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Finals > O&G: GU medicine > Flashcards

O&G: GU medicine Flashcards

1
Q

Bacterial Vaginosis

what is it

A

overgrowth of bacteria in the vagina, specifically anaerobic bac

not a STI but can increase the risk of developing one

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2
Q

Bacterial Vaginosis

cause

A

a loss of lactobacilli (friendly bac) in the vagina

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3
Q

Bacterial Vaginosis

why is lactobacilli healthy friendly bac

A

they produce lactic acid that keeps the vaginal pH low (<4.5)

the acidic environment prevents other bac from overgrowing

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4
Q

Bacterial Vaginosis

what happens where there is a reduced number of lactobacilli

A

the pH rises in the vagina, which enable anaerobic bacteria to multiple in the more alkaline environment

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5
Q

Bacterial Vaginosis

example of anaerobic bacteria associated with BV

A
  • Gardnerella vaginalis (most common)
  • Mycoplasma hominis
  • Prevotella species
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6
Q

Bacterial Vaginosis

can BV occur alongside other infections

A

yes. inc candidiasis, chlamydia and gonorrhoea

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7
Q

Bacterial Vaginosis

RFs (5)

A
  1. multiple sexual partners (although not sexually transmitted)
  2. XS vaginal cleaning (douching, use of cleaning products and vaginal washes)
  3. recent abx
  4. smoking
  5. copper coil
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8
Q

Bacterial Vaginosis

who does it occur less frequently in

A
  • women taking COCP

- women using condoms effectively

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9
Q

Bacterial Vaginosis

key presentation

A

fishy smelling discharge

watery grey/white discharge

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10
Q

Bacterial Vaginosis

what symptoms may suggest an alternative cause or co-occurring infection

A

itching

irritation

pain

half of women with BV are asymptomatic

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11
Q

Bacterial Vaginosis

examination

A

speculum can be performed to confirm the typical discharge

high vaginal swab to exclude other causes of symptoms

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12
Q

Bacterial Vaginosis

inx

A
  • Vaginal pH using a swab and pH paper
  • standard charcoal vaginal swab for microscopy. Can be a high vaginal swab during speculum or self taken low vaginal swab
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13
Q

Bacterial Vaginosis

BV occurs with a pH of?

A

above 4.5

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14
Q

Bacterial Vaginosis

what is shown on microscopy

A

clue cells

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15
Q

Bacterial Vaginosis

what are clue cells

A

epithelial cells from the cervix that have bacteria stuck inside them, usually Gardnerella vaginalis

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16
Q

Bacterial Vaginosis

mnx of asymptomatic BV

A

none

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17
Q

Bacterial Vaginosis

mnx

A

Metronidazole specifically targets anaerobic bac

PO or vaginal gel

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18
Q

Bacterial Vaginosis

what is an alternative to metronidazole

A

clindamycin but less optimal

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19
Q

Bacterial Vaginosis

what advice can you give

A
  • avoid vaginal irrigation or cleaning with soaps that may disrupt the natural flora
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20
Q

Bacterial Vaginosis

what advice to give when prescribing metronidazole

A

avoid alcohol as it can cause a ‘disulfiram-like reaction’ with N+V, flushing and sometimes severe sx of shock + angioedema

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21
Q

Candidiasis

what is it

A

aka thrush

vaginal infection with a yeast of the Candida family

candida may colonise without causing sx. It then progresses to infection when the right environment occurs eg pregnancy or after trx with broad-spectrum abx that alters the vaginal flora

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22
Q

Candidiasis

what is the most common yeast

A

Candida albicans

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23
Q

Candidiasis

RFs (4)

A
  • increased oestrogen (higher in pregnancy, lower pre-puberty + post-menopause)
  • poorly controlled diabetes
  • immunosuppression (eg using corticosteroids)
  • broad spectrum abx
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24
Q

Candidiasis

presentation

A
  • odourless thick, white discharge

- vulval + vaginal itching, irritation or discomfort

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25
Q

Candidiasis

what can more severe infection lead to? (6)

A
  • erythema
  • fissures
  • oedema
  • dyspareunia
  • dysuria
  • excoriation
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26
Q

Candidiasis

how can candidiasis be differentiated from BV and trichomonas

A

BV + trichomonas have a pH >4.5

candidiasis has a pH <4.5

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27
Q

Candidiasis

what confirms the dx

A

a charcoal swab with microscopy

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28
Q

Candidiasis

mnx

A

antifungal medication eg clotrimazole

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29
Q

Candidiasis

how can antifungal medication be delivered

A

cream (clotrimazole) inserted into vagina with an applicator

pessary (clotrimazole)

tablet (fluconazole)

