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Year 4 OBGYN > STI > Flashcards

STI Flashcards

1
Q

How does Gonorrhoea present in Women?

A

Altered Vaginal Discharge
Lower Abdo Pain
Dysuria
Altered Menstrual Bleeding

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2
Q

How should you investigate suspected Gonorrhoea?

A

Vaginal or Endocervical Swab

Culture for sensitivity

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3
Q

How is Gonorrhoea managed?

A

Ceftriaxone IM
(If complicated add Doxycycline or Metronidazole)

Partner Tracing
Avoid Sexual Contact until treatment complete

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4
Q

Name three complications of Gonorrhoea in Pregnancy

A

Spontaneous Abortion
Premature Labour
Gonococcal Conjunctivitis

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5
Q

Give three general complications of Gonorrhoea

A

PID
Infertility
Ectopic Pregnancy

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6
Q

How does Chlamydia present in Women?

A

Dysparenuria
PCB/IMB
Increased Discharge

Or

Reiters Syndrome (Urethritis/Arthritis/Conjunctivitis)

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7
Q

How should you investigate suspected Chlamydia?

A

Vulvovaginal Swab and NAAT

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8
Q

How should you manage suspected Chlamydia?

A

100mg Doxycycline BD for one week

Partner Tracing

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9
Q

Give three complications of Chlamydia in Pregnancy

A

Premature Delivery
Neonatal Conjunctivitis
Pneumonia

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10
Q

Give three complications of Chlamydia

A

PID
Infertility
Ectopic Pregnancy

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11
Q

Name the four ways Syphilis can be transmitted

A

Sexual
Vertical
Blood Transfusions
Breaks in Skin

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12
Q

How does Primary Syphilis present?

A

Develops at site of inoculation less than 90 days after
Transforms from Macule to Papule to Painless Ulcer/Chancre
Highly Infectious

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13
Q

How does Secondary Syphilis present?

A

Usually 6 weeks after Primary Lesion

Polymorphic Rash affecting palms and soles
Systemic: Night time headaches, Malaise, Slight Fever

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14
Q

How does Tertiary Syphilis Present?

A

Neurological: Tapes Dorsalis (Sensory Ataxia and Pain), Dementia
Cardiovascular: Aortitis
Gummata: Inflammatory nodules that can occur in any organ

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15
Q

How would you investigate Syphilis?

A

Treponemal Enzyme Immunoassay for IgM, IgG or both

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16
Q

How would you manage Syphilis?

A

Benzathine Penicillin 2.4 Mega Units

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17
Q

What is Jarisch Herxheimer Reaction?

A

Reaction to Syphilis treatment

Febrile, Myalgia, Chills, Headaches

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18
Q

Describe the features of Congenital Syphilis

A

Saddle Nose
Rashes
Failure to gain weight

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19
Q

What are Genital Warts?

A

Benign epithelial growths caused by HPV 6 and 11

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20
Q

Give three risk factors for Genital Warts

A

Smoking
Multiple Sexual Partners
Immunosupression

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21
Q

How do Genital Warts present?

A

Painless lesions causing itching/bleeding/Dysparenuria

On moist hairy skin (soft and non keratinised) on dry skin (firm and keratinised)

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22
Q

How would you counsel patients on a Genital Warts diagnosis?

A

Explain long latent period and that the recurrence of warts does not mean infidelity

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23
Q

How would you manage Genital Warts?

A

May choose no treatment

Non Keratinised - Podophyllotoxin Cream
Keratinised - Imiquimod Cream

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24
Q

Trichomonas Vaginalis is spread almost exclusively through Sexual Intercourse, how does it present?

A

Often confused for Bacterial Vaginosis

Vaginal Discharge, Vulval Itching, Dysuria, Offensive Odour

Strawberry Cervix

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25
Q

How do you investigate Trichomonas Vaginalis?

A

High Vaginal Swab

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26
Q

How should Trichomonas Vaginalis be managed?

A

Avoid intercourse for at least one week

Single dose 2g Oral Metronidazole

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27
Q

What is Bacterial Vaginosis?

A

Overgrowth of predominantly anaerobic bacteria in Vagina (Gardnerella Vaginalis)
Outgrow Lactobacilli so pH increases

28
Q

Give three risk factors and three protective factors for Bacterial Vaginosis

A

Risk Factors: Sexual Activity, IUCD, Douching

Protective Factors: COCP, Condoms, Circumcised Partner

29
Q

How does Bacterial Vaginosis present?

A

Offensive fishy smelling discharge without irritation

30
Q

Diagnosis of Bacterial Vaginosis is difficult in Primary Care so generally just treated empirically. How is it managed?

A

Asymptomatic don’t need treating unless pregnant
Avoid Douching
Oral Metronidazole 400-500mg BD for 5-7 days

31
Q

How is Genital Herpes transmitted?

A

Through skin to skin contact during Vaginal/Oral/Anal Sex

Can lie dormant (in nearest nerve ganglion) and reoccur

32
Q

What are the two different types of Genital Herpes?

A

HSV1 - Genital and Oral

HSV2 - Genital and Anal

33
Q

What are the clinical features of Primary Genital Herpes?

