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Obs & Gynae > STI + Non-STI Genital Conditions > Flashcards

STI + Non-STI Genital Conditions Flashcards

1
Q

What caues urethritis

A 
Chlamydia Trachomatis = most common
Neisseria gonorrhoea
Mycoplasma genitalium
Ureaplasma
Trichomona's 
HSV
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2
Q

What are the symptoms of urethritis

A

PAIN on passing urine
Urethral discharge
Meatitis (erythema of urethral meatus)

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3
Q

How do you Dx urethritis

A

Swab in F
First void urine in M

Culture for gonorrhoea
NAAT for chlamydia
Microscopy for gram stain is best way but not always available

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4
Q

What do you always test for

A

C+G
G = gram -ve dipplococci
C = NAAT +Ve

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5
Q

How do you know its not UTI

A

Don’t get discharge

Discharge can be physiological

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6
Q

What do you do for recurrent / persistent urethritis

A

Test for mycoplasma

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7
Q

What is the most common STI

A

Chlamydia

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8
Q

What should you always do if vaginal bleeding

A

Chlamydia test

Also do smear and pregnancy test

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9
Q

How does chlamydia present on men

A

Asymptomatic
Watery discharge
Dysuria

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10
Q

How does chlamydia present in women

A

Vaginal discharge
Dysuria
IMB / PCB

More suggestive of PID 
Pelvic pain 
Inflammed friable cervix
Cervical excitation 
Abdo tenderness on VE
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11
Q

What colour discharge is suggestive of bacteria

A

Green yellow

Due to neutrophils

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12
Q

How do you test for chlamydia

A

NAAT on First void or swab

Same for gonorrhoea

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13
Q

Where do you swab

A

Vaginal

Can do rectal if anal sex or throat for oral sex

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14
Q

When should you test for chlamydia

A 
Urethritis
Reactive arthritis
Epididymitis 
Termination of pregnancy 
IUD insertion
Other STI
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15
Q

What examination do you do

A

If asymptomatic none needed

Speculum and bimanual

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16
Q

What are complications of chlamydia in male

A 
Epididymitis
Proctitis
Infertility 
Reiter
- Reactive arthritis 
- Conjunctivitis
- Urethritis
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17
Q

What are complications in female

A

PID -> ectopic -> infertility
Reiter
Perihepatitis

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18
Q

What are complications in pregnancy

A

Premature
LBW
Pneumonia / conjunctivitis in new born

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19
Q

What is Reiter syndrome

A

Urethritis
Conjunctivitis
Reactive arthritis

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20
Q

How does gonorrhoea present in men

A

Thick profuse yellow / green discharge
Dysuria
Testicular pain
Rectal / pharyngeal infection

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21
Q

How does gonorrhoea present in women

A

Vaginal discharge
Dysuria
Pelvic pain
IMB / PCB

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22
Q

How do you Dx gonorrhoea

A

NAAT of urine / swab
May need to do rectal swab if proctitis suspected
Swab - Gram stain + culture for Ax sensitivity
Gram -ve diplococcus

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23
Q

What else do you do if Dx

A

STI screen
HIV + syphillis
Hep B if vaccine / at risk or check vaccine worked

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24
Q

How do you treat chlamydia

A

Azithromycin single dose or
Doxycycline 100mg 2x daily 7 days
Treat if possible exposure even before results back

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25
Q

When do you do once treated

A

Test 3 months for reinfection
Contact tracing
STI screen

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26
Q

How do you treat gonorrhoea

A

Ceftriaxone 1000mg IM

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27
Q

When do you test for cure and reinfection

A

2 weeks cure

Reinfection 3 months

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28
Q

What do you do if SA

A

Ceftriaxone

Wash out

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29
Q

What are complications of gonorrhoea

A 
Epididymitis
Urethral stricture 
PID
Bartholin's abscess
Septic arthritis
Disseminated infection 
Skin lesion
Perihepatitis
Reiter's
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30
Q

