Week 2 Flashcards
dysuria
pain or discomfort on urinating
urethritis causes
Chlamydia
Gonorrhoea
Non-specific urethritis
investigating urethritis
don’t let them pee first
clinical exam
Urethral swab for Gram stain and microscopy
Urethral swab for gonorrhoea culture and sensitivities
First void urine, Throat and rectal swabs for chlamydia and gonorrhoea NAAT
Blood for syphilis and HIV
gonococcal urethritis on mircroscope
gram negative intracellular diplococci
gonorrhoea discharge colour
yellow/green
Gonococcal Urethritis incubation period
2-5 days
Non gonococcal urethritis incubation period
7-21 days
what is the typical age of someone with gonorrhoea
<25
first line gonorrhoea treatment
Ceftriaxone 1G IM
second line gonorrhoea treatment
Cefixime 400 mg oral plus Azithromycin 2G
is partner notification needed in gonorrhoea?
yes
what is tysonitis a complication of?
gonorrhoea
most common non-specific urethritis cause
chlamydia
who is the risk of PID highest in?
women aged under 25 not using barrier contraception and with a history of a new sexual partner
chlamydia symptoms
urethral discharge (milky)
irregular bleeding
abdominal pain
dysuria
chlamydia signs
Urethritis
Cervicitis
Epididymo-orchitis
Proctitis (LGV)
complications of chlamydia
PID
reactive arthritis
ectopic pregnancy
conjunctivitis
Fitz Hugh-Curtis
chlamydia treatment
Doxycycline 100mg BD x 1 week
PID – Ceftriaxone 1G IM, Doxycycline 100mg BD x 2 weeks and metronidazole 400 mg BD x 2 weeks
what is mycoplasma genitalium associated with?
Non Gonococcal Urethritis (15-25%) and PID
non STI most common cause of infective vaginal discharge
bacterial vaginosis
is bacterial vaginosis sexually transmitted
no
bacterial vaginosis treatment
Reassure
Metronidazole 400mg bd 5/7
Worsening/recurring advice
candidiasis treatment
Reassure
Clotrimazole 500mg pessary OR Fluconazole 150mg stat
Clotrimazole 1% cream for external symptoms
Worsening/recurring advice
bacterial vaginosis associations
Cunnilingus
Recent change in sexual partner
Concurrent STI
Smoking
Intrauterine device
in bacterial vaginosis, is the pH increased or decreased?
increased
bacterial vaginosis clinical features
Can be asymptomatic 50%
Fishy smelling discharge
NO irritation /discomfort/itch
bacterial vaginosis complications
Possible adverse outcomes in pregnancy
Post TOP endometritis and PID
High rate of recurrence (30-50% within 3 months)
risk factors for candidiasis
Diabetes mellitus
SGLT2i (Type 2 DM)
Recent antibiotic use
Immunosuppression
is candidiasis sexually transmitted?
no
what type of infection is candida
fungal
candidiasis management
Genital skin care advice (soap substitutes)
Azole anti-fungal (cure rate >80%)
+/- hydrocortisone
Manage risk factors
Consider HIV test if recurrent
Suppressive therapy if recurrent
trichomonas treatment
metronidazole 400mg BD x5-7/7
is trichomonas sexually transmitted
yes
sexually transmitted causes of genital ulceration
herpes (types 1 and 2)
syphilis
primary HIV infection
Lymphogranuloma venereum
Mpox
not sexually transmitted causes of genital ulceration
Varicella zoster
Fixed drug eruption
Crohns
Dermatosis
Bechet’s disease
Trauma
Lipschutz ulcers
Idiopathic
herpes transmission
close contact of oral or genital with an individual who is shedding virus
primary herpes incubation period
3-9 days
primary herpes symptoms
pain
dysuria
discharge
painful lymphadenopathy
systemic symptoms
rectal symptoms
primary herpes signs
erythema
vesicles/ulcers (scab)
lymphadenopathy
cervicitis
primary herpes complications
aseptic meningitis, dissemination, sacral neuropathy, secondary bacterial infection
recurrent herpes symptoms
Prodrome (tingling, itching, burning), localised vesicles/ulcers, heal with scab, lasts 5-10 days
how long do recurrent herpes symptoms last
5-10 days
primary herpes treatment
aciclovir
are recurrent episodes worse or better than the primary episode of herpes
better
ways to reduce risk of herpes transmission
disclosure
condom
suppressive antivirals
most common cause of genital ulceration
herpes
chancre
lesion of primary syphilis
is a chancre usually painful or painless
painless
primary syphilis incubation
10-90 days (usually 14-21)
secondary syphilis incubation
<2 years (usually 3-6 weeks)
secondary syphilis rash typical sites
palms, soles
pictures of back/trunk/forearms
secondary syphilis more serious stuff!
Meningitis
Hepatitis
Iritis
Uveitis
Glomerulonephritis
Periostitis
Condylomata lata
Pregnancy complications
treatment for all stages of syphilis
benzathene penicillin IM
genital lumps that are sexually transmitted or infective
Genital warts (HPV)
Molluscum contagiosum
Monkeypox
Scabies
genital lumps not sexually transmitted
Physiological
Folliculitis
Hydradenitis suppurativa
Seborrhoeic keratoses
Cancers
Bartholin’s abscess
Skin tags
Lichen planus
Pyoderma granuloma
genital warts treatment
Cryotherapy
Topical podophylotoxin
Solution (0.5%)
Cream (0.15%)
Imiquimod
Cataphen
Surgical
-Electrocautery
-Curette
-Debulking
is HPV a lifelong condition
no
Fordyce spots - are they physiological
yes
is chlamydia a bacteria or a virus
bacteria
is gonorrhoea a bacteria or a virus
bacteria
what is the main symptom of lichen sclerosis
itch
when are the two peak ages of onset of lichen sclerosis?
prepubertal girls and postmenopausal women
lichen sclerosis on examination
white papules and plaques
ecchymosis, erosions and fissures
architectural change
extragenital skin involvement (10% of women with vulval disease
can vaginal oestrogen be used with a history of breast cancer
yes, no risk because it isn’t systemic
genitourinary syndrome of the menopause symptoms
Vaginal dryness
Vaginal burning
Vaginal discharge
Genital itching
Burning with urination
Urgency with urination
Frequent urination
Recurrent urinary tract infections
Urinary incontinence
Light bleeding after intercourse
Discomfort with intercourse
Decreased vaginal lubrication during sexual activity
Shortening and tightening of the vaginal canal
Vulvodynia
persistent, unexplained pain in the vulva.
diagnosis of exclusion
vaginismus
involuntary muscle spasm
the body’s automatic reaction to the fear of some or all types of vaginal penetration. Whenever penetration is attempted, your vaginal muscles tighten up on their own
