Week 2 Flashcards by Katy Russell

dysuria

pain or discomfort on urinating

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urethritis causes

Chlamydia
Gonorrhoea
Non-specific urethritis

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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

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gonococcal urethritis on mircroscope

gram negative intracellular diplococci

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gonorrhoea discharge colour

yellow/green

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Gonococcal Urethritis incubation period

2-5 days

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Non gonococcal urethritis incubation period

7-21 days

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what is the typical age of someone with gonorrhoea

<25

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first line gonorrhoea treatment

Ceftriaxone 1G IM

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second line gonorrhoea treatment

Cefixime 400 mg oral plus Azithromycin 2G

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is partner notification needed in gonorrhoea?

yes

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what is tysonitis a complication of?

gonorrhoea

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most common non-specific urethritis cause

chlamydia

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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

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chlamydia symptoms

urethral discharge (milky)
irregular bleeding
abdominal pain
dysuria

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chlamydia signs

Urethritis
Cervicitis
Epididymo-orchitis
Proctitis (LGV)

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complications of chlamydia

PID
reactive arthritis
ectopic pregnancy
conjunctivitis
Fitz Hugh-Curtis

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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

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what is mycoplasma genitalium associated with?

Non Gonococcal Urethritis (15-25%) and PID

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non STI most common cause of infective vaginal discharge

bacterial vaginosis

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is bacterial vaginosis sexually transmitted

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bacterial vaginosis treatment

Reassure

Metronidazole 400mg bd 5/7

Worsening/recurring advice

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candidiasis treatment

Reassure

Clotrimazole 500mg pessary OR Fluconazole 150mg stat

Clotrimazole 1% cream for external symptoms

Worsening/recurring advice

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bacterial vaginosis associations

Cunnilingus
Recent change in sexual partner
Concurrent STI
Smoking
Intrauterine device

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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?

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

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