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Obs and Gynae > STIs and GUM > Flashcards

STIs and GUM Flashcards

1
Q

what non- STIs infections affect the GU tract?

A

Candidiasis

Bacterial vaginosis

Genital dermatoses
E.g. Lichen sclerosis, Balanitis

Vulval conditions
E.g. Vulvodynia, Vestibulitis

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2
Q

what aspects are include in a sexual health history?

A

History of presenting complaint

Past GU history

Past general medical/surgical history

Drugs (any antibiotics in last month)

Sexual history – last 3-12 months

  • Last sexual intercourse
  • Regular/casual partner
  • Male/female
  • Condom use
  • Type of SI

(stuff specific to females) - pregnancy, menstruation, contraception, cervical cytology if relevant)

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3
Q

why do STI clinics often screen for multiple infections?

A

many are often asymptomatic

and STIs often occur in multiples

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4
Q

what gender specific things might you include in a sexual history?

A

Females

  • Menstrual history
  • Pregnancy history
  • Contraception
  • Cervical cytology history (when and results)

Men
- when last voided urine - because they’re probably going to need to do one for you!

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5
Q

when examining the genitals what do you look for in both sexes?

A

pubic hair
genital skin
inguinal nodes

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6
Q

when examining a woman’s genitals specifically, what do you look at/do?

A 
Vulva
Perineum
Vagina
Cervix
Bimanual pelvic examination
Possibly anus & oropharynx
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7
Q

when examining a man’s genitals specifically, what do you look at/do?

A

Penis
Scrotum
Urethral meatus
Anus & oropharynx in MSMs

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8
Q

what tests would an asymptomatic female get, presenting to the GUM clinic?

A

Female
Self taken Vulvo-vaginal swab for Gonorrhoea/Chlamydia NAAT (Nucleic Acid Amplification Test)

can do: Blood for STS + HIV

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9
Q

what tests would an asymptomatic male who has sex with men get, presenting to the GUM clinic?

A

MSM (Men who have Sex with Men)
First void urine for Chlamydia/Gonorrhoea NAAT
Pharyngeal swab for Chlamydia/Gonorrhoea NAAT (may be self taken)
Rectal swab for Chlamydia/Gonorrhoea NAAT (may be self taken)

Blood for STS, HIV, Hep B (& Hep C if indicated)

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10
Q

what tests would an asymptomatic heterosexual male get, presenting to the GUM clinic?

A

Heterosexual male
First void urine for Chlamydia/Gonorrhoea NAAT
Blood test for STS + HIV

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11
Q

how are males and females tested differently for gonorrhoea/chlamydia?

A

females - vulvo-vaginal swab

males - first void urine

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12
Q

what test is done in the lab for chlamydia and gonnorhea

A

NAAT - nucleic acid amplification test

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13
Q

what are the possible presentations of STIs in females?

A

Vaginal discharge (smelly, sticky, discoloured)

Vulval discomfort/soreness, itching or pain

Superficial dyspaerunia

Pelvic pain/deep dyspareunia

Vulval lumps

Vulval ulcers

Inter-menstrual bleeding

Post-coital bleeding

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14
Q

possible STI presentations in males?

A

Pain/burning during micturition

Pain/discomfort in the urethra

Urethral discharge

Genital ulcers, sores, or blisters

Genital lumps

Rash on penis or genital area

Testicular pain/swelling

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15
Q

if a female presented to clinic with some of the symptoms for possible STIs, what would you do?

A

Vulvo-vaginal swab for Gonorrhoea + Chlamydia NAAT (same as asymptomatic)

High vaginal swab (wet & dry slides) for

  • Bacterial Vaginosis (BV)
  • Trichomonas Vaginalis (TV)
  • Candida

Cervical swab for slide + Gonorrhoea culture

Dipstick urinalysis (If has dysuria)

Bld for STS + HIV

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16
Q

if a heterosexual male presented to clinic with any of the symptoms possibly suggestive of STI, what would you do?

A

Heterosexual male

First void urine for Gonorrhoea + Chlamydia NAAT (same as asymptomatic)

Urethral swab for slide + Gonorrhoea culture

Dipstick urinalysis (If has dysuria)

Bld for STS + HIV

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17
Q

if a homosexual male presented to clinic with symptoms possibly suggestive of an STI, what tests would you do?

