Gynaecology Flashcards
1
Q
What condition is the risk of malignancy index used in?
A
For ovarian tumours to determine the likelihood of them being malignant
2
Q
What are some risk factors and protective factors for ovarian cancer?
A
Risk factors: FHx, obesity, nulliparity, early menarche and late menopause, Oestrogen only HRT, smoking, Lynch II syndrome, BRCA 1/2
Protective: COCP, multiparity, breast feeding
3
Q
BRCA 1 & 2 increases the risk of developing what?
A
Breast and ovarian cancer
4
Q
What is the inheritance pattern of Lynch II syndrome?
A
Autosomal dominant
5
Q
Lynch II syndrome predisposes to which cancers?
A
Colorectal
Endometrial
Ovarian
Breast
6
Q
What is the most common type of malignant ovarian tumour?
A
Serous cystadenoma
7
Q
What are chocolate cysts?
A
A type of non-neoplastic ovarian cyst seen in those with endometriosis
8
Q
Meig’s syndrome is an association between ascites + pleural effusion + which type of ovarian cyst?
A
Fibroma
9
Q
Are follicular cysts neoplastic?
A
No
They occur in the first half of the menstrual cycle and represent the developing follicle
10
Q
What histologically type are most cervical carcinomas?
A
Squamous cell carcinoma
11
Q
What causes cervical cancer?
A
HPV, serotypes 16 and 18 mainly
Progressed over 10-20 year period from CIN to Ca
12
Q
Whereabouts is the most likely location of an ectopic pregnancy?
A
Ampulla of the Fallopian tube
13
Q
What is the next step in a female found to have borderline dyskariosis on her routine screening cervical smear?
A
HPV testing
If +ve: colposcopy
If -ve: back to routine recall
(If moderate or severe, refer for urgent colposcopy)
14
Q
A perimenopaual woman who has not had a hysterectomy would like to try HRT for her menopausal symptoms. Which type of HRT is most appropriate?
A
Cyclical combined HRT
This will still produce a withdrawal bleed rather then unpredictable bleeding with continuous HRT
(Can then transfer to use continual combined HRT once amenorrhoeic for 1yr or aged 54)
15
Q
What is the tumour marker for ovarian Ca?
A
CA-125
16
Q
What investigation is first line in suspected endometrial Ca?
A
Trans vaginal USS
Biopsy if endometrial thickness >4mm
17
Q
A 55 yr old woman has a normal smear on screening. When should her next call for smear test be?
A
In 5 years
For women aged 25 to 49 screen every 3 years
For women aged 50 to 64 screen every 5 years
18
Q
What is the drug of choice for medical management of an unruptured ectopic pregnancy?
A
Methotrexate
19
Q
What is the gold standard investigation for patients with suspected endometriosis?
A
Laparoscopy
20
Q
What is the mechanism of action of oxybutynin and what is it’s indication?
A
Antimuscarinic
Used in urge urinary incontinence
21
Q
What are the recommended treatment options for stress urinary incontinence?
A
Conservative: weight loss, pelvic floor exercises, pads, smoking cessation
Medical: Duloxetine, tx of chronic cough
Surgical: tension free vaginal tape, fascial sling procedures
22
Q
When is methotrexate indicated for use in gynaecology?
A
Medical mx of small, unruptured ectopic pregnancy
23
Q
What is the first line treatment for menorrhagia?
A
NSAIDs e.g. mefenamic acid
IUS (Mirena)
TXA if the woman does not require contraception
24
Q
What class of drug is mefenamic acid and what is it’s indication?
A
NSAID
Indicated for use in menorrhagia for women who do not requir contraception
25
Which ligament attaches the ovaries to the uterus?
Ovarian ligament
26
Endometriosis commonly affects which ligaments?
Uterosacral ligaments, which can be palpated through the posterior vaginal fornix
27
Smoking and the COCP are protective against which gynaecological condition?
Endometrial Ca
28
What medication is used for Oestrogen receptor positive Breast Ca?
Tamoxifen
29
What is the different between a partial mole and a complete hydatidiform mole?
Partial mole: normal egg is fertilised by 2 sperm, hence 69 chromosomes in cells
Complete mole: empty egg fertilised by one sperm and chromosome duplicates, hence 46 chromosomes all of paternal origin
30
What are some presenting features of a molar pregnancy?
- PV bleeding and abdominal pain
- raised hCG
- large for dates
- exaggerated symptoms of pregnancy e.g. hyperemesis (due to raised hCG)
- hyperthyroidism
31
How would a molar pregnancy be diagnosed?
