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Obstetrics and Gynaecology > Infections > Flashcards

Infections Flashcards

1
Q

What are the causes for vaginal discharge?

A 
Physiological
Candida
Trichimonas vaginalis
Bacterial vaginosis
Gonorrhoea
Chlamydia
Ectropion
Foreign body
Cervical cancer
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2
Q

What type of discharge is seen in candida infections?

A

Curd like
Non-offensive
White

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3
Q

What type of discharge is seen in trichimonas?

A

Yellow, frothy, offensive

Strawberry cervic

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4
Q

What type of discharge is seen in bacterial vaginosis?

A

Thin
White/grey
Fishy

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5
Q

What type of discharge is seen in gonorrhoea?

A

Thin
Watery
Yellow

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6
Q

What type of discharge is seen in chlamydia?

A

Copious amounts of purulent yellow discharge

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7
Q

What type of discharge is seen in ectropion?

A

Increased amounts of normal discharge

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8
Q

What type of discharge may be seen with foreign bodies?

A

Foul smelling

+ blood

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9
Q

What type of discharge is seen in cervical cancer?

A

Persistent discharge which doesn’t respond to treatment

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10
Q

What are the main risk factors for STI’s?

A 
Age <25
Sexual partner positive
Recent change in sexual partner
Co-infection with another STI
Non-barrier contraception
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11
Q

How are STI’s managed in general?

A

Abstain from sex until both treated
Offer screening for other STI’s
Encourage talking to previous partners
Talk about safe sex in future

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12
Q

What organism causes chlamydia and how long is the incubation period?

A

Chlamydia trachomatis
Intracellular gram -ve cocci/rod shaped
7-21 day incubation

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13
Q

How is chlamydia transmitted?

A

Vaginal, oral or anal sex
Skin-skin genital contact
Can infect eye, pharynx and rectum

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14
Q

How does chlamydia present in women?

A 
70% asymptomatic
Cervicitis - discharge and bleeding
Dysuria
Pelvic pain
Cervical excitation
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15
Q

How does chlamydia present in males?

A

50% asymptomatic
Dysuria
Discharge
Testicular pain

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16
Q

How is chlamydia investigated?

A

NAAT technique on:

Vulvo-vaginal swab
First void urine

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17
Q

How is chlamydia managed?

A

1 dose azithromycin or

7 days doxycycline (erythromycin if CI)

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18
Q

How is chlamydia followed up?

A

TOC 5 weeks after treatment start

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19
Q

What are the main complications of chlamydia?

A

PID
Epididymo-orchitis and epididymitis
Sexually acquired reactive arthritis

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20
Q

What contact tracing is required for chlamydia?

A

Symptomatic men - 4 weeks prior to symptoms

Women and asymptomatic men - partners from last 6 months

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21
Q

What is important to know about chlamydia in pregnancy?

A

Risk of premature delivery, low birth weight and still birth
Give azithromycin or erythromycin (doxy is CI)
Neonatal erythromycin

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22
Q

What organism causes gonorrhoea? how long is the incubation period?

A

Neisseria gonorrhoea - gram -ve cocci

2-5 day incubation

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23
Q

How is gonorrhoea transmitted?

A

Vaginal, oral or anal sex
Vertical transmission - mother to child

Can infect rectum and pharynx

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24
Q

What is the main additional risk factor for gonorrhoea?

A

MSM

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25
Q

How does gonorrhoea present in women?

A 
50% asymptomatic
Cervicitis - thin watery yellow discharge
Dysuria
Pelvic pain
Easily induced cevical bleeding
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26
Q

How does gonorrhoea present in men?

A

Purulent discharge
Dysuria
Epididymal tenderness

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27
Q

How is gonorrhoea investigated?

A

NAAT technique - endocervical/vaginal swab or first pass urine

Microscopy and culture - endocervical/urethral swabs

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28
Q

How is gonorrhoea managed?

A

Treat while waiting for swab results - IM ceftriaxone

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29
Q

How is gonorrhoea followed up?

A

TOC 2 weeks after treatment complete

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30
Q

What are the main complications associated with gonorrhoea?

A 
PID
Epididymo-orchitis
Prostatits
Salpingitis --> infertility
Disseminated gonococcal infection
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31
Q

How would you contact trace for gonorrhoea?

