P year‎ > ‎Obstetrics & Gynaecology‎ > ‎

13.07.04 GUM

Men
  • NSU
    • Very common
    • 1-2 weeks incubation
    • 1/3 of cases are Chlamydia
    • Women are carriers
      • Mouth
      • Vagina
      • Anus
    • Symptoms
      • Discharge 
      • Dysuria
    • Microscopy
      • Bacteria
      • Pus
    • Management
      • Doxycycline 100 mg BD for 7 days
  • Gonorrhoea
    • 1-10 day incubation
    • Symptoms
      • Profuse yellow/green discharge
      • Extreme dysuria (razor blades)
    • Microscopy
      • Gram -ve intracellular diplococci
    • Management
      • Ceftriaxone 500 mg IM + Azithromycin 1 g
      • (Azithromycin also covers for Chlamydia)

Women
  • Bacterial vaginosis
    • Symptoms
      • FISHY SMELL (pathognomonic)
      • Runny, bubbly, white, creamy discharge
    • Cause
      • Primarily anaerobes
      • Role of smoking?
      • Role of alkaline pH? (Bubble bath)
    • Microscopy
      • Epithelial cells with "salt and pepper" appearance (smothered with bacteria)
      • Glue cells
    • Effect
      • Harmless except in pregnancy => Prematurity
    • Management
      • Metronidazole 400 mg BD for 5 days
  • Trichomonas
    • Symptoms
      • Very itchy
      • Thick, yellow/green, bubbly pus
      • Rotten eggs smell
    • Common in Afro-Caribbean population
    • 2 week incubation period
    • Single-celled protozoa - Highly motile, flagellated cells
    • Can => PID
    • Asymptomatic in men => Don't forget to treat them too
    • Management
      • Metronidazole 400 mg BD for 5 days
  • Thrush
    • Symptoms
      • Itchy
      • Cottage-cheese discharge
    • Cause
      • Loss of normal commensals/Immunosuppression => Colonisation
    • Histology
      • Bamboo shoots / grape vine
    • Always looks for a cause in recurrent thrush
      • Check FBC, iron, ferritin
      • HIV
      • Steroids
      • Antibiotics
      • Diabetes
      • Anaemia
    • Management
      • Canestan cream
      • Fluconazole 150 mg


Both
  • Genital warts
    • Management
      • Cryotherapy 
      • Podophyllotoxin 
      • Imiquimod
    • Some won't respond to cream (big, HSV 16,18 ones) => Weekly cryotherapy 
  • Herpes
    • Symptoms
      • Rapid onset (hours - days)
      • Flu-like illness
      • Painful, itchy blisters
      • Dysuria (urine irritates sores)
    • Very severe initial infection, especially in women
    • Management
      • Aciclovir 200 mg 5 times a day for 5 days
      • Instiligel to allow urination
    • Pregnancy
      • No need for caesarian unless primary infection in last 6 weeks
    • Recurrent attacks
      • PRN aciclovir
      • Or aciclovir 200 mg TDS for 6 months
  • HIV
    • ALWAYS think of HIV when investigating unusual symptoms

Syphilis
  • Primary
    • Any genital sore is primary syphilis until proven otherwise
    • Esp. with an unusual sexual history
  • Secondary
    • REALLY generalised maculo-papular pink rask
      • Face, palms, soles of feet - Unlike any other condition
  • Management
    • IM Benzathine Benzylpenicillin
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