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Genital Tract Infections - Coggle Diagram
Genital Tract Infections
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STIs
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Screening
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- Contraception consultations
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Bacterial Vaginosis
Definition
Infection with unhealthy bacteria, usually anaerobic, particullary Gardnerella vaginalis
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Causes / Risk Factors
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- Agents that increase pH - reduce healthy bacteria (lactobacilli
- Alkalising agents - soaps, blood
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Investigations
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- Ligh microscopy
Clue cells (studded epithelial cells)
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Diagnosis
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Amsels
- Thin, white homogenous discharge
- Clue cells on microscopy: stippled vaginal epithelial cells
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- Positive whiff test (addition of potassium hydroxide results in fishy odour)
Treatment
Abx
- Metronidazole (or clindamycin) 5-7 days
Disulfarim reaction with metronidazole +alcohol
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Candida / Genital Thrush
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Causes / Risk Factors
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- ABx - altering healthy flora
- Oestrogen - pregnancy, COCP
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Investigations
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- Light microscopy - present hyphae
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Chlamydia Trachomatis
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Pathophysiology
Infection of columnar epithelium
Endocervic, urethra, rectum, pharynx, conjunctiva
Complications
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Reactive arthritis - Reiters syndrome (urethritis, arthritis, conjunctivitis)
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Investigations
- Endocervical swab (if speculum)
- Vulvovaginal swab (no speculum)
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Management
- PO DOxycycline x7 days
Azithromycin in pregnancy - less efficacious in tx of pharyngeal /rectal chlamydia
- Test of cure not indicated unless pregnant or IUCD
Wait 3 weeks after tx completed
- No sexual contact during tx and for 2 weeks post completion
- Test and treat current sexual artners
If tested within 2 week window test may not yet be possible - may be advisable to tx
- STI management:
Contact tracing past 6 months
Full STI screen
Pt education + prevention
- Notifiable disease - by testing lab
Gonorrhoea
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Pathophysiology
Infects columnar epithelium - endocervic, urethra, rectum, pharynx, conjucntiva
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Investigations
- Endocervical swab (if speculum)
- Vulvovaginal swab (no speculum)
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- Microscopy - gram neg diplococcus
- Culture and sensitivities
- Depending on hx - rectal, pharyngeal swabs
Management
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- Culture and sensitivity - tx can be indicated without results
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- Test of cure 2-3 wks post completion of tx
- Test and treat sexual partners
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- General STI managment:
Contact tracing 6 months prior
Full STI screen
Bloods for BBV
PT education
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Mycoplasma Genitalium
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Investigations
- Endocervical swab (speculum)
- Vulvovaginal swab (no speculum)
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Trichomoniasis
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Investigations
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- Light microscopy - present, mobile
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Genital Herpes
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Complications
- Reactivation (of latent sensoy ganglia)
- Superinfection (with bacteria / candida)
- Urinary retention - autonomic neuropathy
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- Autoinoculation (fingers / oral)
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Clinical Presentation
- Vulval blistering vesicles / ulceration
- Painful multiple vesicles
- Bilateral if primary
Unilateral if recurrent - in infected dermatome
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- Systemic symptoms - fever and mylagia if primary
- Often no or minimal symptoms
Investigations
- Viral swab of vesicle / ulcer → NAAT
- Serology in certain circumstances
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Management
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- Simple oral analgesia / local anaesthetic cream
- Adivise micurition into bath water to relieve dysuria
- Hospitalisation for urinary retention, meningism, severe constitutional symptoms
- Speculum exam rarely indicated - defer
- Suppressive therapy for frequent recurrences ≥ 1 /month managed in GUM clinic
- Pregnant pt - inform obstetrician - refer to GUM clinic
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- Avoid sexual contact at time of symptoms
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Syphilis
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Causes / Risk Factors
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Vascular spread - IVDU, rarely transfusion
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Clinical Presentation
Chancre
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Anogenital, labial, peri-anal
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Investigations
- Dark ground microscopy - spirochaetes
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Management
Dose, duration, route determined by clinical circumstance
Dose, duration determined by clinical circumstance
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