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30
Q

Candidiasis

what options do NICE recommend for initial uncomplicated cases

A
  • single dose of intravaginal clotrimazole cream (5g of 10% cream) at night
  • single dose of clotrimazole pessary (500mg) at night
  • 3 doses of clotrimazole pessaries (200mg) over 3 nights
  • single dose of fluconazole (150mg)
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31
Q

Candidiasis

what is a standard over the counter treatment

A

Canesten Duo

contains a single fluconazole tablet and clotrimazole cream

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32
Q

Candidiasis

trx for recurrent infections (>4/yr)

A

induction + maintenance regime over 6m with PO or vaginal antifungal medications

this is off label use

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33
Q

Candidiasis

warning to give regarding antifungal creams and pessaries

A

they can damage latex condoms and prevent spermicides from working

so alternative contraceptive is required for at least 5d after use

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34
Q

Chlamydia

what kind of bacteria is Chlamydia trachomatis

A

gram -ve

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35
Q

Chlamydia

it’s an intracellular organism. What does this mean

A

it enters and replicate within cells before rupturing the cell and spreading to others

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36
Q

what is the most common STI in the UK and a significant cause of infertility

A

Chlamydia

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37
Q

Chlamydia

RFs

A
  • young
  • sexually active
  • multiple sexual partners
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38
Q

Chlamydia

what % of men and women are asymptomatic

A

50% in men

75% in women

can still pass it on!

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39
Q

Chlamydia

what is the NCSP

A

National Chlamydia Screening Programme set out by PHE

aims to screen every sexually active person under 25yrs for chlamydia annually or when they change their sexual partner

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40
Q

Chlamydia

if tested +ve in the NCSP. when should they have a re-test

A

3m after trx to ensure they have not contracted it again, rather than to check the trx has worked

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41
Q

Chlamydia

what is the minimum a pt is tested for when attending GUM clinic for STI screening

A
  • Chlamydia
  • Gonorrhoea
  • Syphilis (blood test)
  • HIV (blood test)
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42
Q

what are the 2 types of swabs involved in sexual health testing?

A
  • Charcoal swabs

- Nucleic acid amplification test (NAAT) swabs

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43
Q

what are Charcoal swabs for

A

microscopy

culture

sensitivities

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44
Q

what is the transport medium for charcoal swabs (the liq at the bottom of the tube)

A

Amies transport medium - contains chemical solution for keeping micro organisms alive during transport

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45
Q

charcoal swabs can be used for ___ and ____

A

endocervical swabs and high vaginal swabs

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46
Q

what bacteria can charcoal swabs confirm

A
  • Bacterial vaginosis
  • Candidiasis
  • Gonorrhoea (specifically endocervical swab)
  • Trichomonas vaginalis (specifically a swab from the posterior fornix)
  • other bac eg group B streptococcus
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47
Q

what does NAAT check for

A

the DNA or RNA of the organism

used to test specifically for chlamydia and gonorrhoea

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48
Q

on a women a NAAT test can be performed on what

A
  • vulvovaginal swab (self-taken lower vaginal swab)
  • endocervical swab
  • first-catch urine sample
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49
Q

on a man a NAAT test can be performed on what?

A
  • first-catch urine sample

- urethral swab

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50
Q

Chlamydia

what can be taken to diagnose chlamydia in the rectum and throat (considered where anal or oral sex has occurred)

A

rectal and pharyngeal NAAT swabs

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51
Q

gonorrhoea is suspected, what next?

A

endocervical charcoal swab is required MC&S

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52
Q

Chlamydia

presentation in women

A

majority are asymptomatic

  • abnormal vaginal discharge
  • pelvic pain
  • abnormal vaginal bleeding (intermenstrual or postcoital)
  • dyspareunia
  • dysuria
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53
Q

Chlamydia

presentation in men

A
  • urethral discharge or discomfort
  • dysuria
  • epididymo-orchitis
  • reactive arthritis
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54
Q

Chlamydia

rectal chlamydia and lymphogranuloma venereum presentation

A

anorectal sx:

  • discomfort
  • discharge
  • bleeding
  • change in bowel habits
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55
Q

Chlamydia

examination findings

A
  • pelvic or abdo tenderness
  • cervical motion tenderness (cervical excitation)
  • inflamed cervix (cervicitis)
  • purulent discharge
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56
Q

Chlamydia

dx

A

NAAT

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57
Q

Chlamydia

1st line mnx for uncomplicated chlamydia infection

A

doxycycline 100mg BD for 7d

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58
Q

Chlamydia

why has the recommendation of azithromycin been removed as mnx

A

Due to Mycoplasma genitalium resistance to azythromycin

and it being less effective for rectal chlamydia infection

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59
Q

Chlamydia

whom is doxycycline CI’d in

A

pregnant and breastfeeding women

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60
Q

Chlamydia

what alternative options should be given to treat pregnant or breastfeeding women

