Investigation and management of postcoital bleeding Flashcards
How common is postcoital bleeding?
9%
Post PPV for cervical cancer
Where to refer patient with PCB?
2WW if Sx of cervical cancer
- Unexplained PC bleeding/persistant vaginal discharge
- Abnormal Cx or vagina on speculum
If gynaecologist then suspicious of cancer then refer to colposcopy
Flow diagram how to manage PCB
What is most common cause of PCB in young women?
Cervicitis secondary to chlamydia infection
- Vulvovaginal NAAT for chlamyia
- Cervical NAAT for gonorrhoea
How to manage ectropian?
Can only Dx if regular negative cervical screening.
If COCP can switch to POP
Offer cautery but explain risk discharge, cervical stenosis.
If any doubt in Dx perform cervical Bx
How to manage cervical polyp
Remove with forceps and send for histology. If broad base loop diathermy at colposcopy.
If peri/post menopausal 55% chance of endometrial abnormality - should be sent for hysteroscopy and endometrial Bx
Risk of malignancy or dysphasia with endometrial polyp?
1.7%
Treatment for chlamydia
o Chlamydia azithromycin 1g, then 500mg OD for 2 days
o Doxycycline 100mg BD 7D
Test of cure if compliance issue or pregnancy
Best swab NAAT vulvovaginal
Treatment for gonorrhoea
ceftirxone 1g IM
All patients should have test of cure due to issue with drug resistance
Inpatient and outpatient treatment for PID
How common is CIN in patients with PCB?
18%
What HPV strains does Gardesel protect from?
HPV 6,11,16,18
Offered to age 12-13
What to offer if CIN1 or CIN2/3
CIN 1 - review again in 12 months
CIN 2/3 - Treatment and TOC in 6 months
What treatments can be offered for vaginal atrophy?
topical moisturiser, topical oestrogen, DHEA, ospemifene & laser
What proportion of women with PCB is no cause found? In what proportion of these women will it resolve within 6 months
50%
60% resolve within 6 months
