Women's Health: Sexually Transmitted Infections Flashcards
How do you differentiate the STIs producing white discharge?
Candida // bacterial vaginosis
Thick // thin
Itch // KOH addition makes fish smell
What are the risk factors for candida?
High oestrogen
Altered immunity: antibiotics, T2DM, Immuncompromised
How do you diagnose and treat candida infection?
high vaginal swab
- Oral fluconazole 10mg
- Clotrimazole 500mg pessary
How do you manage recurrent candida?
Blood glucose to exclude diabetes
Oral fluclonazole every 3 days for 3 doses
THEN Oral fluclonazole weekly for 6 months
How do you investigate bacterial vaginosis?
3/4 Amsel’s criteria
- Thin, white discharge
- Vaginal pH >4.5
- Positive Whiff test
- Strippled vaginal epithelial cells (clue cells) on microscopy
How do you treat bacterial vaginosis?
Oral metronidazole 5-7 days
top met/clindamycin are alternatives
What organism tends to be the cause of bacterial vaginosis?
Gardnerella vaginalis
What is the significance of bacterial vaginosis in pregnancy?
Risk of preterm, low birth weight and choriomanionitis
Still give metronidazole
How does trichomonas vaginalis compare to bacterial vaginosis
Also has smelyl discharge but is frothy yellow not white
Very itchy
Vulva ulceration + ‘strawberry cervix’
How do you investigate trichomonas vaginalis?
High vaginal swab and PCR/NAATs to exclude differentials
wet mount microscopy shows motile trophozoites
How is trichomonas vaginalis treated?
Oral metronidazole 5-7 days OR one off 2g dose
How do chlamydia and gonorrhea compare in terms of…
Pathogen
Discharge
Pain
Gonorrhea // Chlamydia
GM -ve diplococcus // GM -ve intracellular
Green, odourless // pus-like +/- intermenstrual bleeding
urination, defecation // F: intercourse + cervicitis; M: urination, testicular
What are the investigations for differentiating chlamydia and gonorrhea?
NAAT using swab for females, first pass urine for males
3 days after gonococcal infection
2 weeks after chlamydial
Then culture for sensitivity
How do you treat
Gonorrhea
Chlamydia
G: Ceftriaxone 500mg IM OR Cefixime 400mg PO + Oral azithromycin 2g
C: Oral doxycycline 100mg BD (7 days) OR Oral azithromycin 1g then 500mg two days
A sore wrist, spreading joint pain and a rash in a young adult raises suspicion of what?
Disseminated gonococcal infection
Need to admit to ID
Sexually active female presents with RUQ pain, what could be the cause?
Perihepatitis, along with other RUQ causes
How do HSV, Chanroid, Syphilis and LG compare in terms of
Ulceration
Lymph node
Other features
Pathogen
HSV // Chancroid // Syphilis // LG
Painful, multiple // Painful, ragged border // Painless, single // painless, single
None // unilateral painful lymphadenopathy // none // unilateral painful lymphadenopathy
// Proctocolitis is a late feature
HSV 1+2 // H. ducreyi // Trepnonema pallidum // C. trachomatis (L1-3)
Painless pustle that progresses to ulcer –> painful lymph nodes –> proctocolitis indicates what?
Lymphogranuloma venerum
Complication of chlamydia L1-3 infection
What strain of chlamydia causes genital symptoms?
D-K
How do you diagnose and treat HPV
Clincal
Podophyllotoxin // imiquimod // cryotherapy
What investigations help diagnose gential herpes
PCR swab of deroofed blister
+ IgG serology
What is the treatment of genital herpes?
Aciclovir 400mg TDS if early
+ lidocaine for pain relief
What is the investigations for syphilis?
Treponemal (immunoassay, haemagglutination) and non-treponemal (RPR, VDRL)
+ve treponema +ve non-treponemal = active infection
-ve trep, +ve non-trep = False positive (SLE, pregnancy)
+ve trep, -ve non-trep = Treated infection
+ PCR, dark ground microscopy
How do treat syphilis?
IM Benzathine (Doxycycline if allergic)
If benzathine causes fever, rash and raised HR what do you do?
If no wheeze or hypotension then give antipyretics
How do pubic lice present and how do you treat?
Intense itch and burrows
Give malathion lotion
If someone with HIV has symptoms, what are the early features?
Fever
Rash
Aseptic meningitis
Myalgia
Pharyngitis
After initial symptoms, how does HIV present?
2nd stage: 30% get lymphadenopathy *>1cm, >2sites, >3months)
Followed by fever, night sweats, diarrhoea +/- opportunistic infection
Who are more likely to be infected by HIV?
Black-African, MSM
Hx non-consensual or infections
Hetero men most underdiagnosed
How is HIV tested for?
p24 antigen + HIV antibody combination test
Perform at 4 weeks, repeat at 12 weeks
How is HIV treated pre and post-exposure?
Pre: prEP (truvada, raltegivir)
Post: Antiretroviral therapy of 2NRTIs + another agent
abacavir, tenofovir, didanosine, -tabines, vudines are all examples of what?
NRTIs
What class of antiretrovirals causes the following
Renal impairment, osteoporosis
anaemia, myopathy, black nails
pancreatitis
rashes
diabetic, cushingoid
NRTIs
zidovudine
didanosine
NNRTIs
protease inhibitors
What lab results do you monitor in HIV?
RNA for viral load (get to 0)
CD4+ count (stay above 200)
What conditions within the following categories are seen in HIV?
Respiratory
Cancers
Skin
TB, Pneumocystis jirovecci
Kapowskis and NHL (EBV), Cervical (HPv)
All the Hs (HSV, HPV, histioplasmosis
How can vertical transmission be reduced between mother and baby in pregnancy?
What circumstances would a vaginal delivery be considered?
Zidovudine 4hrs before C-section + Either neonatal zidovudine (if maternal <50/ml) or triple therapy
viral load <50/ml at 36 weeks
How can you differentiate gonococcal dissemination from septic arthritis or reactive arthritis?
Joints affected
Associated symptoms
Joint fluid findings
Pathogen
Dissemination // Septic // Reactive
Migrates // Single // single
rash // restricted movement // uveitis, urethritis
yellow // yellow // nothing
Gonnorhoea // Gonorrhoea in young, S. aureus in old //