A
  • Azithromycin 1g stat then 500mg OD for 2d
  • Erythromycin 500mg QDS for 7d
  • Erythromycin 500mg BD for 14d
  • Amoxicillin 500mg TDS for 7d
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61
Q

Chlamydia

when should a test of cure be used

A

for rectal cases

in pregnancy

where sx persist

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62
Q

Chlamydia

how long should sex be abstained for and why

A

for 7d of trx of all partners to reduce the risk of re-infection

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63
Q

Chlamydia

who should you refer the pt to

A

refer all pts to genitourinary medicine (GUM) for contact tracing and notification of sexual partners

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64
Q

Chlamydia

complications (8)

A
  • PID
  • chronic pelvic pain
  • infertility
  • ectopic pregnancy
  • epididymo-orchitis
  • conjunctivitis
  • lymphogranuloma venereum
  • reactive arthritis
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65
Q

Chlamydia

pregnancy related complications (5)

A
  • preterm delivery
  • PROM
  • low birth weight
  • postpartum endometritis
  • neonatal infection (conjunctivitis + pneumonia)
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66
Q

Chlamydia

what is lymphogranuloma venereum (LGV)

A

a condition affecting the lymphoid tissue around the site of infection with chlamydia

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67
Q

Chlamydia

whom does lymphogranuloma venereum most commonly occur in

A

men who have sex with men (MSM)

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68
Q

Chlamydia

how many stages does lymphogranuloma venereum have

A

3

primary stage
secondary stage
tertiary stage

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69
Q

Chlamydia

LGV: what does the primary stage involve

A

a painless ulcer (primary lesion)

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70
Q

Chlamydia

LGV: where does the primary lesions occur in men and women

A

men: penis
women: vaginal wall

rectum after anal

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71
Q

Chlamydia

LGV: what does the secondary stage involve

A

lymphadenitis: swelling, inflammation + pain in the lymph nodes infected with the bacteria

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72
Q

Chlamydia

LGV: which lymph nodes may be affected in the secondary stage

A

inguinal or femoral

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73
Q

Chlamydia

LGV: what does the tertiary stage involve?

A

inflammation of the rectum (proctitis) and anus

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74
Q

Chlamydia

LGV: what does proctocolitis lead to in the tertiary stage

A
  • anal pain
  • change in bowel habit
  • tenesmus (feeling of needing to empty the bowel)
  • discharge
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75
Q

Chlamydia

1st line treatment for Lymphgranuloma Venereum

A

Doxycycline 100mg BD for 21d

erythromycin, azithromycin and ofloxacin are alternatives

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76
Q

Chlamydia

how does Chlamydial Conjunctivitis occur

A

genital fluid comes in contact with the eye eg hand-to-eye spread

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77
Q

Chlamydia

chlamydia conjunctivitis presentation

A
  • chronic erythema
  • irritation
  • discharge >2w
  • most cases are unilateral
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78
Q

Chlamydia

Ddx for chlamydia conjunctivitis

A

Gonococcal conjunctivitis

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79
Q

Chlamydia

whom does chamydial conjunctivitis commonly affect

A
  • young adults

- neonates with mothers infected with chlamydia

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80
Q

Gonorrhoea

what kind of bacteria is
Neisseria gonorrhoeae

A

gram -ve diplococcus

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81
Q

Gonorrhoea

what membranes does it infect

A

mucous membranes with a columnar epithelium

eg endocervix in women
urethra, rectum, conjunctiva and pharynx

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82
Q

Gonorrhoea

how does it spread

A

via contact with mucous secretions from infected areas

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83
Q

Gonorrhoea

what increases the risk of infection

A
  • young
  • sexually active
  • having multiple partners
  • having other STIs
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84
Q

Gonorrhoea

why is ciprofloaxin or azithromycin no longer used to treat gonorrhoea

A

high levels of resistance to these antibiotics

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85
Q

Gonorrhoea

what % of men and women are symptomatic

A

90% men

50% women

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86
Q

Gonorrhoea

what may females present with

A
  • odourless purulent discharge, possibly green or yellow
  • dysuria
  • pelvic pain
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87
Q

Gonorrhoea

what may males present with

A
  • odourless purulent discharge, possibly green or yellow
  • dysuria
  • testicular pain or swelling (epididymo-orchitis)
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88
Q

Gonorrhoea

presentation of rectal infection

A

may cause anal or rectal discomfort and discharge

but often asymptomatic

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89
Q

Gonorrhoea

presentation of pharyngeal infection

A
  • sore throat

but often asymptomatic

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90
Q

Gonorrhoea

symptoms of prostatitis

A
  • perineal pain
  • urinary sx
  • prostate tenderness on ex
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91
Q