Urine dip and blood test would show raised hCG
USS would show grape like sac
Can do histology on products
32
What is the concern with molar pregnancies?
That they can develop into invasive moles or malignant choriocarcinoma
33
A miscarriage is a loss of pregnancy before what gestation?
24 weeks
34
What type of miscarriage will have a closed cervical os?
Threatened miscarriage
35
What is a missed miscarriage?
When the foetus dies but remains in utero
May be previously Hx of threatened miscarriage, or may be small for dates uterus or have ongoing discharge (or can be asymptomatic)
36
What are the features of an inevitable miscarriage?
Pain and PV bleeding
Cervical os is open on examination
Foetus can be viable or non-viable on TVUSS
Will progress to complete/ incomplete miscarriage
37
What is the difference between a complete and a incomplete miscarriage?
Incomplete: Hx of passing clots, but still some remaining products of conception seen on TVUSS, endometrial diameter >15mm
Complete: Hx of bleeding and clots which have settled, endometrial diameter <15mm, no remaining products of conception seen on TVUSS
38
What are some risk factors for miscarriage?
```
Increasing maternal age
Previous miscarriage
Coagulopathies
Smoking
Obesity
Chromosomal abnormalities
Uterine abnormalities
```
39
How are miscarriages managed?
Conservative/ expectant: wait for products to pass spontaneously
Medical: mifepristone and vaginal misoprostol, analgesia and antiemetic
Surgical: manual vacuum aspiration if <12 weeks, evacuation of retained products
Follow up with pregnancy test 3/52 later
40
What causes genital warts?
HPV types 6 and 11
41
Which serotypes of HPV are oncogenic?
16 and 18
42
What are some risk factors for genital warts?
Early age at first sexual intercourse
Multiple sexual partners
Smoking
Immunosuppression
43
How may trichomonas vaginalis present?
Females: itchy, offensive yellow discharge, dyspareunia, strawberry cervix, vulvovaginitis
Males: urethral discharge, pain/ itching, dysuria
44
How is trichomonas vaginalis treated?
Metronidazole
(2g single dose of 500mg BD for 5-7 days)
Treat both partners at same time!
Full STI screen
45
What is bacterial vaginosis?
Not an STI!
Disturbance of normal vaginal Flora reduces number of lactobacilli and subsequent increase in vaginal pH
Allows growth of other organisms, commonly Gardnerella vaginalis
Most common causes of abnormal vaginal discharge
46
What are some risk factors for bacterial vaginosis?
```
Sexual activity
Vaginal douching
IUD
Recent Abx use
STI
Smoking
African American
```
47
How does bacterial vaginosis present?
Offensive, fishy vaginal discharge
| Thin white/ get discharge
48
Clue cells are indicative of what infection?
Bacterial vaginosis
49
What are some features of bacterial vaginosis on high vaginal swab?
Clue cells
Reduced lactobacilli
pH >4.5
Also positive KOH whiff test
50
KOH whiff test can be used in what infection?
Bacterial vaginosis
51
What antibiotic is used for bacterial vaginosis?
Metronidazole
52
What management advice would you give to a patient with bacterial vaginosis?
Avoid douching
| Avoid scented shower gels
53
What medical treatment options are available for menorrhagia?
If requiring contraception: 1st line = mirena IUS, 2nd = COCP, 3rd = long acting progestogens e.g. depot/ implant
If not requiring contraception: TXA or mefenamic acid
54
What is menorrhagia defined as?
Blood loss >80ml per menses
| Although now moving towards definition of excessive blood loss for the woman that impacts her quality of life
55
What are some causes of menorrhagia?
PALM-COEIN (structural and functional)
Polyps,adenomyosis, leiomyoma, malignancy and hyperplasia
Coagulopathy (eg VW), ovarian (PCOS, hypothyroid), endometriosis, iatrogenic (copper IUD), dysfunctional uterine bleeding
56
What is the inheritance pattern of von Willebrands disease?
Autosomal dominant
57
How can Von Willebrands disorder be treated?
TXA (antifibrinolytic)
Desmopressin (increases vWF)
Factor VIII concentrate
58
What are some investigations that can be done for a woman presenting with menorrhagia?
```
FBC (anaemia)
TFTs (hypothyroid)
USS (pelvic or TVS)
Hormone levels (if predicting PCOS
Clotting tests
Cervical smear if not up to date
Swans for infection
Endometrial biopsy
```
59
How will bleeding time and APTT be in Von Willebrands disease?
