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Gynaecology > Infections > Flashcards

Infections Flashcards

1
Q

What is bacterial vaginosis most commonly caused by?

A

Gardnerella vaginalis.

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2
Q

Classic presentation of bacterial vaginosis

A
  • Vaginal discharge: watery, grey-white, thin, foamy
  • fishy smell esp after sex or menstruation
  • vulvar/vag itch.
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3
Q

Dx bac vaginosis (4)

A

Amsel’s criteria

Presence of 3 or more:
1. Typical vaginal discharge: greyish thin homogenous 
2. Vag ph >4,5
3. Positive amine whiff test (add 10% KOH to discharge-enhance fishy odour).
4 presence of clue cells on smear microscopy (vag epithelial cells studded with adherent coccobacilli)
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4
Q

Rx bac vaginosis

A

Only treat symptomatic , pregnant or planning pregnancy.

Metronidazole 500 mg oral twice daily for 7 days. If pregnant, only begin end of first semester.

Alternative: vaginal preparations metronidazole gel 0,75% 5g daily for 5 days or clindamycin cream 2% 5 g nightly 7 days or clindamycin 300 mg oral bd 7 days

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5
Q

How is bac vaginosis spread

A

STI

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6
Q

What is condyloma acuminata

A

Genital warts

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7
Q

What is condyloma acuminata caused by

A

HPV 6 and 11

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8
Q

How are genital warts transmitted

A

STI

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9
Q

diagnosis condyloma acuminata

A
  • colposcopy after apply 3-5% acetic acid. Show acetowhite lesions
  • schiller’s test: stain with iodine solution. Healthy tissue stain dark brown, abnormal tissue unstained-appear white or yellow
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10
Q

Rx condyloma accuminata if small

A
  • Aldara(imiquimod) (immune response modifier)
  • podofilox (podophyllotoxin)
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11
Q

Rx medium size condyloma accuminata (3)

A
  • Cryotherapy
  • electrocautery
  • laser
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12
Q

Rx large size condyloma accuminata

A

Electrocautery under general anaesthesia

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13
Q

Rx condyloma accuminata in pregnancy

A

Laser therapy. Medical rx not known if safe.

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14
Q

How often test mothers for HIV? (6)

A
  • Universal at first prenatal visit. If negative:
  • repeat 3 monthly in pregnancy
  • at labour/ delivery
  • at 6 week immunisation EPI visit
  • 3 monthly while breastfeeding
  • 6 weeks after completing bf
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15
Q

How manage mother with positive rapid HIV test? (7)

A
  • Confirm with second rapid
  • hb, CD4, creatinine
  • stage HIV clinically
  • initiate art ( if Tb confirmed before art, initiate Tb therapy and AZT. 2 weeks later once stable switch AZT to fdc)
  • review in 1 week for hb, CD4, creatinine results
  • screen for Tb at each visit ( may delay rx), acute neuropsychiatric illness ( efavirenz contraindicated), renal impairment (no tenfovir )
  • check vl 3 months after started art
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16
Q

Name contraindication efavirenz

A

Neuropsychiatric illness

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17
Q

Name contraindication tenofovir

A

Renal disease creat >85
(Switch to azt)

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18
Q

Name 4 side effects HIV FDc

A
  • Dizzy
  • strange dreams
  • potential renal toxicity (tenofovir)
  • rash (unlikely)
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19
Q

How manage newly diagnosed HIV with CD4 < 200

A

Start Bactrim 1 week after FDC

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20
Q

How manage newly diagnosed HIV with CD4 < 100

A

Test for cryptococcal antigen and give Bactrim

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21
Q

Management positive HIV test at labour? (3)

A
  • Single dose NvP + single dose Truvada (emtricitabine + tenofovir) + AZT 3 hourly in labour
  • start FDC next day regardless of CD4
  • HIV PCR to neonate. Start nvp 12 weeks + AZT 6 weeks; follow up in 1 week to retest
22
Q

Name 4 causes bacterial vaginosis

A
  • gardnerella vaginalis
  • mobiluncus spp
  • Mycoplasma hominis (rx azithromycin); Ureaplasma
  • Bacteroides spp : prevotella
23
Q

Normal vaginal ph?

A

3,5 - 4,2

24
Q

Cause vulvovaginal candidiasis?

A

Mostly c albiccans but can also be C globrata

25
Q

Risk factors vulvo vaginal candidiasis? (4)

A
  • Diabetes and other immunosuppressive
  • pregnancy
  • hormonal contraceptives
  • recent antibiotic use
26
Q

Clinical presentation vulvo vaginal candidiasis (5)

A
  • Pruritis
  • dyspareunia
  • dysuria from erythema
  • thick curdy discharge
  • erythema, swelling, excoriations from itching
27
Q

Diagnosis vulvo vaginal candidiasis

A

Mostly clinical but can do -

Wet preparation (saline, 10% koh ) or gram stain of vaginal discharge showing budding yeasts, hyphae or pseudohyphae
Consider swab from anterior fornix for MCs if recurrent or suspected resistant

28
Q

Treatment vulvo vaginal candidiasis (3)

A
  • OTC: clotrimazole 2 % cream 5g intravaginally daily 3 days (can also use miconazole, tioconazole)
  • Prescription: butoconazole 2% cream (single dose bioadhesive) 5g intravaginal (can also use terconazole)
  • Oral: fluconazole 150 mg single dose

In Pregnancy can only be treated with topical azoles and longer, 7-14 days
If complicated/recurrent (>4/year) , longer therapy and suppression therapy with fluconazole weekly for 6 months in recurrent.

29
Q

Cause syphilis?