Gonorrhoea in neonate

A

Conjunctivitis

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31
Q

What is perihepatiis known as

A

Fitz-Hugh syndrome

- Adhesions between liver and abdominal wall causing RUQ pain

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32
Q

What causes genital herpes

A

HSV 1+2

HSV 1 more likely to cause cold sore

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33
Q

What is the progress of herpes

A

Recur monthly or annually
Not everyone with virus shows symptoms
Can lie dormant
First episode is most severe

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34
Q

How is herpes transmitted

A

Genital skin contact

Oral

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35
Q

What are the symptoms of herpes

A 
Asymptomatic 
May present with lesions in mouth as well - gingivostomatitis
Small blisters -> ulcers 
Painful / burn / itch 
Lasts 10-20 days 
Tender inguinal LN
Discharge 
Dysuria 
Groin swelling
Fever
FLu like prodrome 
Neuralgic pain
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36
Q

What is DDX of herpes / genital ulcer

A 
Syphillis
Tropical STI 
Secondary scabies
Trauma
Chron's
Chancroid 
- multiple painful ulcers
- Rx = azithromycin 
Neoplastic
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37
Q

How do you Dx herpes

A

Clinical impression
PCR of ulcer
Full STI esp syphillis

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38
Q

How do you treat primary infection

A

Oral acyclovir 5 days

Lidocaine for analgesia

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39
Q

What do you do if frequency recurrence

A

Acyclovir long term suppression

40
Q

What else can you do

A

Analgesia

Ice pack

41
Q

What are the complications of hereps

A 
Post-herpatic neuralgia 
Autonomic neuropaty
Secondary bacterial infection 
Co-factor for HIV transmission
Neonate infection
42
Q

What does herpes cause in neonate

A

Neonatal herpe
Encephalitis
High mortality

43
Q

How do you deal with risk to neonate

A

Acyclovir prophylaxis
Elective C-section
Avoid invasive

44
Q

What causes syphillis

A

Treponema pallidum (spirochete)

45
Q

What is an early infection

A

<2 years since caught

Infectious

46
Q

What can early infection be split into

A 
Primary <90 days 
- Painless solitary genital ulcer 
Secondary
- Rash / fever / LN 
Early latent if no Sx
47
Q

What is late infection

A

> 2 years
Latent = no Sx

Late tertiary
CVS - AR / aneurysm / aortic dissection (think if someone presents with chest pain / inferior I - do CT aorta gram and refer surgeons )
Neuro - meningitis / focal neuro / seizures / tabes dorsalis
Gummatous

48
Q

What are the symptoms of syphillis

A 
Asymptomatic
Local ulcer (chancre)
Painless
Fever
Rash
LN
Abnormal LFT
Mucosal ulceration 
Arthralgia
Patch alopecia
49
Q

If rash on palms or soles of feet

A

Syphillis
HFMD unlikely
Have high index of suspicion

50
Q

How do you Dx syphillis

A

Clinical
Microscopy or PCR of ulcer swab
Serology - 8 weeks after
Unusual neurology = syphillis screen

51
Q

Serology of syphillis

A 
Treponema IM and IgG 
Lots of different
- VDRL - use for monitoring 
- EIA - will always remain +VE 
- TPHA - will always remain +Ve
PRR - used for active monitored 
If only one then retest
52
Q

What is required to treat syphillis

A

2 pieces of evidence

e.g. symptoms + blood result

53
Q

What do you do for early syphillis no neuro

A

Penicillin IM
- Watch for jarisch-herxheimer reaction
- Due to death of harmful organism = flu like Sx etc
- Rx with this in pregnancy as doxypclicine DCI
Doxycycline 2 weeks

54
Q

What do you do for late syphillis no neuro

A

Penicillin IM x3

Doxycyline 4 weeks

55
Q

How does neurosyphilis present

A 
CN palsy
Dementia
Tabes dorsalis 
Focal neuro / seizure 
Menignitis 
Optic neuritis / retinitis
56
Q

What does congenital infection cause

A 
Congenital abnormality 
Growth restriction
HSM
Anaemia
Thrombocytopenia
Rash
57
Q

What causes trichomoniasis

A

Trichomonas vaginalis

58
Q

What are the symptoms

A 
Thin vaginal discharge
Green / yellow / frothy and foul smell
Vulvitis
Strawberry cervix
Increased pH
59
Q