Gonorrhoea

symptoms of conjucntivitis

A
  • erythema

- purulent discharge

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92
Q

Gonorrhoea

dx

A

NAAT to detect the RNA or DNA of gonorrhoea

then charcoal endocervical swab for MC&S

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93
Q

Gonorrhoea

what swabs to use in genital infection

A
  • endocervical
  • vulvovaginal
  • urethral
  • 1st catch urine
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94
Q

Gonorrhoea

trx for uncomplicated gonococcal infection

A

if the sensitivities are NOT known:
- single does of IM ceftriaxone 1g

if the sensitivities ARE known:
- single dose of PO ciprofloaxin 500mg

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95
Q

Gonorrhoea

when should a test of cure be done after trx for culture

A

72hrs after trx

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96
Q

Gonorrhoea

when should a test of cure be done after trx for RNA NATT

A

7d after trx

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97
Q

Gonorrhoea

when should a test of cure be done after trx for DNA NATT

A

14d after trx

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98
Q

Gonorrhoea

how long should you abstain from sex

A

7d of treatment of all partners to reduce risk of re-infection

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99
Q

Gonorrhoea

complications

A
  • Pelvic inflammatory disease
  • Chronic pelvic pain
  • Infertility
  • Epididymo-orchitis (men)
  • Prostatitis (men)
  • Conjunctivitis
  • Urethral strictures
  • Disseminated gonococcal infection
  • Skin lesions
  • Fitz-Hugh-Curtis syndrome
  • Septic arthritis
  • Endocarditis
100
Q

Gonorrhoea

what is a key complication in a neonate

A

gonococcal conjunctivitis

medical emergency

101
Q

Gonorrhoea

what is neonatal conjunctivitis called

A

ophthalmia neonatorum

102
Q

Gonorrhoea

what is Disseminated Gonococcal Infection (GDI)

A

a complication of gonococcal infection

where the bacteria spreads to the skin and joints

103
Q

Gonorrhoea

what does Disseminated Gonococcal Infection cause

A
  • various non-specific skin lesions
  • polyarthralgia (joint aches + pains)
  • Migratory polyarthritis (arthritis that moves between joints)
  • Tenosynovitis
  • Systemic symptoms such as fever + fatigue
104
Q

Mycoplasma Genitalium

what is it

A

a bacteria that causes non-gonococcal urethritis

an STI

105
Q

Mycoplasma Genitalium

what presentation is MG similar to

106
Q

Mycoplasma Genitalium

what is the key feature

A

urethritis

107
Q

Mycoplasma Genitalium

what may infection lead to

A 
Urethritis
Epididymitis
Cervicitis
Endometritis
Pelvic inflammatory disease
Reactive arthritis
Preterm delivery in pregnancy
Tubal infertility
108
Q

Mycoplasma Genitalium

inx

A

NAAT to look specifically for the DNA or RNA of the bacteria

109
Q

Mycoplasma Genitalium

why are traditional cultures not helpful in isolating MG

A

it is a very slow growing organism

110
Q

Mycoplasma Genitalium

what samples are recommended to be taken for men and women

A

men: 1st urine sample in morning
women: self taken vaginal swabs

111
Q

Mycoplasma Genitalium

what do the guidelines recommend after trx in every +ve pt

A
  • check sample for macrolide resistance

- perform a test of cure

112
Q

Mycoplasma Genitalium

mnx

A
  • doxycycline 100mg BD for 7d
  • then Azithromycin 1g stat
  • then 500mg OD for 2d

unless known to be resistant to macrolides

113
Q

Mycoplasma Genitalium

what can be used as an alternative to doxycycline and azithromycin or in complicated infections

A

Moxifloxacin

114
Q

Mycoplasma Genitalium

trx in pregnant and breastfeeding women

A

azithromycin alone because doxycycline is CI’d

115
Q

Pelvic Inflammatory Disease

what is it

A

inflammation and infection of the organs of the pelvis , caused by infection spreading up through the cervix

116
Q

what is significant cause of tubular infertility and chronic pelvic pain

A

Pelvic Inflammatory Disease

117
Q

Salpingitis

A

inflammation of the fallopian tubes

118
Q

Oophoritis

A

inflammation of the ovaries

119
Q

Parametritis

A

inflammation of the parametrium, which is the connective tissue around the uterus

120
Q

Peritonitis

A

inflammation of the peritoneal membrane

121
Q

Pelvic Inflammatory Disease

STI causes (3)

A
  • Neisseria gonorrhoea (more severe)
  • Chlamydia trachomatis
  • Mycoplasma genitalium
122
Q

Pelvic Inflammatory Disease

non STI causes (3)

A
  • Gardnerella vaginalis (assc w/ BV)
  • Haemophilus influenzae (assc resp infection)
  • Escherichia coli (assc w/ UTIs)
123
Q

