Vaginal discharge + STI's Flashcards
What are the risk factors for STI’s? (give 4)
Age <25
>1 Sexual partner in the last 12 months
New sexual partner
Unprotected sexual intercourse
Previous STI’s
What investigations would you perform for vaginal discharge?
Get a pregnancy test
Triple swabs:
Vulvovaginal NAAT - for Chlamydia + Gonorrhoea
High vaginal charcoal swab - Trichomonas vaginalis, Gardnerella vaginalis, Candida
Endocervical charcoal swab - think this is more for Gonorrhoea culture + sensitivity
What STI investigations would you perform for ASYMPTOMATIC males
First pass urine NAAT - for Neisseria gonorrhoea + Chlamydia Trachomatis
Bloods - for HIV + Syphilis +/- Hep B/C
Rectal + Pharyngeal swabs - in MSM
What STI investigations would you perform for SYMPTOMATIC males?
First pass urine NAAT - for Neisseria Gonorrhoea + Chlamydia Trachomatis
Bloods - for HIV + Syphilis +/- Hep B/C
Rectal + Pharyngeal swabs - in MSM
+
Urethral smear - GC/Non-gonococcal urethritis (microscopy)
GC culture plate
Rectal + Pharyngeal swabs + Culture in MSM
Dark ground microscopy (primary syphilis)
Herpes simplex virus PCR
Urinalysis
Give 4 risk factors for Candidia Albicans infection
Immunosuppression (HIV, steroids etc…)
Diabetes mellitus
High oestrogen levels (pregnancy, luteal phase, some OCP’s)
Recent antibiotic usage (up to 3 months before)
Mucosal breakdown (sexual contact, dermatitis)
What is the treatment for Candida Albicans infection
Clotrimazole 500mg pessary PV
Fluconazole 150mg PO (AVOID IN PREGNANCY + BREASTFEEDING)
What is the treatment for recurrent candidiasis
Induction therapy followed by maintenance therapy:
Fluconazole 150mg every 72hours for 3 doses
Then Fluconazole 150mg once weekly for 6 months
Clotrimazole pessaries can be used if Fluconazole is contraindicated
What is the triggers for Bacterial vaginosis (Gardnerella Vaginalis)
Sex
Menses
Receptive oral SI
Vaginal douching
Perfumed bath products
Change in sexual partners
Presence of STI
What criteria are used for diagnosis of Bacterial Vaginosis?
Hay-Ison criteria
or
Amsel criteria
What are the components of the Amsel criteria of Bacteria Vaginosis?
Characteristic discharge
Clue cells on microscopy (wet mount)
Raised pH (>4.5)
Odour with KOH (whiff test)
What are the components of the Hay-Ison criteria of Bacterial Vaginosis?
0 = No bacteria
1 = Normal
2 = Reduce lactobacilli + mixed flora (intermediate)
3 = Few/absent lactobacilli + mixed flora; predominant Gardnerella morphotypes
4 = Gram-positive cocci dominate
What is the treatment for Bacterial vaginosis?
Treat symptomatic patients only unless pre-surgery or patient requests
Metronidazole 400mg BD for 5 days
What are the symptoms of Trichomonas Vaginalis
50% = Frothy vaginal discharge
Dysuria
Vulval soreness / itching
Strawberry cervix
What are the complications for Trichomonas Vaginalis?
Pregnancy complications (pre-term, low birth weight)
Enhance HIV transmission
How is Trichomonas Vaginalis diagnosed?
Female = Posterior fornix swab (NAAT = 98-100% sensitive)
Male = TV testing should be considered if persistent urethritis with urethral culture or culture first void urine
What is the treatment for Trichomonas Vaginalis?
Metronidazole 400mg PO BD for 5-7 days
Treat male partners empirically
What is non-specific urethritis?
Inflammation of the urethra in the absence of a diagnosis of Chlamydia or Gonorrhoea
(same as non-gonococcal urethritis?)
What symptoms are experienced with non-specific urethritis?
Urethral discharge,
Dysuria,
Penile irritation
How is non-specific urethritis diagnosed?
> =5 polymorphonuclear leucocytes per high power field
What is the management for non-specific urethritis?
Send STI screening
1/52 of Doxycycline 100mg PO BD
Abstain during treatment and treat partners
What are the causative organisms for non-specific urethritis (non-gonococcal urethritis)?
Chlamydia trachomatis (11-50%)
Mycoplasma genitalium (6-50%)
Ureaplasmas (11-26%)
Trichomonas vaginalis (1-20%)
Adenovirus (2-4%)
Herpes simplex virus (2-3%)
What are the complications of Chlamydia Trachomatis infections? (give 3)
Pelvic inflammatory disease
Epididymo-orchitis (for men)
Seronegative autoimmune reactive arthritis
Tubal factor infertility
Increased risk of ectopic pregnancies
What is the treatment for Chlamydia Trachomatis
1st line = Doxycycline 100mg BD for 7 days
2nd line = Azithromycin 1g PO stat followed by 500mg PO OD for 2 days
Note complicated infections (Eg PID) require longer treatment
What is the presentation for Chlamydia Trachomatis in women?
Lower abdominal pain // PID
Dysuria
Post-coital bleeding + IMB
Vaginal discharge
What is the presentation for Chlamydia Trachomatis infections in men?
Discharge (often clear)
Dysuria
Testicular pain (epididymitis)
What is the gram stain appearance of Neisseria Gonorrhoea
Gram negative diplococci
What are the investigations for Neisseria Gonorrhea in women?
Vulvovaginal NAAT testing
Endocervical charcoal swab for culture - always required prior to any treatment to check antibiotic sensitivities
What is the treatment for Gonorrhoea trachomatis?
Ceftriaxone 1g STAT IM single dose
(if sensitivities known consider Ciprofloxacin 500mg PO stat - to reduce ceftriaxone resistance)
No sexual intercourse until 1 week post treatment + until sexual partner also received treatment
What is the treatment for Mycoplasma Genitalium infections?
1/52 Doxycycline followed by 3/7 Azithromycin
May fail if previous exposure + resistance»_space; develops resistance to macrolides (eg Azithromycin, Clarithromycin) easily
