STIs, PID and Vaginitis Flashcards
What is the differential diagnosis (5) for a vulval ulcer?
- Genital herpes
- Syphilis
- Chancroid
- Candidiasis
- Molluscum contagiosum
What is the differential diagnosis (3) for abnormal vaginal discharge (vaginitis)?
- Candidiasis
- Bacterial vaginosis
- Trichomoniasis
What is the differential diagnosis of cervicitis?
- Chlamydia
- Gonorrhoea
What are the risk factors for candidiasis?
Antibiotics
Steroids
Diabetes
Immunosuppression
What is the management of candidiasis?
Anti-fungal agent (miconazole)
Hygiene (dry after bathing, cotton underwear, continence care in elderly patients)
What is the causative organism in syphilis?
Treponema pallidum
When is syphilis most contagious?
Primary stage when there is a painless chancre
Describe the primary stage of syphilis.
Painless genital ulcer (chancre)
Most contagious stage
Appears for 2-3 weeks and then spontaneously disappears
Describe the secondary stage of syphilis.
Latent phase
Condyloma lata (erythematous plaques, occurring anywhere on the body)
Describe the tertiary stage of syphilis.
Destructive effects on CNS, CVS and MSK
Gummas (cold abscess on skin)
How is syphilis screened for in pregnancy?
All women screened on booking bloods
Rapid plasma reagin (RPR) - positive titre followed up with Serum Treponemal Antibody
How is syphilis treated in pregnancy?
IM Pencillin G
If allergic, desensitise patient and give penicillin G at low dose and build (with analgesia and antihistamine)
Differentiate between chancre and chancroid.
Chancre - painless, firm genital ulcer with central clearing (Treponema pallidum)
Chancroid - painful, soft ulcer (Haemophilus ducreyi)
What is molluscum contagiosum caused by?
Pox virus
What agents are genital herpes caused by?
HSV-1 and HSV-2
What is the clinical course of genital herpes?
- Vesicular rash
- Rupture
- Crust/ulceration
- Resolution
How is genital herpes diagnosed?
Rupture vesicle and swab - send for culture
Where is HSV-1 latent?
Trigeminal ganglion
Where is HSV-2 latent?
Lumbar-sacral plexus
How is genital herpes treated? How is it treated in pregnancy?
Acyclovir
Pregnancy - acyclovir for last 4 weeks of pregnancy
What bacteria make up the normal vaginal ecosystem?
Gram + cocci, Gram - rods, anaerobes,
What are the characteristics of vaginal candidiasis?
Cottage cheese discharge
Pruritis
Is the vaginal pH increased or decreased in candidiasis?
pH >4.5
What organism causes BV?
Gardnerella vaginalis
What are the characteristics of BV?
Grey watery discharge
Fish odor smell
Smell strong after sex
How is BV treated?
Metronidazole
How is trichomoniasis trasmitted?
Sexually transmitted
What are the characteristics of trichomoniasis?
Strawberry cervix
Frothy discharge
Foul smell
How is vaginitis diagnosed?
High vaginal swab
How are chlamydia and gonorrhoea diagnosed?
Nucleic acid amplification test (NAAT)
What is PID?
Ascending infection of the upper genital tract
What is the pathogenesis of PID?
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
What are the signs and symptoms of PID?
Abdo pain
Abnormal discharge
Fever
Cervical motion tenderness
Adnexal tenderness
What patients require inpatient treatment for PID?
Nulliparous
WBC >15
High fever
Tubo-ovarian abscess
Sepsis
What are the long-term complications in PID?
Tubo-ovarian abscess
Risk of ectopic pregnancy
Infertility
Chronic pain
