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Women's Health - Year 4 > Vaginal Discharge > Flashcards

Vaginal Discharge Flashcards

1
Q

VAGINAL DISCHARGE

physiological causes

A
  • Oestrogen related -puberty, pregnancy, COCP
  • Cycle related – maximal midcycle and premenstrual
  • Sexual excitement and intercourse
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2
Q

VAGINAL DISCHARGE

pathological causes

A

Infection – non STI (BV, candida) / sexually transmitted (TV, chalmydia, gonorrhea)

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3
Q

VAGINAL DISCHARGE

history

A
  • Characteristics – onset, duration, odour, colour
  • Associated symptoms – itching, burning, dysuria, superficial dyspareunia
  • Relationship of discharge to menstrual cycle
  • Precipitating factors – pregnancy contraceptive pill, sexual excitement
  • Sexual history – risk factors for STI
  • Medical history -diabetes immunocopromised
  • Non infectious causes (foreign body, ectopy, malignancy, dermatological conditions)
  • Hygiene practices – douches, bath products, talcum powder
  • Allergies
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4
Q

VAGINAL DISCHARGE

examination

A
  • External genital inspection for vulvitis, obvious discharge, ulcers, other lesiosn
  • Speculum – appearance of vagina, cervic, foreign bodies, amount, coour, consistency
  • Bimanual examination – masses, adrenal tenderness, cervical motion tenderness
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5
Q

VAGINAL DISCHARGE

investigations

A

Endocervical or vulvovaginal swabs for gonorrhoea and chlamydia

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6
Q 
VAGINAL DISCHARGE
physiological
1. colour
2. consistency
3. odour
4. vulval itching
5. treatment
A
  1. clear/white
  2. mucoid
  3. none
  4. none
  5. reassure
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7
Q 
VAGINAL DISCHARGE
candida infection
1. colour
2. consistency
3. odour
4. vulval itching
5. treatment
A
  1. white
  2. curd-like
  3. none
  4. itching
  5. antifungal
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8
Q 
VAGINAL DISCHARGE
Trichomonal infection
1. colour
2. consistency
3. odour
4. vulval itching
5. treatment
A
  1. green/grey
  2. frothy
  3. offensive
  4. itching
  5. metronidazole
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9
Q 
VAGINAL DISCHARGE
gonococcal infection
1. colour
2. consistency
3. odour
4. vulval itching
5. treatment
A
  1. greenish
  2. watery
  3. none
  4. none
  5. antibiotics
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10
Q 
VAGINAL DISCHARGE
bacterial vaginosis
1. colour
2. consistency
3. odour
4. vulval itching
5. treatment
A
  1. white/grey
  2. watery
  3. offensive
  4. none
  5. metronidazole
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11
Q 
VAGINAL DISCHARGE
malignancy
1. colour
2. consistency
3. odour
4. vulval itching
5. treatment
A
  1. bloody
  2. watery
  3. offensive
  4. none
  5. according to disease
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12
Q 
VAGINAL DISCHARGE
foreign body
1. colour
2. consistency
3. odour
4. vulval itching
5. treatment
A
  1. grey or bloody
  2. purulent
  3. offensive
  4. none
  5. remove object
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13
Q 
VAGINAL DISCHARGE
atrophic vaginitis
1. colour
2. consistency
3. odour
4. vulval itching
5. treatment
A
  1. clear/blood stained
  2. watery
  3. none
  4. none
  5. topical oestrogen
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14
Q 
VAGINAL DISCHARGE
cervical ectropion
1. colour
2. consistency
3. odour
4. vulval itching
5. treatment
A
  1. clear
  2. watery
  3. none
  4. none
  5. cryotherapy
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15
Q 
JOCK ITCH (TINEA CRURIS)
what is it
causative organisms
contagious?
risk factors
A
  • Superficial fungal infection or groin
  • Trichophyton rubran, Epidermophyton floccosum
  • Contagious – transmitted by fomites eg contaminated towels of hotel bedroom sheets
  • Risk factors – tight fitting/wet clothing
  • More common in men
  • Recent visit to tropical climate, tight clothing, shared clothing, sports, coexisting diabetes, obesity
  • Symmetric erythematous rash in groin
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16
Q

