Non-STI related infections Flashcards
What is bacterial vaginosis?
A disease of the vagina caused by excessive overgrowth. It is an imbalance of bacterai rather than infection (usually anaerobes).
Why does bacterial vaginosis occur?
Due to an overgrowth of anaerobic bacteria, geintal mycoplasma and gardnerella vaginalis. Lactobacilli are reduced
What are symptoms of BV?
Asymptomatic in 50%, or:
- Thin, white, fishy smelling vaginal discharge
- No itching
- No soreness (unlike thrush)
What are signs of bacterial vaginosis?
Thin homogenous discharge
How would you investigate someone with suspected BV?
- Clinical history and examination
- Gram staining of vaginal flora
- Vaginal pH
What might you see on gram staining of swabs from someone with suspected BV?
- Depletion of lactobacill
- Mixed organisms
- Clue cells
What will the vaginal pH be in someone with BV?
>4.5
What are clue cells?
Clue cells are vaginal squamous epithelial cells coated with the anaerobic gram-variable coccobacilli Gardnerella vaginalis and other anaerobic bacteria causing bacterial vaginosis.
What can give a raised vaginal pH?
- Menses
- Semen
- T. vaginalis
What is “whiff’s test”
KOH added to discharge sample
Positive if strong fishy odour produced
(NOTE THAT TRICHOMONAS IS THE ONLY OTHER OFFENSIVE DISCHARGE)
How would you manage someone with BV?
- Metranidazole Oral/PV
- Clindamycin PV
Is BV a sexually transmitted disease?
No
What are complications of BV?
- Associated with endometritis if uterine instrumentation / delivery
- Associated with premature labour
- Increases risk of HIV acquisition
What is BV associated with?
Vit D deficiency in black women
Endometritis if uterine instrumen
Premature labour
Increased risk of HIV acquisation
What are the causative organisms implicated in genital candidiasis?
90% caused by
- Candida Albicans
- Candida Glabrata
(Acquired from bowel)
Risk factors for thrush
Pregnancy
DM (screen if recurrent)
Steroids
Immune supression including HIV
Antibiotics
Reproductive age group
How does genital candidiasis present?
- Genital itch
- Burning
- Cottage cheese like discharge (usually no offensive)
- Dyspareunia
What are signs of genital candidiasis?
- Fissuring
- Erythema with satellite lesions
- Characterisitc discharge - cottage cheese
What investigation would you consider doing if you suspected Genital candidiasis?
- Clinical history and examination
- Microscopy and gram staining (shows yeast spores)
How would you manage someone with genital candidiasis?
-
Topical treatment
- Clotrimazole pessaries
- Miconazole pessaries
-
Oral treatment
- Fluclonazole PO (CI in pregnancy)
Risk factors balantitis
DM
Poor hygine
Chemical/phsical irritation
Immunospuression
What is smegma?
Collection of dead skins cells from fungal/bacterial infection.
Presentation balantitis
Sore, inflamed and swollen flans/foreskin
Phimosis
Ulceration, plaques
Dysuria
Discharge
What is the following?
Zoon’s balanitis - chronic inflammation secondary to overgrowth of commensal organisms plus foreskin malfunction
Management balantitis
Avoid irritants, hygeine, candida treatment
Antibiotics - amoxicillan
What is tinea cruris?
Fungal infections cause by dermatophytes leading to itching red inguinal regions (inside thighs) usually men. Antifungals - fluconazole
What erythrasma
Caused by corynebacterium minutissimum.
Brown and scaly patches in skin fols and groins
Mx = topical fuscic acid +/- macrolides
