Reproductive

Question 1

PCOS

Answer 1

Need 2/3 of infrequent/absent periods, hyperandrogenism (acne, hirsuitism, alopecia), USS evidence of cysts (>12 on one ovary)
High LH, high oestrogen, insulin resistance
LH:FSH ratio >3:1 in first 5 days menstrual cycle

Mx
- COCP for periods/androgenism
- metformin, + clomifene to induce ovulation for fertility. Can consider ovarian drilling if ineffective.
- weight loss and diet

Question 2

Syphilis

Answer 2

Primary - PAINLESS ulcer (chancre) on genitals, maybe with local lymphadenopathy
Secondary - 1-3 months later, widespread rash and gen unwell with malaise and lymphadenopathy
Tertiary - can be years later with latency, neuro/cardio effects or gumma (soft tissue masses)

IM benpen to treat
Treponema bacteria

Question 3

Chlamydia

Answer 3

Asymptomatic commonly, can have urethritis, abnormal discharge, abdo pain
Biggest assoc to PID
NAAT test

7 days doxycycline or azithromycin

Question 4

Gonorrhoea

Answer 4

Can be asymptomatic in women or with discharge, urethral discharge in men
Can disseminate to skin/synovial infection
Risk to baby if in pregnancy - ophthalmia neonatorum (leads to blindness if untreated)

IM ceftriaxone STAT

Question 5

HSV

Answer 5

PAINFUL blistering rash
Chronic relapsing/remitting course

Question 6

Trichomoniasis

Answer 6

Purulent green discharge
Strawberry cervix