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Sexual Health > Infective vaginal discharge > Flashcards

Infective vaginal discharge Flashcards

1
Q

What are the non-STI causes of vaginal discharge?

A

Bacterial vaginosis

Candida (thrush)

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2
Q

What is the cause of BV?

A

Low levels of lactobacilli and high levels of anaerobic bacteria

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3
Q

What are the symptoms of BV?

A

Offensive fishy discharge
Increased volume of thin watery discharge
Absence of soreness, itching and irritation

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4
Q

How is BV diagnosed?

A

May be a clinical diagnosis
If clincial doubt:
- Low vaginal swab
- Gram staining of vaginal smear using Hay/Ison criteria

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5
Q

How is BV treated in non-pregnant and pregnant women?

A

Non-pregnant:
- PO 400mg metronidazole BD for 5/7
Pregnant:
- PV metronidazole OD for 5/7

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6
Q

What are the complications of untreated BV in pregnant and non-pregnant women?

A 
All women: 
- PID
- Cellulitis
Pregnant women:
- Late miscarriage
- PPROM
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7
Q

What is the cause of thrush?

A

Candida albicans

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8
Q

What are the symptoms of thrush?

A

Vulval itch and soreness
Thick, chunky white discharge
Superficial dyspareunia

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9
Q

What are the risk factors for thrush?

A 
Recent course of antibiotics
Immunocompromised 
DM
Elevated oestrogen
Pregnancy
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10
Q

How is thrush diagnosed?

A

Nil investigations required

Clinical diagnosis

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11
Q

How is thrush managed in pregnant and non-pregnant women?

A

Non-pregnant:
- PO fluconazole 150mg stat
OR
- Clotrimazole pessary stat

Pregnant:
- 7/7 clotrimazole pessary

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12
Q

Do asymptomatic partners need to be treated in thrush?

A

No

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13
Q

What are the STI causes of vaginal discharge and how are they classified?

A

Vaginal causes:
- Trichomoniasis vaginalis

Endocervical causes:

  • Chlamydia trachomatis
  • Neisseria gonorrhoeae
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14
Q

What is are the cardinal symptoms of trichomoniasis vaginalis?

A

Frothy yellow discharge
Vulval itch
Discomfort in vagina and vulva

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15
Q

What is a cardinal sign of trichomoniasis vaginalis on speculum examination?

A

Strawberry cervix

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16
Q

How is trichomoniasis vaginalis diagnosed?

A

Posterior fornix swab with microscopy

NAAT if available

17
Q

How is trichomoniasis vaginalis managed?

A

PO metronidazole 400mg BD for 5/7

18
Q

What is the advice for sexual partners in trichomoniasis vaginalis?

A

Must also be treated for trichomoniasis vaginalis AND avoid sex completely for 1/52

19
Q

What is the most common STI?

A

Chlamydia

20
Q

How does chlamydia present in women?

A 
Largely asymptomatic
Increased vaginal discharge
Dysuria
PCB
IMB
Deep dyspareunia and lower abdominal pain
21
Q

What signs are present on speculum in chlamydia?

A

Mucopurulent cervictis

May also have contact bleeding

22
Q

What is the window period after infection for chlamydia to be detectable?

A

2/52

23
Q

How is chlamydia diagnosed in women?

A

Vulvovaginal swab + NAAT if available

+ rectal or pharyngeal swabs if required

24
Q

How is chlamydia treated in pregnant and non-pregnant women?

A 
Non-pregnant:
- Doxycycline 100mg BD for 7/7
Pregnant:
- Azithromycin 1g PO stat on Day 1
Day 2 and 3 500mg PO azithromycin OD AND a test of cure
25
Q

What is the advice for sexual partners in chlamydia?

A

Treat all sexual partners and abstain from sex completely for 1/52

26
Q

Which STIs require a test of cure in pregnant women and how long after treatment should this be carried out?

A

Chlamydia 5/52

Gonorrhoea 2/52

27
Q

How might gonorrhoea present?

A 
Largely asymptomatic
Increased vaginal discharge
IMB
PCB
Deep dyspareunia
28
Q

What signs may be present on speculum in gonorrhoea?

A

Mucopurulent cervicitis

May also be contact bleeding

29
Q

How is gonorrhoea diagnosed?

A

Vulvovaginal NAAT swab or culture

30
Q

How is gonorrhoea treated in non-pregnant and pregnant women?

A

Both:

IM ceftriaxone 1g single dose

31
Q

What is the advice for sexual partners in gonorrhoea?

A

Treat all sexual partners and abstain from sex completely for 1/52

32
Q

What is the best practice advice when treating gonorrhoea?

A

Treat BOTH - high likelihood of them coexisting.
IM 1g ceftriaxone
100mg BD doxycycline for 7/7

Sexual Health (5 decks)

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