A

Small red blisters that are very painful and can form open sores
Vaginal/Penile Discharge
Flu Like

34
Q

What are the clinical features of Secondary Genital Herpes?

A

Shorter and less severe

Burning/Itching/Painful Red Blisters

35
Q

How is Primary and Secondary Genital Herpes managed respectively?

A

1 - Acyclovir, Contact Tracing

2 - Painkillers, Petroleum Jelly, Ice Packs, Episodic Acyclovir

36
Q

Describe the effect of Genital Herpes on Pregnancy

A

Baby is normally protected via placental antibodies , last trimester is more dangerous as antibodies not formed

37
Q

What are the three types of Neonatal Herpes?

A
  • SEM (Skin, Eyes, Mouth)
  • DIS (Disseminated)
  • CNS Herpes
38
Q

Describe the pathophysiology of HIV

A

Penetrates CD4, empties contents, reverse transcriptase, combined with host DNA via integrase, maturation with protease

39
Q

Define Seroconversion

A

Process of producing anti HIV antibodies during primary infection

Extremely infectious

Flu like symptoms

40
Q

How does Symptomatic HIV present?

A

Weight Loss, High Temperature, Diarrhoea, Frequent Minor Opportunistic Infection

41
Q

How should you investigate HIV?

A

ELISA - for salivary/serum antibodies, gives reliable results in 4-6 weeks

Contact Tracing

42
Q

What is HAART?

A

Highly Active Anti-Retroviral Therapy
Aims to reduce load to virtually undetectable

Eg Nucleoside Reverse Transcriptase Inhibitors, Protease Inhibitors

43
Q

When should PEP be given?

A

Within 72 hours of exposure

44
Q

What is monitored in HIV?

A 
CD4 count
HIV viral load
FBC
U&Es
Urinalysis
45
Q

What is Vulvovaginal Candidiasis?

A

Fungal infection of lower reproductive tract with Candida Albicans

46
Q

Give three risk factors for Vulvovaginal Candidiasis

A

Pregnancy
Diabetes
Immunosupression

47
Q

Name three symptoms of Vulvovaginal Candidiasis

A

Pruritus Vulvae
Vaginal Discharge (white, curd like, non offensive)
Dysuria

48
Q

How would Vulvovaginal Candidiasis present OE?

A

Erythema and Vulval Swelling

Satellite Lesions (Red Pustular with White Superficial Plaques)

Curd like discharge

49
Q

How is Vulvovaginal Candidiasis managed?

A

1) Intravaginal Clotrimazole (oil based so may weaken condoms)
2) Oral Antifungal (Fluconazole/Itraconazole) (Not in Pregnancy)

50
Q

Why does Pregnancy encourage Vulvovaginal Candidiasis?

A

Increased Oestrogen stimulates glycogen production (more favourable environment)
Encourages growth and sticking to vaginal walls

51
Q

Define Pelvic Inflammatory Disease

A

Infection of the Upper Genital Tract affecting Uterus/Fallopian Tubes/Ovaries

52
Q

How does PID present?

A 
Lower Abdo Pain
Deep Dysparenuria
PCB
Abnormal Discharge
Fever
53
Q

Give three differentials of PID

A

Ectopic Pregnancy
Ruptured Ovarian Cyst
Endometriosis

54
Q

How would you investigate PID?

A 
Endocervical Swabs (Chlamydia, Gonorrhoea)
High Vaginal Swabs (TV and BV)
Urine Dip
Pregnancy Test
Transvaginal USS
55
Q

Describe the antibiotic therapy for PID

A

Oxaflocin
Doxycycline
Ceftriaxone
Metronidazole

All partners from last 6 months should be tested/treated

56
Q

Give three complications of PID

A

Ectopic Pregnancy
Tubo- Ovarian Abscess
Fitz Hugh Curtis (Perihepatitis)

57
Q

What should you treat needle phobic patients with for Gonorrhoea?

A

Cefixime and Azithromycin (PO)

58
Q

Name the three features of Disseminated Gonococcal infection

A

Dermatitis
Migratory Arthritis
Tenosynovitis

59
Q

Hen should you treat Chlamydia?

A

Before you get the results

60
Q

When should you test for Chalmydia?

A

2 weeks after suspected exposure

61
Q

Describe contact tracing for STIs

A

Female -all sexual partners in last 6 months

Males - all sexual partners in last 4 weeks

62
Q

Name three similarities between BV and TV

A

pH<4.5

Foul smelling discharge

Both treated with Metronidazole

63
Q

Name two differences between BV and TV

A

BV: Thin white watery discharge, Clue Cells on microscopy

TV: Yellow/Green frothy discharge, Protozoa on microscopy

64
Q

How do you treat pregnant women with Genital Herpes?

A

> 28 weeks - caesarean

Recurrent during pregnancy - Prophylactic Aciclovir

65
Q

How should you treat gonorrhoea in needle-phobic patients?

A

Single dose cefixime and azithromycin

66
Q

What is disseminated gonoccal infection?

A

Tenosynovitis, Migratory Polyarthritis and Dermatitis

Year 4 OBGYN (15 decks)

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