Sexual Health: Discharge

Question 1

Most common cause of abnormal vaginal discharge in child-bearing age

Answer 1

BV

Question 2

BV:
Vaginal pH
Dominated by what bacteria
RFs

Answer 2

pH >4.5
Lactobacilli

RFs: anything increasing pH (menstruation, semen, products). black ethnicity, smoking, change in partner, STI

Question 3

BV: complications in pregnancy

Answer 3

Late miscarriage, preterm birth, PROM, post-partum endometriosis

Question 4

BV: who to treat (3)

Answer 4

Symptomatic women
Undergoing some surgical procedures
Patient choice

Question 5

Mx of BV

How would you treat if breast feeding?

Answer 5

Metronidazole 400mg BD for a week

Breast feeding: give vaginally

Question 6

Cautions when taking metronidazole

Answer 6

Don’t drink alcohol

Warfarin monitoring

Question 7

Give 3 RFs for candida infection

Answer 7

Immunosuppression (w.g. DM, pregnancy)
Antibiotic use
Elevated oestrogen

Question 8

Diagnosis of candida

Answer 8

Often symptomatic
? microscopy
? culture of low vaginal swab

Question 9

Mx of candida

Answer 9

Clomitrazole pessary

OR oral fluconazole

Question 10

Mx of candida in pregnancy

Answer 10

Pessary (NOT ORAL!!)

Question 11

Presentation of trichomanas in women

Answer 11

Offensive frothy yellow discharge
Vulvitis & vaginitis
Dysuria

Question 12

Diagnosis of TV

Answer 12

High vaginal swab for wet mount microscopy

OR NAAT (make sure to include TV)

Question 13

Mx of tricomonas vaginalis

Answer 13

2g metronidazole STAT

or 400mg BD for 7 days

Question 14

Chlamydia:
Infection of
Usually symptomatic or not?
Type of bacteria

Answer 14

Infection of endocervix

Usually asymptomatic

Intracellular bacteria

Question 15

Presentation of chlamydia in women

Answer 15

Vaginal discharge
Dysuria
Deep dyspareunia
Lower abdo pain
PCB & IMB

Question 16

Complications of chlamydia

Answer 16

PID, endo, tubal infertility, ectopic, SARA, FHC syndrome

Question 17

Chlamydia in pregnancy: what does it increase the risk of?

Answer 17

PPROM, preterm delivery, low birth weight

Question 18

Management of chlamydia

Answer 18

Doxycycline for 7 days

Question 19

Mx of chlamydia in pregnancy

Answer 19

Azithromycin

Question 20

Where does gonorrhoea affect?

Answer 20

Urethra, endocervix, pharynx, conjunctiva

Question 21

Mx of gonorrhoea

Answer 21

Ciprofloxacin or ceftriacone IM PLUS azithromycin PO

Question 22

Invs in gonorrhoea

Answer 22

NAAT

Always culture!! for sensitivity testing

Question 23

In men, what type of urine sample is needed?

How long are they recommended to hold urine?

Answer 23

First catch urine sample

Hold for an hour

Question 24

Presentation of gonorrhoea in men

Answer 24

Urethritis, yellow discharge

Question 25

MSM: where do you need to screen?

Answer 25

Urethra, rectum + throat

Question 26

Presentation of chlamydia in men

Answer 26

Clear/ white urethral discharge

Question 27

What is lymphogranuloma venerum?

Who is it most common in?

Answer 27

Form of chlamydia that can invade the lymphatic system

Most common in MSM

Question 28

Mx of non-specific urethritis (NSU)

Answer 28

Investigate as per gonorrhoea + chlamydia
If tests neg: refer to GUM
Mx like chlamydia (doxycycline)

Question 29

Microplasma genitalium:
Presentation
Testing
Mx

Answer 29

Usually asymptomatic/ F: PID/ M: urethritis

Abx: but can be difficult due to resistance

Question 30

STI causes of rectal discharge

Answer 30

Chlamydia
Gonorrhoea
Herpes
STI enteric infections (e.g. shigella)