A

Test as for asymptomatic MSM
First void urine for Chlamydia/Gonorrhoea NAAT
Pharyngeal swab for Chlamydia/Gonorrhoea NAAT (may be self taken)
Rectal swab for Chlamydia/Gonorrhoea NAAT (may be self taken)

Blood for STS, HIV, Hep B (& Hep C if indicated)

with the addition of:
+ urethral and rectal slides
+ urethral, rectal, pharyngeal culture plates

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18
Q

which populations are offered Hep B screening?

what should you aim to do when you see them?

A

Men who have Sex with Men (MSM)
Commercial Sex Workers (CSW) and their sexual partners
IVDUs (current or past), and their sexual partners
People from high risk areas and their sexual partners
Africa, Asia, Eastern Europe

Aim to vaccinate them if non-immune

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19
Q

why do GUM clinics try to contact trace and treat partners?

what must you be careful of?

A

Necessary to prevent re-infection of index patient

To identify & treat asymptomatic infected individuals as a public health measure

confidentiality!

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20
Q

what is urethritis and who gets it?

+ risk factors

A

inflammation of urethra in those who are normally young, biologically male with STIs

so risk factors are unprotected sexual intercourse and multiple sexual partners/ partner with STI

21
Q

name 5 causes of urethritis from most common to least

A

infectious:

  • chlamydia trachomatis
  • neisseria gonorrheoea
  • mycoplasma genitalium

non infectious:

  • chemical irritation - spermicides, soap
  • trauma
22
Q

complications of urethritis?

A

reactive arthritis secondary to c.trachomatis

gonoccocal conjunctivitis

epididimitis

prostatitis

penile lymphangitis

periurethral abscess

23
Q

signs and symptoms of urethritis?

A

dysuria
urethral pruritus
urethral discharge
inflammation of urethral meatus

24
Q

diagnosis of urethritis?

A

diagnostic criteria = 1 or more of the following

mucopurulent/purulent urethral discharge

> 1 leukocytes per oil immersion field of gram stain urethral discharge

positive leukocyte esterase on FIRST CATCH urine

25
Q

what lab tests can you do for urethritis?

A

urethral discharge microscopy

leukocyte esterase on first catch urine

NAATs - c.trachomatis, N.gonnorhea

26
Q

what features of a urethritis might point you in the direction of what infection is causing it?

A

chlamydia = dysuria on its own

gonorrhea = purulent discharge

herpes Simplex Virus - dysuria + painful genital ulcers

27
Q

what medication do you give for gonococcal urethritis and what classes of abx are they?

what other interventions should you suggest?

A

ceftriaxone (cephalopsorin) + azithromycin
(macrolide)

barrier protection: condoms

abstinence until treated

28
Q

what medication do you give to someone with urethritis causes by chalmydia?

what other interventions should you suggest?

A

azithromycin or doxycycline

barrier protection: condoms

abstinence until treated

29
Q

what is reactive arthritis and what can you get it from?

A

seronegative spongyloarthropathy:

autoimmune condition also known as reiter’s syndrome which causes inflammation of the joints most commonly after an infection (STI or GI)

STI is commonly after chlaymdia infection

30
Q

what is PID?

A

pelvic inflammatory disease: infection of the upper reproductive tract in a woman due to bacterial infection inflaming the mucosa of the uterus, fallopian tubes and ovaries

31
Q

complications of PID?

A

tubal infertility
risk of ectopic pregnancy
chronic pelvic pain

tubo-ovarian abscess
hydrosalpinx

fitz-hugh-curtis syndrome

32
Q

what is an infection of the fallopian tubes called?

what about if it include the ovaries?

A

salpingitis

salping-oophritis

33
Q

what is the pathophysiology of what causes the complications of PID - like infertility, ectopic pregnancy, tubo-ovarian abscess, hydrosalpingx

A

chronic inflammation of the fallopian tubes causes scarring and adhesions causing pockets to form inside them

34
Q

what is fitz-hugh-curtis syndrome/

A

inflammation from PID spread to the peritoneum

this inflammation then spreads to glisson’s capsule, which surrounds the liver

violin string adhesions which attach the liver to the peritoneum

35
Q

what bacteria most commonly cause PID?

A

chlamydia trachomatis

neisseria gonorrhoeae

most of the time its only one type of bacteria but can become polybacterial because one infection makes you more susceptible to another

36
Q

risk factors for developing PID?

A

Factors related to sexual behaviour, such as:
Young age (younger than 25 years).
Early age of first coitus.
Multiple sexual partners.
Recent new partner (within the previous 3 months).
History of STI in the woman or her partner.

