Post-Coital Bleeding Flashcards
Which 3 organs are gonna be the cause?
Uterine
Cervical
Vaginal
(PCB) Vaginal Causes
What are the 3 vaginal causes of PCB?
Infection
Trauma
Atrophy
Infective causes of PCB?
What infective diseases could cause PCB?
Non STI
Candidiasis (Thrush)
Bacterial Vaginosis
STI
Chlamydia
Gonorrhea
Candidiasis
What is the most striking feature of Candidiasis and what other signs/symptoms would you expect to see?
‘Cottage Cheese’ discharge
Itch
Red/inflamed vulva/vagina
Superficial Dyspareunia
Dysuria
Most common vaginal infection, ~20%
Candidiasis
Give 3 important risk factors for candidiasis infection?
Pregnancy
Diabetes
Abx
Candidiasis
How would you diagnose candidiasis?
Swab and culture
Don’t necessarily have to culture before treating
Candidiasis
What is the treatment for candidiasis?
Oral fluconazole / clotrimazole pessary
Fluconazole
What O&G risks are there to using this drug?
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.
Bacterial Vaginosis
What is the most striking feature of Candidiasis and what other signs/symptoms would you expect to see?
Grey white discharge Fishy odour (amines) NO itch/redness
Bacterial Vaginosis
What are the risk factors
Douching
Bacterial Vaginosis
How would you diagnose bacterial vaginosis
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
Bacterial Vaginosis
What is the treatment for Bacterial Vaginosis?
Topical metronidazole (nitroimidazole)
OR
Clindamycin (licosamide)
Both safe in pregnancy and breastfeeding
Bacterial Vaginosis
What other presentation would warrant investigation for this disease?
PID
Preterm labour
Chlamydia
What is the most striking feature of Chlamydia and what other signs/symptoms would you expect to see?
Discharge with odour
Fever, abdo pain
Ureitis
Chlamydia
Risk factors
Unprotected sex
Chlamydia
Diagnosis?
Urine (NAAT) - PCR
Chlamydia
Rx?
Doxycycline
Azithromycin
partner inform and Rx
Chlamydia
Complications?
Sub/infertility, chronic pelvic pain
Reiter’s Syndrome - triad of urethritis, arthritis and conjunctivitis
Gonnorhea
Sx?
o Asymptomatic
o Vaginal discharge
o Urethritis
o Bartholinitis (inflammation of the Bartholi glands) o Cervicitis
Bartholinitis
What is this?
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.
Gonnorhea
RF?
Unprotected sex
Gonnorhea
Dx?
Endocervical swab, urine NAAT (PCR)
Gonnorhea
Complications?
Septic arthritis
- knee or wrist symptoms
Gonnorhea
Rx?
Ceftriaxone
partner inform and Rx
Traumatic causes of PCB?
What are the traumatic causes for PCB?
Lack of lubrication
- not enough arousal
- Oestrogen levels are low. This happens during breastfeeding and with menopause.
Rough sex
Vaginal Trauma
Complications?
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
Vaginal Trauma
DIagnosis?
Examination - look for lacerations
Vaginal Atrophy
Sx?
Dyspareunia, itching, dryness, prolapse
Happens in menopause
Rx - Treat menopause (HRT), lubricants and moisturiser
Cervical causes of PCB
What cervical causes are there for PCB?
Cervicitis
Ectropion
Neoplasia
Cervicitis
Causes?
STI (see Chlamydia and Gonorrhea)
Allergic Reactions
-latex
-hygiene products
Bacterial Overgrowth
- overgrowth of vaginosis in vagina can make it spread to cervix
Cervicitis
Symptoms?
Discharge
Pain during sex
Painful urination
Cervicitis
Diagnosis?
Examination
- speculum - look for inflammation
Cervical causes of PCB - Ectropion
Sx?
When eversion of the cervix causes columnar epithelium of the endocervix to be visible (as a red area around the external os)
Discharge, PCB
What investigations should you do if you find an ectropion on examination?
Cervical Smear
See cervical smear section for further details
Ectropion
Rx?
Cryotherapy - only indicated if very severe
Uterine causes of PCB?
Endometrial hyperplasia
Polyps
Fibroids
Check heavy menstrual bleeding for further information
