INFECTION

ORGANISM

SYMPTOMS/SIGNS

DIAGNOSIS

TREATMENT

RISKS

THRUSH

Candida Albicans

White cottage
cheese/curd, nonoffnsive discharge.
Vulval or vaginal
redness, fissured or sore.
(Vulvitis)

MICROSCOPY:
strings of mycelium
or oval spores.
& CULTURE

Topical treatment
CLOTRIMAZOLE
500mg pessary + cream
for vulva
(if pregnant or
breastfeeding)
FLUCANOZOLE
150mg PO

Pregnancy
Contraception
Steroids
Immunodeficiency
Abx
Diabetes

HIGH VAGINAL
MICROSCOPY:
Vaginal epithelial
clue cells.
Coccobacilli

METRONIDAZOLE
2g PO once.
CLINDAMYCIN 2%
vaginal cream pv
7nights.

++ preterm labour

Males rash, balbingitis

BACTERIAL
VAGINOSIS

Gardenella,
Mycoplasma
hominis
Peptostreptococci
Mobiluncus
Bacteriodes

Thin, off white, fishy

smelling discharge.
Vaginal infamy or itch
uncommon.
Vaginal pH > 4.5

intra amniotic
infection.

Pregnant =
metroinidazole
400mg/12h PO 5d.
TRICHOMONAS
VAGINALIS

Flagellated protozoa,
Anaerobic

Thin, bubbly/frothy,
yellow discharge
Irritant vulvo-valginits

HIGH VAGINAL
MICROSCOPY:
Motile flagella
CYTOLOGY:
strawberry cervix
colpitis.

METRONIDAZOLE
400mg/12h PO 5d OR
2g PO stat.
Pregnant (5day routine)

Exclude gonnorhoea
(often co-exsists)

CHLAMYDIA

C. Trachomonis
50%

Asymptomatic nature
~80%
Vaginal discharge +/dysuria
Postcoital bleeding
IMB

ENDOCERVICAL
MICROSCOPY:
C. Trachomatis
(obligate
intracellular
pathogen)
(reticulate bodies)

PID L abdo pain,

dyspareaunia, IMB
MEN acute epidiymoorchitis, urithritis,
discharge
GONNORHOEA

Niesseria
Gonnorrhoea,
Gram ve

Usually asymptomatic
~50%
Vaginal dischage
white/green/yellow,
distinctive smell
Dysuria
Dysparaeria
MEN- urethral
discharge +/- dysuria
Proctitis, tenesmus,

ENDOCERVICAL
MICROBIOLOGY:
Gram ve
intracellular
diplococci

DOXYCYCLINE
100mg/12h PO 7days

OFLOXACIN 400mg/d
7d

PID
Infertility
Ectopic
Pragnany PROM,
late miscarriage
Neonate
conjunctivits,
pneaumonia

Pregnancy
Azithromycin as above
Erythromycin 500mg
bd 14d

Perihepititis
adhesions btwn liver
capsule and ant abdo
wall.

CIPROFLOXACIN
500mg PO stat

Acute prostitis
Epidiymo-orchitis
Bartholns gland
abscess
PID
Perihepititis
Systemic septicaemia
(petechiae, hand/foot
pustules, arthritis,
fever reiters)
Opthalmia
neonatorum
Infertility

AZITHROMYCIN 1g
po (single dose)

CEFTRIAXONE
250mg IM stat
OFLOXACIN 400mg
PO stat
CEFIXIME 400mg
Postat
(50% concomitant so
trat also)

GENITAL HERPES HSV 1

HSV- 2

Irritable lesions
rupture to form small,
tender ulcers on
ex.genitalia

PAP SMEAR

ACICLOVIR 200mg
OD 5d
FAMCICLOVIR
250mg 8hrly

Lesions at urethra,
vagina, cervix,
perianally, anus with
assoc dysuria,
vaginal/urethral
discharge, pain.

VALACICLOVIR
500mg 12hrly
Pregnancy- aciclovir

HSV in neonateseptic, dissemination

to lungs, liver &
CNS.

Constitutional fever,
headache, malaise
Dermatome based
ANOGENITAL
WARTS

HPV-6
HPV-11

Subclinical infection
Warts on penis, vulva,
vagina, cervix,
perineum or anus.
Oral warts

Urinary retention
(autonomic
neuropathy)
aseptic meningitis
recurrent episodes
particularly with
stress.
Prodromal synirritation, burning,
neuralgic pains

CYTOLOGY:
HPV changes
Koilocytotic cells

Use barrier
contraception ~3m.
0.5% podophyllotoxin
soln 12h/ 3d, 4days rest
fro 4 weeks
topical 90%
trichlloroacetic acid
wkly

SYPHILIS

Treponema Pallidum

PRIMARY
Incubation 14-28d
CHANCRE painless,
ulcerated lesion
ENLARGED LYMPH
NODESmobile,descrete,rubbery
SECONDARY
6-8 wks post chancre
due to dissemantion =
multisystem disease.
RASH palms and
soles feet, (initially
macular on trunk and
limbs)
FEVER< MALAISE
CONDYLOMATA
LATA papules
coalesque to plaques
(warm moist areas ie.
vulva, perianal area)
MUCOSAL PATCHES
genitalia, mouth,
pharynx larynx, eroded
papules.

SEROLOGY:
Non treponemal test:
IgG and IgM levels
using cardilolipn
antigen
Often ve in pt with
just chancres
Treponemal test:
FTA-ABS test
t.pallidum
immobilized
Both +ve by 3m

PROCAINEBENZYLPENICCILLIN G,
1.2MU IM 12d
BENZATHINE PEN G
Or
ERYTHROMYCIN
(early)
DOXYCLYCLATE
HYCLATE (late)

Others = meningitis,
ureittis, CN palsy,
gastritis, hepatitis
LATE/TERTIARY
3-10yrs post infection
CHRONIC
GRANULOMATOUS
LESIONS gumma at
skin, muous mem,
bone , muscle, vulva
involvement tongue
may cause leukopenia +
rsik malignant change.
ARGYLE
ROBERTSON PUPIL
small and not constrict
to light.
DEMUSSET pigeon
head bob
NEUROSYPHILLIS
meningovascular
syphilis = stroke
CARDIOSYPHILLIS
aortic aneurysm, AR.

HX in GUM CLINIC
PC

vaginal discharge
- how much
- colour
- smell
Vaginal irritation itchiness, soreness, redness
Dysuria
Dyspareunia
Post-coital bleeding
IMB
Pelvic pain

HPC how long?, how much? Etc..

Sexual Hx

PMC
Drug Hx

no of partners or recent change of partner?

Casual vs regular
Type of sex ie. oral, active, passive
Use barrier contraception?
Travel hx
Recent or previous STI infection or test (result and treatment)