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