Urinary Tract Flashcards
Bacterial Vaginosis
Normal Lactobacilli are overgrown by anaerobes
Gardnerella and Mycoplasma hominis
Grey-white discharge
Fishy odour due to production of amines by bacterial proteolysis
Can cause secondary infection and PID
Associated with PTL
Dx
Increased pH
Positive whiff test
Presence of clue cells
Tx
Metronidazole or clindamycin cream
Candidiasis
Cottage cheese discharge Vulval irritation Itchy Superficial dyspareunia Dysuria
Risk Factors
DM
Use of Antibiotics
Pregnancy
Tx
Topical clotrimazole or oral fluconazole
More severe in immunocomprimised and uncontrolled DM
Chlamydia
Chlamydia trachomatis
Can cause silent PID
Tubal damage –> subfertility
Reiter’s syndrome
can’t see, can’t pee, can’t climb a tree
Conjunctivitis, Urethritis, Arthritis
Dx
NAAT and PCR on urine
Mx
Azithromycin
Or Doxycycline
Gonorrhoea
Neisseria gonorrhoeae
Gram negative diplococcus
Asymptomatic Symptoms Vaginal discharge Urethritis Barthonlinitis Cervicitis Pelvic infection
Systemic complications: Acute monoarticular septic arthritis
IM ceftriaxone or oral cefixime
Perihepatitis = Fitz-Hugh-Curtis syndrome
RUQ pain due to adhesions
Visible on laparoscopic
Genital Warts (Condylomata acuminata)
Caused by HPV
Associated with CIN if 16 or 18
Tx
Topical podophyllin
Imiquimod cream (external warts)
Cryotherapy
Vaccine against HPV can protect against warts too
Genital Herpes
Usually HSV-2 (but also HSV-1)
Primary infection: small painful vesicles and ulcers around intraoitus, local lymphadenopathy, systemic sym, dysuria
Secondary bacterial infection, aseptic meningitis, or acute urinary retention are rare
75% recurrence, less severe, less painful, preceded by localised tingling
Tx: Aciclovir
Syphilis
spirochaete Treponema pallidum
Primary syphilis: Solitary painless vulval chancre
Secondary syphilis: Weeks later, Rash, Influenza-like symptoms, wart genital /peritoneal growths (condylomata lata)
At this stage the spirochaete infiltrates other organs and can cause a variety of symptoms
Latent syphilis: follows secondary phase
Primary or secondary syphilis during pregnancy –> congenital malformations
Tertiary syphilis: very rare, develops years later and any organ affected:
Aortic regurgitation
Dementia
Tabes dorsalis (loss of proprioception vibration and discrimative touch)
Gummata in skin and bone
Dx:
Immunoassay: syphilis EIA
VDRL test
Tx: parenteral IM penicillin
Trichomoniasis
Trichomonas vaginalis
Flagellate protozoan
Offensive grey green discharge
Vulval irritation
Superficial dyspareunia
Cervicitis with strawberry red appearance (punctate erythematous)
Dx
Wet film microscopy
Staining and culture of vaginal swabs
Tx: Metronidazole
Endometritis
Infection confined to uterus alone
Commonly spreads to the pelvis is left untreated
Causes:
Instrumentation of uterus (TOP)
Complications of pregnancy (common after CS)
Chlamydia and gonococcus from genital tract
BV, E.Coli, staphylococci and clostridia
Presentation Heavy vaginal bleeding Persistent vaginal bleeding Pain Tender uterus Open cervical os
Septicaemia may develop –> fever present
Ix
Vaginal and cervical swabs
FBC
USS
Tx
Broad spec abx
ERPC if appropriate
Pelvic Inflammatory Disease
Sexually transmitted infections (80%)
Endometritis usually coexists
Protective
COCP
Mirena
Risk factors
Instrumentation
Appendicitis (descending)
younger, poorer, sexually active nulliparous women
60% chlamydia –> silent PID
Gonococcus –> acute presentation
Endometritis, bilateral salpingitis and parametritis occur
Perihepatitis = Fitz-Hugh-Curtis syndrome
RUQ pain due to adhesions
Visible on laparoscopic
Hx Asymptomatic Menstrual problems and subfertility Bilateral lower abdo pain and deep dyspareunia Abnormal VB and discharge
Ex Tachycardia and high fever Signs of lower abdominal peritonism Bilateral adenexal tenderness Cervical excitation Pelvic abscess
Ix
Endocervical swabs for chlamydia and gonococcus
Blood cultures if fever
WCC + CRP
TVUS/PUS
Laparoscopy with fibrial biopsy (uncommon but gold standard)
Tx analgesics IM ceftriaxone Doxycycline and Met to follow If febrile --> admit for IV therapy Pelvic abscess may require drainage
Chronic PID
Dense pelvic adhesions and dilated fallopian tubes
Hyrosalpinx
Pyosalpinx
Chronic pelvic pain Dysmenorrhoea Deep dyspareunia Heavy and irregular menstruation Chronic vaginal discharge Subfertility
Fixed retroverted uterus
Abdominal and adenexal tenderness
TVUS –> fkuid collection in fallopian tubes
