Nose, Ears, Mouth And uTI Flashcards
What’s the shape of normal uterus
Mid line, firm and smooth, not tender to touch
Abnormal uterus
Enlarged, asymmetrical and discomfort with palpitation
Trachomonasis is caused by what?
T. Vaginalis.
Women>men, increase with sex increase in sex patterers
What’s the clinical manifestations of T vaginalis infection
Off white or yellow frothy vigainal discharge often malodorous and profuse
Erythema of Vulva and cervix
STRAWBERRY CERVIX
Itch
Dysuria
10-50% asymptomatic in women
What’s cause of bacterial vaginosis?
Imbalance in normal flora
What’s the clinical manisfeststions of Bacterial vaginosis?
Greyish-white or milky thin watery discharge with unpleasant FISHY ODOR
Less common in women- itchy/burning near vagina
Up to 50% asymptomatic
Bacterial vaginosis is associated with what
Increase susceptibility to STDs e.g HIV and PID
Pregnacy can cause preterm birth
Vulvovaginal candidiasis
Cause by candida and 75% women will experience it in life time
What’s the clinical manifestation of vulvovaginal candidiasis
White thick clumpy COTTAGE CHEESE like vaginal discharge. Sometimes adhering to wall of cervix and vagina
VULVAR PRURITUS dorminant feature
Small vulvar fissures- burning, soreness, dyspareunia and dysuria
Genital herpes is it sexually transmitted
Yes, more prevalent if 14-59yrs
What the classical symptom of genital herpes
Clusters of vesicles or pustules on an erythematous base
What’s the clinical manifestation of primary infection with herpes
Severe and multiple bilateral genital ulcers, dysuria, fever, tender local inguinal lymphadenopathy flu like symptoms (malaise myalgia)
What’s the manifestation of recurrent herpes episode?
Tingling, burning or shooting pain <24hrs before symptoms
Less severe and unilateral
What’s the most commonly reported bacterial STI in Canada?
Chlamydia trachomatis
What are the clinical manifestations of chlamydia infection?
Mucopurulent vaginal discharge
Dysuria
Dyspareunia
Bleeding during sexual intercourse, abnormal spotting or bleeding btw periods
Pelvic pain
70% women and 50% men infected are asymptomatic
Bacterial vaginosis is caused by what?
Grardnerella vaginalis and mucoplasma hominis
Discharge grey, thin watery profuse with fishy odor
Trachomoniasis is cause by what and what’s the definition symotom
T. Vaginalis
Strawberry cervix
Frothy yellow or white discharge
Classical defining symptoms of vulvovaginal candidiasis
Defining signs= itchy, burning erythema/edema of vulva/vagina
White thick cottage cheese discharge
Why is the presence or absence id type specific antibodies to herpes important in pregnacy?
It help differentiate between primary and non primary infection and help
Determine vertical transmission when herpes is acquired late in pregnancy
Why should type specific serology (TSS) not used in asymptomatic people
High false positive rates
What’s the first line treatment of trachomoniasis (T. Vaginalis) in adults and pregnant (symptomatic)
Metronidazole oral. Intravaginal metronidazole gel not effective
Note
Treat all cases and sexual partners
Is treatment recommended in asymptotic women in pregnancy for triachomoniasis?
No
Is treatment with Metronidazole contraindicated in lactation
No.
It can get into milk and affect taste. So hold 12-24hrs
Asymptomatic bacterial vaginosis do you need to treat?
No.
Unless high risk (e.g prior to preterm delivery)
Prior IUD insert
Gyn surgery
Induced abortion
Upper tract instrumentation
What is the treatment for symptomatic adult not pregnant
1st line
metronidazole’ oral or gel
Clindamycin cream
2nd line
Metronidazole oral single dose
Clindamycin oral
Recurrent bacterial vaccines is caused by overgrowth of G. Vaginalis M. Hominis anaerobes first line treatment is?
Metronidazole oral or gel
1st line Treatment of bacterial vaginosis
Metronidazole oral or gel
Or Clindamycin
Second line treatment for bacterial vaginosis is
Metronidazole single dose 2g
Or
Clindamycin oral
Recurrent bacterial vaginosis treatment is what
Metronidazole oral or gel
Should bacterial vaginosis be treated in pregnancy
Yes to avoid adverse outcome
Avoid oral metronidazole in 1st trimester
Use topical in 1 and 2nd trimester - no oral.
After 7th month use oral.
Asymptomatic candidiasis, is treatment necessary
No
What’s the first line for candidiasis in non pregnant people
Cotrimazoke intravaginal
Cotrimazole cream
Miconazole intravaginal
Fluconazole oral
Tercomaze cream - intravaginal
What are the preferred treatment of candidiasis in pregnacy
Topical agents
Avoid Azoles (fluconazole)
What the first line treatment of chlamydia in none pregnant and non lactating people
Doxycycline and azithromyxine
What’s the treatment of chlamydia in pregnancy
Azithromycin- single dose
Amoxicillin- 7days
Erythromycin’s
Is doxycycline and quinolone contraindicated in pregnacy and lactation
Yea
If an individual is positive for chlamydia do you report
Yes. Contract tracing and treatment of all partners in last 60days
Cervicitis is caused by what organisms?
C. Trachomatis
N. Gonorrohea
When is treatment if candidiasis in male partner indicated
If causative organisms is candida bamantitis
Xtic presentation: erythematous glans + pruritus or irritation
What’s the causative agents of cervicitis and the presentation
C. Trachomatis
N. Gonorrhoea
Presentation is inflamed cervix
Purulent or mucopurulent exudate
Induced or sustain bleeding
Friability of the endocervical is
Treatment of cervicitis
Ceftriaxonr or cefixime +
Azithromycin or Doxycycline
Undiagnosed cervicitis can result in what
Pelvic Inflammation Disease which can cause infertility and chronic pelvic pain
What’s the treatment for first symptomatic genital herpes?
Acyclovir
Or
Femiciclovir
Or
Valacyclovir
Herpes simplex in adults first symptomatic episodes, acute recurrent <6/yr or chronic suppressive >6/yr
First line is
Acyclovir
Or
Femicclovir
Or
Valacyclovir
Treatment of herpes simplex in pregnacy, first symptomatic episode
First line is acyclovir
What is PID
Infectious and inflammatory disorder of upper female genital tract and adjacent t pelican structures
What’s the clinical presentation of PID
Lower abdominal pelvic pain, bilateral dull aching worse with physical activity/sex
Abnormal vaginal discharge, fever chill Dysuria intemenstural/post coital bleed
Fever > 38 cervidal motion tenderness, adnexal tenderness
PID first line treatment
Cefixime or ceftriaxone IM
+ doxycycline +|- metronidazole