A

Symptomatic men - all partners 2 weeks

Women and asymptomatic men - all partners 3 months

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32
Q

What is important to know about gonorrhoea in pregnancy?

A

Risk of spontaneous abortion, premature labour and early rupture of membranes

IM ceftriaxone and oral azithromycin

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33
Q

How is chlamydia screened in the UK?

A

Open to all men/women 15-24yo

Rely on opportunistic testing

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34
Q

How does a disseminated gonococcal infection present and how is it managed?

A

Skin lesions and joint pain

Admit to hospital for management - can lead to sepsis

35
Q

What organism causes syphilis? How long is incubation?

A

Treponema pallidum - gram negative spirochete bacteria

2-3 weeks

36
Q

How is syphilis transmitted? what are the key additional risk factors?

A

Vaginal, oral, anal sex, vertical transmission, blood products

MSM and HIV

37
Q

What are the stages of a syphilis infection?

A

Primary –> secondary –> Latent (asymptomatic) –> Tertiary

38
Q

How does a primary syphilis infection present?

A

Papule ulcerate into chancre

Chancre is painless, hard and non-itchy

Heals in 3-10 weeks

39
Q

How does a secondary syphilis infection present?

A

3 months post infection
Non-itchy, non-painful rash on hands and soles of feet
Fever, malaise, arthralgia, weight loss
Painless lymphadenopathy
Condylomata lata - elevated wart like plaques in moist skin creases

Can affect kidneys liver and brain

40
Q

How does a tertiary syphilis infection present?

A

Many years later:
Gummatous - granulomas form almost anywhere
Neuro - tabes dorsalis, dementia, argyll robertson pupil, stroke
CVS - aortic valvulitis, ascending aorta dilation, angina

41
Q

How would you investigate syphilis?

A

Serological tests:
Treponemal test - TPHA (remain +ve after treatment)
Cardiolipin tests - VLDR (go -ve after treatment)

42
Q

When can false positives for syphilis serological tests occur?

A 
Pregnancy
SLE
Antiphospholipid syndrome
TB
Leprosy
Malaria
HIV
43
Q

How is syphilis managed?

A

IM benpen

44
Q

What is Jarisch-Herxheimer reaction?

A

Flu like illness after first dose of Abx in syphilis

Due to endotoxins released from dying bacteria

Manage with supportive measures

45
Q

What organisms cause genital warts?

A

HPV - esp. 6 and 11

46
Q

How are genital warts transmitted?

A

Skin to skin contact - doesn’t need to be penetrative

47
Q

How would you investigate genital warts?

A

Generally clinical diagnosis

Females may need speculum - internal warts

Biopsy if lesions atypical

48
Q

How are genital warts managed?

A

Not always needed

Physical ablation:

  • if 1 or 2
  • either cryotherapy, laser or excision

Topical:

  • many warts
  • Podophyllotoxin or imiquimod - weaken latex condoms
  • CI in pregnancy and breastfeeding
49
Q

How do genital warts present?

A

Most asymptomatic and resolve spontaneously

  • Painless fleshy growths
  • Can be hard or soft
  • May bleed or itch
50
Q

What is important to know about genital warts in pregnancy?

A

No associated complications

Small risk of transmission in birth - usually self resolve

51
Q

What causes genital herpes?

A

Herpes simplex 1 and 2

1 - genital and cold sores
2 - genital and anal

52
Q

How is genital herpes transmitted?

A

Skin to skin contact

Oral sex from someone with cold sore

53
Q

What is the pathophysiology of genital herpes?

A

Remain dormant in nerve root ganglion

Can reactivate

54
Q

How does genital herpes present?

A

May be months to years after infection

Small red painful blister - crust and heal in 20 days
Discharge
Itchy genitals
Flu like symptoms

Secondary infections like primary but much shorter

55
Q

How is genital herpes investigated?

A

Swab open sore

PCR - differentiate between HSV 1 and 2

56
Q

If a patient has >5 outbreaks of genital herpes, what should be done?

A

Test for HIV

57
Q

How is genital herpes managed?

A

Oral acyclovir
Painkillers
Petroleum jelly and ice packs

58
Q

What is important to know about genital herpes in pregnancy?