Prolonged
60
What are some management options for a patient with PCOS?
```
Weight loss and dietary advice
COCP
Clomifene for infertility
Laser hair removal
Anti-androgens
```
61
Which hormones are raised in PCOS?
Luteinising hormone
| This stimulates ovarian production of androgens, hence raised testosterone
62
Where is luteinising hormone produced in the body?
In the anterior pituitary gland
63
Why is sex hormone binding globulin reduced in PCOS?
Due to high insulin, which suppressed the hepatic production of SHBG
64
What are some presenting features of PCOS?
```
Oligo/amenorrhoea
Acanthosis nigricans
Obesity
Hirsutism
Infertility
Depression
Chronic pelvic pain
Acne
```
65
Is the LH:FSH ratio low or high in PCOS?
High
66
Would progesterone be low or high in PCOS?
Low, due to oligo-amenorrhoea
67
What are some protective factors for endometrial Ca?
Smoking
| COCP
68
Why does endometrial Ca develop?
Due to unopposed Oestrogen
69
Which genetic condition can predispose to endometrial Ca?
Lynch syndrome
70
Endometrial carcinoma that has extended to the cervix is what stage?
Stage 2
| Stage 1 confined to uterine body, stage 2 to cervix, stage 3 beyond uterus but still in pelvis, stage 4 metastasised
71
What are the different stages of endometrial Ca?
1 confined to uterine body
2 extended to cervix
3 still within pelvis but outside of uterus
4 metastasised
72
How would stage 1 endometrial carcinoma be treated?
Hysterectomy + bilateral saplingo-oophorectomy
73
Are most cervical cancers squamous or adeno carcinoma?
Squamous cell carcinoma
74
What causes cervical squamous cell carcinomas?
Persistent HPV infection
75
A lady with stage 1 cervical Ca wishes to opt for treatment that will preserve her fertility. What is the best option for her?
Radical trachelectomy (removal of cervix and upper vagina)
Other options not preserving fertility would include hysterectomy, brachytherapy/ external beam radiotherapy alongside chemotherapy (gold standard)
76
What is the gold standard treatment for cervical cancer.
Chemo radiotherapy (stages 1b to 3)
77
What are some risk factors for cervical Ca?
```
HPV
Smoking
Many sexual partners
Lower socioeconomic status
COCP
Early first intercourse
```
78
For cervical cancer not diagnosed through routine screening, what is the most common symptom?
Abnormal PV bleeding (post coital, intermenstrual, postmenopausal)
79
What result on routine cervical smear test would warrant urgent 2 week referral for colposcopy?
If moderate or severe dyskaryosis or suspected invasive cancer
80
What is Asherman’s syndrome?
Formation of adhesions in the uterus following dilation and curettage
Can result in amenorrhoea/ dysmenorrhea, infertility and recurrent, miscarriage
81
What will hormone levels show in premature ovarian failure?
Low Oestrogen, high FSH and high LH (due to -ve feedback)
82
Premature ovarian failure is defined as undergoing the menopause before what age?
40 years old
83
What happens to the LH and FSH levels in PCOS?
LH raised, LH to LSH ratio raised
| Also can have high testosterone, low SHBG
84
What is the indication for metformin in PCOS?
To treat infertility
85
What are some causes of amenorrhoea?
- primary (turners, androgen insensitivity syndrome)
- secondary:
hypothalamic (anorexia, excessive exercise )
pituitary (prolactinoma, Sheehan’s syndrome, post contraception)
ovarian (PCOS, menopause, premature ovarian failure)
genital (ashermans syndrome, imperforate hymen)
thyroid
Pregnancy
86
Will GnRH be high or low in a patient with a prolactinoma?
Low
87
A 42 yr old px with menorrhagia has an USS which confirms presence of a large uterine fibroid. She wishes to undergo a hysterectomy. What medication would be appropriate to shrink her fibroid prior to surgery?
GnRH agonist
88
How does hyperprolactinaemia result in anovulation?
High levels of prolactin inhibit hypothalamic GnRH release so less FSH and LH is released from the anterior pituitary
89
What are some causes of hyperprolactinaemia?
Pituitary tumour (prolactinoma)
Hypothyroid
Antipsychotics
90
What is infertility defined as?
Unable to become pregnant after at least 1 year of regular, unprotected sex
Primary if unable to have first child
Secondary if already had at least one child
91
What are some male causes of infertility?
