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Michael O&G - Connecting the dots > Post-Coital Bleeding > Flashcards

Post-Coital Bleeding Flashcards

1
Q

Which 3 organs are gonna be the cause?

A

Uterine
Cervical
Vaginal

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2
Q

(PCB) Vaginal Causes

What are the 3 vaginal causes of PCB?

A

Infection
Trauma
Atrophy

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3
Q

Infective causes of PCB?

What infective diseases could cause PCB?

A

Non STI

Candidiasis (Thrush)
Bacterial Vaginosis

STI

Chlamydia
Gonorrhea

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4
Q

Candidiasis

What is the most striking feature of Candidiasis and what other signs/symptoms would you expect to see?

A

‘Cottage Cheese’ discharge
Itch

Red/inflamed vulva/vagina
Superficial Dyspareunia
Dysuria

Most common vaginal infection, ~20%

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5
Q

Candidiasis

Give 3 important risk factors for candidiasis infection?

A

Pregnancy
Diabetes
Abx

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6
Q

Candidiasis

How would you diagnose candidiasis?

A

Swab and culture

Don’t necessarily have to culture before treating

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7
Q

Candidiasis

What is the treatment for candidiasis?

A

Oral fluconazole / clotrimazole pessary

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8
Q

Fluconazole

What O&G risks are there to using this drug?

A

Pregnancy - ?harm to foetus - miscarriage and birth defects. Evidence not strong, low dose is probably fine.

Breast feeding - not recommended

Clotrimazole has no pregnancy or breastfeeding risks.

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9
Q

Bacterial Vaginosis

What is the most striking feature of Candidiasis and what other signs/symptoms would you expect to see?

A 
Grey white discharge
Fishy odour (amines)
NO itch/redness
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10
Q

Bacterial Vaginosis

What are the risk factors

A

Douching

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11
Q

Bacterial Vaginosis

How would you diagnose bacterial vaginosis

A

Examination: look at the discharge
↑Vaginal pH
+ve Whiff test (fishy odour)

Microscopy - Clue cells (epithelial cells with bacterial dots on them)

Ax - PID, preterm labour

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12
Q

Bacterial Vaginosis

What is the treatment for Bacterial Vaginosis?

A

Topical metronidazole (nitroimidazole)
OR
Clindamycin (licosamide)

Both safe in pregnancy and breastfeeding

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13
Q

Bacterial Vaginosis

What other presentation would warrant investigation for this disease?

A

PID

Preterm labour

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14
Q

Chlamydia

What is the most striking feature of Chlamydia and what other signs/symptoms would you expect to see?

A

Discharge with odour
Fever, abdo pain
Ureitis

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15
Q

Chlamydia

Risk factors

A

Unprotected sex

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16
Q

Chlamydia

Diagnosis?

A

Urine (NAAT) - PCR

17
Q

Chlamydia

Rx?

A

Doxycycline
Azithromycin

partner inform and Rx

18
Q

Chlamydia

Complications?

A

Sub/infertility, chronic pelvic pain

Reiter’s Syndrome - triad of urethritis, arthritis and conjunctivitis

19
Q

Gonnorhea

Sx?

A

o Asymptomatic
o Vaginal discharge
o Urethritis

o	Bartholinitis (inflammation of the Bartholi glands)
o	Cervicitis
20
Q

Bartholinitis

What is this?

A

Pea shaped gland at opening of vagina, can be infected

pain and soreness in the region of one of the labia minora
swelling in the same area
possibly a slight discharge from the same region.

21
Q

Gonnorhea

RF?

A

Unprotected sex

22
Q

Gonnorhea

Dx?

A

Endocervical swab, urine NAAT (PCR)

23
Q

Gonnorhea

Complications?

A

Septic arthritis

  • knee or wrist symptoms
24
Q

Gonnorhea

Rx?

A

Ceftriaxone

partner inform and Rx

25
Q

Traumatic causes of PCB?

What are the traumatic causes for PCB?

A

Lack of lubrication

  • not enough arousal
  • Oestrogen levels are low. This happens during breastfeeding and with menopause.

Rough sex

26
Q

Vaginal Trauma

Complications?

A

Although not common, vaginal lacerations are usually the cause of postcoital bleeding that is heavy enough to bring a woman to the emergency room after sex.

The vagina has a rich blood supply and these types of lacerations bleed a lot. Usually, it means stitches or suturing are needed to stop the bleeding. Sometimes it even means a trip to the operating room.

So if very heavy PCB in A&E, think sex

27
Q

Vaginal Trauma

DIagnosis?

A

Examination - look for lacerations

28
Q

Vaginal Atrophy

Sx?

A

Dyspareunia, itching, dryness, prolapse

Happens in menopause

Rx - Treat menopause (HRT), lubricants and moisturiser

29
Q

Cervical causes of PCB

What cervical causes are there for PCB?

A

Cervicitis
Ectropion
Neoplasia

30
Q

Cervicitis

Causes?

A

STI (see Chlamydia and Gonorrhea)
Allergic Reactions
-latex
-hygiene products

Bacterial Overgrowth
- overgrowth of vaginosis in vagina can make it spread to cervix

31
Q

Cervicitis

Symptoms?

A

Discharge
Pain during sex
Painful urination

32
Q

Cervicitis

Diagnosis?

A

Examination

- speculum - look for inflammation

33
Q

Cervical causes of PCB - Ectropion

Sx?

A

When eversion of the cervix causes columnar epithelium of the endocervix to be visible (as a red area around the external os)

Discharge, PCB

34
Q

What investigations should you do if you find an ectropion on examination?

A

Cervical Smear

See cervical smear section for further details

35
Q

Ectropion

Rx?

A

Cryotherapy - only indicated if very severe

36
Q

Uterine causes of PCB?

A

Endometrial hyperplasia
Polyps
Fibroids

Check heavy menstrual bleeding for further information

Michael O&G - Connecting the dots (14 decks)

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