Gynae infections Flashcards by Kate Bernard

4 groups of women prone to thrush

pregnant
diabetic
on antibiotics
immunocompromised

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oral thrush treatment is fluconazole. What’s the cream / pessary called?

clotrimazole

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vaginal lactobacilli flora overgrown by anaerobes, mycoplasma etc. What’s this?

bacterial vaginosis

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The vulva is red and itchy in BV. True or false?

false!!

grey discharge, fishy smell

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what happens to the pH of the vagina in BV?

raised pH - alkaline

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add KOH to vaginal discharge, and get a strong fishy odour. what is this test called?

‘whiff test’ for BV

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what do you see on microscopy with BV?

clue cells

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what is the treatment for BV?

metronidazole cream

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which STI is caused by an obligate intracellular parasite?

chlamydia (chlamydia trachomatis)

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what is the treatment for chlamydia if she’s pregnant

azithromycin

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what antibiotic is used to treat chlamydia

doxycycline

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what are the two main complications of chlamydia

PID

reiter’s syndrome

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what’s is the triad of reiter’s syndrome

urethritis, conjunctivitis, arthritis

cant pee cant see cant climb a tree

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what does NAAT stand for

nucleic acid amplification testing

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what do you see on microscopy for chlamydia?

nothing! chalmydia invisible on microscopy

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what test is diagnostic for chlamydia

NAAT (women - vaginal swab) (men - first void urine)

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what are the main symptoms of chlamydia for women

often asymp.
urethritis
vaginal discharge

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what organism causes trichomoniasis

trichomonas vaginalis (protozoan)

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what sti causes strawberry cervix

trichomoniasis

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what kind of discharge do you get with trichomonas

grey green frothy

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which sti is diagnosed with wet film on microscopy

trichomoniasis

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what is treatment for trichomoniasis

metronidazole

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which sti is caused by a gram neg diplococcus

gonorrhoea (Neisseria gonorrhoea)

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Gonorrhoea is often asymptomatic. Symptoms for women include urethritis and vaginal discharge. Give me two more.

inter-menstrual bleeding

Bartholinitis

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investigations for gonorrhoea

NAAT urine | or swab --> microscopy, culture and sensitivities

where would you get a swab for gonorrhoea from MSM

urethra + rectum

where do you get a gonorrhoea/chlamydia swab from women

endocervical (high vaginal)

what does high vaginal CHARCOAL swab test for

BV and trichomoniasis

what is the treatment for gonorrhoea

antibiotics according to sensitivities | e.g. im ceftriaxone

what are three dodgy complications of gonorrhoea

PID septic arthritis opthalma neonatorum

which sti is caused by a spirochaete

syphilis (treponema pallidum)

which sti is highly infectious especially during oral sex

syphilis

apart from sexually, how else can syphilis be transmitted?

transplacentally | can cause miscarriage, seizures, congenital abnormalities

what is the sign in primary syphilis

chancre (painless ulcer at the site of infection. heals)

weeks or months after the primary infection, patients can get a rash, oral-snail track ulcers, meningism, lymphadenopathy and warts. What condition is this?

secondary syphilis

what are the warts called in secondary syphilis

condylomata lata

where do you get a rash in secondary syphilis

trunk palms soles

what is the sign in tertiary syphilis

gummas | granulomas in skin/joints/organs

name the two key organs that get affected in quaternary syphilis

heart | brain

what heart condition do you get in quaternary syphilis

aortic aneurysm (syphilitic aortitis)

Name three features of neurosyphilis

Cranial nerve palsies dementia tabes dorsalis ataxia

what is tabes dorsalis?

ataxia in quaternary syphilis (dorsal columns)

what are the investigations for syphilis?

miscroscopy of lesions | serology

what do you find on microscopy of lesions in syphilis

treponemes

what do you find on serology in syphilis

treponeme antibodies

what is the treatment for syphilis?

IM penicillin

which are the two commonest HPV types causing genital warts

6+ 11

which are the two baddest HPV types

16+ 18

which HPV types does the quadrivalent vaccine cover?