Pelvic Inflammatory Disease

RFs ((6)

A
  • not using barrier contraception
  • multiple sexual partners
  • younger age
  • existing STIs
  • previous PID
  • intrauterine device (eg copper coil)
124
Q

Pelvic Inflammatory Disease

presentation

A
  • pelvic or lower abdo pain
  • abnormal discharge
  • abnormal bleeding (intermenstrual or postcoital)
  • dyspareunia
  • fever
  • dysuria
125
Q

Pelvic Inflammatory Disease

examination findings (4)

A
  • pelvic tenderness
  • cervical excitation
  • cervicitis
  • purulent discharge
  • may have fever and other signs of sepsis
126
Q

Pelvic Inflammatory Disease

inx

A

testing for causative organisms and other STIs:

  • NAAT swabs for gonorrhoea + chlamydia
  • NAAT swabs for Mycoplasma genitalium
  • HIV test
  • Syphilis test
  • high vaginal swab: BV, candidiasis, trichomoniasis
  • pregnancy test
  • pus cells under microscopy
  • inflammatory markers (CRP, ESR)
127
Q

Pelvic Inflammatory Disease

how can you exclude PID

A

the absence of pus cells under microscopy from vagina or endocervix swabs

128
Q

Pelvic Inflammatory Disease

mnx

A
  • refer to GUM
  • signs of sepsis or pregnant: admit

one suggested outpatient regime:
- single dose of IM ceftriaxone 1g (to cover gonorrheoa)

  • Doxycycline (to cover chlamydia + Mycoplasma genitalium)
  • Metronidazole (to cover anaerobes such as Gardnerella vaginalis)
129
Q

Pelvic Inflammatory Disease

mnx of pelvic abscess

A

may need drainage by interventional radiology or surgery

130
Q

Pelvic Inflammatory Disease

complications (6)

A
  • sepsis
  • abscess
  • infertility
  • chronic pelvic pain
  • ectopic pregnancy
  • Fitz-Hugh-Curtis syndrome
131
Q

Pelvic Inflammatory Disease

what is Fitz-Hugh-Curtis Syndrome

A

a complication of PID

caused by inflammation and infection of the liver capsule (Glisson’s capsule) leading to adhesions between the liver and peritoneum

132
Q

Pelvic Inflammatory Disease

how may bacteria spread from the pelvis in Fitz-Hugh-Curtis Syndrome

A

via the peritoneal cavity, lymphatic system or blood.

133
Q

Pelvic Inflammatory Disease

Fitz-Hugh-Curtis Syndrome presentation

A

RUQ pain

that can be referred to the right shoulder tip if there is diaphragmatic irritation

134
Q

Pelvic Inflammatory Disease

Fitz-Hugh-Curtis Syndrome inx and trx

A

Laparoscopy to visualise and also treat the adhesions by adhesiolysis

135
Q

Trichomoniasis

what is Trichomonas vaginalis

A

a type of parasite spread through sex

136
Q

Trichomoniasis

what kind of organism is Trichomonas

A

classed as a protozoan

single-celled organism with flagella

137
Q

Trichomoniasis

how many flagella do trichomonas have

A

4 flagella at the front

1 at the back

138
Q

Trichomoniasis

what can Trichomoniasis increase the risk of

A
  • contracting HIV (by damaging the vaginal mucosa)
  • BV
  • cervical cancer
  • PID
  • pregnancy-related complications such as preterm delivery
139
Q

Trichomoniasis

symptoms (5)

A

50% are asymptomatic

  • vaginal discharge
  • itching
  • dysuria
  • dyspareunia
  • balanitis (inflammation of the glans penis)
140
Q

Trichomoniasis

what is the typical description of the vaginal discharge

A

frothy and yellow-green

but can vary significantly. May have a fishy smell

141
Q

Trichomoniasis

what will examination of the cervix show

A

‘strawberry cervix’ aka colpitis macularis

142
Q

Trichomoniasis

why is it called a strawberry cervix

A

inflammation of the cervix

tiny haemorrhages across the surface of the cervix giving the appearance of a strawberry

143
Q

Trichomoniasis

what will the vaginal pH show

A

raised pH >4.5 (similar to BV)

144
Q

Trichomoniasis

dx

A

charcoal swab with microscopy

145
Q

Trichomoniasis

where should swabs be taken in a woman

A

from the posterior fornix of the vagina (behind the cervix)

self-taken low vaginal swab may be used as an alternative

146
Q

Trichomoniasis

where should swabs be taken in a man

A

urethral swab

or first catch urine

147
Q

Trichomoniasis

mnx

A

refer to GUM

metronidazole

148
Q

Genital Herpes

which organism is responsible for both cold sores (herpes labialis) and genital herpes

A

the herpes simplex virus (HSV)

