ulstrasound.
presentation of PCOS
Oligomenorrhoea or amenorrhoea Infertility Obesity (in about 70% of patients with PCOS) Hirsutism Acne Hair loss in a male pattern
differentials for PCOS
Medications, such as phenytoin, ciclosporin, corticosteroids, testosterone and anabolic steroids
Ovarian or adrenal tumours that secrete androgens
Cushing’s syndrome
Congenital adrenal hyperplasia
how does insulin resistance relate to PCOS
increased insulin:
promotes androgen release
suppresses sex hormone binding globulin from the liver
halts development of follicles
hormonal investigations for PCOS
Raised luteinising hormone Raised LH to FSH ratio (high LH compared with FSH) Raised testosterone Raised insulin Normal or raised oestrogen levels
US appearance of PCOS
string of pearls (12 or more) and ovarian volume of more than 10cm cubed.
general management of PCOS
Weight loss
Low glycaemic index, calorie-controlled diet
Exercise
Smoking cessation
Antihypertensive medications where required
Statins where indicated (QRISK >10%)
PCOS increases risk for which cancer?
endometrial
why does PCOS increase risk for endometrial cancer?
unopposed oestrogen due to anovulation resulting in reduced progesterone.
options for reducing risk of endometrial hyperplasia in PCOS includes
mirena coil, cyclical progestogens and COCP
use of metformin in PCOS is for
fertility
treatment for hirsutism in PCOS
spironolactone
management for Acne in PCOS
COCP, as well as oral tetracycline, topic antibiotics or topical azelaic acid.
presentation of ovarian cyst
Pelvic pain
Bloating
Fullness in the abdomen
A palpable pelvic mass
most common type of ovarian cyst is
follicular
appearance of a follicular cyst on US
thin walls with no internal structure
common cyst to appear in early pregnancy
corpues luteum cyst
ovarian cysts Serous Cystadenoma is
benign epithelial tumour
Dermoid Cysts / Germ Cell Tumours is
benign teratoma of germ cells
Sex Cord-Stromal Tumours
rare connective tissue tumour may be benign or malignant
features that hint at malignany
Abdominal bloating Reduce appetite Early satiety Weight loss Urinary symptoms Pain Ascites Lymphadenopathy
risk factors for ovarian malignancy
Age Postmenopause Increased number of ovulations Obesity Hormone replacement therapy Smoking Breastfeeding (protective) Family history and BRCA1 and BRCA2 genes
ovarian cancer tumour marker
CA125
tumour markers for germ cell tumour
Lactate dehydrogenase (LDH) Alpha-fetoprotein (α-FP) Human chorionic gonadotropin (HCG)
Meig’s syndrome is a triad of
Ovarian fibroma (a type of benign ovarian tumour)
Pleural effusion
Ascites
ovarian torsion is usually due to a mass larger
5cm
presentation of ovarian torsion
sudden onset severe unilateral pelvic pain +/- nausea and vomiting. localised tenderness and mass.
US appearance of ovarian torsion
whirlpool sign of free fluid.
definitive diagnosis of ovarian torsion is by
laparoscopic surgery
treatment of ovarian torsion is by
laparscopic surgery
women with a uterus and HRT require
endometrial protection with progesterone
women without a uterus and HRT require
oestrogen only HRT
women with periods and HRT require
cyclical progesterone with breakthrough bleeds
HRT - postmenopausal women with a uterus and 12 months without a bleed require
continuous combined HRT
use of clonidine for menopausal symptoms is for
vasomotor symptoms and hot flushes (Alpha 2-adrenergic receptor agonist)
long term use of HRT for over 60’s risks
endometrial, ovarian and breast cancer. VTE, stroke and coronary artery disease.
risk reduction of HRT cancers through
local progestogens
VTE risk of HRT reduced through
patches rather than pills for oestrogen
CI for HRT
Undiagnosed abnormal bleeding Endometrial hyperplasia or cancer Breast cancer Uncontrolled hypertension Venous thromboembolism Liver disease Active angina or myocardial infarction Pregnancy
mirena coil is licensed for how many years
four
C19 progestogens are derived from
testosterone
C21 progestogens are derived from
progesterone
when should oestrogen contraceptives or HRT be stopped for surgery
4 weeks prior
oestrogenic SE
Nausea and bloating Breast swelling Breast tenderness Headaches Leg cramps
progetogenic SE
Mood swings Bloating Fluid retention Weight gain Acne and greasy skin
Asherman’s syndrome refers to
uterine adhesions post trauma commonly pregnancy, infection or surgical.
