Minor illnesses Flashcards
Bacterial vaginosis
Characterised by an overgrowth of predominantly anaerobic organisms and a loss of lactobacilli
Vagina loses its normal acidity & its pH increases > 4.5
Bacterial vaginosis risk factors
Sexual activity
Use of douches, deodorant, vaginal washes, menstruation & presence of semen in the vagina
Copper IUD
Smoking
Bacterial vaginosis protective factors
Use of hormonal contraception
Consistent condom use
Circumcised partner
Bacterial vaginosis presentation
50% are asymptomatic
Fishy-smelling, grey/white homogenous discharge
NOT associated with itching or soreness
Bacterial vaginosis management
Non-pregnant women with asymptomatic BV do not usually require BV treatment
Symptomatic women:
- Oral metronidazole
- Intravaginal metronidazole gel/intravaginal clindamycin cream are alternative choices
Should be advised to avoid exposure to contributing factors
Symptoms persist/recur after initial treatment – adherence should be checked, diagnosis reconsidered, continued exposure to contributing factors checked, adequate management of current episode ensured
Persistent bacterial vaginosis treatment
Treat current episode with 7-day course of oral metronidazole
Consider prescribing metronidazole vaginal gel as suppressive treatment or discuss management with gynaecologist/GUM specialist
Vulvovaginal candidiasis
Symptomatic inflammation of the vagina and/or vulva caused by a superficial fungal infection
Usually with candida albicans
Acute – first/single isolated presentation of vulvovaginal candidiasis
Recurrent – 4 or more symptomatic episodes in one year
Vulvovaginal candidiasis risk factors
Increased oestrogen
Poorly controlled diabetes
Immunosuppression
Broad-spectrum antibiotics
Vulvovaginal candidiasis presentation
Thick, white discharge that does not typically smell
Vulval and vaginal itching, irritation or discomfort
More severe: erythema, fissures, oedema, dyspareunia, dysuria & excoriation
Vulvovaginal candidiasis investigations
Testing the vaginal pH using a swab and pH paper can be helpful
- BV and trichomonas (pH > 4.5)
- Candidiasis (pH < 4.5)
Charcoal swab with microscopy can confirm the diagnosis
Vulvovaginal candidiasis management
Antifungal medications delivered in several ways – cream, pessary, oral tablets
Initial management of uncomplicated cases:
- Single dose of intravaginal clotrimazole cream at night
- Single dose of clotrimazole pessary at night
- Three doses of clotrimazole pessaries over three nights
- Single dose of fluconazole
Recurrent infections (> 4 in a year) can be treated with an induction and maintenance regime over six months with oral/vaginal antifungal medications
Antifungal creams and pessaries can damage latex condoms & prevent spermicides from working, so alternative contraceptive is required for at least five days after use
Congenital rubella syndrome
Maternal infection with the rubella virus during first 20 weeks of pregnancy
Risk is highest before ten weeks gestation
Women planning to become pregnant should ensure they have had the MMR vaccine (if in doubt, test for rubella antibodies)
Congenital rubella syndrome features
Congenital deafness
Congenital cataracts
Congenital heart disease
Learning disability
Chickenpox in pregnancy features
More severe cases in the mother – varicella pneumonitis, hepatitis or encephalitis
Fetal varicella syndrome
Severe neonatal varicella infection
Exposure to chickenpox in pregnancy
Previously had chickenpox – safe
Not sure about immunity – test VZV IgG levels, if positive, they are safe
Not immune -> can be treated with IV varicella immunoglobulins as prophylaxis, given within ten days of exposure
Congenital varicella syndrome
Occurs when infection occurs in the first 28 weeks of gestation
Typical features include:
- Fetal growth restriction
- Microcephaly, hydrocephalus and learning disability
- Scars & significant skin changes located in specific dermatomes
- Limb hypoplasia
- Cataracts and inflammation in the eye (chorioretinitis)
Congenital cytomegalovirus
Occurs due to CMV infection in the mother during pregnancy, most cases do not cause congenital CMV
Features of congenital CMV:
- Fetal growth restriction
- Microcephaly
- Hearing loss
- Vision loss
- Learning disability
- Seizures
Parvovirus B19 infection in pregnancy
Can lead to several complications, particularly in the first and second trimesters
- Miscarriage or fetal death
- Severe fetal anaemia
- Hydrops fetalis
- Maternal pre-eclampsia-like syndrome
Parvovirus B19 infection in pregnant woman tests & treatment
IgM to parvovirus – tests for acute infection within the past four weeks
IgG to parvovirus – tests for long term immunity to the virus after a previous infection
Rubella antibodies (differential diagnosis)
Treatment – supportive, need referral to fetal medicine to monitor for complications and malformations
Vaccines for babies under 1 year old
8 weeks: 6-in-1 vaccine, rotavirus vaccines, menB vaccine
12 weeks: 6-in-1 vaccine (2nd dose), pneumococcal vaccine, rotavirus vaccine (2nd dose)
16 weeks: 6-in-1 vaccine (3rd dose), menB vaccine (2nd dose)
Vaccines for children aged 1 to 15
1 year: Hib/MenC vaccine (1st dose), MMR vaccine (1st dose), pneumococcal vaccine (2nd dose), menB vaccine (3rd dose)
2 to 10/11 years: children’s flu vaccine (every year until children finish primary school)
3 years and 4 months: MMR vaccine (2nd dose), 4-in-1 pre-school booster vaccine
12-13 years: HPV vaccine
14 years: 3-in-1 teenage booster vaccine, menACWY vaccine
Vaccines for adults
50 years (and every year after): flu vaccine
65 years: pneumococcal vaccine
70 to 79 years: shingles vaccine
Vaccines for pregnant women
During flu season: flu vaccine
From 16 weeks: pertussis vaccine
Exanthem
Eruptive skin rashes associated with a fever or other constitutional symptoms
Commonly arise from an infectious disease, but can also be drug-related
Aphthous ulcers
Small, painful ulcers of the mucosa in the mouth
Well-circumcised, punched-out, white appearance
Commonly occur in otherwise health people, with no underlying cause
Aphthous ulcers associated conditions
Inflammatory bowel disease – Crohn’s disease, UC
Coeliac disease
Behcet disease
Vitamin deficiency (iron, B12, folate, vitamin D)
HIV
Aphthous ulcers management
Usually heal within 2 weeks, manageable ulcers do not require any intervention
Topical treatments can be used
- Choline salicylate
- Benzydamine
- Lidocaine
Topical corticosteroids can be used in more severe ulcers, may reduce the duration and severity of symptoms eg. hydrocortisone buccal tablets
2WW in patients with unexplained ulceration lasting > 3 weeks
