Sexual health Flashcards
What are some non-infective causes of changes in discharge?
Cervical ectropion
Foreign body
Physiological (some discharge for women is normal)
What are some infective causes for changes in discharge?
NOT STI (bacterial vaginosis, candida) STI (Trichomonas vaginalis, chlamydia trachomatis, Neisseria gonorrhoeae)
What is physiological vaginal discharge like?
It is clear, has a non-offensive odour, is approx 1-4mls every 24 hours and varies with the menstrual cycle
What is the commonest cause of vaginal discharge in women of CBA?
Bacterial vaginosis
What is the pathophysiology of bacterial vaginosis? What does the discharge look like and what symptoms are commonly experienced?
There is bacterial overgrowth causing lack of lactobacilli meaning the pH of the vagina increases (normal=4.5m BV=4.5-6)
Discharge is thin, watery, white
There is no soreness, itchiness or irritation
What are some possible complications of BV?
PID Obstetric complications - Late miscarriage - Pre-term birth - Post-Delivery endometritis - PROM
If you suspect BV what tests should you do?
Low vaginal swab
pH of vagina
Gray-Ison gram stained vaginal smear
What management should be recommended for BV?
Avoid douching - just wash with water
Only treat if symptomatic or undergoing gynaecological surgery
MEDICATION: metronidazole
What organism causes thrush?
Candida albicans
Who is most likely to get candida?
immunosuppressed (e.g. HIV)
Abx use
Elevated oestrogen
What are the symptoms of candida?
Thick, creamy, lumpy discharge (cottage cheese)
Vulval itch and soreness, excoriations
Redness/rash on the vulva - satellite lesions, fissuring, oedema
Superficial dyspareunia and dysuria
How should we investigate a patient with suspected candida?
Candida is so common that it often doesn’t require investigation before treatment
- Ca do microscopy in GUM if clinically picture is slightly more confusing
How should we manage a case of candida?
Soap substitute, emollient for skin irritation, loose cotton underwear and avoid local irritants
MEDICAL: Oral fluconazole 150mg PO (cannot give if pregnant)
OR
500mg CLOTRIMAZOLE PESSARY
Is trichomonas vaginalis an STI?
YES - it is commonly mistaken for BV or candida
What are some symptoms of trichomonas vaginalis?
Vulval itch and soreness Frothy, yellow discharge Dysuria Vulvitis Vaginitis STRAWBERRY CERVIX (highly suggestive but only present in 10%)
If you suspect a woman might have TV how should you investigate?
Swabs from posterior fornix then mount on wet mount slide for microscopy
Also do VVS NAAT swabs
How should we manage a woman with TV?
Treat partners and avoid sex for 1/52
2g Metronidazole stat dose
OR
400mg metronidazole BD for 5-7 days (this is the more effective regime and this should be given to males always)
What is the most common STI in the UK?
Chlamydia Trachomatis