Vaginal infections

Question 1

What are the causes of vaginal discharge? give the types of discharge they can cause

Answer 1

1. Physiological - pregnancy, sexual arousal, puberty, COCP
2. Infection - itchy and smelly
3. Foreign body

Question 2

What is the 2nd commonest cause of discharge?

Answer 2

Thrush

Question 3

What is the organism causing thrush

Answer 3

95% Candida albicans

5% Candida glabrata

Question 4

What are the sx of thrush

Answer 4

→ Sore, red, fissured vagina

→ White curd discharge

Question 5

What are the RF of thrush

Answer 5

−	Pregnancy 
−	Contraceptives
−	Steroids
−	Immunodeficiency’s
−	Diabetes
−	Abx

Question 6

What are the Ix for thrush

Answer 6

microscopy and culture

Question 7

What is Rx of thrush

Answer 7

topical treatment clotrimazole

Fluconazole single dose

Question 8

What is the cause of trichomoniasis?

Answer 8

Trichomonas vaginalis

Question 9

What are the sx of trichomoniasis?

Answer 9

vaginitis and a bubbly, thin, fish-smelling appearance. Strawberry appearance of the cervix

Question 10

What are the ix for trichomoniasis?

Answer 10

• Exclude gonorrhoea

* Motile flagellates are seen on wet films or cultured

Question 11

What is the treatment of trichomoniasis?

Answer 11

metronidazole

Question 12

What are the sx of bacterial vaginosis?

Answer 12

Fishy, thin, grey/white discharge

Vagina not inflamed or itchy

Question 13

What is the cause of BV?

Answer 13

overgrowth of bacterial flora e.g. of ‘Gardnerella vaginalis’ and too few lactobacillae

Question 14

What is seen on wet microscopy in BV?

Answer 14

clue cells

Question 15

What are complications of BV

Answer 15

• Increased risk of preterm labour
• Intra-amniotic infection in pregnancy
• Susceptibility to HIV
• Post-termination sepsis

Question 16

how is a diagnosis of BV made/

Answer 16

culture

Question 17

What is treatment of BV

Answer 17

metronidazole or clindamycin

Question 18

What are the causes of discharge in children?

Answer 18

→ Infection from faecal flora
→ Staphs and streps causing pus
→ Threadworms - also cause pruritus
→ Rectal foreign body

Question 19

What are the ix for discharge in children?

Answer 19

vulval/vaginal swab

MSU (look for glycosuria)

Question 20

What is the treatment of discharge in children?

Answer 20

erythromycin

oestrogen cream

Question 21

What is the most common bacterial STI in the UK?

Answer 21

Chlamydia

Question 22

What % of women are asymptomatic w chlamydia?

Answer 22

70

Question 23

What are the sx of chlamydia?

Answer 23

• Dysuria
• Vaginal discharge
• IMB/PCB

Question 24

What are the complications of chlamydia?

Answer 24

→	PID
→	Perihepatitis
→	Reiter’s syndrome - arthritis, conjunctivitis and urethritis
→	Tubal infertility 
→	 risk of ectopic pregnancy

Question 25

How is the diagnosis of chlamydia made?

Answer 25

vulvo-vaginal or endocervical swab for nucleic acid amplification test (NAAT) Self-swabs

Question 26

What is the treatment of chlamydia in non-pregnant women?

Answer 26

azithromycin single dose OR doxycycline BD for 7 days | Abstain from sex until both partners treated

Question 27

What is the treatment of chlamydia in pregnant women?

Answer 27

erythromycin BD for 10-14 days

Question 28

what are the risks of having chlamydia during pregnancy?

Answer 28

preterm ROM prematurity neonatal conjunctivitis and pneumonia

Question 29

What is the causative organism of gonorrhoea?

Answer 29

Neisseria gonorrhoeae - gram -ve diplococcus

Question 30

What are sx of gonorrhoea in women

Answer 30

``` Increased or altered vaginal discharge Lower abdo pain Dysuria IMB Dyspareunia ```

Question 31

What are the sx of gonorrhoea in men?

Answer 31

Purulent urethral discharge Dysuria Anal discharge

Question 32

What are the complications of gonorrhoea in men?

Answer 32

prostatitis epididymitis orchitis

Question 33

What are the complications of gonorrhoea in women?

Answer 33

* PID * Bartholin’s or skene’s abscess * Tubal infertility * risk of ectopic pregnancy * Can become disseminated in which there is: fever, pustular rash, migratory polyarthralgia and septic arthritis

Question 34

How is a diagnosis of gonorrhoea made?

Answer 34

vulvovaginal/endocervical swab for NAAT using special medium May need urethral, pharyngeal and rectal swabs

Question 35

What is the rx of gonorrhoea?

Answer 35

ceftriaxone IM stat and azithromycin PO stat

Question 36

What is rx of gonorrhoea in penicillin allergic women?

Answer 36

spectinomycin IM in place of ceftriaxone