Sexual and Reproductive Health 3 Flashcards
How does trichomonas vaginalis present?
asymptomatic offensive grey-green discharge vulval irritation superficial dyspareunia cervicitis has punctate erythematous appearance
What is the diagnosis of trichomonas vaginalis?
wet film microscopy
special staining
culture of vaginal swabs
What is the treatment for trichomonas vaginalis?
metronidazole
What is endometritis?
infection in the cavity of the uterus
spread to the pelvis is common
usually secondary to instrumentation of uterus or complication of pregnancy
How does endometritis present?
o Persistent + heavy vaginal bleeding o Pain o Tender uterus o Cervical os open o Poss septicaemia
How is endometritis treated?
o Broad-spectrum abx
o ERPC if symptoms do not subside
What is the cause of acute pelvic infection and PID?
ascending infection of bacteria in vagina and cervix
What are the risk factors for PID?
young
poor
sexually active
nulliparous women
How does PID present?
o Asymptomatic
o Later subfertility or menstrual problems
o Bilateral lower abdominal pain with deep dyspareunia
o Abnormal vaginal bleeding or discharge
o If severe, tachycardia, high fever, lower abdominal peritonism with bilateral
adnexal tenderness + cervical excitation
What are the investigations for suspected PID?
- endocervical swabs for chlamydia and gonococcus
- blood cultures if fever
- WBC and CRP poss raised
- Pelvic USS excludes abscess or ovarian cyst
- laparoscopy with fimbiral biopsy and culture
What is the treatment for PID?
- analgesics and parenteral cephalosporins (IM ceftriaxone followed by doxycycline and metronidazole/ofloxacin and metronidazole)
- if febrile, admit for IV
- if abscess, may need drainage
What are the complications of PID?
abscess pyosalpinx tubal obstruction and sub fertility chronic pelvic pain/infection ectopic pregnancy more likely
What is chronic pelvic inflammatory disease?
persisting infection
dense pelvic adhesions
fallopian tubes may be obstructed and dilated with fluid or pus
How does chronic pelvic inflammatory disease present?
chronic pelvic pain or dysmenorrhoea deep dyspareunia heavy irregular menstruation chronic vaginal discharge subfertility abdominal tenderness and fixed retroverted uterus
How is chronic pelvic inflammatory disease diagnosed?
laparoscopy
What is the treatment for chronic pelvic inflammatory disease?
analgesics and abs if active infection
adhesiolysis
What are the RFs for HIV/aids?
multiple sexual partners migration from high prevalence countries failure to use barrier contraception IV drug use sexual contact with high risk males
How is HIV diagnosed?
can be asymptomatic
development of opportunistic infection or malignancy or CD4 count <200 diagnostic of AIDS
What are the gynaecology issues imp in HIV+ women?
yearly smears as cervical malignancy affects 1/3
genital infections esp candidiasis and menstrual disturbances are more common
What are the principles of treating HIV?
combination antiretroviral regimens - turns HIV into a chronic controllable condition
contact tracing
What are the principles of managing HIV in pregnancy?
Prevent vertical transmission to fetus by antiretroviral therapy, elective C-section +
avoidance of breastfeeding
What are the national screening programmes for STDs?
National Chlamydia Screening programme, for sexually active under 25-
year-olds for information + access to sexual health services