Asherman’s syndrome presents with
Secondary amenorrhoea (absent periods)
Significantly lighter periods
Dysmenorrhoea (painful periods)
diagnosis and treatment of Asherman’s syndrome is by
hysteroscopy
cervical ectropion refers too
cervical erosion resulting in the extension of the columnar epithelium of the endocervix extending out to the ectocervix
presentation of cervical ectropion
younger women pregnant or on COCP either asymptomatic or with discharge, vaginal bleeding, dyspareunia and post coital bleeding.
presentation of cervical ectropion of speculum
demarcted border between redder velvety columnar epithelium and pale pink squamous epithelium
management of cervical ectropion
asymptomatic - nothing
Trouble with bleeding - cauterisation.
Nabothian cysts are
trapped mucous of the columnar epithelium by squamous epithelium. asymptomatic benign finding.
rectoceles are caused by a defect in the
posterior vaginal wall
cystoceles caused by defects in the
anterior vaginal wall
risk factors for a prolapse
Multiple vaginal deliveries
Instrumental, prolonged or traumatic delivery
Advanced age and postmenopause status
Obesity
Chronic respiratory disease causing coughing
Chronic constipation causing straining
presentation of prolapse
A feeling of “something coming down” in the vagina
A dragging or heavy sensation in the pelvis
Urinary symptoms, such as incontinence, urgency, frequency, weak stream and retention
Bowel symptoms, such as constipation, incontinence and urgency
Sexual dysfunction, such as pain, altered sensation and reduced enjoyment
what speculum would you use for investigation of a prolapse
Sim’s speculum.
grade classification of pelvic organ prolapse
POP Q grade
POP Q grade 1
the lowest part is more than 1cm above the vaginal canal (introitus)
POP Q grade 2
The lowest part is within 1cm of the introitus
POP Q grade 3
The lowest part is more than 1cm below the introitus, but not fully descended
POP Q grade 4
Full descent with eversion of the vagina
A prolapse extending beyond the introitus (vaginal canal) can be referred to as .
uterine procidentia.
management for a prolapse
Conservative management
Vaginal pessary
Surgery
urge incontinence is caused by
overactivity of the detrusor muscle of the bladder
stress incontinence is due to
weakness of the pelvic floor and sphincter muscles
overflow incontinence occurs when
there is chronic urinary retention due to an outflow obstruction
potential causes for overflow incontinence
anticholinergic medications, fibroids, pelvic tumours, neurological conditions, MS and diabetic neuropathy
risk factors for urinary incontinence
Increased age Postmenopausal status Increase BMI Previous pregnancies and vaginal deliveries Pelvic organ prolapse Pelvic floor surgery Neurological conditions, such as multiple sclerosis Cognitive impairment and dementi
modifiable lifestyle factors for incontinence
Caffeine consumption
Alcohol consumption
Medications
Body mass index (BMI
how to assess severity of incontinence by asking about
Frequency of urination
Frequency of incontinence
Nighttime urination
Use of pads and changes of clothing
the modified oxford grading system is for
strength of pelvic muscle contractions during a bimanual examination
investigations for incontinence
bladder diary, urine dipstick testing, post-void residual bladder volume and urodynamic testing
management of stress incontinence involves
pelvic floor exercises
duloxetine
surgery
surgical management of stress incontinence involves
tension free vaginal tape (TVT), colposuspension, sling procedure, intramural urethral bulking.
