Vaginal infections Flashcards
What are the causes of vaginal discharge? give the types of discharge they can cause
- Physiological - pregnancy, sexual arousal, puberty, COCP
- Infection - itchy and smelly
- Foreign body
What is the 2nd commonest cause of discharge?
Thrush
What is the organism causing thrush
95% Candida albicans
5% Candida glabrata
What are the sx of thrush
→ Sore, red, fissured vagina
→ White curd discharge
What are the RF of thrush
− Pregnancy − Contraceptives − Steroids − Immunodeficiency’s − Diabetes − Abx
What are the Ix for thrush
microscopy and culture
What is Rx of thrush
topical treatment clotrimazole
Fluconazole single dose
What is the cause of trichomoniasis?
Trichomonas vaginalis
What are the sx of trichomoniasis?
vaginitis and a bubbly, thin, fish-smelling appearance. Strawberry appearance of the cervix
What are the ix for trichomoniasis?
- Exclude gonorrhoea
* Motile flagellates are seen on wet films or cultured
What is the treatment of trichomoniasis?
metronidazole
What are the sx of bacterial vaginosis?
Fishy, thin, grey/white discharge
Vagina not inflamed or itchy
What is the cause of BV?
overgrowth of bacterial flora e.g. of ‘Gardnerella vaginalis’ and too few lactobacillae
What is seen on wet microscopy in BV?
clue cells
What are complications of BV
- Increased risk of preterm labour
- Intra-amniotic infection in pregnancy
- Susceptibility to HIV
- Post-termination sepsis
how is a diagnosis of BV made/
culture
What is treatment of BV
metronidazole or clindamycin
What are the causes of discharge in children?
→ Infection from faecal flora
→ Staphs and streps causing pus
→ Threadworms - also cause pruritus
→ Rectal foreign body
What are the ix for discharge in children?
vulval/vaginal swab
MSU (look for glycosuria)
What is the treatment of discharge in children?
erythromycin
oestrogen cream
What is the most common bacterial STI in the UK?
Chlamydia
What % of women are asymptomatic w chlamydia?
70
What are the sx of chlamydia?
- Dysuria
- Vaginal discharge
- IMB/PCB
What are the complications of chlamydia?
→ PID → Perihepatitis → Reiter’s syndrome - arthritis, conjunctivitis and urethritis → Tubal infertility → risk of ectopic pregnancy
How is the diagnosis of chlamydia made?
vulvo-vaginal or endocervical swab for nucleic acid amplification test (NAAT)
Self-swabs
What is the treatment of chlamydia in non-pregnant women?
azithromycin single dose OR doxycycline BD for 7 days
Abstain from sex until both partners treated
What is the treatment of chlamydia in pregnant women?
erythromycin BD for 10-14 days
what are the risks of having chlamydia during pregnancy?
preterm ROM
prematurity
neonatal conjunctivitis and pneumonia
What is the causative organism of gonorrhoea?
Neisseria gonorrhoeae - gram -ve diplococcus
What are sx of gonorrhoea in women
Increased or altered vaginal discharge Lower abdo pain Dysuria IMB Dyspareunia
What are the sx of gonorrhoea in men?
Purulent urethral discharge
Dysuria
Anal discharge
What are the complications of gonorrhoea in men?
prostatitis
epididymitis
orchitis
What are the complications of gonorrhoea in women?
- 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
How is a diagnosis of gonorrhoea made?
vulvovaginal/endocervical swab for NAAT using special medium
May need urethral, pharyngeal and rectal swabs
What is the rx of gonorrhoea?
ceftriaxone IM stat and azithromycin PO stat
What is rx of gonorrhoea in penicillin allergic women?
spectinomycin IM in place of ceftriaxone
