Infection (Gynae): BV, Candida, Chlamydia trachomatis

Question 1

What is BV?

Answer 1

Infeciton of vagina with anaerobes.

Question 2

What is the aetiology of BV?

Answer 2

Garedenerella Vaginalis, Prevotella, and Mycoplasma Hominis. -> increase pH.

Associated with recent anitibiotic use, low oestrogen production, IUD, douching, and sexual activity with new partner. NOT STD.

Question 3

What is the epidemiology of BV?

Answer 3

1/3 of women

Question 4

What is the history/ exam of BV?

Answer 4

Vaginal odor, (fishy) increased discharge

Valvular irritation

Dysuria or dyspareunia

O/E: Gray white thin homogenous discharge, increased ligh reflex of vaginal walls, normal labia and cervix (rarely cervicitis).

Question 5

What investigations do you do for BV?

Answer 5

Amsel’s criteria (3 of 4 of: ) Thin white homogenous discharge, Microscopy of discharge showing clue cells (epithelial with bacteria attached), High pH (>4.5), Fishy odor with 10% KOH.

Question 6

What is the management of BV?

Answer 6

Antibiotics (PO Metronidazole or Topical clindamycin).

Asymptomatic do not need treatment.

Advise to stop douching or using OTC vaginal cleaning products.

Question 7

What are the complications/ prognosis of BV?

Answer 7

Good, resolves.

May lead to increased risk of salpingitis or endometritis, and adverse outcomes in pregnancy

Question 8

What is Candida?

Answer 8

Overgrowth of naturally occurring vaginal fungi candida.

Question 9

What is the aetiology/ pathology of Candida?

Answer 9

Commensal of skin, gut, vagina. 25% asymptomatic colonisation. Proliferation occurs in favorable conditions such as alkaline pH or change of protective flora.

RF: pregnancy, sexual activity, diabetes, immunosuppression, BSABx, douching.

Yeast infects epithelioid cells, developing spores and pseudohyphae.

Question 10

What is the epidemiology of Candida?

Answer 10

> 75% lifetime occurrence in women.

Question 11

What is the history/ exam of Candida?

Answer 11

Several different types.

· Vulvovaginal causes erythema of the vulva, and curdy discharge. Superficial dyspareunia. Especially in skin folds.

· Balantis causes penile rash.

· Cystitis causes frequency, dysuria and haematuria. Ascending pyelonephritis may occur. Fungal balls may form leading to an obstruction.

Fever, macronodular skin lesion, skin changes in folds, candidial endopthalmitis, shock.

White plaques may be seen on vaignal walls.

Question 12

What investigations do you do for Candida?

Answer 12

A urinalysis: WBC, hematuria, protein, yeast cells.

Urine fungal cultures. Skin scrapes and culture, HVS.

Recurent: screen immune function and diabetes

Question 13

What is the management of Candida?

Answer 13

General – cotton underwear, avoid douching.

Medical: topical clotrimazole, or oral fluconazole (NOT IF PREGNANT). Treat partner If recurrent thrush.

Question 14

What are the complications/ prognosis of Candida?

Answer 14

Recurring atacks in 5%.

Question 15

What is Chlamydia Trachomatis?

Answer 15

Small gram negative obligate intracellular organism causing infection in GU tract. Referentially infect squamocolumnar cells.

Question 16

What is the aetiology of Chlamydia Trachomatis?

Answer 16

Chlamydial transmission usually is caused by sexual contact through oral, anal, or vaginal intercourse. Neonatal infection (eg, conjunctivitis or pneumonia) may occur secondary to passage through the birth canal of an infected mother.

Question 17

What is the epidemiology of Chlamydia Trachomatis?

Answer 17

Most frequent STD, highest prevalence under 24 (1%).

Question 18

What is the history/ exam of Chlamydia Trachomatis?

Answer 18

· 50% M and 80% F asymptomatic. Coinfection with ghonorreae common.

· Mucopurulent cervicitis , vaginal bleeding, abdominal pain, dyspareunia in females, and urethritis/dysuria in males.

· 5-10% develop PID due to ascending infection, and may cause epidydimitis in males.

O/E F; Speculum: cervical friability, intermenstrual bleeding, mucopurulent discharge (V/U/R), Vaginal: cervical motion tenderness, dysrutie, adenxal fullness or tenderness, Abdo: L abdominal pain on palpation.

O/E M: mucopurulent U/R discharge, urinary frequency or urgency, dysuria, pain, scrtal tenderness or swelling, perneal fullness.

O/E newborn: fever, cough, wheeze, crackles (pneumonia). Conjunctival erythema, mucoid discharge, periorbital swelling, bilateral.

Question 19

What investigations do you do for Chlamydia Trachomatis?

Answer 19

Chlamydia screening for u25. Microscopy of endocervical swabs, HRV, firstvoid urine samples (DNA amplification techniques)

Other: urethral, rectal or oropharyngeal specimens.

FBC if suspect PID, pap smear, pregnancy test.

Question 20

What is the management of Chlamydia Trachomatis?

Answer 20

Medical: doxocycline 100mg bd, for 1 week. OR single dose azythromycin 1g.

Pregnancy: erythromycin/amoxicillin (NO TETRACYCLINES!–> teratogens)

Other: full STI screen for self and other sexual contacts.

Question 21

What are the complications/ prognosis of Chlamydia Trachomatis?

Answer 21

Rare ascending infection may complicate. (PID/Epidydidmits). Reactive arthritis.

Pregnant women passing onto newborn -> neonatal conjunctiviti or pneumonia.

Infertility. Higher risk of cervical cancer (serotype G). Especially if LT infection.

Pregnancy: PTL, PPROM, PP endometritis.