Infection (Gynae): BV, Candida, Chlamydia trachomatis Flashcards
What is BV?
Infeciton of vagina with anaerobes.
What is the aetiology of BV?
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.
What is the epidemiology of BV?
1/3 of women
What is the history/ exam of BV?
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).
What investigations do you do for BV?
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.
What is the management of BV?
Antibiotics (PO Metronidazole or Topical clindamycin).
Asymptomatic do not need treatment.
Advise to stop douching or using OTC vaginal cleaning products.
What are the complications/ prognosis of BV?
Good, resolves.
May lead to increased risk of salpingitis or endometritis, and adverse outcomes in pregnancy
What is Candida?
Overgrowth of naturally occurring vaginal fungi candida.
What is the aetiology/ pathology of Candida?
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.
What is the epidemiology of Candida?
> 75% lifetime occurrence in women.
What is the history/ exam of Candida?
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.
What investigations do you do for Candida?
A urinalysis: WBC, hematuria, protein, yeast cells.
Urine fungal cultures. Skin scrapes and culture, HVS.
Recurent: screen immune function and diabetes
What is the management of Candida?
General – cotton underwear, avoid douching.
Medical: topical clotrimazole, or oral fluconazole (NOT IF PREGNANT). Treat partner If recurrent thrush.
What are the complications/ prognosis of Candida?
Recurring atacks in 5%.
What is Chlamydia Trachomatis?
Small gram negative obligate intracellular organism causing infection in GU tract. Referentially infect squamocolumnar cells.
What is the aetiology of Chlamydia Trachomatis?
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.
What is the epidemiology of Chlamydia Trachomatis?
Most frequent STD, highest prevalence under 24 (1%).
What is the history/ exam of Chlamydia Trachomatis?
· 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.
What investigations do you do for Chlamydia Trachomatis?
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.
What is the management of Chlamydia Trachomatis?
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.
What are the complications/ prognosis of Chlamydia Trachomatis?
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.
