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