149
Q

Genital Herpes

what are the 2 main strains of HSV

A

HSV-1 and 2

150
Q

Genital Herpes

after infection, where does the virus become latent (in cold sores)

A

trigeminal nerve ganglion

151
Q

Genital Herpes

after infection, where does the virus become latent (in genital herpes)

A

sacral nerve ganglia

152
Q

Genital Herpes

what can HSV cause

A
  • cold sores (herpes labialis
  • genital herpes
  • aphthous ulcers
  • herpes keratitis
  • herpes whitlow
153
Q

Genital Herpes

what is aphthous herpes

A

small painful oral sores in the mouth

154
Q

Genital Herpes

what is herpes keratitis

A

inflammation of the cornea in the eye

155
Q

Genital Herpes

what is herpetic whitlow

A

a painful skin lesion on a finger or thumb

156
Q

Genital Herpes

how is HSV spread

A

through direct contact with affected mucous membranes

or viral shedding in mucous secretions

157
Q

Genital Herpes

what does it mean when the virus can be shed even when no symptoms are present

A

it can be contracted from asymptomatic individuals

158
Q

Genital Herpes

when is asymptomatic shedding more common

A

in the first 12m of infection and where recurrent sx are present

159
Q

Genital Herpes

which strain is most associated with cold sores

160
Q

Genital Herpes

what happens to HSV-1 contracted in childhood <5yrs usually

A

remains dormant in the trigeminal nerve ganglion

and reactivates as cold sores, particularly in times of stress

161
Q

Genital Herpes

how is genital herpes caused by HSV-1 usually contracted

A

through oro-genital sex, where the virus spreads from a person with an oral infection to the person that develops a genital infection

162
Q

Genital Herpes

what does HSV-2 typically cause

A

genital herpes

163
Q

Genital Herpes

how is HSV-2 mostly spread

164
Q

Genital Herpes

when do symptoms of an initial infection with genital herpes usually appear

A

within 2w

but may display no symptoms or develop them months/years later

165
Q

Genital Herpes

presentation of genital herpes (5)

A
  • ulcers or blistering lesions affecting the genital area
  • neuropathic type pain (tingling, burning, shooting)
  • flu-like sx (fatigue, headaches)
  • dysuria (painful urination)
  • inguinal lymphadenopathy
166
Q

Genital Herpes

how long can symptoms last in a primary infection

A

3w

recurrent episodes are usually milder and resolve more quickly

167
Q

Genital Herpes

dx

A

clinically based on hx and exam

viral PCR swab from a lesion can confirm dx and causative organism

168
Q

Genital Herpes

mnx

A

refer to GUM

Aciclovir

169
Q

Genital Herpes

additional measures as mnx

A
  • paracetamol
  • topical lidocaine (instillagel)
  • cleaning with warm salt water
  • topical vaseline
  • additional oral fluids
  • wear loose clothing
  • avoid intercourse with sx
170
Q

Genital Herpes

what is the main issue with genital herpes during pregnancy

A

risk of neonatal herpes simplex infection contracted during labour and delivery

it has a high morbidity and mortality

171
Q

Genital Herpes

how does the fetus gain passive immunity to the virus

A

after initial infection, the woman develops antibodies

during pregnancy, these antibodies can cross the placenta into the fetus

172
Q

Genital Herpes

how is primary genital herpes contracted before 28w gestation treated?

A

with aciclovir during initial infection

followed by regular prophylactic aciclovir starting from 36w gestation

173
Q

Genital Herpes

what mode of delivery is recommended in women with primary genital herpes contracted before 28w

A

asymptomatic: vaginal delivery (provided it is is >6w after initial infection)
symptomatic: caesarean

174
Q

Genital Herpes

how is primary genital herpes contracted after 28w gestation treated?

A

aciclovir during the initial infection

followed immediately by regular prophylactic aciclovir.

Caesarean section is recommended in all cases

175
Q

Genital Herpes

what is recurrent genital herpes in pregnancy

A

where the woman is known to have genital herpes before the pregnancy

176
Q

Genital Herpes

what is the risk of neonatal infection in women with recurrent genital herpes

A

low risk of neonatal infection (0-3%), even if the lesions are present during delivery

177
Q

Genital Herpes

what is the mnx if the pregnant woman has recurrent genital herpes

A

Regular prophylactic aciclovir is considered from 36 weeks gestation to reduce the risk of symptoms at the time of delivery.

