Infections Of The Genital Tract

Question 1

Complications of PID

Answer 1

Tubo-ovarian abscess, infertility, ectopic pregnancy, chronic pelvic pain, Fitz-Hugh-Curtis Syndrome

Question 2

Chlamydia discharge

Answer 2

Minimal, milky white

Question 3

Chlamydia complications

Answer 3

PID (infertility, ectopic), Reiter syndrome, conjunctivitis and pneumonia in neonates

Question 4

Trichomonas vaginalis discharge

Answer 4

Offensive smelling, yellow-green, purulent and frothy

Question 5

Candidiasis diagnosis

Answer 5

High vaginal swab for gram stain, microscopy and culture

Question 6

Candidiasis treatment

Answer 6

Topical and intravaginal cotrimazole, oral fluconazole

Question 7

Complications of bacterial vaginosis infection

Answer 7

Miscarriage, premature labour, PROM, chorioamnionitis, postpartum endometritis, PID, increased risk of HIV

Question 8

Can Hep A be transmitted sexually?

Answer 8

Yes, especially in MSM

Question 9

Gonorrhoea complications

Answer 9

male: epididymoorchitis
Female: PID, infertility, septic arthritis
Fetus: Ophthalmia neonatorum (can be septic)

Question 10

Mild-mod management of PID

Answer 10

Gonorrhea and chlamydia: Ceftriaxone 500mg IM + Azithromycin 1g
Anaerobes: Metronidazole 400mg PO BD 1/52
Gram-ve: Doxycycline 100mg PO BD 1/52

Question 11

Severe management of PID

Answer 11

Ceftriaxone 2g IV OD + azithromycin 2g IV TDS
Metronidazole 200mg IV BD
Gentamicin PO 2/52

Question 12

Trichomonas vaginosis symptoms

Answer 12

Itch, soreness, ‘strawberry cervix’ with punctuate red spots, can be asymptomatic

Question 13

Chlamydia and gonorrhea diagnosis

Answer 13

Vulvovaginal swab for culture and microscopy, NAAT (urine PCR)

Question 14

Gonorrhea discharge and symptoms

Answer 14

Purulent yellow-green

Asymptomatic or cervicitis, UTI, dyspareunia, abdominal pain

Question 15

Gonorrhea treatment

Answer 15

IM Ceftriaxone + oral azithromycin

Question 16

Chlamydia treatment

Answer 16

Oral azithromycin or doxycycline

Question 17

HPV incubation period and symptoms

Answer 17

1-6 months

Pain, pruritus, bleeding, warts (popular, raised, irregular, pink)

Question 18

Genital warts management

Answer 18

Topical imiquimod, laser ablation, cryo

Question 19

Diagnosing bacterial vaginosis and managing

Answer 19

Amsel criteria

• ph > 4.5
• positive whiff-amine test
• clue cells on gram stain and microscopy
• homogenous discharge

Oral/vaginal metronidazole esp before gynae procedures

Question 20

Bacterial vaginosis discharge

Answer 20

Thin, white-grey, homogenous, fishy odor

Question 21

Tests for PID

Answer 21

MSU dipstick + culture
FBC, CRP, blood culture, STI screen
High vaginal and endocervical swab
Pelvic U/S

Question 22

Syphilis clinical features

Answer 22

Primary: painless ulcer/ulcers on vulva, vagina or cervix, enlarged groin/inguinal LN

Secondary: maculopapular rash on palms and soles, mucous membranes ulcers, generalized lymphadenopathy, arthritis

Neurosyphilis: meningitis, stroke, tabes dorsalis

Cardiovascular: aortic aneurysm

Question 23

How to manage syphilis

Answer 23

Procaine penicillin 1.2 MU daily IM for 12 days

Benzathine penicillin 2.4 MU IM, repeat again after 7 days

Doxycycline 100mg BD for 14 days

Erythromycin 500mg QDS for 14 days