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    O&G: Sexually Transmitted Infections

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    Sok-Moi Chok
    Obstetrics and gynaecology. Notes comparing presentations, examination findings, investigations and treatments for different types of sexually transmitted infections.

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    © All Rights Reserved
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    O&G: Sexually Transmitted Infections

    Uploaded by

    Sok-Moi Chok
    157 views3 pages
    Obstetrics and gynaecology. Notes comparing presentations, examination findings, investigations and treatments for different types of sexually transmitted infections.

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    © © All Rights Reserved

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    PDF, TXT or read online from Scribd

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    Obstetrics and gynaecology. Notes comparing presentations, examination findings, investigations and treatments for different types of sexually transmitted infections.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    157 views3 pages

    O&G: Sexually Transmitted Infections

    Uploaded by

    Sok-Moi Chok
    Obstetrics and gynaecology. Notes comparing presentations, examination findings, investigations and treatments for different types of sexually transmitted infections.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 3
    At a glance
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    The document discusses various sexually transmitted infections including their symptoms, investigations, and treatments.

    Chlamydia, HPV, herpes, gonorrhea, and trichomoniasis are some of the most common STIs mentioned.

    Symptoms of pelvic inflammatory disease can include pelvic pain, abnormal vaginal discharge or bleeding, and fever.

    OBS & GYNAE: Sexually Transmitted Infections

    Explanation
    Chlamydia

    bacteria
    commonest STI

    Symptoms

    70% asymptomatic
    vaginal discharge
    bleeding (IMB, PCB)
    dysuria

    Ix

    endocervical swab
    self-taken
    vulvovaginal swab

    Tx

    HPV Warts

    HPV 6 & 11
    2nd most common
    HPV vaccination
    (started in 2012)

    asymptomatic
    painless lumps
    (anywhere in
    genitoanal area)

    examination: typical

    Untreated

    azithromycin 1g STAT
    doxycycline 100mg bd
    for 7days
    pregnant:
    erythromycin 500mg
    bd 10-14days
    contact tracing

    podophyllotoxin or
    imiquimod cream
    cryotherapy
    excision

    Pregnancy

    tubal infertility
    ectopic pregnancy
    PID
    Fitz-Hugh-Curtis

    DO NOT cause cervical


    cancer
    immunosuppression/
    smokingrisk

    Herpes Simplex

    virus (type 1&2)


    3rd most common
    recurrent can be
    triggered by stress,
    sexual intercourse,
    menstruation

    tingling/itching
    flu-like illness
    vulvitis/pain
    vesicles on vulva

    examination: typical
    PCR testing of fluid
    culture of fluid

    Gonorrhoea

    bacteria
    4th most common

    asymptomatic
    vaginal discharge
    low abdo pain
    bleeding (IMB/PCB)

    endocervical swab
    vulvovaginal (self)
    urethral/ rectal/
    pharyngeal swabs if
    contact with
    gonorrhoea

    no cure
    symptomatic relief
    oral aciclovir 200mg
    5td for 5 days (if
    immunosuppressed)
    condom
    pregnant: acyclovir or
    Csection

    azithromycin 1g PO
    STAT + ceftriaxone
    500mg IM STAT
    spectinomycin 2g IM
    STAT + azithromycin
    (if penicillin allergy)
    same for pregnancy
    contact tracing

    meningitis
    sacral radiculopathy
    (urinary retention/
    constipation)
    transverse meylitis
    disseminated
    infection

    PID
    tubal infertility
    ectopic pregnancy
    Bartholin's / Skene's
    disseminated (fever,
    rash, arthritis,
    polyarthralgia)

    mum:
    PROM
    baby:
    PREM
    conjunctivitis
    pneumonia

    mum:
    number and size
    needs Csection if
    warts are too big
    (rare)
    baby:
    laryngeal/ genital
    warts
    mum:
    may lead to
    miscarriage
    baby:
    PREM
    neonatal herpes
    75% die
    mental retardation
    mum:
    PROM
    chorioamnionitis
    baby:
    opthalmia
    neonatarum

    OBS & GYNAE: Sexually Transmitted Infections


    Thrush / Vaginal
    Candidiasis

    Trichomonas

    yeast

    like fungus
    predisposing factors:
    immunosuppression
    abx
    pregnancy
    DM
    anaemia

    protozoan
    vaginal, urethral,
    para-urethral glands

    spirochaete
    rare STI

    examination: vulva
    erythema & fissuring,
    wall w hite plaques
    culture (HSV, LVS)
    microscopic
    detection