management of urge incontinence
bladder retraining, anticholinergic medication, mirabegron, invasive options
anti cholinergics side effects
dry mouth, dry eyes, urinary retention, constipation and postural hypotension. Importantly they can also lead to a cognitive decline, memory problems and worsening of dementia,
mirabegron is CI in
uncontrolled hypertension as may lead to a hypertensive crisis
invasive options for overactive bladder
botox, percutaneous sacral nerve stimulation, augmentation cytoplasty and urinary diversion
atrophic vaginitis arises due to
lack of oestrogen
diagnostic consideration in a older women presenting with recurrent UTI’s, stress incontinence or pelvic organ prolapse
atrophic vaginitis
symptoms of atrophic vaginitis
Itching
Dryness
Dyspareunia (discomfort or pain during sex)
Bleeding due to localised inflammation
management of atrophic vaginitis
topical oestrogen
name of the glands located either side of the posterior part of the vaginal opening
bartholin’s glands
treatment of a bartholin’s cyst
good hygiene, analgesia and warm compress
bartholin’s abscess treatment
swab, culture and antibiotics
common cause of bartholin’s abscess
E. Coli
surgical management of a bartholin’s abscess
word catheter or marsupialisation
lichen sclerosus is a
chronic inflammatory skin condition resulting in porcelain white skin
typical presentation of lichen sclerosus
45-60 years complaining of vulval itching and skin changes or may be asymptomatic
koebner phenomenon refers too
made worse by friction
management of lichen sclerosus
topical steroids long term
the upper vagina, cervix, uterus and fallopian tubes develop from the
paramesonephric ducts (mullerian ducts)
what hormone suppresses the growth of the paramesonephric ducts in men?
anti-mullerian hormone
genetic transmission of androgen insensitivity syndrome
X-linked recessive
sex chromosomes of someone with androgen insensitivity
XY, however absent response to testosterone and conversion of androgens to oestrogen results in a female phenotype.
androgen insensitivity often presents in infancy with
inguinal hernias containing testes
management of androgen insensitivity syndrome
bilateral orchidectomy, oestrogen therapy, vaginal dilators
cervical cancers are commonly what type?
squamous cell carcinoma
HPV strains responsible for cervical cancer is
type 16 and 18
pathological mechanism of HPV causing cancer is
inhibits tumour suppressor genes
other than sexual activity what are other risk factors for cervical cancer
family history, HIV, full term pregnancies, COCP >5yrs, smoking
presentation of cervical cancer
asymptomatic, Abnormal vaginal bleeding
Vaginal discharge
Pelvic pain
Dyspareunia
CIN is grading for
level of dysplasia in cervix
CIN 1
mild dysplasia, affecting 1/3 the thickness of the epithelial layer, likely to return to normal without treatment
CIN 2
moderate dysplasia, affecting 2/3 the thickness of the epithelial layer, likely to progress to cancer if untreated
CIN 3
severe dysplasia, very likely to progress to cancer if untreated
what does dyskaryosis refer to
precancerous changes
cervical screening regime
Every three years aged 25 – 49
Every five years aged 50 – 64
HPV positive with normal cytology follow up
repeat the HPV test after 12 months
in colposcopy Acetic acid causes
abnormal cells to appear white
Schiller’s iodine test in colposcopy causes
normal cells to stain brown
treatment for CIN
A large loop excision of the transformation zone (LLETZ) or cone biopsy
risk of performing LLETZ A large loop excision of the transformation zone is
depth of tissue may increase risk of preterm labour
management of stage 1b-2a cervical cancer
Radical hysterectomy and removal of local lymph nodes with chemotherapy and radiotherapy
management of stage 2b-4a of cervical cancer
Chemotherapy and radiotherapy
management of stage 4b of cervical cancer
Management may involve a combination of surgery, radiotherapy, chemotherapy and palliative care
strain of HPV responsible for genital warts is
strain 6 and 11
majority of endometrial cancer is
adenocarcinoma
endometrial cancer is an example of what type of dependent cancers
oestrogen
endometrial hyperplasia may be treated with
intrauterine mirena coil or oral progestogens
risk factors for endometrial cancer
(unopposed oestrogen) Increased age Earlier onset of menstruation Late menopause Oestrogen only hormone replacement therapy No or fewer pregnancies Obesity Polycystic ovarian syndrome Tamoxifen type 2 diabetes hereditary nonpolyposis colorectal cancer (HNPCC)
why is obesity a key risk factor for endometrial cancer
adipose tissue is a source of oestrogen.