178
Q

HIV

what is it

A

an RNA retrovirus

179
Q

HIV

what is the most common type

A

HIV-1

HIV-2 is rare outside West Africa

180
Q

HIV

how is it transmitted

A
  • unprotected anal, vaginal or oral sexual activity
  • vertical transmission (mother to child)
  • mucous membrane, blood or open wound exposure to infected blood or bodily fluids
181
Q

HIV

when does AIDs occur

A

when the CD4 count is under 200 cells/mm3

182
Q

HIV

name some AIDS-defining illnesses

A
  • Kaposi’s sarcoma
  • Pneumocystis jirovecii pneumonia
  • Cytomegalovirus infection
  • Candidiasis (oesophageal or bronchial)
  • Lymphomas
  • TB
183
Q

HIV

why can HIV antibody tests be negative for 3m following exposure

A

it can take up to 3m to develop antibodies to the virus after infection

repeat testing is necessary

184
Q

HIV

whom should you test in hospital and do you need consent

A

everyone admitted to hospital with an infectious disease for HIV

patients with any RFs

needs verbal consent but don’t need counselling

185
Q

HIV

types of testing (3)

A
  • antibody testing
  • testing for the p24 antigen
  • PCR testing for the HIV RNA
186
Q

HIV

facts about antibody testing

A
  • the typical screening test for HIV
  • simple blood test
  • pts can self sample at home and order online
187
Q

HIV

facts about testing for the p24 antigen

A
  • checks directly for this specific HIV antigen

- can give a +ve result earlier in the infection compared with the antibody test

188
Q

HIV

how do you calculate the viral load

A

PCR testing for the HIV RNA levels tests directly for the number of viral copies in the blood

189
Q

HIV

how do you monitor it

A
  • CD4 count

- Viral load (VL)

190
Q

HIV

what is the CD4 count

A

the number of CD4 cells in the blood

these are the cells destroyed by the virus

the lower the count the higher the risk of opportunistic infection

191
Q

HIV

what is the normal CD4 count range

A

500-1200 cells/mm3

192
Q

HIV

what is the CD4 count in AIDS

A

<200 cell/mm3

193
Q

HIV

what is the viral load

A

the number of copies of HIV RNA per ml of blood

194
Q

HIV

what does ‘undetectable’ mean

A

the viral load below the lab’s recordable range (usually 50-100 copies/ml)

195
Q

HIV

what is offered to everyone with a diagnosis irrespective of viral load or CD4 count

A

antiretroviral therapy (ART)

196
Q

HIV

what do the BHIVA guidelines recommend starting a regime of

A

2 NRTIs
+
3rd agent

197
Q

HIV

what is HARRT

A

Highly Active Anti-Retrovirus Therapy

198
Q

HIV

name some classes of HAART medications that work slightly differently on the virus

A
  • Protease inhibitors (PIs)
  • Integrase inhibitors (IIs)
  • Nucleoside reverse transcriptase inhibitors (NRTIs)
  • Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
  • Entry inhibitors (EIs)
199
Q

HIV

what is additionally given to patients with a CD4 <200/mm3 and why

A

Prophylactic co-trimoxazole (Septrin)

to protect against pneumocystis jirovecii pneumonia (PCP)

200
Q

HIV

what does HIV increase the risk of developing and what is done to help

A

CV disease

close monitoring of CV RFs and blood lipids

statins may be required

201
Q

HIV

what additional mnx is done for women with HIV and why

A

yearly cervical smears because HIV predisposes to developing HPV and cervical cancer

202
Q

HIV

which vaccines should be up to date and which should they avoid

A

influenza, pneumococcal, hepatitis A and B, tetanus, diphtheria and polio vaccines

avoid live vaccines

203
Q

HIV

advice for reproductive health

A
  • condoms for vaginal and anal sex
  • dams for oral sex

even if both partners are HIV +ve

  • partners should have regular HIV tests
  • if viral load is undetectable = untransmissionable
204
Q

HIV

how to conceive safely

A

sperm washing

IVF

205
Q

HIV

when is normal vaginal delivery recommended

A

for women with a viral load <50 copies/ml

206
Q

HIV

when is Caesarean section considered

A

in patients with >50 copies/ml

207
Q

HIV

when is Caesarean section recommended

A

> 400 copies/ml

208
Q

HIV

when should IV zidovudine be given during the caesarean section

A

if the viral load is unknown or there are >10,000 copies/ml

209
Q

HIV

what prophylactic trx is given to low risk babies (mother’s viral load <50)

A

zidovudine for 4w

210
Q

HIV

what prophylactic trx is given to high risk babies (mother’s viral load >50)

A

zidovudine, lamivudine and nevirapine for 4w

211
Q

HIV

is breastfeeding okay even if the mother’s viral load is undetectable

A

no , it can be transmitted

212
Q

HIV

what is PEP

A

Post-exposure prophylaxis

used after exposure to HIV to reduce the risk of transmission

combination of ART therapy

213
Q

HIV

what is the current PEP regime

A

Truvada (emtricitabine and tenofovir)

and raltegravir for 28 days.