A

Pre existing herpes:

  • Maternal antibodies cross via placenta
  • Option of vaginal or c-section as risk of transmission v low

Herpes contracted in trimester 3:

  • No maternal antibodies to pass on
  • C-section highly recommended
59
Q

What causes trichomonas vaginalis? what is the incubation period?

A

A protozoa

1 month incubation

60
Q

How is trichomonas vaginalis transmitted? what are the additional risk factors?

A 
Vaginal sex (NOT ORAL OR ANAL)
Vertical transmission - mother to child at delivery

Older women

61
Q

How does trichomonas vaginalis present in men?

A

Usually asymptomatic in men

Discharge
Dysuria
Urinary frequency
Itching and soreness

62
Q

How does trichomonas vaginalis present in women?

A 
Vaginal odour
Yellow/green frothy discharge
Itching and soreness
Dyspareunia
Dysuria
"strawberry cervix" on examination
63
Q

How would you investigate trichomonas vaginalis?

A

Microscopy and culture:

F - High vaginal swab
M - Urethral swab or first void urine

64
Q

How is trichomonas vaginalis managed?

A

Oral metronidazole

Treat all partners from previous month

65
Q

What is important to know about trichomonas vaginalis in pregnancy?

A

Risk of premature labour and low birth weight

Metronidazole can be used but affect taste of breast milk

66
Q

What are the similarities between BV and trichomonas?

A

“Offensive” vaginal discharge

Vaginal pH >4.5

Treat with metronidazole

67
Q

How does BV vary from trichomonas?

A

Thin white discharge

Microscopy - clue cells

68
Q

How does trichomonas vary from BV?

A

Frothy yellow green discharge
Vulvovaginitis
Strawberry cervix

Wet mount - motile trophozoites

69
Q

What is bacterial vaginosis?

A

Not an STI
Normal vaginal flora disturbed leading to reduced lactobacilli
Other micro-organisms grow - Gardnerella Vaginalis, anaerobes and mycoplasmas

70
Q

Why do you have a raised pH in bacterial vaginosis?

A

Lactobacilli produce hydrogen peroxide to maintain acidity

Reduced lactobacilli

71
Q

What are the main risk factors for bacterial vaginosis?

A 
Multiple sexual partners
Receptive oral sex
IUD
Concurrent STI
Vaginal douching or soaps
Recent Abx use
72
Q

How does bacterial vaginosis present?

A

Offensive fishy discharge
Thin white/grey discharge
Not normally sore or itchy

73
Q

How is bacterial vaginosis diagnosed?

A

High vaginal swab for microscopy:

  • Clue cells (vaginal epithelia studded with coccobacilli)
  • Reduced lactobacilli
  • Absence of pus cells

Vaginal pH >4.5
Positive whiff test - add alkali to discharge and strong fishy odour smelt

74
Q

How is bacterial vaginosis managed?

A 
Asymptomatic - dont need treating
Oral metronidazole - can be vaginal
Clindamycin second line
Advice regarding risk factors
Consider IUD removal
75
Q

What is the recurrence rate of bacterial vaginosis and how is it managed?

A

> 50% in 3 months

Oral metronidazole

76
Q

What is important to know about bacterial vaginosis in pregnancy?

A

Symptomatic BV can increase risks of premature birth, miscarriage and chorioamnionitis

Treat with metronidazole

77
Q

What is candidiasis?

A

Not an STI

Also called thrush

Overgrown of Candida albicans

78
Q

What is the peak incidence of candidiasis?

A

20-40yo

79
Q

What are the main risk factors for thrush?

A 
Pregnancy
Diabetes
Recent abx use
Corticosteroid use
Immunocompromised
80
Q

How does thrush present?

A

Vulval itching
White curd like discharge - non-offensive
Dysuria

On examination:

  • erythematous vulva
  • satellite lesions - red pustular lesions with superficial white pseudomembranous plaques that can be scraped off
81
Q

How is thrush managed?

A

Intravaginal cream or pessary - clotrimazole

Oral fluconazole

82
Q

What should you do if thrush management fails?

A

Measure vaginal pH (<4.5 in thrush) and swab for microscopy

Address risk factors

Treat for longer period

83
Q

Why is thrush more likely in pregnancy? How is it managed?

A

Oestrogen levels - increased glycogen create favourable environment. Promote growth and sticks it to walls

Treat with intravaginal not oral meds

Obstetrics and Gynaecology (21 decks)

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