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Gynae
infections
Quiz by b conrad
What should you ask
about in a sexual hx?
• Number of contacts ?in last 3 months
• Contraception- reliable? Compliance?
• Anal oral vaginal?
• Past sti?
• Sexual preference?
• Menstraul and medical history?
• Risk factors- paid for sex, injected drugs, msm etc
After the history what
would you examine?
• Genitalia
• Inguinal nodes
• Pubic hair
• Scrotum
• Pr exam
• Pv/ speculum exam (cusco speculum)
What could cause vaginal
discharge?
• Physiological- increased in pregnancy, sexual arousal, puberty, cocp
• Foreign body (tampon)
• Thrush (95% C.albicans). Non-offensive white curd.
• Trichomonas vaginalis- thin bubbly fishy
• Bacterial vaginosis- fishy
• Gonorrhoea
• Chlamydia
• Ref- p404 OCH and p284 OCHS
What are the symptoms
Chlamydia?
• Asymptomatic 70% women 50% men
• Discharge/ dysuria
• PCB/ IMB
• Abdo pain
What are the possible
complications of chlamydia?
• PID -> infertility, ectopic pregnancy, chronic
pelvic pain
• Epididymoorchitis
• Reiters syndrome
What is Reiters
syndrome?
• Reactive arthritis etc
• Conjunctivitis/ uveitis
• Urethritis
• Arthritis
• “can’t see, can’t pee, can’t climb a tree”
What is Fitz-Hugh Curtis
syndrome?
• Transabdominal spread of PID
• RUQ pain
• Perihepatitis
• http://www.patient.co.uk/doctor/Fitz-Hugh-
Curtis-syndrome.htm
How do you diagnose
Chlamydia?
• Chlamydia trachomatis- gram -ve
• High vaginal swab
• Stuarts medium -> culture and microscopy
• Endocervical swab
• Antigen detection or enzyme immunoassays (EIAs)
• Nucleic acid amplification tests (NAATs)
• With reactive arthritis, paired serology may detect
rising titres
How do you treat
Chlamydia?
• Azithromycin 1g stat dose (ok in pregnancy)
• Or Doxycycline 100mg bd for 1 week
• Abstain for 1 week
• Contact trace- treat partners as well even if
asymptomatic
• Alternative= erythromycin 500mg BD for 14
days or QDS for 7 days
Who is at higher risk of
thrush?
• DM
• Immunodeficeincy
• Steroid treatment
• Antibiotic treatment
How do you treat thrush?
• Clotrimazole pessary and cream
• Or oral Fluconazole single dose
What is Gonorrhoea?
• Gram –ve diplococcus
• Men- urethral pus, dysuria, tenesmus, proctitis,
pr discharge if msm.
• Women- often asymptomatic. Discharge,
dysuria, proctitis
Suggest 5 complications
of Gonorrhoea?
• Prostatitis
• Cystitis
• Salpingitis/ epididymitis
• Septicaemia (petechiae, hand/ foot pustules,
arthritis, reiters syn)
• Obstetris- ophthalmia neonatorum
• Urethral stricture
• infertility
How do you treat
Gonorrhoea?
• Cefixime 400mg PO stat
• Or Ciprofloxacin 500mg stat
• Usually treat for chlamydia at the same time
(Azithromycin stat or doxycycline)
• Contact trace
• No sex till cured
How could an HIV
infection present?
• Acute infection often asymptomatic
• Seroconversion- 2-6 weeks. Transient illness.
Fever, malaise, myalgia, pharyngitis.
• Persistent generalised lymphadenopathy
(>1cm at >2 sites for >3months)
 Constitutional symptoms
 Opportunistic infections
How do you diagnose
HIV?
• Anti-HIV antibodies in serum
• HIV RNA (PCR)
• Rapid diagnostic kit OraQuick- uses oral fluid
What causes genital
warts?
• HPV 6 & 11 most common (these types are
associated with cancer)
• Ds DNA
• Lifetime risk is 50% but most are asymptomatic
How do you treat warts?
• Podophyllotoxin or imiquimod topical
treatment
• Cryotherapy
• Need explanation and information possibly
counselling.