also in post menopausal women aromatase in adipose converts androgens into oestrogen.
protective factors against endometrial cancer include
Combined contraceptive pill
Mirena coil
Increased pregnancies
Cigarette smoking
endometrial cancer may present with
post menopausal bleeding Postcoital bleeding Intermenstrual bleeding Unusually heavy menstrual bleeding Abnormal vaginal discharge Haematuria Anaemia Raised platelet count
NICE recommends transvaginal ultrasound in women over 55 year with
unexplained vaginal discharge and visible haematuria
3 key investigations for endometrial cancer are
transvaginal ultrasound, pipelle biopsy and hysteroscopy
endometrial thickness less than how many mm is a negative predictor for endometrial cancer?
<4mm
treatment for stage 1 and 2 endometrial cancer is
total abdominal hysterectomy with bilateral salpingo-oophorectomy
how may progesterone be used in the treatment of endometrial cancer?
slow down progression
protective factors against ovarian cancer
Combined contraceptive pill
Breastfeeding
Pregnancy
how may an ovarian mass cause hip or groin pain?
pressing on the obturator nerve
refer to a 2 week wait if a physical examination reveals (gynae red flags for ovarian cancer)
Ascites Pelvic mass (unless clearly due to fibroids) Abdominal mass
name of a metastatic tumour in the ovary is
krukenburg tumour
histiological sign for a krukenberg tumour is
signet ring cells
significant level of Ca125 is
> 35IU/mL
risk for malignancy index for ovarian mass being malignant takes into accord
Menopausal status
Ultrasound findings
CA125 level
further investigations for an ovarian mass may require
paracentesis, CT and histology
additional tumour cell markers for a complex ovarian mass include
A-FP and HCG
non malignant causes of a raised Ca-125
Endometriosis Fibroids Adenomyosis Pelvic infection Liver disease Pregnancy
ovarian cancer management
MDT, surgery and chemo
risk factors for vulval cancer
Lichen sclerusos
vulval cancers are usually
squamous epithelium
vulval cancer frequently affects the
labia majora
staging and diagnosis of vulval cancer requires
biopsy, sentinel node biopsy and CT
management of vulval cancer requires
wide local excision, groin lymph node dissection, chemo or RT
bacterial vaginosis is an overgrowth of what type of bacteria?
anaerobic bacteria such as gardnerella vaginalis
bacterial vaginosis is due to the loss of what bacteria and what is their role?
lactobacilli and due to the production of lactic acid that lowers vaginal PH
what pH does anaerobic bacteria prefer the vagina to be like?
alkaline
risk factors of bacterial vaginosis
Multiple sexual partners (although it is not sexually transmitted)
Excessive vaginal cleaning (douching, use of cleaning products and vaginal washes)
Recent antibiotics
Smoking
Copper coil
presentation of bacterial vaginosis
fishy smelling watery grey or white discharge
examination for BV?
speculum
investigations for BV?
vaginal pH, charcoal swab with micropscopy
BV appearance on microscopy
clue cells
treatment for BV is
metronidazole
why is metronidazole CI with alcohol
disulfram like reaction causes nausea, vomiting, flushes and even shock with angiodema
complications of BV in pregnancy
Miscarriage Preterm delivery Premature rupture of membranes Chorioamnionitis Low birth weight Postpartum endometriti
risk factors for vaginal candidiasis
Increased oestrogen (higher in pregnancy, lower pre-puberty and post-menopause)
Poorly controlled diabetes
Immunosuppression (e.g. using corticosteroids)
Broad-spectrum antibiotics
presentation of vaginal candidiasis
Thick, white discharge that does not typically smell.