```
Impotence
Abnormal sperm
Testicular tumour
Varicocele
Orchitis
Hyperprolactinaemia
Undescended testes
Retrograde ejaculation
```
92
Anti-mullerian hormone is best to measure what?
Ovarian stores (high = good reserve)
93
What hormone can be used to check if someone is ovulating, and what day of the cycle is this measured?
Progesterone
Measure on day 21
High levels confirm ovulation
94
What are some structural causes of infertility?
```
Adhesions
Polyps
Fibroids
Vaginal septum
Blocked tubes (PID, adhesions)
```
95
What investigation can test Fallopian tube patency?
Hysterosalpingogram
| Used x Ray with contrast dye
96
What drug should be prescribed for a patient with Trichomonas vaginalis?
Metronidazole
97
What drug treatment should be used for gonorrhoea?
IM ceftriaxome single dose
| Oral azithromycin single dose
98
What drug treatment should be used for bacterial vaginosis?
```
Oral metronidazole
(2g single dose or 400mg BD 5-7 days)
```
99
What are some differences in the presentation of trichomonas vaginalis and bacterial vaginosis for women?
TV: yellow/ green frothy discharge, itch, dyspareunia, dysuria, vulvovaginitis, strawberrry cervix
BV: fishy thin white/ grey discharge, clue cells, ph >4.5 (not associated with itchiness or soreness unlike TV)
100
Strawberry cervix is a sign seen in what?
Trichomonas vaginalis infection
101
How is urge urinary incontinence managed?
Conservative: bladder retraining (at Keats 6/52 increasing intervals between voiding), reduce caffeine and fluid intake
Medical: oxybutynin (anticholinergics)
Surgical: Botox toxin to detrusor
102
What is cervical excitation?
Aka cervical motion tenderness/ chandelier sign
Excruciating pain upon bimanual examination
Indicates pelvic pathology e.g. PID, ectopic pregnancy
103
What is the most useful investigation for suspected endometriosis?
Laparoscopy
| Chocolate cysts
104
By how much should bHCG rise approximately in a normal pregnancy?
Double every 48 hours
105
What is a cystocele?
Defect in the anterior vaginal wall causing prolapse of the bladder
106
What is the name of the genitourinary prolapse associated with a defect in the posterior vaginal wall?
Rectocele, allows rectum to prolapse
107
What are the different types of pelvic prolapse?
Uterine prolapse: uterine prolapses into vagina
Cystocele: defect in anterior vaginal wall causes prolapse of bladder
Urethrocele:defect in anterior vaginal wall causes prolapse of urethra
Rectocele: defect in posterior vaginal wall causes prolapse of rectum
108
What are some management options for genitourinary prolapse?
Conservative e.g. pelvic floor exercise, tx incontinence, weight loss
Pessary
Surgical repair
109
What Ca is a nulliparous women who suffers with primary infertility and has undergone repeated cycles of ovarian stimulation at most risk of?
Ovarian Ca
110
What is the next step for a woman with 3 consecutive borderline smear tests?
Refer for colposcopy
111
What chemical is thought to be the cause of dysmenorrhea?
Prostaglandins (causing spiral artery vasospasm and increased myometrial contractions)
112
What management options are available for patients with primary dysmenorrhea?
Conservative: quit smoking, hot water bottle
Medical: NSAIDs 1st line (inhibit prostaglandin synthesis which causes the pain) +/- paracetamol, 2nd line is COCP/ IUS
Transcutaneous nerve stimulation
113
What are some causes of secondary dysmenorrhea?
```
Endometriosis
Adenomyosis
Adhesions
Pelvic inflammatory disease
Copper IUD
Fibroids
```
114
Cervical excitation is suggestive of which conditions?
Pelvic inflammatory disease
| Ectopic pregnancy
115
What is adenomyosis?
The presence of functional endometrial tissue within the myometrium of the uterus
116
How does adenomyosis usually present (history and examination?)
```
Dysmenorrhea
Menorrhagia
Dyspareunia
Irregular bleeding
Enlarged, boggy uterus (symmetrical, unlike asymmetry with fibroids)
```
117
What are some risk factors for adenomyosis?
High parity, uterine surgery, previous C section
Most commonly occurs in multiparous women at the end of their reproductive life
118
What is the mechanism of GnRH agonists and what can they be used in?
Downregulate the GnRH receptors so after a while of usage they cause pituitary de-sensitisation, so less LH and FSH so less gonadotrophic hormones
Used in menorrhagia, adenomyosis, fibroids (also prostate Ca, precocious puberty, IVF)
119
What is the mechanism of action of duloxetine?