6 + 11 | 16 + 18

what is the treatment for genital warts (condylomata accuminata)?

topical podophyllin

if genital warts are resistant to topical podophyllin, what is the next treatment?

cryotherapy / cautery | still, high recurrence

which HSV is most likely to cause herpes encephalitis

HSV1

which is the most common form of HSV

HSV 2

which HSV is cold sores usually

HSV1

In the primary herpes infection, as well as painful ulcers around the introitus, what are other possible symptoms?

lymphadenopathy | dysuria

In what percent of HSV patients does it reactivate after primary infection?

75%

where does HSV lie dormant?

dorsal root ganglia

what is the investigation for herpes, after examining?

viral swabs

give me three possible complications of herpes

- aseptic meningitis - herpes encephalitis - neonatal herpes

explain R = BCD

reproductive rate (of STI) = infectivity rate x partners over time x duration of infection

give me three reasons why partner tracing is important

1. break chain of transmission 2. prevent re-infection of treated patients 3. prevent complications of untreated infection in partners

explain primary, secondary and tertiary prevention of STIs

``` primary = decrease risk of acquiring secondary = case finding tertiary = decrease morbidity /mortality ```

PID almost never occurs in presence of viable pregnancy. True or false?

true

Three risk factors for PID

multiple partners unprotected sex instrumentation (coil, top, erpc)

PID can be from infection ascending spontaneously, by birth complication, or by instrumentation such as... (x3)

coil ERPC TOP

PID if often polymicrobial (e.g. chlamydia plus gonorrhoea). True or false.

true

RUQ pain in a patient with PID. What is this likely to be?

FITZ-HUGH CURTIS SYNDROME (PERIHEPATITIS) | occurs in 10% of PID

What is finding on examination of acute PID?

cervical excitation | adnexal tenderness

PID is often asymptomatic for a while. But it can present acutely with what symptoms?

``` pain (bilateral lower abdo) deep dyspareunia discharge fever abnormal bleeding ```

What are the investigations for suspected PID (give me a few)…. and what is the gold standard diagnostic test?

endocervical swabs (chlamydia/gonorrhoea) blood cultures, WBC, CRP pelvic ultrasound diagnostic = LAPAROSCOPY + fimbrial biopsy + culture (after you've reviewed them for 24hrs)

What investigation is gold standard diagnostic for PID?

laparoscopy + fimbrial biopsy+culture

Give me an EARLY complication of acute PID...

abscess / pyosalpinx

Give me a LATE complication of acute PID

subfertility ectopic preg progression to chronic PID ...

When is PID chronic?

when there's persisting infection

give me three symptoms of chronic PID

chronic pelvic pain dysmenorrhoea deep dyspareunia

HOW DO YOU TREAT PID ? xx

IM ceftriaxone then 2wks doxycycline + metronidazole if acute - +analgesics, maybe admit for IV Abx

IM ceftriaxone then 2wks doxycycline + metronidazole … What is this the treatment for?

PID

What two surgeries can be done for CHRONIC PID?

adhesiolysis | salpingectomy

HIV is a single stranded RNA virus. True or false?

true

What is the maximum time from exposure PEP can be started?

72hrs

What is absolute contraindication for VBAC ?

Classical C-Section | due to risk of uterine rupture

What is the role of Kleihauer test in rhesus disease?

assess presence of foetal blood in maternal circulation

Which point during pregnancy carries the greatest risk of developing a VTE?

postnatal

Which syndrome describes the development of intrauterine adhesions?

Ashermann's

first line treatment for cervical ectropion?

stop oestrogen-containing meds!

What laparoscopic treatment for bad PCOS INFERTILITY?

ovarian drilling

what disease do you perihepatitis Fitz High Curtis syndrome in?

PID (10%) | RUQ pain

PID almost never occurs in the presence of a viable preg. True or false?

true

3 risk factors for PID

multiple partners unprotected sex instrumentation (coil, ERPC, ToP)

Pus in the tubes. What's this?

pyosalpinx (chronic PID)

Fluid in the tubes. What's this?

hydrosalpinx (chronic PID)

on examination of PID?

cervical excitation | adnexal tenderness

If acute PID is severe, what symptoms do you expect??

high fever, tachy, peritonitic

24 yr old presents with bilateral lower abdo pain, with deep dyspareunia. She has RFs for PID. What other symptoms would you ask about.

discharge abnormal bleeding fever