Vulval and vaginal itching, irritation or discomfort
investigations for vaginal candiasis
PH, charcoal swab and microscopy
treatment for vaginal candiadiasis
single dose of intravaginal clotrimazole cream (5g) or single dose of fluconazole (150mg)
OTC for vaginal candiadiasis
canesten duo
chlamydia trachomatis is what type of bacteria
gram negative intracellular organism
charcoal swabs are for
microscopy and culture
the transport medium for charcoal swabs are
Amies transport medium
charcoal swabs can confirm
Bacterial vaginosis
Candidiasis
Gonorrhoeae (specifically endocervical swab)
Trichomonas vaginalis (specifically a swab from the posterior fornix)
Other bacteria, such as group B streptococcus (GBS)
NAAT is used for
DNA or RNAA of chlamydia or gonorrhoea
female presentation of chlamydia
asymptomatic Abnormal vaginal discharge Pelvic pain Abnormal vaginal bleeding (intermenstrual or postcoital) Painful sex (dyspareunia) Painful urination (dysuria)
male presentation of chlamydia
asymptomatic Urethral discharge or discomfort Painful urination (dysuria) Epididymo-orchitis Reactive arthritis
signs of chlamydia infection on examination
Pelvic or abdominal tenderness Cervical motion tenderness (cervical excitation) Inflamed cervix (cervicitis) Purulent discharge
treatment for chlamydia includes
doxycycline 100mg twice a day for 7 days.
is doxycycline CI in pregnancy
yes
complications of chlamyida include
Pelvic inflammatory disease Chronic pelvic pain Infertility Ectopic pregnancy Epididymo-orchitis Conjunctivitis Lymphogranuloma venereum Reactive arthritis
lymphogranuloma venereum refers too
lymphoid tissue around the site of infection with chlamydia
primary stage of LGV
painless ulcer
secondary stage of LGV
lymphadenitis
tertiary stage of LGV
inflammation of the rectum, changes in bowel habit, tenesmus and discharge
Tx for LGV
Doxycycline 100mg twice daily for 21 days
presentation of chlamydial conjunctivitis
It presents with chronic erythema, irritation and discharge lasting more than two weeks. Most cases are unilateral.
neisseria gonorrhoeaeis an example of
gram negative diplococcus bacteria
pathology of gonorrhoea
STI that infects mucuous membranes with columnar epithelium
female presentation of gonorrhoea
Odourless purulent discharge, possibly green or yellow
Dysuria
Pelvic pain
male presentation of gonorrhoea
Odourless purulent discharge, possibly green or yellow
Dysuria
Testicular pain or swelling (epididymo-orchitis)
investigation of gonorrhoea
NAAT through first catch urine or swab will determine presence
Charcoal swab will determine specificity and sensitivity
tx of gonorrhoea
A single dose of intramuscular ceftriaxone 1g if the sensitivities are NOT known
A single dose of oral ciprofloxacin 500mg if the sensitivities ARE known
test of cure for gonorrhoea should be conducted after
72 hours after treatment for culture
7 days after treatment for RNA NATT
14 days after treatment for DNA NATT
complications of gonorrhoea
Pelvic inflammatory disease Chronic pelvic pain Infertility Epididymo-orchitis (men) gonococcal conjunctivitis in a neonate and disseminated gonococcal infection
disseminated gonococcal infection causes
Various non-specific skin lesions
Polyarthralgia (joint aches and pains)
Migratory polyarthritis (arthritis that moves between joints)
Tenosynovitis
Systemic symptoms such as fever and fatigue
mycoplasma genitalium is a
bacteria that causes non-gonococcal urethritis
investigations for mycoplasma genitalium
NAAT through vaginal swabs or first urine sample
management of mycoplasma genitalium is
Doxycycline 100mg twice daily for 7 days then;
Azithromycin 1g stat then 500mg once a day for 2 days (unless it is known to be resistant to macrolides)
pelvic inflammatory disease is a major cause of
tubular infertility and chronic pelvic pain
PID may be caused by
Neisseria gonorrhoeae tends to produce more severe PID
Chlamydia trachomatis
Mycoplasma genitalium
presentation of PID is
