Men- NSU
- Very common
- 1-2 weeks incubation
- 1/3 of cases are Chlamydia
- Women are carriers
- Symptoms
- Microscopy
- 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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