CANDIDIASIS

THRUSH

A
  • Yeast like fungus – candida albicans
  • 75% women experience at least one episode
  • 10-20% asymptomaic chronic carriers (40% in pregnancy)
  • Predisposing factors: immunosuppression, antibiotics, pregnancy, diabetes mellitus, anaemia
  • Symptoms – vulval itchng, soreness, thick, curd like, white vaginal discharge, dysuria, superficial dyspareunia
  • Diagnosis: appearance of erythema, vulval fissuring, typical white plaques adherent to vaginal wall, culture from HVS or LVS, microscopic detection of spores and pseudohypae onwet slides
  • Treatment: only treat if symptomatic, clotrimazole 500mg psseary +/- topical clotrimazole cream OR flyconazole 150mg (single dose)
  • Prevention – wear cotton underwear, avoid chemical irritants eg soap and bath salts
  • In pregnancy is common – topical imidazoles aren’t systemically absorbed so are safe
17
Q

MOLLUSCUM CONTAGIOSUM

A
  • Benign viral infection

* Poxviridae family

18
Q

GENITAL HERPES/HERPES SIMPLEX

what is it

A
  • DNA virus – herpes simplex (orolabial/genital) and type 2 (genital only)
  • 3rd most common STI in England
19
Q

GENITAL HERPES/HERPES SIMPLEX

symptoms

A

primary infection – most severe and results in..
• prodrome (tingling/itching)
• flu like illness +/- inguinal lymphadenopathy
• vulvitis and pain (urinary retention)
• small charactereistic vesicles on vulva – can be atypical with fissues, erosions, erythema of skin

recurrent attacks
• result from reactivation of latent virus in sacral ganglia
• shorter and less severe
• triggered by – stress, sexual intercourse, menstruation

20
Q

GENITAL HERPES/HERPES SIMPLEX

  1. complications
  2. diagnosis
A
  1. meningitis, sacral radiculopathy, transverse myelitis, disseminated infection
  2. appearance of typical rash, PCR testing of vesicular fluid (gold standard), culture of vesicular fluid
21
Q

GENITAL HERPES/HERPES SIMPLEX

treatment

A
  • no cure
  • symptomatic relief with simple analgesia, saline bathing, topical anaesthetic
  • oral acyclovir not beneficial
  • condoms/abstinence whilst prodromal/symptomatic to reduce transmission
  • suppressive antiviral treatment if >6 recurrences/year
22
Q

SYPHILIS

  1. causative organisms
  2. prevalence
A
  1. treponema pallidum – spirochaete

2. rare, increasing prevelance

23
Q

SYPHILIS

primary syphilis

A
  • 10-90 days postinfection

* Painless, genital ulcer, inguinal lymphadenopathy

24
Q

SYPHILIS

secondary syphilis

A
  • Occurs within 2yrs of infection
  • Generalised polymorphic rash affecting palms and soles
  • Generalised lymphadenopathy
  • Genital condyloma lata
  • Anterior uveitis
25
Q

SYPHILIS

tertiary syphilis

A
  • Presents in upto 40% infected for at least 2yrs but may take 40+yrs to develop
  • Neurosyphilis – tabes dorsalis and dementia
  • Cardiovascular syphilis – commonly affecting aortic root
  • Gummata – inflammatory plaques or nodules
26
Q

SYPHILIS

diagnosis

A
  • Specific treponemal enzyme immunoassay for screening (IgG +IgM)
  • Primary lesion smear may show spirochaetes on dark field microscopy
  • Quantitative cardioipin tests ie rapid plasma regain useful in assessing need for and response to treatment
27
Q

SYPHILIS

treatment

A
  • Depends on penicillin allergy
  • Benzathine benzylpenicillin 2.4MU single dose IM
  • Doxycycline 100mg bd PO 14 days
  • Erythromycin 500mg qds PO 14 days
  • Longer treatment in tertirary syphilis
  • Contract trace
28
Q