Recent instrumentation of the uterus or interruption of the cervical barrier, such as due to:
Termination of pregnancy.
Insertion of an intrauterine device (within the past 4–6 weeks, especially in women with pre-existing gonorrhoea or C. trachomatis infection).
Hysterosalpingography.
In vitro fertilization and intrauterine insemination.

37
Q

symptoms of PID?

A

Pelvic or lower abdominal pain (usually bilateral).

Deep dyspareunia.

Abnormal vaginal bleeding (intermenstrual, postcoital, or ‘breakthrough’).

Abnormal vaginal or cervical discharge.

feeling on pelvic fullness

dysuria

Right upper quadrant pain. - fitz-hugh-curtis syndrome

Secondary dysmenorrhoea.

38
Q

signs of PID?

A

Signs of PID include:

Lower abdominal tenderness (usually bilateral).

Adnexal tenderness (with or without a palpable mass)

cervical motion tenderness, or uterine tenderness (on bimanual vaginal examination).

Abnormal cervical or vaginal mucopurulent discharge (on speculum examination).

A fever of greater than 38°C, although the temperature is often normal.

39
Q

differentials for PID (lower abdo pain)?

A

Pregnancy should be ruled out.

Other causes of lower abdominal pain in a young woman such as

acute appendicitis;
endometriosis; 
irritable bowel syndrome;
ovarian cyst rupture, torsion, or haemorrhage; 
urinary tract infection)
40
Q

tests for suspected PID

A

pregnancy test

high vaginal swabs - BV, candiasis

test for chlamydia, gonorrhoea + mycoplasma genitalium where possible

endocervical or vaginal pus cells (leukocytes) under a microscope on a wet-mount vaginal smear.

elevated support diagnosis but non specific: Erythrocyte sedimentation rate (ESR), C-reactive protein, Leucocyte count.

offer HIV and syphilis blood tests

USS if suspected hydrosalpinx or tuba-ovarian abscess

41
Q

where should PID be managed and why?

A

in a GUM clinic -

facilitate screening for infections and

for contact tracing -current and recent partners [within the last 6 months]

42
Q

who should you diagnosis PID in?

A

A diagnosis of pelvic inflammatory disease (PID) should be considered (and usually empirical antibiotic treatment offered) in any sexually active woman who has recent onset lower abdominal pain associated with local tenderness on bimanual vaginal examination, in whom pregnancy has been excluded and no other cause for the pain has been identified.

43
Q

empirical antibiotics treatment for PID?

A

Ceftriaxone 1 g as a single intramuscular (IM) dose,

followed by

oral doxycycline 100 mg twice daily

plus

oral metronidazole 400 mg twice daily

for 14 days.

BUT there are different regimens based on age, contraindications etc

44
Q

what should you do if a woman has recently had an IUC inserted and presents with PID?

A

discuss and remove if she wants it removed

but consider removing if symptoms have not resolved after 72 hours

either way consider emergency hormonal contraception if removed

45
Q

what is BV?

A

bacterial vaginosis:

characterized by an overgrowth of predominantly anaerobic organisms and a loss of lactobacilli.

The vagina loses its normal acidity, and its pH increases to greater than 4.5.

46
Q

what are the risk factors for BV?

A

Being sexually active — BV is not a sexually transmitted infection (STI), but being sexually active or having concurrent STIs increases the risk of developing BV.
The use of douches, deodorant, and vaginal washes; menstruation; and presence of semen in the vagina.
Copper intrauterine device.
Smoking.

47
Q

what at the signs/symptoms of BV?

A

Approximately 50% of women with BV are asymptomatic.

When symptoms are present, BV is characterized by a fishy-smelling vaginal discharge.

It is not usually associated with soreness, itching, or irritation.

Examination may reveal a thin, white, homogeneous discharge coating the walls of the vagina and vestibule.

48
Q

how do you treat BV?

A

Non-pregnant women with asymptomatic BV do not usually require treatment.

For symptomatic women (pregnant or non-pregnant):
Oral metronidazole is the treatment of choice.

if asymptomatic pregnant women: consult obstetrician

49
Q

how do you treat PID?

A

ibuprofen/paracetamol for the pain

empirical antibiotics (ceftriaxone IM, then doxycycline and metronidazole for 2 weeks)

Obs and Gynae (5 decks)

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