How do you Dx

A

PCR swab
NAAT
Clue cells on microscopy
No test in men

60
Q

How do you treat

A

Metronidaole

61
Q

What are complications in pregnancy

A

Miscarriage

Pre-term

62
Q

What causes anogenital wats

A

HPV 6+11

Genital skin contact

63
Q

Symptoms of waste

A 
Lumps
Cauliflower texture
Itch
Bleeding
Painless
64
Q

How do you Dx

A

Clinical

Biopsy if unusual to exclude

65
Q

What is ablative Rx

A

Podophyllotoxin = 1st line
Cyrotherapy = 1st line if keratinised
Surgery
Diathermy if bully

66
Q

What are other Rx measures

A

Imiquimod - immune modulator

Garadasil vaccine

67
Q

What should you do if don’t clear

A

Biopsy

68
Q

What is rare complications

A

Neonatal laryngeal papillomatosis

69
Q

What is Ddx of vulval lump

A 
Molluscum contagiosa
Scabies nodule
Skin tag
Sebaceous cyst
Female fordyce spot
Bartholin's cyst / abscess
Dermatoses
Malignancy
70
Q

What are molluscs contagiousum

A

Pearly papule in children

71
Q

How do you differentiate from scabies

A

Itch starts at genitals and spread if STI

72
Q

What causes vulvovaginal candidiasis

A

Candida albilcan

73
Q

What are symptoms

A 
Asymptomatich
Itch
Thick cottage cheese discharge 
Vulvitis 
Dysuria
Dyspareuni
Vulva erythema / fissure
74
Q

What is thrush until proven otherwise

A

Discharge and itch

75
Q

What is recurrent

A

> 4 a year

76
Q

What are RF for thrush

A 
DM
Steroid
Recent Ax
Immunosuppression 
Pregnancy
Reproductive age
Anaemia
Irritant 
Poor hygiene
77
Q

How do you Dx

A

Clinical usually
ph <4.5
Culture on charcoal swab + gram stain

78
Q

What does examination show

A

Discharge
Erythmea
Satellite lesions

79
Q

Is smear needed

A

Not if symptom specific

80
Q

How do you treat thrush

A 
Azole anti-fungal
Pessary or oral
Pessary if pregnant 
Avoid irritant
Treat dermatitis
81
Q

What do you do if recurrent

A

Compliance
Vaginal swab to confirm
Exclude DDX e.g. lichen sclerosis
Induction maintenance routine for 6 months

82
Q

DDX of discharge that is important to rule out

A 
Physiological
Bacterial vaginosis
STI
Ectropian
FB
Cancer
83
Q

What is most common cause of vaginal discharge

A

Bacterial vaginosis

84
Q

What causes vaginosis

A 
Increased mycoplasma / gardnella / anarobes
Reduced lactobacilli (healthy bacteria that keep pH low) 
Vit D deficient
85
Q

How does it present

A 
Watery grey / yellow discharge
Fishy smell
Worse after period or sex
Sore itch from damp
PH >4.5
86
Q

Diff between thrush and vaginosis

A

Thrush low pH

Vaginosis high pH

87
Q

How do you Dx

A

Clinical - most don’t need further
Swab to rule out other
Gram stain and culture

88
Q

What do you do to rule out cystitis

A

Urinanlysis

89
Q

What do you do for persistent discharge

A

Rule out FB

90
Q

How do you treat

A

Most no Rx
Topical clindamycin = 1st line
Metronidazole

91
Q

What are complications

A 
Endometritis
Pre-term
HIV
Chorioamnitis 
Risk of other infections 
LBW
92
Q

If someone presents with discharge what do you want to know

A 
Consistency 
Appearance
Smell 
Itch
Bleeding
93
Q

How do you investigate

A

Speculum
PH
Vaginal swab

94
Q

How does PID present

A 
Pain
Discharge
Dyspareunia 
Bleeding
INfertiitly
Adenexal tednerness
Cervical excitation
95
Q

How do you investigate

A

Laparoscopy

96
Q

How do you Rx

A

Broad spec Ax

Obs & Gynae (23 decks)

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