Sexual Health (GUM) Flashcards
Risk factors for thrush/candidiasis
Diabetes Mellitus
Pregnancy
Immunosuppression (steroids, HIV)
Abx
Mx of Thrush
Local - clotrimazole pessary
Oral - itraconazole 200mg bd or fluconazole 150 mg PO stat
Differential diagnoses of a genital sore/ulcer
Infection
- Syphilis (treponema pallidum) - all genital ulcers are syphilis until proven otherwise
- HSV (type 2)
- HZV
Dermatological
- Lichen sclerosis
- Lichen planus
- Pemphigoid (BP)
- Pemphigus (PV)
- Erythema multiforme (drug reaction or HSV reaction)
Neoplasm
- VIN
- Vulval SCC
- BCC
- Melanoma
Other
- Trauma
- Apthous ulcer
- Insect bite
Differential diagnoses of genital discharge
- Candida Albicans (cottage cheese like, non-offensive)
- Bacterial vaginosis / Gardnerella Vaginalis (fishy, offensive, grey or colourless)
- Trichomonas vaginalis (fishy, thin and bubbly; strawberry cervix)
- Chlamydia Trachomatis
- Neisseria Gonorrhoea
PID
How may candidiasis present
Thick, non-offensive, white ‘cottage cheese like’ discharge
Dysuria
Dyspareunia (vulval involvement)
Ix for candidiasis
High vaginal swab
What to test for if recurrent candidiasis?
HIV
Diabetes Mellitus
Adherence to treatment
Name the organism responsible for chlamydia infection
Chlamydia Trachomatis
What is the most common STI ?
Chlamydia Trachomatis
How may chlamydia present ?
Asymptomatic (70%) cases Dysuria Discharge IMB or PCB Dyspareunia Epididymo-orchitis (testicular pain and swelling)
Which STI has a national screening programme ?
Chlamydia
List some complications of chlamydia infection
Fitz-Hugh-Curtis syndrome
Reiter’s syndrome
PID
Tubal infertility
Mx of Chlamydia
Azithromycin (single dose)
or
Doxycycline (7 days)
Erythromycin in pregnancy
Ix for Chlamydia
Vulvovaginal and endocervical swab for NAAT (nucleic acid amplification test)
What is the gram staining of Neisseria Gonorrhoeae ?
Gram neg diplococcus
Symptoms of Gonorrhoea infection
Asymptomatic Dysuria Discharge (purulent penile) Pelvic pain (women) IMB / PCB Epididymo-orchitis (males) Proctitis
Complications of gonorrhoea infection
Septic arthritis (monoarthritis)
PID
Bartholin’s abscess
Ix for gonorrhoea infection
Endocervical swab for microscopy and nAAT (nucleic acid amplification test)
Mx of gonorrhoea infection
Ceftriaxone (stat)
AND
Azithromycin (stat)
Consequences of gonorrhoea infection in pregnancy
Chorioamionitis
Preterm delivery
PPROM
Ophthalmia neonatarum
Consequences of chlamydia infection in pregnancy
Neonatal conjunctivitis
PPROM
Preterm delivery
Neonatal pneumonia
What organism causes syphilis ?
Treponema Pallidum (spirochaete bacteria)
How does syphilis present ?
Primary syphilis (within 9-90 days) - Raised, painless, indurated ulcerated papule = chancre (often at the site of inoculation) Lymphadenopathy
Secondary syphilis (6-8 weeks after chancre has healed)-
Seroconversion. Rash (widespread mucocutaneous lesions), malaise, fever, sore throat, headache and lymphadenopathy.
Enter late latency after 1 year.
Tertiary syphilis -
Characterised by the gumma (chronic granulomatous lesions) often seen on skin, bone and mucosa
Quaternary syphilis (10-20 years after infection)- Neurosyphilis (Argyll-Robertson pupil, tabes dorsalis) Cardiosyphilis (aortic aneurysms and regurgitation)
Ix for syphilis
Dark ground microscopy (detect spirochaete in primary and secondary stages)
Can only test after 6 weeks (second stage)
- Cardiolipin antibody (VDRL test)
- TPHA test (treponema pallidum haemagglutination assay)
CXR
LP
CT / MRI
What abx is used to treat syphilis ?
Benzathine penicillin / long acting procaine penicillin IM 10-12 days
Or
Benzylpenicillin 2 weeks
Can use doxycycline if early stage
What may happen after staring treatment for syphilis ?
Jarisch- Herxheimer Reaction
(Rise in temp and HR, vasodilation due to release of endotoxins after first dose of Abx)
Seen in 50% pts with primary syphilis and 90% pts with secondary syphilis
What can happen if maternal syphilis infection in pregnancy
Birth defects
Spontaneous abortion
What organism is responsible for genital warts ?
HPV 6 and 11
Mx of genital warts
Podophyllotoxin cream (warticon)
Cryotherapy with liquid nitrogen
Offensive Fishy, thin and bubbly discharge with a strawberry cervix seen on examination
& urethritis / dysuria ?
Trichomonas vaginalis
Mx of Trichomonas vaginalis
Metronidazole
What kind of microorganism is trichomonas vaginalis
Protozoa
Offensive grey/colourless fishy discharge?
Bacterial vaginosis
Bacteria associated with bacterial vaginosis
Overgrowth of gardnerella vaginalis (natural floral, but overgrown due to reduce lactobacillus)
What can trigger bacterial vaginosis ?
Perfumed products
Insertion of an IUD
Ix / diagnosis of bacterial vaginosis
Whiff test
Clue cells seen on microscopy
Mx of bacterial vaginosis
Metronidazole STAT
Or
Topical clindamycin for 7 days