• Partner tracing not needed unless they have
symptoms.
What is herpes?
• Hsv 1 and 2
• Cold sores- herpes labialis (type 1)
• Painless anal or vaginal ulcers (hsv 2)
• Can be asymptomatic
• Febrile prodrome, neuropathic pain, genital blisters/
ulcers, tender inguinal nodes, dysuria, discharge
• Lies latent in sensory ganglia
• Recurrences are shorter and more mild
How do you diagnose
hsv?
• PCR for DNA detection
• Viral culture
• Treatment= Aciclovir if >5 attacks in a year. No
cure. Lifelong. Most will eventually stop having
recurrences.
What causes syphilis?
• Treoponema pallidum
What are the 4 stages of
syphilis?
• Primary syphilis- macule at site (any ulcer is
syphilis until proven otherwise) painless hard
ulcer.
• Secondary syphilis- 4-8wk later. Rash (trunk,
face, palms, soles), malaise, lymphadenopathy,
high temp, alopecia, condylomata lata, palatal
or buccal snail-track ulcers. Rarely- hepatitis,
meningism, nephrosis, uveitis
• Tertiary syphilis- >2yrs latency. Gummas-
granulomas in skin, mucosa, bone, joint, visera
• Quaternary syphilis:
• Cardiovascular- AAA, aortic regurg
• Neuro- cn palsies, stroke, general paralysis of
insane (dementia/ psychosis), tabes dorsalis
(sensory ataxia, numb legs and chest, upgoing
plantars, lightening pains, charcots joints)
STI's and Gynae infections
How is syphilis diagnosed
and treated?
• Cardiolipin antibody- detectable in primary
syphilis. Becomes –ve after tx
• Treponeme specific antibody- stays +ve after
tx
• Contact tracing
• Procaine benzylpenicillin 600mg/ 24h im for 28
days or Doxycycline 200mg/ 12h for 28 days

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STI's and Gynae infections

  • 2. What should you ask about in a sexual hx? • Number of contacts ?in last 3 months • Contraception- reliable? Compliance? • Anal oral vaginal? • Past sti? • Sexual preference? • Menstraul and medical history? • Risk factors- paid for sex, injected drugs, msm etc
  • 3. After the history what would you examine? • Genitalia • Inguinal nodes • Pubic hair • Scrotum • Pr exam • Pv/ speculum exam (cusco speculum)
  • 4. What could cause vaginal discharge? • Physiological- increased in pregnancy, sexual arousal, puberty, cocp • Foreign body (tampon) • Thrush (95% C.albicans). Non-offensive white curd. • Trichomonas vaginalis- thin bubbly fishy • Bacterial vaginosis- fishy • Gonorrhoea • Chlamydia • Ref- p404 OCH and p284 OCHS
  • 5. What are the symptoms Chlamydia? • Asymptomatic 70% women 50% men • Discharge/ dysuria • PCB/ IMB • Abdo pain
  • 6. What are the possible complications of chlamydia? • PID -> infertility, ectopic pregnancy, chronic pelvic pain • Epididymoorchitis • Reiters syndrome
  • 7. What is Reiters syndrome? • Reactive arthritis etc • Conjunctivitis/ uveitis • Urethritis • Arthritis • “can’t see, can’t pee, can’t climb a tree”
  • 8. What is Fitz-Hugh Curtis syndrome? • Transabdominal spread of PID • RUQ pain • Perihepatitis • http://www.patient.co.uk/doctor/Fitz-Hugh- Curtis-syndrome.htm
  • 9. How do you diagnose Chlamydia? • Chlamydia trachomatis- gram -ve • High vaginal swab • Stuarts medium -> culture and microscopy • Endocervical swab • Antigen detection or enzyme immunoassays (EIAs) • Nucleic acid amplification tests (NAATs) • With reactive arthritis, paired serology may detect rising titres
  • 10. How do you treat Chlamydia? • Azithromycin 1g stat dose (ok in pregnancy) • Or Doxycycline 100mg bd for 1 week • Abstain for 1 week • Contact trace- treat partners as well even if asymptomatic • Alternative= erythromycin 500mg BD for 14 days or QDS for 7 days
