SH Revision 5 Flashcards

1
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

PID is a major complication of chlamydia. Up to 16% of patients with untreated infections are at risk. The risk of tubal infertility is 1-20% following PID.

Describe the features of PID:

Signs [3]
Symptoms [4]
Long [3] and short [2] term complications

A

Systemic upset:
fever
malaise
anorexia

Symptoms:
- low abdominal pain
- abnormal vaginal bleeding
- vaginal discharge or cervical discharge

Signs
- marked abdominal pain
- cervical excitation
- mucopurulent discharge

Long-term complications:
- infertility
- ectopic pregnancy
- chronic pelvic pain

Short-term complications:
- Tubo-ovarian abscess
- Fitz-Hugh-Curtis syndrome

NB: see PID notes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Describe how you investigate for chlamydia in men [1] and women [1]

A

Women:
- NAAT vulvovaginal swab

Men:
- urine test (first catch)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Tx for:

  • uncomplicated urogenital chlamydia? [2]
  • rectal infections [1]
A

A seven day course of doxycycline
OR
Aziothromycin due to potentially poor compliance with a 7 day course of doxycycline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Lymphogranuloma venereum (LGV) is caused by which specific organisms? [1]

A

Chlamydia trachomatis serovars L1, L2 and L3.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Describe the clinical stages of LGV infection [3]

A

Typically infection comprises of three stages:
* stage 1: small painless pustule which later forms an ulcer
* stage 2: painful inguinal lymphadenopathy
* stage 3: proctocolitis - leading to anal pain; tenesmus and discharge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Which patient populations do you offer a repeat Chlaymdia test in and why? [1]

A

Patients < 25 years old who are diagnosed with chlamydia should be offered a repeat chlamydia test in 3-6 months.

This is because there is a higher risk of reinfection (2-6x higher), which also increases the risk of PID and infertility.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Describe some complications of Chlamydia infection

A

PID:
- can result in tubo-ovarian abscesses and peritonitis

Epididymitis

Fertility issues:
- due to tubal damage from PID in women
- secondary to epididymitis in men

LGV

FItz-Hugh-Curtis syndrome:
- inflammation of the liver capsule and RUQ pain

Ocular complications:
- conjunctivitis that can progress to corneal scarring and blindness if not treated promptly.

Reactive arthritis
- urethritis, conjunctivitis, and arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Describe the diagnostic criteria that needs to be met for BV dx

A

Amsel’s criteria for diagnosis of BV - 3 of the following 4 points should be present:
* thin, white homogenous discharge
* clue cells on microscopy: stippled vaginal epithelial cells
* vaginal pH > 4.5
* positive whiff test (addition of potassium hydroxide results in fishy odour)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How do you differentiate between BV & trichomonas

A

Trichomonas:
- Frothy, yellow / green discharge
- Vulvovaginitis
- Strawberry cervix
- Wet mount: motile trophozoites

BV:
- Microscopy: clue cells
- thin, white discharge

NB: both have pH > 4.5; treat with metronidazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How do you treat BV in:

  • asymptomatic women [1]
  • symptomatic [1]
  • pregnant [2]
A

asymptomatic women:
- treatment not required (unless undergoing pregnancy termination)

symptomatic:
- oral metronidazole for 5-7 days
- a single oral dose of metronidazole 2g may be used if adherence may be an issue

pregnant
- oral metronidazole is used throughout pregnancy if symptomatic
- If asymptomatic: may be considered for treatment, but should discuss with obstetrician.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Describe the clinical presntation of chancroid [4]

A

Painful papules:
- early lesion that deteriorates into pustule then ulcer. May be one or more lesions

Multiple, deep ulcers

Lymphadenopathy:
- usually inguinal region

Buboe:
- infected, painful lymphadenitis that ulcerates and becomes suppurative. Can cause chronic draining sinuses.

NB: note it is rarely seen in the UK

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Describe how you investigate for chancroid [2]

A

Chancroid is usually a clinical diagnosis. There are no laboratory tests currently available for the immediate diagnosis of chancroid.

The main investigative techniques are:
Culture and sensitivity
PCR (most sensitive)
Microscopy
Serology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Which tests should you perform if you suspect chancroid to rule out DDx? [4]

A

Herpes culture
Syphilis serology
HIV test
LGV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

State three management options for chancroid [3]

A

A single IM dose (250 mg) of ceftriaxone
or
a single IM dose (1gram) of azithromycin

or an oral (500 mg) of erythromycin four times a day for seven days.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Which factors predispose patients to vaginal candidiasis? [5]

A
  • diabetes mellitus
  • drugs: antibiotics, steroids
  • pregnancy
  • immunosuppression: HIV, iatrogenic
  • Local irritatants
  • Sexual activity
  • Oestrogen exposure (incidence rises post menarche, but decreases post-menopause)
17
Q

Treatment for uncomplicated thrush? [2]

A

Local tx:
- clotrimazole 500mg PV stat

Oral:
* itraconazole 200mg PO bd for 1 day or
* fluconazole 150mg PO stat

18
Q

Treatment for recurrent thrush? [2]

> 4 episodes a year

A

induction:
- oral fluconazole every 3 days for 3 doses

maintenance:
- oral fluconazole weekly for 6 months

19
Q

Treatment for thrush in pregnant patients? [2]

A

avoid oral anti-fungal treatments
- use intravaginal anti-fungal cream or pessary (e.g. clotrimazole 10% cream as single dose or clotrimazole pessary for 2 nights), OR

20
Q

Clinical presentation of trichomoniasis?

A
  • Frothy green-yellow discharge
  • Vulval itching
  • Dysuria
  • Urethral irritation
  • Urethral discharge
  • Vulval inflammation
  • Cervical inflammation (often described as ‘strawberry cervix’)
  • pH > 4.5
21
Q

Investigations for trichomoniasis?

A

Swabs taken from lateral walls of vagina: pH > 4.5
and high vaginal swab: staining, microscopy and culture.

microscopy of a wet mount shows motile trophozoites

NAAT testing - gold standard

22
Q

A 15-year-old presents with a mouth ulceration and fever. On examination he has severe gingivostomatitis is a stereotypical history for infection by:

A

HSV - primary infection

23
Q
A

Gardnerella vaginalis

24
Q

Tx for LGV? [1]

A

Doxycycline 100mg twice daily for 21 days is the first-line

treatment for LGV recommended by BASHH. Erythromycin, azithromycin and ofloxacin are alternatives.

25
Q

TOM TIP: Remember that [] cells on microscopy mean bacterial vaginosis. This is a common association tested in MCQ exams.

A

TOM TIP: Remember that clue cells on microscopy mean bacterial vaginosis. This is a common association tested in MCQ exams.

Bacterial vaginosis gives “clue cells” on microscopy. Clue cells are epithelial cells from the cervix that have bacteria stuck inside them, usually Gardnerella vaginalis.