214
Q

HIV

disadvantages of PEP

A

not 100% effective

must be commenced within 72h

215
Q

Syphilis

what bacteria causes it and what kind is it

A

Treponema pallidum

spirochete, a type of spiral shaped bacteria

216
Q

Syphilis

what is the incubation period

217
Q

Syphilis

how may it be contracted

A

oral, vaginal or anal sex involving direct contact with an infected area

vertical transmission

IV drug use

blood transfusions and other transplants

218
Q

Syphilis

what are the stages

A
  • primary
  • secondary
  • latent
  • tertiary
219
Q

Syphilis

how does primary syphilis present

A

painless ulcer (chancre) at the original site of infection (usually on genitals). resolved over 3-8w

local lymphadenopathy

220
Q

Syphilis

how does secondary syphilis present

A
  • systemic symptoms can resolve after 3-12w
  • condylomata lata
  • maculopapular rash
  • low grade fever
  • lymphadenopathy
  • alopecia
  • oral lesions
221
Q

what is latent syphilis

A

occurs after the secondary stage, where symptoms disappear despite still being infected

222
Q

when does early latent syphilis occur

A

within 2 years of the initial infection

223
Q

when does late latent syphilis occur

A

from 2 years after the initial infection onwards

224
Q

what is tertiary syphiliis

A

can occur many year after the initial infection

affects many organs

development of gummas and CV + neuro complications

225
Q

what is neurosyphilis

A

occurs if the infection involves the CNS

presents with neuro sx

226
Q

syphilis

what is condylomata lata

A

grey wart like lesion around the genitals and anus which presents at the secondary stage

227
Q

syphilis

what are gummas

A

granulomatous lesions that can affect the skin, organs and bones

228
Q

syphilis

how may tertiary syphilis present

A
  • gummas
  • aortic aneurysms
  • neurosyphilis
229
Q

what may neurosyphilis present with

A
  • Argyll-Robertson pupil
  • Headache
  • Altered behaviour
  • Dementia
  • Tabes dorsalis (demyelination affecting the spinal cord posterior columns)
  • Ocular syphilis (affecting the eyes)
  • Paralysis
  • Sensory impairment
230
Q

Neurosyphilis

what is Argyll-Robertson pupil

A

a specific finding for neurosyphilis

a constricted pupil that accommodates when focusing on a near object but does not react to light

aka prostitutes pupil: it accommodates but does not react

231
Q

Neurosyphilis

what is Tabes dorsalis

A

demyelination affecting the spinal cord posterior columns

232
Q

Neurosyphilis

what is ocular syphilis

A

affecting the eyes

233
Q

Syphilis

screening

A

antibody testing for antibodies to T.pallidum bacteria

234
Q

Syphilis

inx for pts with suspected syphilis or +ve antibodies

A

refer to GUM

samples from sites of infection can be tested to confirm presence of T.pallidum with:

  • Dark field microscopy
  • PCR
235
Q

Syphilis

what are 2 non-specific but sensitive tests used to assess for active syphilis infection

A
  • rapid plasma reagin (RPR)

- venereal disease research lab (VDRL)

236
Q

what does non-specific mean

A

they often produce false positive results

237
Q

syphilis

mnx

A

single deep IM dose of benzathine benzylpenicillin (penicillin)

238
Q

Recurrent candidiasis indicates the need to test for what?

A

diabetes mellitus with Glycated haemoglobin

239
Q

painful lesion on his penis. He has recently returned from a holiday in the Gambia

what is it and how to treat

A

Chancroid

ciprofloxacin and Ceftriaxone

240
Q

bilateral bihilar interstitial infiltrates on CXR and uncompliant with cART therapy. What is it and what trx

A

Pneumocystis Pneumonia (PCP)

trx: Co-Trimoxazole

241
Q

engaged in receptive anal sex. Do you prescribe PEP

A

yes, prescribe PEP to anyone who has engaged in receptive anal sex, regardless of whether the HIV status of the partner is known

242
Q

18y with multiple uniform smooth lesions present around the coronal margin of the glans.

what is it

A

pearly penile papules

reassure and discharge

243
Q

numerous lesions on the glans penis
painless, irregular in shape
soft and moist to the touch

what is it

A

genital warts

244
Q

mnx of genital warts if not concerned about appearance

A

a conservative approach can be adopted. If there is concern, keratinised lesions can be removed using cryotherapy whilst non keratinised lesions can be removed using podophyllotoxin, imiquimod or sinecatechin

245
Q

mnx of genital warts if concerned about appearance

A

keratinised lesions: removed using cryotherapy

non keratinised lesions: podophyllotoxin, imiquimod or sinecatechin

246
Q

what is the most likely diagnosis in a HIV positive patient with a raised opening pressure on lumbar puncture.

A

cryptococcal meningitis

Finals (47 decks)

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