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Obstetrics and Gynaecology > Infections > Flashcards

Infections Flashcards

1
Q

What is pelvic inflammatory disease?

A

Inflammation of upper genital tract (above cervix) including endometrium, fallopian tubes, ovaries, pelvic peritoneum +/- contiguous structures

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2
Q

What is the aetiology of PID?

A

Sexually transmitted - chlamydia trachomatis, n. gonorrheae, mycoplasma

Non-sexually transmitted - anaerobic - e.coli, strep, staph etc.

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3
Q

Which signs would make you suspicious of PID? (Must haves (3) + one or more of… (6))

A

Must have: lower abdominal pain, cervical motion tenderness, adnexal tenderness (latter two elicited by bimanual palpation)

Plus one or more of: temperature >38, mucopurulent cervical discharge, positive for chlamydia or gonorrhea or other vaginal flora, pelvic abscess or inflammatory mass on U/S or bimanual, leukocytosis,elevated ESR or CRP

can also complain of dyspareunia and menstrual changes

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4
Q

What investigations are used to diagnose PID? (5)

A

Diagnosis is almost always based on hx and clinical findings

  1. Bloodwork - beta-HCG (always rule out pregnancy in this population), CBC, blood cultures if suspect septicaemia
  2. Urinalysis
  3. Speculum examination - vaginal swab for gram stain and C&S, cervical cultures for gonorrhoea and chlamydia
  4. US - usu. transvaginal, free fluid or pelvic/tubo-ovarian abacess
  5. Laparoscopy (gold standard) - but may miss subtle inflammation of tubes or endometritis
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5
Q

When is inpatient treatment of PID warranted? (4)

A
  1. Severe clinical disease such as fever, tubo-ovarian abscess or peritonitis
  2. Pregnant
  3. Surgical emergency cannot be excluded (e.g. ovarian torsion or appendicitis)
  4. Unable to tolerate outpatient therapy or failed oral therapy
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6
Q

How is mild to moderate PID treated?

A

Outpatient

Ceftriaxone + metronidazole + azithromycin + either azithromycin (1 week later) OR doxycycline (12 hourly for 2 weeks)

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7
Q

How is severe PID treated?

A

Inpatient

ceftriaxone + azithromycin + metronidazole

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8
Q

What are the basic principles of PID management? (8)

A
  1. Antibiotics dependent on severity
  2. Rest and simple analgesia when required
  3. Patient to avoid sexual intercourse for a week or until symptomatically better
  4. Prophylactic Candida treatment
  5. Offer sexual partners screening for STI
  6. Contact tracing for chlamydia, gonorrhoea
  7. No need for removal of IUCD if patient wishes to continue to use it
  8. Follow-up: at 72 hours and at 2 weeks
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9
Q

What are the clinical features of chlamydia? (6)

A
  1. Asymptomatic (80% of women)
  2. Muco-purulent cervical discharge
  3. Urethral syndrome: dysuria, frequency, pyuria
  4. Pelvic pain
    5 Post-coital bleeding or intermenstrual bleeding
  5. Symptomatic sexual partner
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10
Q

How is chlamydia investigated?

A
  1. First void urine test PCR OR

2. Cervical sample for PCR

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11
Q

How is chlamydia managed? (4)

A
  1. Azithromycin single dose
  2. Treat gonorrhoea because high rate of infection - ceftriaxone
  3. Treat partners
  4. Report
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12
Q

Which STIs are tested using a vaginal swab?

A

Bacterial vaginosis - not an STI
Trichomoniasis
Candida - not an STI

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13
Q

Which STIs are tested using a cervical swab?

A

Gonorrhoea

Chlamydia

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14
Q

What are the clinical features of gonorrhoea? (6)

A

Same as chlamydia

  1. Asymptomatic (80% of women)
  2. Muco-purulent cervical discharge
  3. Urethral syndrome: dysuria, frequency, pyuria
  4. Pelvic pain
    5 Post-coital bleeding or intermenstrual bleeding
  5. Symptomatic sexual partner
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15
Q

How is gonorrhoea investigated?

A

Cervical/rectal/throat MCS

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16
Q

How is gonorrhoea managed? (4)

A
  1. Ceftriaxone
  2. Treat chlamydia because of co-infection - azithromycin
  3. Treat partners
  4. Reportable disease
17
Q

What are the clinical features of genital herpes? (5)

A
  1. May be asymptomatic
  2. Prodromal symptoms: tingling, burning, pruritus
  3. Multiple, painful, shallow ulcerations with small vesicles appear 7-10d after initial infection (lesions are infectious)
  4. Inguinal lymphadenopathy, malaise and fever
  5. Can have dysuria
18
Q

How is genital herpes investigated?

A

Viral swab of lesions for complex PCR

Consider full STI screen in patients presenting for first time

19
Q

How is genital herpes managed?

A

Acyclovir - not curative. Can shorten episode if commenced within 72 hours of symptoms

20
Q

List 4 clinical features of candidiasis.

A
  1. Whitish, cottage cheese discharge
  2. Intense pruritus
  3. Swollen, inflamed genitals
  4. Vulvar burning, dysuria, dyspareunia
21
Q

What does a vaginal swab for candidiasis show?

A

Hyphae and spores

22
Q

How is candidiasis treated? (2)

A
  1. Oral fluconazole OR

2. Vaginal imidazole e.g. clotrimazole cream

23
Q

What are the clinical features of bacterial vaginosis? (4)

A
  1. Grey thin diffuse discharge
  2. Can be asymptomatic
  3. Fishy odour, esp. after coitus
  4. Absence of vulvar/vaginal irritation
24
Q

How is bacterial vaginosis treated?

A
  1. Oral or vaginal gel - metronidazole
25
Q

List 4 clinical features of trichomoniasis

A
  1. Yellow-green, frothy discharge
  2. Petechiae on vagina and cervix
  3. Occasionally irritated tender vulva
  4. Dysuria, frequency
26
Q

How is trichomoniasis treated?

A

Single dose metronidazole

27
Q

What are the clinical features of primary syphilis? (3)

A
  1. 3-4 weeks after exposure
  2. Painless chancre on vulva, vagina or cervix
  3. Painless inguinal lymphadenopathy
28
Q

What are the clinical features of secondary syphilis? (3)

A
  1. 2-6 months after clinical features
  2. Nonspecific symptoms: malaise, anorexia, headache, diffuse lymphadenopathy
  3. Generalised maculopapular rash: palms, soles, trunk, limbs
29
Q

In which type of syphilis are serological tests more likely to be negative?

A

Primary syphilis - local infection only

30
Q

How is syphilis diagnosed? (2)

A
  1. Darkfield microscopy of lesions - spirochetes
  2. Serological - non-treponemal rapid plasma reagin (RPR) test (screening) + specific treponemal antibody tests (confirmatory)
31
Q

What are the clinical features of tertiary syphilis? (3)

A
  1. Neurological: tabes dorsalis, general paresis
  2. Cardiovascular: aortic aneurysm
  3. Vulvar gumma: nodules that enlarge, ulcerate and become necrotic (rare)
32
Q

How is syphilis managed? (3)

A

Benzathine penicillin single dose

Treat partners

Report

Obstetrics and Gynaecology (10 decks)

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