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Flashcards in Sexual Health Deck (141)
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1

What is the normal vaginal pH.

How is this beneficial?

<4.5

inhibits growth of other bacteria

2

What maintains the normal vaginal pH

lactobacilli produce hydrogen peroxide - maintains acidic pH

3

What is the pathophysiology of bacterial vaginosis

disturbance of normal vaginal flora
decrease in lactobacilli
increase in Gardnerella vaginalis, anaerobes and mycoplasma
increase in vaginal pH >4.5

4

What are the risk factors for BV?

new or multiple sexual partners
scented soaps/douching
STIs
recent abx
IUD
receptive oral sex
smoking

5

What are the symptoms of BV

50% asymptomatic
fishy odour
white/grey homogenous thin vaginal discharge
no soreness/irritation

6

What is the differential diagnosis for BV

vaginal candidiasis
STI
trichomonas vaginalis

7

What investogations are done for BV

high vaginal smear of discharge, gram stained

8

What are Amsel's criteria

help to diagnose BV - need >=3

homogenous white/grey thin discharge
bacilli on microscopy of smear - clue cells
pH >4.5
positive KOH whiff test

9

What are clue cells

vaginal epithelium studded with gram variable coccobacilli - indicate presence BV

10

What are the Ison/Hay criteria?

Way of classifying BV depending on gram stained smear of vaginal discharge

Grade 1 - mainly lactobacilli = normal
grade 2 - some lactobacilli, others present = intermediate
grade 3 - few lactobacilli, others predominate = BV

11

What is the management of BV

metronidazole 400mg BD 5 days
avoid scented shower gels, douching
?removal IUD

12

What are the risks of BV in pregnancy

premature birth
miscarriage
chorioamnionitis

13

What microorganism is involved in Vaginal candidiasis

Candida albicans - 90%

14

Describe the pathophysiology of vaginal candidiasis

opportunistic - immunocompromised leads to infection

hypersensitivity - changes in oestrogen etc leads to hypersensitivity reaction

15

What are the risk factors for candida

pregnancy
DM
immunocompromised
recent course of broad spectrum Abx
corticosteroids

16

What are the symptoms of candida

vulval itch
superficial dysruria
vaginal discharge -white, curd like, non-offensive

17

What can be seen in examination in candida

white curd like vaginal discharge
satellite lesions
erythema and swelling of vulva

18

Differential diagnosis of candidiasis

BV
TV
UTI
contact dermatitis
eczema/psoraisis

19

What investigations are needed to diagnose candidiasis

if uncomplicated - none! do on history + examination

if complicated eg. DM, pregnancy, recurrent
- do vaginal smear and microscopy (see spores adn mycelia)

20

What is the management of candidiasis

topical clotrimazole for vagina
oral fluconazole

21

What is the management of recurrent candidiasis

3 x 150mg oral fluconazole over 10 days
500mg clotrimazole once a week for 6 months

22

What is the management of candidiasis in pregnancy

NOT oral
pessary of clotrimazole - avoid damaging cervix with applicator for vaginal cream

check for otehr STIs which could be dangerous in pregnancy

23

How quickly should candidiasis clear up with treatment

What should be done if the infection does not clear?

within 7-10 days

consider alternative diagnosis
modify predisposing factors eg. diabetic control
consider concordance

24

When is emergency contraception used?

after sexual intercourse if:

unprotected sex
failed method of contraception

25

What are the options for emergency contraception

levonorgestrel
ullipristal acetate
copper IUD

26

Which method of emergency contraception is most effective?

copper IUD

27

How does levonorgestrel work?

synthetic progesterone
prevents ovulation for 5-7days
no effect on implantation

28

How does ullipristal acetate work?

progesterone receptor modulator
delay ovulation for 5-7days
prevents development of follicles/rupture of follicles at time of LH surge but not after

29

How does the copper IUD work as emergency contraception?

toxic to sperm
makes implantation impossible due to inflammation of endometrium

30

What time frame can each form of emergency contraception be used within?

levonorgestrel - 72 hours
ullipristal acetate - 72-120 hours
copper IUD - 5 days/ 5 days ovulation