A

Treponema pallidum (spirochete)

30
Q

Name the 4 stages syphilis and their time frames and contagion

A

Primary: 3-4 weeks after exposure. Highly contagious

Secondary: 2-6 months after initial infection. Contagious

Latent: early latent a year or less after infection, late latent more than 1 year.

Tertiary: not contagious

31
Q

Clinical presentation primary syphilis?

A
  • Single painless ulcer/ chancre on vulva, vagina, cervix
  • erodes and heals spontaneously within 1 -8 weeks
  • painless inguinal lymphadenopathy

Serological tests negative.

32
Q

Clinical presentation secondary syphilis?

A
  • Non-specific: malaise, anorexia, headache, diffuse lymphadenopathy
  • generalised maculopapular rash. on palms, soles, trunk, limbs which resolves within 4-10 weeks but may reoccur any time within 4 years
  • condyloma lata: anogenital, broad based, fleshy grey lesions

Serological tests positive

33
Q

Clinical presentation latent syphilis?

A

Asymptomatic
25% will progress to tertiary/ neurosyphilis

34
Q

Clinical presentation tertiary syphilis? (3)

A
  • Vulva gumma: nodules that enlarge, ulcerate and are necrotic
  • neurological
    → early: cn palsy, meningitis, stroke, altered mental status, auditory/ophthalmic abnormalities
    → late: tabes dorsalis (dorsal column degeneration), general paresis
  • cardiovascular: aortic aneurysm, dilated aortic root
35
Q

Microscopic diagnostic tests syphilis? (2)

A
  • Dark field microscopy
  • direct fluorescent antibody for t pallidum (dfa - tp) (better)
36
Q

Serologic diagnostic tests syphilis? (5)

A

Nontreponemal (screening) (monitor rx)

  • venereal disease research lab (vdrl) slide test
  • rapid plasma reagin (rpr) test

Treponemal (confirmation) (positive for life)

  • fluorescent treponema antibody absorption (fta-abs)
  • t palladium haemagglutination assay (tpha)
  • t palladium particle agglutination assay (tppa)
37
Q

Treatment primary/ secondary/early latent syphilis? (3)

A

Benzathine penicillin G 2,4 million units IM stat

Follow up: quantative titres (nontreponemal test) at 6 and 12 months for primary + secondary syphilis
6,12,24 months early latent syphilis

More frequent in HIV

38
Q

Treatment late latent syphilis? (2)

A

Benzathine penicillin G 2,4 million units IM weekly X3 doses
Follow up after 6,12 and 24 months

39
Q

Treatment neuro syphilis? (2)

A

Iv aqueous penicillin G 3-4 million units
4 hourly
for 10-14 days

Follow up: CSF evaluation every 6 months until normal values

40
Q

Clinical presentation gonorrhoea? (10)

A

Local symptoms, if present:

  • Mucopurulent cervical/vaginal discharge
  • postcoital bleed
  • AUB
  • cervical excitation tenderness
  • concomitant UTI - dysuria

Mostly asymptomatic, present with complications later:

  • PID (15.%)
  • Tubal factor infertility
  • ectopic
  • chronic pelvic pain
  • disseminated gonococcal infection: tender necrotic skin lesions, tenosynovitis, monoarticular arthritis
41
Q

Who should be screened for gonorrhoea

A
  • All sexually active women <25 (and for chlamydia)
  • high risk sexual behaviour
  • genital symptoms

Not done in sa but ideal

42
Q

Diagnosis gonorrhoea (3)

A
  • nucleic acid amplification test (naat) (preferred): endocervical or vaginal dry swab held for 15-30 sec
  • gram stain: gram negative diplococci with atypical kidney bean shape
  • culture (valuable in resistant disease)
43
Q

Treatment uncomplicated gonorrhoea cervicitis (2)

A
  • ceftriaxone 250 mg IM stat +
  • azithromycin 1 mg po stat OR doxycycline 100 mg po bd x7 days

(Also covers chlamydia)

44
Q

Treatment disseminated gonorrhoea Infection (2)

A
  • Ceftriaxone 1 g IM or iv daily until response then switch to
  • oral cefixime 400 mg po bd for 7 days
45
Q

Prophylaxis gonorrhoea conjunctivitis to infants

A

Erythromycin 0,5% ointment

46
Q

Clinical presentation chlamydia? (4)

A

Even more asymptomatic than gonorrhoea. But if present:

  • mucopurulent endocervical discharge
  • urethral syndrome: dysuria, frequency, pyuria, no bacteria on culture
  • postcoital/intermenstrual bleeding due to cervicitis
  • chronic: chronic pelvic pain, fitz-hugh - Curtis syndrome (peritonitis)
47
Q

Diagnosis chlamydia (2)

A
  • NAAT test
  • culture
48
Q

Treatment chlamydia (2)

A

Azithromycin 1g oral +
Doxycycline 100 mg oral bd x 7 days

(Also give ceftriaxone because high rate gonorrhoea co-infection)

49
Q

What is lymphogranuloma venereum?

A

Caused by chlamydia trachomatis stereotypes L1, L2 or L3.

50
Q

lymphogranuloma venereum clinical course? (4)

A
  • Within 1-6 weeks after infection: small, painless, primary papule/ulcer on vulva / vagina
  • then: unilateral regional inguinal/femoral lymphadenopathy +/- systemic symptoms
  • untreated→ buboes (conglomerate of pustular abscess) → sinus drainage / inguinal ulceration
  • anogenitorectal syndrome if acquired by anal sex: genital fistula, lymphoedema, perirectal abscess, proctitis, rectal stricture.
51
Q

Treatment lymphogranuloma venereum?

A

Doxycycline 100mg po bd x21 days

Gynaecology (40 decks)

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