Serotonin and noradrenaline reuotake inhibitor
| Antidepressant and also indicated for stress urinary incontinence
120
Which ligaments are responsible for holidaying the uterus in place in the pelvis?
Pubocervical ligaments attaches to pubic symphysis
Transverse ligaments attach to pelvic side wall
Uterosacral ligaments attach to sacrum
Broad ligaments is a sheet of peritoneum that covers the uterus
Pelvic floor muscles hold it in place inferiorly
121
Which pelvic ligament is a sheet of peritoneum?
Broad ligament, covers the uterus anteriorly and posteriorly
122
What side effects would you earn a women having an oophorectomy?
Vasomotor symptoms
Subfertility
Reduced Oestrogen:
Risk of oesteoporosis
CVD risk risk
Menopausal mood swings, insomnia
Thin hair, skin
Adhesions can lead to chronic pelvic pain
Vaginal dryness, reduced libido
Surgery: Risk of injury to bladder and bowel, Infection, Bleeding, VTE
Reduced testosterone: reduced concentration, aches and pains
123
What can happen when an ovarian mucous cystadenoma ruptures?
Psuedomhxoma peritonei (jelly like contents irritating the peritoneum)
124
What are some type of ovarian cysts?
```
Follicular (associated with menstruated cycle)
Teratoma (contain hair and teeth)
Theca lutein (associated with molar pregnancy, regress when bHCG lowers)
Fibroma (associated with Meigs syndrome
Endometrioma (chocolate cysts)
Corpus luteal cyst
Polycystic (ring of pearl sign
Serous cystadenoma
Mucous cystadenoma
```
125
What factors does the risk of malignancy index look at?
CA125, ultrasound scan results, woman’s age
126
How would you manage an ovarian cyst?
If pre menopausal and small, rescan in 6/52 to see if resolution. If large of persistent, offer laparoscopic cystectomy/ oophorectomy
If postmenopausal, follow up if low, surgery if high
127
What are some differentials for chronic pelvic pain?
```
Adhesions
PID
Endometriosis
Adenomyosis
Pelvic congestion
Psychosexual e.g. unwanted children, childhood sexual abuse
```
128
When is large loop of excision of the the transformation zone offered to women?
LLETZ offered in >CIN 1, then f/u and HPV test at 6 months
129
Which medication can be used to reduce the size of a fibroid prior to surgery?
GnRH analogues e.g. goserelin
| But can only be used for 6/12 due to risk of osteoporosis
130
What surgical options can be offered for fibroids?
Transcervical resection (good for submucosal)
Myomectomy
Hysterectomy
Uterine artery embolisation
131
What is the Rotterdam criteria used in the diagnosis of?
Polycystic ovarian syndrome
132
What is the rotterdam criteria for PCOS?
Polycystic ovaries (>12)
Oligo/amenorrhoea
Signs of hyperandrogenism
133
What are some causes of recurrent miscarriage?
```
Antiphospholipid syndrome
Factor V Leiden
Protein C and S deficiency
Uterine abnormalities e.g. fibroids, septum, adhesions, cervical weakness
Chromosomal abnormalities
Teratogens
```
134
What treatment options are available for a women miscarrying a pregnancy?
Conservative/ expectant: analgesic and wait for products to pass (can be done at home not guaranteed and will cause pain and bleeding)
Medical: mifepristone and misoprostol to expel products (avoids surgery but CN be in pain and bleed for a few weeks)
Surgical: suction curette to empty uterus (quickest option but risks of surgery)
135
What will transvaginal USS scan show in ectopic pregnancy?
No uterine pregnancy seen
136
What would you advise a px who is prescribed methotrexate for medical management of her ectopic pregnancy?
That she must comply with liver function tests
| And that she can not get pregnant for a further 6 months
137
What bacteria causes syphilis?
Treponema pallidum
138
What are the stages of a syphilis infection?
Primary syphilis: painless chancre forms after a couple of weeks (can cause obliterating arteritis is left untreated)
Secondary syphilis: develops 3 months post infection with generalised symptoms e.g. fever, weight loss, arthralgia, malaise, lymphadenopathy, non itchy rash
Tertiary syphilis: years after initial infection, neurosyphilis, cardiovascular syphilis, gummatous syphilis
139
What drug is used to treat syphilis?
Penicillin
140
What cells does HIV infect?
CD4 T helper cells
141
How can HIV be vertically transmitted?
In utero
During delivery
Breastfeeding
142
What are some examples of AIDS defining illnesses?