  • 11. Who is at higher risk of thrush? • DM • Immunodeficeincy • Steroid treatment • Antibiotic treatment
  • 12. How do you treat thrush? • Clotrimazole pessary and cream • Or oral Fluconazole single dose
  • 13. What is Gonorrhoea? • Gram –ve diplococcus • Men- urethral pus, dysuria, tenesmus, proctitis, pr discharge if msm. • Women- often asymptomatic. Discharge, dysuria, proctitis
  • 14. Suggest 5 complications of Gonorrhoea? • Prostatitis • Cystitis • Salpingitis/ epididymitis • Septicaemia (petechiae, hand/ foot pustules, arthritis, reiters syn) • Obstetris- ophthalmia neonatorum • Urethral stricture • infertility
  • 15. How do you treat Gonorrhoea? • Cefixime 400mg PO stat • Or Ciprofloxacin 500mg stat • Usually treat for chlamydia at the same time (Azithromycin stat or doxycycline) • Contact trace • No sex till cured
  • 16. How could an HIV infection present? • Acute infection often asymptomatic • Seroconversion- 2-6 weeks. Transient illness. Fever, malaise, myalgia, pharyngitis. • Persistent generalised lymphadenopathy (>1cm at >2 sites for >3months)  Constitutional symptoms  Opportunistic infections
  • 17. How do you diagnose HIV? • Anti-HIV antibodies in serum • HIV RNA (PCR) • Rapid diagnostic kit OraQuick- uses oral fluid
  • 18. What causes genital warts? • HPV 6 & 11 most common (these types are associated with cancer) • Ds DNA • Lifetime risk is 50% but most are asymptomatic
  • 19. How do you treat warts? • Podophyllotoxin or imiquimod topical treatment • Cryotherapy • Need explanation and information possibly counselling. • Partner tracing not needed unless they have symptoms.
  • 20. What is herpes? • Hsv 1 and 2 • Cold sores- herpes labialis (type 1) • Painless anal or vaginal ulcers (hsv 2) • Can be asymptomatic • Febrile prodrome, neuropathic pain, genital blisters/ ulcers, tender inguinal nodes, dysuria, discharge • Lies latent in sensory ganglia • Recurrences are shorter and more mild
  • 21. How do you diagnose hsv? • PCR for DNA detection • Viral culture • Treatment= Aciclovir if >5 attacks in a year. No cure. Lifelong. Most will eventually stop having recurrences.
  • 22. What causes syphilis? • Treoponema pallidum
  • 23. What are the 4 stages of syphilis? • Primary syphilis- macule at site (any ulcer is syphilis until proven otherwise) painless hard ulcer. • Secondary syphilis- 4-8wk later. Rash (trunk, face, palms, soles), malaise, lymphadenopathy, high temp, alopecia, condylomata lata, palatal or buccal snail-track ulcers. Rarely- hepatitis, meningism, nephrosis, uveitis
  • 24. • Tertiary syphilis- >2yrs latency. Gummas- granulomas in skin, mucosa, bone, joint, visera • Quaternary syphilis: • Cardiovascular- AAA, aortic regurg • Neuro- cn palsies, stroke, general paralysis of insane (dementia/ psychosis), tabes dorsalis (sensory ataxia, numb legs and chest, upgoing plantars, lightening pains, charcots joints)
  • 26. How is syphilis diagnosed and treated? • Cardiolipin antibody- detectable in primary syphilis. Becomes –ve after tx • Treponeme specific antibody- stays +ve after tx • Contact tracing • Procaine benzylpenicillin 600mg/ 24h im for 28 days or Doxycycline 200mg/ 12h for 28 days

Notas del editor

  1. Reference- http://www.patient.co.uk/doctor/chlamydial-genital-infection
  2. http://www.patient.co.uk/doctor/chlamydial-genital-infection
  3. http://www.patient.co.uk/doctor/herpes-simplex-genital
  4. From top left going clockwise: Gumma Primary syphilis ulcer secondary syphilis rash