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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?
• ...
After the history what
would you examine?
• Genitalia
• Inguinal nodes
• Pubic hair
• Scrotum
• Pr exam
• Pv/ speculum exa...
What could cause vaginal
discharge?
• Physiological- increased in pregnancy, sexual arousal, puberty, cocp
• Foreign body ...
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
• Epididymo...
What is Reiters
syndrome?
• Reactive arthritis etc
• Conjunctivitis/ uveitis
• Urethritis
• Arthritis
• “can’t see, can’t ...
What is Fitz-Hugh Curtis
syndrome?
• Transabdominal spread of PID
• RUQ pain
• Perihepatitis
• http://www.patient.co.uk/do...
How do you diagnose
Chlamydia?
• Chlamydia trachomatis- gram -ve
• High vaginal swab
• Stuarts medium -> culture and micro...
How do you treat
Chlamydia?
• Azithromycin 1g stat dose (ok in pregnancy)
• Or Doxycycline 100mg bd for 1 week
• Abstain f...
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...
Suggest 5 complications
of Gonorrhoea?
• Prostatitis
• Cystitis
• Salpingitis/ epididymitis
• Septicaemia (petechiae, hand...
How do you treat
Gonorrhoea?
• Cefixime 400mg PO stat
• Or Ciprofloxacin 500mg stat
• Usually treat for chlamydia at the s...
How could an HIV
infection present?
• Acute infection often asymptomatic
• Seroconversion- 2-6 weeks. Transient illness.
F...
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 5...
How do you treat warts?
• Podophyllotoxin or imiquimod topical
treatment
• Cryotherapy
• Need explanation and information ...
What is herpes?
• Hsv 1 and 2
• Cold sores- herpes labialis (type 1)
• Painless anal or vaginal ulcers (hsv 2)
• Can be as...
How do you diagnose
hsv?
• PCR for DNA detection
• Viral culture
• Treatment= Aciclovir if >5 attacks in a year. No
cure. ...
What causes syphilis?
• Treoponema pallidum
What are the 4 stages of
syphilis?
• Primary syphilis- macule at site (any ulcer is
syphilis until proven otherwise) painl...
• Tertiary syphilis- >2yrs latency. Gummas-
granulomas in skin, mucosa, bone, joint, visera
• Quaternary syphilis:
• Cardi...
How is syphilis diagnosed
and treated?
• Cardiolipin antibody- detectable in primary
syphilis. Becomes –ve after tx
• Trep...
STI's and Gynae infections
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STI's and Gynae infections

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STI's and Gynae infections

  1. 1. Gynae infections Quiz by b conrad
  2. 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. 3. After the history what would you examine? • Genitalia • Inguinal nodes • Pubic hair • Scrotum • Pr exam • Pv/ speculum exam (cusco speculum)
  4. 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. 5. What are the symptoms Chlamydia? • Asymptomatic 70% women 50% men • Discharge/ dysuria • PCB/ IMB • Abdo pain
  6. 6. What are the possible complications of chlamydia? • PID -> infertility, ectopic pregnancy, chronic pelvic pain • Epididymoorchitis • Reiters syndrome
  7. 7. What is Reiters syndrome? • Reactive arthritis etc • Conjunctivitis/ uveitis • Urethritis • Arthritis • “can’t see, can’t pee, can’t climb a tree”
  8. 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. 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. 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. 11. Who is at higher risk of thrush? • DM • Immunodeficeincy • Steroid treatment • Antibiotic treatment
  12. 12. How do you treat thrush? • Clotrimazole pessary and cream • Or oral Fluconazole single dose
  13. 13. What is Gonorrhoea? • Gram –ve diplococcus • Men- urethral pus, dysuria, tenesmus, proctitis, pr discharge if msm. • Women- often asymptomatic. Discharge, dysuria, proctitis
  14. 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. 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. 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. 17. How do you diagnose HIV? • Anti-HIV antibodies in serum • HIV RNA (PCR) • Rapid diagnostic kit OraQuick- uses oral fluid
  18. 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. 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. 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. 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. 22. What causes syphilis? • Treoponema pallidum
  23. 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. 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)
  25. 25. 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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