PID, Prostatitis, Inguinal and Scrotal Swellings

Question 1

Why is PID important?

Answer 1

Important cause of infertility, ectopic pregnancy and pelvic pain.

Question 2

What are some risk factors for getting PID?

Answer 2

• Sexually acquired
• Post-delivery
• Post-instrumentation
• UTIs

Question 3

What are some causative organisms for PID?

Answer 3

• Gonorrhoea
• Chlamydia
• Mycoplasma
• Anaerobes

Question 4

List some symptoms of PID?

Answer 4

• Pelvic pain
• RUQ pain
• Vagina discharge
• Vaginal bleeding
• Dysuria

Question 5

Treatment for PID?

Answer 5

Generally follows treating the most common cause - chlamydia and gonorrhoea

• Ceftriaxone or azithromycin (immediate)
  
  • Doxycycline or metronidazole (2 weeks)

Question 6

What is epididymitis and how is it treated?

Answer 6

Pain and swelling in scrotum.

Important to differentiate from testicular torsion.

Treatment- Ceftriaxone and doxycycline.

Question 7

What is LGV? How does it present? How is it treated?

Answer 7

Lymphogranuloma venereum caused by chlamydia trachomatis

Presents with proctitis.

Treatment - Doxycycline

Question 8

Describe the 5 stages of syphilis.

Answer 8

Primary syphilis:

• Chancre on genital area or mouth
• Resolves without treatment

Secondary syphilis

• 6wks - 6mths
• Skin rash
• Condylomas
• Alopecia/hair loss

Early Latent Syphilis

• <2yrs of exposure
• Same symptoms as secondary syphilis + neuro symptoms

Late Latent Syphilis

• >2yrs of exposure
• No symptoms
• Not infectious
• May test positive in serology still
• May last months - lifetime

Tertiary Syphilis

• Between 1 - 35yrs post exposure
• Vascular, skin, bone, organ, neuro complications

Question 9

How is syphilis diagnosed?

Answer 9

PCR of ulcer.

Question 10

How are the different stages of syphilis treated?

Answer 10

Infectious syphilis (primary, secondary, early latent)

• Benzathine pencillin, single dose

Late Latent Syphilis

• Benzathine penicillin (one weekly for 3 weeks)

Tertiary Syphilis

• IV penicillin (Benzathine penicillin doesn’t penetrate BBB)

Question 11

What is the Jarisch-Herxheimer Reaction

Answer 11

Common reaction to patients with primary/secondary syphilis

• Fever
• Headache
• Malaise
  
  • Joint pain

Question 12

How is herpes treated?

Answer 12

No cure!

Treated with antivirals:

• Famciclovir
• Valaciclovir