    Syphilis

    asymptomatic
    vulva itching, soreness
    thick, curd-like, white
    vaginal discharge
    dyspareunia
    dysuria

    asymptomatic
    cervix - strawberry
    appearance
    frothy, greenish,
    offensive smelling
    discharge
    vulval-itchy and sore
    dysuria

    painless genital ulcers


    generalised
    polymorphic rash
    (palms and soles)
    uveitis

    microscopic (smear)
    culture
    NAAT

    specific enzyme
    immunoassay to
    screen for IgG+M
    microscopic (smear)
    quantitative
    cardiolipin tests

    Bacterial
    Vaginosis

    overgrowth of mixed
    anerobes
    common in women of
    childbearing age
    NOT STI

    asymptomatic
    discharge:
    profused
    whities grey
    offensive fishy smell

    vaginal pH > 5.5


    examination:
    discharge and smell
    'clue cells' present on
    microscope

    treat if symptomatic
    cotton underwear
    avoid chemicals (soap
    and bath salts)
    clotrimazole 500mg
    pessary cream
    fluconazole 150mg
    STAT (contraindicated
    in pregnancy)

    metronidazole 2g PO
    STAT
    metronidazole 400mg
    bd for 5-7days
    contact tracing

    benzathine benzylpenicillin 2.4MU IM


    STAT (pregnancy)
    doycycline 100mg bd
    PO 14days ()
    erythromycin 500mg
    qds PO 14 days ()
    contact tracing

    resolve w/o Tx
    avoid overwashing
    metronidazole 400mg
    PO BD 5days
    metronidazole 2g PO
    STAT
    clindamycin 2%
    cream at night 7days

    no significant probs

    may enhance HIV


    transmission

    >2yrs: neuro-, cardiosyphilis, gummata

    pelvic infection after


    gynae surgery

    mum:
    no adverse effects
    baby:
    no adverse effects
    Tx (imidazole) safe
    for pregnancy

    mum:
    N/A
    baby:
    PREM
    low birth weight
    transmission

    mum:
    still birth
    miscarriage
    baby:
    PREM
    congenital syphilis

    mum:
    mid-trimester
    miscarriage
    PROM
    baby:
    PREM

    OBS & GYNAE: Sexually Transmitted Infections


    Pelvic Inflammatory Disease
    Infection of upper genital tract
    most common cause: ascending infection from endocervix
    may be caused by descending infection from appendix
    25% caused by Chlamydia and Gonorrhoea
    age <25yo
    Presenting Complaints
    maybe asymptomatic
    pelvic pain
    uni-/bi-lateral
    constant or intermittent

    Sexual Hx
    new/multiple sexual partners
    contraception:
    IUDrisk
    barrier, LNG, COCPrisk
    Examination
    at least 1 of these signs should be present to diagnose PID
    cervical excitation
    adnexal tenderness (uni-/bi-lateral)
    elevated temperature
    Ix

    Associated Symptoms
    dyspareunia
    vaginal discharge
    bleeding: irregular period (dysmenorrhoea), IMB, PCB
    fever
    PMHx
    previous STIs
    uterine surgery/procedure eg TOP
    recurrent PID (complication)
    tubal-ovarian abscess (complication)
    Fitz-Hugh-Curtiz syndrome ( complication)
    Obs Hx
    postpartum endometriosis
    infertility (complication)
    ectopic pregnancy (complication)

    swabs: gonnorhoea and chlamydia


    FBC: WCC CRP
    USS: tubo-ovarian abscess
    laparoscopy: gold standard

    Mx
    outpatient Tx
    ceftriaxone 500mg IM STAT + doxycycline 100mg PO BD 14days +
    metronidazole 400mg PO BD 14days
    ofloxacin 400mg PO BD 14days + metronidazole 400mg PO BD 14days
    (avoid if high risk of gonococcal disease)
    inpatient Tx
    ceftriaxone 2g IV OD + doxycycline 100mg IV BD --> doxycycline 100mg PO
    BD 14days + metronidazole 400mg PO BD 14days
    clindamycin 900mg IV TDS + gentamycin IV --> clindamycin 450mg PO QDS
    14days or doxycycline 100mg PO BD 14days
    ofloxacin 400mg IV BD + metronidazole 500mg IV TDS for 14days
    contact tracing and Tx for partner

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