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Gynaecology > STIs, PID and Vaginitis > Flashcards

STIs, PID and Vaginitis Flashcards

1
Q

What is the differential diagnosis (5) for a vulval ulcer?

A
  1. Genital herpes
  2. Syphilis
  3. Chancroid
  4. Candidiasis
  5. Molluscum contagiosum
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2
Q

What is the differential diagnosis (3) for abnormal vaginal discharge (vaginitis)?

A
  1. Candidiasis
  2. Bacterial vaginosis
  3. Trichomoniasis
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3
Q

What is the differential diagnosis of cervicitis?

A
  1. Chlamydia
  2. Gonorrhoea
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4
Q

What are the risk factors for candidiasis?

A

Antibiotics
Steroids
Diabetes
Immunosuppression

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5
Q

What is the management of candidiasis?

A

Anti-fungal agent (miconazole)
Hygiene (dry after bathing, cotton underwear, continence care in elderly patients)

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6
Q

What is the causative organism in syphilis?

A

Treponema pallidum

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7
Q

When is syphilis most contagious?

A

Primary stage when there is a painless chancre

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8
Q

Describe the primary stage of syphilis.

A

Painless genital ulcer (chancre)
Most contagious stage
Appears for 2-3 weeks and then spontaneously disappears

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9
Q

Describe the secondary stage of syphilis.

A

Latent phase
Condyloma lata (erythematous plaques, occurring anywhere on the body)

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10
Q

Describe the tertiary stage of syphilis.

A

Destructive effects on CNS, CVS and MSK
Gummas (cold abscess on skin)

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11
Q

How is syphilis screened for in pregnancy?

A

All women screened on booking bloods

Rapid plasma reagin (RPR) - positive titre followed up with Serum Treponemal Antibody

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12
Q

How is syphilis treated in pregnancy?

A

IM Pencillin G

If allergic, desensitise patient and give penicillin G at low dose and build (with analgesia and antihistamine)

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13
Q

Differentiate between chancre and chancroid.

A

Chancre - painless, firm genital ulcer with central clearing (Treponema pallidum)

Chancroid - painful, soft ulcer (Haemophilus ducreyi)

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14
Q

What is molluscum contagiosum caused by?

A

Pox virus

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15
Q

What agents are genital herpes caused by?

A

HSV-1 and HSV-2

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16
Q

What is the clinical course of genital herpes?

A
  1. Vesicular rash
  2. Rupture
  3. Crust/ulceration
  4. Resolution
17
Q

How is genital herpes diagnosed?

A

Rupture vesicle and swab - send for culture

18
Q

Where is HSV-1 latent?

A

Trigeminal ganglion

19
Q

Where is HSV-2 latent?

A

Lumbar-sacral plexus

20
Q

How is genital herpes treated? How is it treated in pregnancy?

A

Acyclovir

Pregnancy - acyclovir for last 4 weeks of pregnancy

21
Q

What bacteria make up the normal vaginal ecosystem?

A

Gram + cocci, Gram - rods, anaerobes,

22
Q

What are the characteristics of vaginal candidiasis?

A

Cottage cheese discharge
Pruritis

23
Q

Is the vaginal pH increased or decreased in candidiasis?

A

pH >4.5

24
Q

What organism causes BV?

A

Gardnerella vaginalis

25
Q

What are the characteristics of BV?

A

Grey watery discharge
Fish odor smell
Smell strong after sex

26
Q

How is BV treated?

A

Metronidazole

27
Q

How is trichomoniasis trasmitted?

A

Sexually transmitted

28
Q

What are the characteristics of trichomoniasis?

A

Strawberry cervix
Frothy discharge
Foul smell

29
Q

How is vaginitis diagnosed?

A

High vaginal swab

30
Q

How are chlamydia and gonorrhoea diagnosed?

A

Nucleic acid amplification test (NAAT)

31
Q

What is PID?

A

Ascending infection of the upper genital tract

32
Q

What is the pathogenesis of PID?

A

Cervicitis → breakdown of local immunity (friable cervix, decreased mucous, inflammation) → normal vaginal flora ascend into the endometrial cavity → become pathogenic and low O2 leads to flourishing anaerobes

33
Q

What are the signs and symptoms of PID?

A

Abdo pain
Abnormal discharge
Fever
Cervical motion tenderness
Adnexal tenderness

34
Q

What patients require inpatient treatment for PID?

A

Nulliparous
WBC >15
High fever
Tubo-ovarian abscess
Sepsis

35
Q

What are the long-term complications in PID?

A

Tubo-ovarian abscess
Risk of ectopic pregnancy
Infertility
Chronic pain

Gynaecology (6 decks)

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