GONORRHEA

organism, prevelance, symptoms, complications

A
  • Neisseria gonorrhoea – intracellular gram -ve diplococcus
  • 4th most common STI in UK
  • 33% strains are resistant to ciprofloxacin, 70% to tetracyclines
  • Usually asymptomatic
  • Can present with vaginal discharge, low abdo pain, IMB, PCB
  • Diagnosis: endocervical or vulvovaginal swab with NAAT
  • If diagnosed with NAAT, culture for sensitivity testing taken before antibiotic treatment
  • Complications: PID, Bartholins or skenes abscess, disseminated gonorrhoea can cause fever, pustular rash, migratory polyarthralgia, septic arthritis / tubal infertility / ectopic pregnancy
29
Q

GONORRHEA

treatment

A
  • Ceftriaxone 500mg IM stat plus azithromycin 1g PO stat
  • Spectinomycin 2mg IM plus azithromycin 1g PO stat (if penicillin allergy)
  • Contact tracing
30
Q

CHLAMYDIA

A
  • Chlamydia trachomatis – obligate intracellular parasite
  • Commonest bacterial STI in UK
  • Cause of tubal infertility
  • Symptoms: dysuria, vaginal discharge, irregular bleeding, 70% asymptomatic
  • Complications: PID, perihepatitis (fitz-high-curtis syndrome), reiters syndrome (arthritis, urethritis, conjunctivitis), tubal infertility, risk of ectopic pregnancy
  • Diagnosis – vulvovaginal or endocervical swab – NAAT
  • Treatment – azithromycin 1g single dose OR doxycycline 100mg bd 7 days. Contact tracing and treat partners
  • Screening – national chlamydia screening programme
  • Implications in pregnancy – association with preterm rupture of membranes and premature delivery. Risks to baby are; neonatal conjunctivitis, neonatal pneumonia. Treat pregnant women with erythromycin 500mg bd for 10-14 days
31
Q

HPV clinical features

A
  • DNA virus
  • Subtypes 6 and 11 cause genital warts
  • ¼ presenting wih warts have concurrent sti
  • Commonest viral STI
  • Subtypes 16 and 18 associated with CIN and cervical neoplasia
  • Asymptomatic
  • Painless lumps in genitoanal area
32
Q

HPV investigations

A
  • Usually identified by clinical appearance

* Non wart HPV diagnosed by characteristic appearance on cervical cytology or colposcopy

33
Q

HPV management

A
  • Cryotherapy
  • Trichloroacetic acid
  • Electrosurgery/scissors excision/curettage/laser
  • Podophyllotoxin cream 4-6 weeks
  • Imiquimod cream – upto 16 weeks
  • Routine vaccination – 16,18, 6, 11
34
Q

TRICHOMONIASIS

clinical features

A
  • Trichomonal vaginalis – flagellated protozoan
  • Found in vaginal, urethrl and para-urethral glands
  • Cervix may have strawberry appearance from puncture haemorrhages
  • Asymptoatic in 10-50%
  • May present with frothy, greenish, offensive smelling vaginal discharge, vulval itching and soreness, dysuria
  • May enhance HIV transmission
35
Q

TRICHOMONIASIS

investigations

A
  • Observation of organism by wet smear or acridine orange stained slide from posterior vaginal fornix
  • Culture media
  • NAATS
36
Q

TRICHOMONIASIS

management

A
  • Metronidazole 2g oral single dose
  • Metronidazole 400-500mg bd 5-7 days
  • Contact tracing
37
Q

BACTERIAL VAGINOSIS

clinical features

A
  • Due to overgrowth of mixed anaerobes including Gardnerella and mycoplasma hominis
  • Commonest cause of abnormal vaginal discharge in women of childbearing age
  • Not sexually transmitted
  • 12% women experience BV at some point in lives
  • May be asymptomatic
  • Profuse, whitish grey, offensive smelling vaginal discharge, fishy smell
38
Q

BACTERIAL VAGINOSIS

investions

A 
Amsel criteria – 3 out of 4 needed for diagnosis 
• Homogenous grey-white discharge
• Vaginal pH >5.5
• Fishy smell
• ‘clue cells’ on microscopy
39
Q

BACTERIAL VAGINOSIS

management

A
  • May resolve spontaneuously
  • High recurrence rate
  • Metronidazole 400mg oral bd 5 days
  • Metronidazole 2g single dose
  • Clindamycin 2% cream vaginally at night for 7 days
  • Lifestyle – avoid vaginal douching/overwashing which can destroy natural vaginal flora

Women's Health - Year 4 (15 decks)

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