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what are the most common microbial causes of female genital discharge?
- overgrowth of vaginal commensals. recurrence common
- bacterial vaginosis
what are the STI causes of female genital discharge?
- Trichomonas vaginalis
what kind of discharge would you see with gonorrhoea and chlamydia and if suspected what needs to be checked?
- mucopurulent discharge
- check signs of PID: deep dyspareunia, pelvic pain, abnormal bleeding
what % of chlamydia are asymptomatic?
what % of gonorrhoea are asymptomatic?
what Qs need to be asked with female genital discharge?
- 1. duration
- 2. past episodes
- 3. colour, consistency, blood stained
- 4. genital pruritis
- 5. dysuria
- 6. dyspareunia (superficial ie on penetration or deep)
- 7. pelvic pain
- 8. abnormal bleeding: intermenstural or post-coital
what is physiological discharge in women like at start/end of cycle?
what is physiological discharge in women like mid cycle?
clear and stretchy - fertile mucoid. increased in volume
what 2 factors can increase normal discharge? and why
- 1. COCP
- 2. pregnancy
- due to oestrogen effect
what is normal pH of vaginal discharge?
what is the cause of thrush? (organism full name)
candida albicans overgrowth
name 5 pre-disposing factors to thrush
- 1. immunocompromised eg diabetes, corticosteroids
- 2. broad spectrum antibiotics - wipe out normal flora
- 3. intra-uterine devices
- 4. constrictive, non porous underwear
- 5. soaps, bubble bath
what are 3 symptoms of thrush?
- 1. genital pruritis or burning
- 2. dyspareunia - superficial
- 3. thick white cheesy discharge with sour odour
what would you see OE both of genitalia and on speculum of thrush?
- genitals: erythema, oedema, scratching, shallow erosions and lichenification (thick hard skin)
- speculum: cottage cheese like plaques of discharge, sometimes adherent to mucosal surface
what Ix do you do in thrush?
vaginal swab for gram and culture
what is the cause of bacterial vaginosis (BV)?
- alteration of vaginal flora resulting in loss of lactic acid producing lactobacilli
- so overgrowth of BV associated anaerobes
name a BV associated anaerobe?
what happens to vaginal pH in BV?
what are risk factors for BV? (6)
- black ethnicity
- lack of condom use
- genital washing - douche
name 3 symptoms of BV
- 1. dishcharge: fishy smell, more after coitus, white-grey colour, thin watery
- 2. pruritis
- 3. dyspareunia
what are tests for BV?
- pH > 4.5
- vaginal swab for gram stain
- clue cells on microscopy
- release of fishy odour on adding alkali: KOH solution
what is Rx for BV?
- clindamycin vaginal cream
how is trichomonas acquired?
what kind of organism is trichomonas?
protozoa. trichomonas vaginalis
what is incubation period of trichomonas?
name 4 symptoms of trichomonas?
- 1. discharge: profuse, bubbly, white or green, offensive
- 2. vulval soreness
- 3. vulval pruritis or swelling
- 4. superficial dyspareunia
what do you see O/E in trichomonas (think all parts of gentialia)
- 1. vulva, vagina, cervix: all inflammed
- 2. discharge: thin, frothy, purulent, offensive, pools at posterior fornix
- 3. vaginal wall and cervix: strawberry appearance with punctate bleeding erosions
what problems can trichomonas give in pregnancy?
- 1. pre-term delivery
- 2. LBW in new borns
what is Rx for trichomonas?
- metronidazole 2g stat
- and partners
what sample is taken for trichomonas?
HVS - saline, cover slip, microscopy. see flagella kick out back, characteristic jerky motility. undulating membrane.
how sensitive is microscopy?
what is the culture medium for trichomonas?
- liver digest glucose broth. brown medium
- incubate for 2 days in CO2 incubator
what else can the trichomonas media check for?
what is the gold standard test for trichomonas?
name 2 Rx for trichomonas?
what is the cause of gonorrhoea? which organism and what gram and shape is it?
- neisseria gonorrhoea
- gram -ve
- intracellular diplococci
if pts develop symptoms with gonorrhoea, when do they do so?
within 10 days of infection
what % have co-infection with chlamydia?
name 5 symptoms of gonorrhoea?
- 1. absent or v slight so ignored in most cases
- 2. dysuria
- 3. vaginal discharge - actually not vaginal but from cervix, mucopurulent
- 4. DEEP dyspareunia
- 5. pelvic pain
what do you see O/E with gonorrhoea
- 1. examination often normal
- 2. urethral/cervical purulent discharge
- 3. endocervical inflammation
- 4. signs of PID on bimanual examination: cervical excitation or adnexal tenderness
what is the most common complication of gonorrhoea in men? and other comps?
- acute epididymitis
- penile lymphangitis
- periuthetral abscess
where else can gonorrhoea get to?
where are swabs taken for gonorrhoea in females?
- rectal (but most rectal slides in MSM)
what is the most common complication of gonorrhoea in women?
what is the screen for asymptomatic gonorrhoea? why better than culture?
- first catch urine sample for GC NAAT test
- better as quicker!
what is most common test for gonorrhoea?
- endocervical swab
- NAAT test
what is Rx for gonorrhoea? give 3 and dose of first
- cefixime 400mg stat
what is the most common STI in the UK?
what causes chlamydia?
what type of organism is CT? and what gram stain?
- obligate intracellular pathogen, so difficult to culture
- gram negative
what are the symptoms of chlamydia
- 1. often asymptomatic
- 2. vaginal discharge
- 3. deep dyspareunia
- 4. pelvic pain
- 5. abnormal bleeding
what can you see OE chlamydia?
- mucopurulent cervical discharge
- inflamed, friable cervix (contact bleeding)
- adnexal tenderness if PID
what is pH like in chlamydia?
what is the diagnostic test for chlamydia?
- cervical swab (endocervical)
what is Rx for chlamydia? and dose for first
- azithromycin 1g stat
- or doxycycline
what are 2 most common infective causes of male genital discharge?
- NGU: non gonococcal urethritis
if man presents with genital discharge, what Qs to be asked?
- 1. duration
- 2. colour of discharge
- 3. dysuria, frequency, UTI qs
- 4. scrotal pain or swelling
- 5. if MSM - rectal discharge, pain
name 2 physiological causes of male discharge
- 1. prostatorrhoea
- 2. sexual arousal
what is the incubation days for gonorrhoea
what % of men with gonorrhoea are asymptomatic?
what % of men are connected with chlamydia?
what are 2 main symptoms of gonorrhoea in men?
- urethral discharge
what should be checked for OE GC in men?
- urethral discharge
- scrotal swelling or pain: epididymitis, orchitis
what is the commonest cause for NGU?
what % of NGU are asymptomatic?
what is incubation days for NGU with chlamydia?
if NGU with no pathogen found, what is it called?
NSU: non specific urethritis
what are causes of NSU?
- mycoplasma genitalium
- ureaplasma urealyticum
what is difference between GC and NGU?
in NGU discharge is less dramatic and get peri-urethral itching or tingling
who should you look for proctitis in?
what are symptoms of proctitis?
- anal dampness or discharge
what is main difference between gonorrhoea and chlamydia infection in men?
gonorrhoea: profuse yellow/green discharge
what are most common causes of rectal discharge?
gonorrhoea and chlamydia