Vaginal Discharge + STIs Flashcards
What are the most common causes of cervicitis?
Bacterial vaginosis (16%) > chlamydia (8%) > M. genitalium (4%) > gonorrhoea
What is PID and it’s clinical features?
Complex pelvic infection - i.e. salpingitis, endometritis
Pelvic pain - typically bilateral, worse with movement Dyspareunia - deep Vaginal discharge Abnormal bleeding - PCB, IMB Systemic symptoms - fever, malaise
Cervical motion tenderness, adnexal tenderness on bimanual
What causes PID?
STI organisms cause 50% - typically occur straight after infection
-Chlamydia > M. genitalium > gonorrhoea
Remaining caused by endogenous flora of lower genital tract (anaerobes, strep and choleforms)
- Gardenella vaginalis (BV), GBS, E.coli…
70% polymicrobial - diagnosis is difficult, no standard diagnostic tests
What is the treatment for PID?
Multiple antibiotics - higher doses and IV route if more severe
- Ceftriaxone
- Metronidazole (2/52 course)
- High dose azithromycin
- Azithromycin 1 week later OR 2/52 course doxycycline
What are the clinical symptoms for chlamydia?
~75% asymptomatic
Cervicitis -Discharge - usually mucopurulent (green/yellow discharge) -Dyspareunia -PCB Labial redness & swelling Pelvic pain Dysuria in men
~10% infections progress to PID (typically soon after initial infection)
What is the management of chlamydia and who should be screened?
Routine Urine PCR for all sexually active people aged 15 - 29 years
If symptomatic, at higher risk or having papsmear prefer endocervical swabs (more sensitive)
High dose azithromycin (1g) OR doxycycline (10/7 course)
Recommended re-test in 3/12 but generally not performed unless complicated case or increased risk of re-infection
Notifiable disease
Recommend contact tracing
What are the clinical symptoms of gonorrhoea and risk factors for infection?
Highest rates in MSM
Consider if travel to endemic areas i.e. Asia
Sex workers
ATSI
80% asymptomatic Vaginal or urethral discharge - mucopurulent (yellow/green/pus) Dysuria Cervicitis - PCB, dyspareunia Labial redness and swelling
What populations are highest carriers/most at risk of chlamydia?
Sexually active young people (<30 yrs)
More common in ATSI especially young
What are the complications of gonorrhoea?
Disseminated infection - septic arthritis, meningitis
PID - scarring and infertility
What is the management & screening of gonorrhoea?
Combined high dose antibiotics
Azithromycin + Ceftriaxone
Notifiable disease, recommend contact tracing
Asymptomatic MSM should be screened annually
Women not in high risk group (i.e. sex work, ATSI) do not need routine screening
What are the symptoms of M. genitalium?
Same as per chlamydia and gonorrhoea Often asymptomatic (~40%)
Cervicitis - discharge, PCB, dysparunia
Urethritis in men - discharge, dysuria
What are the diagnostic and Rx issues with M. genitalium?
Fastidious and difficult to culture
Antibiotic resistance issue
Diagnosis - Urine or endocervical PCR
Request sensitivities
What is the management of M. genitalium and complications?
Azithromycin
Increasing resistance (15-30%) - moxifloxacin most effective Rx in macrolide resistance
May be associated with premature ROM
What are the symptoms of trochamatis vaginalis?
Malodourous, frothy green and profuse vaginal discharge
Vulval itch and soreness
Cervicitis
Who is at risk trochamatis vaginalis?
Less common in urban settings and lower incidence now
Higher incidence - older women, ATSI, rural/regional areas
