PID

Question 1

PID

Answer 1

endometritis, salpingitis, tuba-ovarian abscess and peritonitis
poorly defined and diagnosed
important cause of tubal infertility, ectopic pregnancy and chronic pelvic pain
worse outcome with repeated infections

Question 2

predisposing causes of PID

Answer 2

sexually acquired, post delivery, post instrumentation, UTIs

Question 3

more likely causes of PID

Answer 3

gonorohea, chlamydia, anaerobes, mycobacterium and ureaplasma, actinomyces, TB

Question 4

symptoms of PID

Answer 4

many asymptomatic early in disease 
bilateral pelvic pain 
RUQ pain - bugs spill into peritoneum and end up around the liver 
vaginal dichagre 
low back pain 
irregular veginal bleeding 
dysuria 
dyspareunia 
toxic

Question 5

signs of PID

Answer 5

abdo tenderness
cervicitis 
cervial excitation 
adnexal tenderness - usually bilateral 
fever 
RUQ tenderness

Question 6

investigations

Answer 6

high vaginal swab and endocervical swab 
pregnancy test 
FBC 
CRP
ultrasound 
laparoscopy

Question 7

treating PID

Answer 7

low threshold
over treatment causes few problems
under treatment causes little damage

azithromycin and ceftriazone

continue with doxycycline and metronidazole

Question 8

epididymitis

Answer 8

pain and swelling in scrotum
torsion of testis may occur - surgical emergency
sexually acquired
UTI

Question 9

prostatitis

Answer 9

acute, chronic bacterial, chronic non bacterial/prostatodynia

Question 10

acute bacterial prostatitis

Answer 10

organisms ascend from urethra and urinary bladder

rarely haematogenous spread

Question 11

chronic prostatitis

Answer 11

may follow acute prostatitis

may develop insidiously

Question 12

prostatitis treatment

Answer 12

depends on organism if found 
long term therapy 6-8 weeks
anti-inflammatory action of macrolides 
often persisting symptoms 
may need alpha blockers or neurogenic pain relief

Question 13

LGV

Answer 13

lymphogranuloma venereum 
chlamyda trachamatis 
previously thought to be tropical 
proctitis is principal presentation 
treatment three weeks of doxycycline

Question 14

primary syphilis

Answer 14

painless ulcer (chancre) on genitalia, perianal area, rectum, pharynx, tongue, lip or elsewhere depending on entry site
non tender enlargement of regional lymph nodes
resolves without treatment
increases risk of HIV

Question 15

secondary syphilis

Answer 15

six weeks to six months following exposure
generalised maculopapular skin rash in most cases
alpaca/patchy hair loess to scalp and eyebrows
mucous membrane lesions
moist papukeis (condylomas) in moist skin areas
associated generalised non tender lymphadenopathy, may be associated fever
complications of meningitis, haptics, osteitis, arthritis, iritis
often resolves without treatment

Question 16

early latent syphilis

Answer 16

within two years of exposure
clinical signs and symptoms similar to that of secondary syphilis
lesions of secondary syphilis can heal spontaneously however relapse may occur if untreated or inadequately treated
neurological involvement in secondary syphilis may be symptomatic but neurological relapses in early latent syphilis may be fulminant

Question 17

late latent syphilis

Answer 17

con occur after 2 years of infection
usually no physical signs however there may be positive serological tests
maybe a history of syphilis which has been inadequately treated
cerebrospinal fluid is negative for trepomonas, and x-ray and physical examination shows no evidence of cardiac involvement
may last from months to a lifetime
patient not infectious

Question 18

tertiary syphilis

Answer 18

occurs between one to thirty fave years after exposure
causes endarteritis
infiltrative tumours of the skin, bones and liver - gummas
aortitis, aneurysms and aortic regurgitation
affects the central nervous system causing meningovascular and degenerative changes
paresthesias, shooting pains, abnormal reflexes, dementia or psychosis
proprioception loss
duvets or retiniiitis
nerve deafness

Question 19

congenital syphilis

Answer 19

preventable with early antenatal care
treat mother before 20 weeks if possible
if treatment is later in pregnancy may not be curative

Question 20

diagnosis of syphili

Answer 20

ulcer PCR is available and can be done with herpes testing

serology

Question 21

syphilis serology

Answer 21

VDRL/RPR - nontreponemal specific tests which measure titres of specific antibodies directed towards cardiolipi, lecithin and cholesterol
specific antibody tests
EIA - enzyme immunoassay
TPHA/TPPA - T pallidum haemagggllutlnation assay/T pallidum particle agglutination
FTA-Abs - fluorescent treponema antibody absorption

Question 22

treatment syphilis

Answer 22

infectious syphilis
benzathine penicillin
doxycycline and ceftriaxone
in pregnancy - only penicillin

late latent syphilis - benzathine penicillin for 3 doses
alternative doxycycline for 4 weeks

neurological and tertiary needs IV penicillin

Question 23

syphilis follow up

Answer 23

if RPR negative prior to treatment, no follow up required

if RPR titre raised prior to treatment requires follow up at 3, 6 and 12 months

Question 24

garish-herxheimer reaction

Answer 24

flu like illness during treatment of syphilis

Question 25

herpes

Answer 25

HSV 1 and 2 
incubation 3-6 days 
clinical fever, malaise and nodes 
no cure 
NAAT - serology
rare complication - recurrent aseptic meningitis

Question 26

herpes testing

Answer 26

PCR swab of lesions and also do syphlis - swab any break in genital skin

Question 27

antivirals for HSV

Answer 27

acyclovir - poor bioavailability, 5 times per day dosing for episodic
newer prodrugs have increase bioavailability

Question 28

first episode of herpes

Answer 28

aciclovir 5x/day for 5-10

valacclovir 1x/AY 5-10 days

Question 29

recurrent episode of herpes

Answer 29

self administer at first sign of symptoms
famciclovir
valaciclovir

Question 30

HPV - diagnosis and clinical spectrum

Answer 30

clinical for warts 
bossy atypical lesions 
cervical screening 
DNA testing 
serology for research only 
vaccination very effective

Question 31

donovanosis

Answer 31

klebiella granulomatis
papule, ulcer then possible development of carcinoma
ulcergrnulomatous, hypertrophic, necrotic foul smelling, scarring, disseminated disease
treat azithromycin