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Gynae > Infections > Flashcards

Infections Flashcards

1
Q

What causes bacterial vaginosis?

A

overgrowth of commensal anaerobic microorganisms and loss of normal vaginal lactobacilli.

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2
Q

Most common organism for BV

A

Gardnerella vaginalis is the most commonly implicated organism

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3
Q

RFs for BV

A

Multiple sexual partners
Intrauterine device
Smoking
Douching

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4
Q

Presentation of BV

A

Offensive vaginal discharge (commonly described as having a fishy odour)
Homogenous off-white discharge

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5
Q

Investigations for BV

A

Bedside

Microscopy of Vaginal Discharge :
Amsel Criteria
Vaginal pH > 4.5
Typical Discharge
Clue Cells
Positive Whiff-Amine Test

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6
Q

What is Amsel criteria?

A

Vaginal pH > 4.5
Typical Discharge
Clue Cells
Positive Whiff-Amine Test

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7
Q

Management of BV

A

Reduce exposure to precipitants (e.g. vaginal douching, bubble baths, shampoos)
1st Line: Oral Metronidazole 400 mg BD for 5-7 Days
If concerns about compliance: a single oral dose of 2 g metronidazole can be used
If topical treatment preferred: intravaginal metronidazole gel 0.75% OD for 5 days or intravaginal clindamycin cream 2% OD for 7 days
Alternative oral options: clindamycin and tinidazole

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8
Q

1st line management for BV

A

1st Line: Oral Metronidazole 400 mg BD for 5-7 Days

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9
Q

Cause of Trichomoniasis

A

Vaginal infection caused by Trichomonas vaginalis (flagellate protozoan) that is usually sexually transmitted.

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10
Q

Presentation of trichomoniasis

A

Foul-smelling, frothy green-yellow vaginal discharge
Vulval itching and discomfort
Dysuria
Abdominal pain
Balanitis in men

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11
Q

What colour discharge in trichomoniasis?

A

Foul-smelling, frothy green-yellow vaginal discharge

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12
Q

Investigations for trichomoniasis

A

Bedside
Speculum Examination
Strawberry cervix appearance (only present in the minority of cases)
High Vaginal and Endocervical Swabs
Microscopy will reveal motile trichomonads
Full STI Screening

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13
Q

What will be seen on speculum examination in trichomoniasis?

A

Strawberry cervix appearance (only present in the minority of cases)

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14
Q

strawberry cervix

A

trichomoniasis

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15
Q

What is seen on high vaginal and endocervical swabs in trichomoniasis?

A

Microscopy will reveal motile trichomonads

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16
Q

Management of trichomoniasis

A

1st Line: Oral Metronidazole 400-500 mg BD for 5-7 days
Alternative: Metronidazole 2 g STAT or tinidazole 2 g STAT
NOTE: this is not recommended if the patient is pregnant or breastfeeding
Offer treatment for current partner(s) and any partners from the 4-week period prior to presentation

17
Q

1st line management of trichomoniasis

A

1st Line: Oral Metronidazole 400-500 mg BD for 5-7 days

18
Q

RFs for vulvovaginal candidaias

A

Pregnancy
Immunosuppression
Poorly-controlled diabetes

19
Q

Presentation of vulvovaginal candidiasis

A

Vulval itching and irritation
Thick, white vaginal discharge

20
Q

Investigations of vulvovaginal candidiasis

A

High Vaginal and Endocervical Swab
Vaginal pH

21
Q

Conservative management of vulvovaginal candidiasis

A

Use simple emollients as soap substitutes to wash the vulval area
Avoid contact with potentially irritant soaps
Avoid vaginal douching
Avoid wearing tight-fitting and/or non-absorbent clothing

22
Q

Antifungal treatments for vulvovaginal candidiasis

A

1st Line: Fluconazole 150 mg PO STAT
2nd Line: Clotrimazole 500 mg intravaginal pessary STAT

23
Q

1st line treatment for vulvovaginal candidiasis

A

1st Line: Fluconazole 150 mg PO STAT

24
Q

What antifungal treatment if primarily vulval symptoms in vulvovaginal candidiasis?

A

If primarily vulval symptoms: consider using topical imidazole (e.g. clotrimazole 1%) in addition to an oral or intravaginal antifungal

25
Q

Management of vulvovaginal candidiasisi in girls aged 12-15 years

A

Consider prescribing topical clotrimazole instead of intravaginal or oral antifungal

26
Q

Management of vulvovaginal candidiasis in pregnant and breastfeeding women

A

Intravaginal Clotrimazole

27
Q

What is recurrent vulvovaginal candidiasis defined as?

A

4 or more episodes per year

28
Q

Management of recurrent vulvovaginal candidiasis

A

Induction: Three doses of oral fluconazole 150 mg every 72 hours
Maintenance: Oral fluconazole 150 mg once a week for 6 months

29
Q
A

Gynae (8 decks)

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