Pneumocystitis jiroveci pneumonia
TB
Non Hodgkin’s lymphoma
Kaposi’s sarcoma
143
What test is used to diagnose HIV?
Fourth generation ELISA test (tests for HIV antibody)
144
How long after HIV infection until ELISA test will be positive?
4-6 weeks
145
How is HIV managed?
Highly active anti retroviral therapy
Reduces virus counts to undetectable levels so px has very good prognosis and minimal chance of onwards transmission
Must take everyday for the rest of their lives
Regular testing of viral load, CD4 count, LFTs, U+Es, FBC, urinalysis
146
CD4 count less than what is an indicator to start HAART?
Less than 350
147
What is post exposure prophylaxis?
Medication to reduce likelihood of infection if someone thinks that may have been exposed HIV
Must be taken within 72 hours of exposure, for one month
148
What measures must be taken for the pregnancy of a HIV +ve mum to reduce risk of transmission to her baby?
- take antiretrovirals during pregnancy and delivery
- avoid breastfeeding
- neonatal post exposure prophylaxis
- can still deliver vaginally, unless viral load is above 50
149
How do genital warts present?
Painless fleshy lesions
| Can present weeks/ months/ years after infection
150
What causes genital warts?
HPV types 6 and 11
151
What management advice would you give to a patient presenting with genital warts?
Likely to resolve spontaneously
Full STI screen due to likelihood of co infection
Can give antiviral creams
If persistent, cryotherapy or surgery possible
152
What first line investigations should be ordered for a couple presenting with infertility?
Semen analysis
| Day 21 serum progesterone
153
What is the FIGO staging for endometrial carcinoma?
Stage 1: confined to uterine body
Stage 2: extend to cervix
Stage 3: extended beyond the uterus but still within the pelvis
Stage 4: metastasised
154
What surgical management would you perform for a woman with stage 2 endometrial cancer?
Radical hysterectomy
| Also removing the vaginal tissue surrounding the cervix as the cancer has extended here for stage 2
155
In what categories of miscarriage would the cervical os be closed?
Threatened
Complete
Missed
156
How does a history of PCOS act as a risk factor for endometrial Ca?
Increased periods of anovulation, so more unopposed Oestrogen
157
How does obesity increase the risk of endometrial and breast cancer?
Increased peripheral conversion of androgens to Oestrogens
158
What are some causes of postmenopausal PV bleeding?
```
Endometrial Ca
Endometrial hyperplasia
Cervical Ca
Endometrial polyp
Cervical polyp
Vulval carcinoma
```
159
What organisms can a high vaginal swab test for?
Gardnerella vaginalis
Trichomonas vaginalis
Group B strep
Candida
160
What is suitable medical management for chlamydia infection?
PO azithromycin 1g STAT
Or, 7 day course doxycycline 100mg BD
161
What is suitable medical management of gonorrhoea?
IM ceftriaxone + P.O. azithromycin
162
What is the diagnostic investigation for chlamydia and gonorrhoea?
NAAT
Via first catch urine sample in men and endocervical swab in women
(Can also swab rectum and oropharynx)
163
What is the management of chlamydia infection?
```
1g PO azithromycin STAT
OR
7/7 doxycycline BD
OR
7/7 ofloxacin
OR
14 days erythromycin
PLUS contact tracing and partner notification
Avoid sex until both parties are tested and treated
```
164
What are some complications of a chlamydia infection?
PID (-> ectopics, subfertility, perihepatitis)
Epididymitis
Reactive arthritis (more common in men)
165
What are the incubation periods for chlamydia and gonorrhoea?
7-21 days chlamydia
| 2-5 days gonorrhoea
166
What is the recommended management of gonorrhoea?
```
IM ceftriaxone 1g STAT
(No longer recommend stat azithromycin)
Partner notification and contact tracing
Avoid sex until treated
Test of cure via NAAT 2 weeks later
```
167
What is the causative organism of syphilis?
Treponema pallidum
168
What investigations would you do for a patient newly positive for HIV?
Viral load (baseline and to measure tx response)
CD4 count (establish stage and their immune status)
Drug resistance testing
Hepatitis B and C serology
Tuberculin skin test (+ve -> BCG)
169
Other than HAART, what other aspects are key in HIV management?
```
Counselling
Up to date vaccines e.g. HPV, pneumococcal, influenza, hepatitis B (live vaccines eg BCG are CI)
Nutrition
Annual cervical smear
Prophylactic co-trimoxazole
Statin for CVD risk
```