Pelvic or lower abdominal pain Abnormal vaginal discharge Abnormal bleeding (intermenstrual or postcoital) Pain during sex (dyspareunia) Fever Dysuria
examination signs of PID involve
Pelvic tenderness
Cervical motion tenderness (cervical excitation)
Inflamed cervix (cervicitis)
Purulent discharge
investigations for PID are
HIV test, NAAT swabs and syphilis test, pregnancy test, inflammatory markers and microscopy
PID sign on microscopy are
pus cells
complications of PID are
Sepsis Abscess Infertility Chronic pelvic pain Ectopic pregnancy Fitz-Hugh-Curtis syndrome
fitz-hugh-curtis syndrome refers too
inflammation and infection of the liver capsule leading to adhesions
fitz-hugh-curtis syndrome presents with
right upper quadrant pain, shoulder tip pain
investigation of fitz-hugh-curtis syndrome
therapeutic laparoscopy
trichomonas is classified as
a protozoan
trichomonas increases risk of
Contracting HIV by damaging the vaginal mucosa Bacterial vaginosis Cervical cancer Pelvic inflammatory disease Pregnancy-related complication
symptoms of trichomonas are
Vaginal discharge (frothy and yellow-green with fishy smell)
Itching
Dysuria (painful urination)
Dyspareunia (painful sex)
Balanitis (inflammation to the glans penis)
examination of the cervis with trichomonas reveals
a strawberry cervix
trichomonas investigation is with
swab, first catch urine or charcoal swab
management of trichomonas is with
metronidazole
HSV-1 remains dormant in the
trigeminal nerve ganglion
HSV-2 remains dormant in the
sacral nerve ganglia
signs and symptoms of genital herpes are
episodic:
Ulcers or blistering lesions affecting the genital area
Neuropathic type pain (tingling, burning or shooting)
Flu-like symptoms (e.g. fatigue and headaches)
Dysuria (painful urination)
Inguinal lymphadenopathy
diagnosis of genital herpes is through
viral PCR
management of genital herpes is with
aciclovir, lidocaine and topical vaseline.
the main issue with genital herpes during pregnancy is
neonatal herpes simplex infection
after an initial infection later on during pregnancy the antibodies can
confer a passive immunity via the placenta
primary infection before 28 weeks gestation with herpes is treated with
aciclovir
primary genital herpes after 28 weeks gestation is treated with
aciclovir with a recommended cesarean section
HIV is what type of virus
RNA retrovirus
aid’s defining illnesses include
Kaposi’s sarcoma Pneumocystis jirovecii pneumonia (PCP) Cytomegalovirus infection Candidiasis (oesophageal or bronchial) Lymphomas Tuberculosis
normal CD4 count is
500-1200
end stage HIV is defined as
<200 CD4
highly active anti retrovirus therapy medication examples
Protease inhibitors (PIs)
Integrase inhibitors (IIs)
Nucleoside reverse transcriptase inhibitors (NRTIs)
Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
Entry inhibitors (EIs)
what prophylaxis is given for CD4 <200 to protect against pneuocystis jirovecii pneumonia
co-trimoxazole
HIV tests should be done
immediately and also three months after exposure.
syphilis is caused by
treponema pallidum a spirochete.
primary syphilis involves
painless ulcer called a chancre
secondary syphilis involves
systemic symptoms
latent syphilis refers too
asymptomatic infection
tertiary syphilis involves
gummas, neurological and aortic aneurysms
secondary syphilis symptoms
Maculopapular rash Condylomata lata (grey wart-like lesions around the genitals and anus) Low-grade fever Lymphadenopathy Alopecia (localised hair loss) Oral lesions
neurosyphilis symptoms are
Headache Altered behaviour Dementia Tabes dorsalis (demyelination affecting the spinal cord posterior columns) Ocular syphilis (affecting the eyes) Paralysis Sensory impairment
argyll-robertson pupil refers too
It is a constricted pupil that accommodates when focusing on a near object but does not react to light in neurosyphilis
diagnosis of syphilis is through
antibody testing (RPR, VDRL), with dark field microscopy and PCR
management of syphilis involves
A single deep intramuscular dose of benzathine benzylpenicillin
