Presentation on theme: "1 Genitourinary Medicine For GPs November 2007. 2 Agenda Recent changes How to take the necessary swabs Brief overview STIs What can be done in General."— Presentation transcript:
10 DIAGNOSIS (chlamydia) Women endocervical swab gives best specimen Urethral swabs will identify additional 10- 20% Men urethral swab (painful!) ELISA vs PCR Urine testing
11 WHAT CAN I DO IN PRACTICE? (chlamydia) 1. POSITIVE RESULT BACK Treat patient Contacts need treatment Advised no SI until both partners treated Can refer to clinic for full tests Guidelines say only retest if symtomatic/possibility of reinfection at 3 weeks
12 TREATMENT (chlamydia) Doxycycline 100mg bd 7 days Azithromycin 1g orally as single dose Erythromycin 500mg qds 10 days (pregnancy) Ofloxacin 200mg bd 7 days
19 WHAT CAN I DO IN GENERAL PRACTICE? Refer any patients with confirmed GC on swabs to GUM Refer any acute urethral discharge Refer contacts of GC to GUM for treatment and ix Refer females with lower abdominal pain
20 TREATMENT (gonorrhoea) Cefixime 400mg oral as single dose Ciprofloxacin 500mg stat Spectinimycin 2g IM single dose Ceftriaxone 250mg IM ( pregnancy)
21 FOLLOW UP 2 Weeks TOC in clinic Pregnant women, symptomatic patients Check contacts have been treated/tested Be aware of possible co-infection with chlamydia
24 NSU Male urethritis in the absence of gonorrhoea Mucopurulent cervicitis equivalent condition in female 30-50% due to chlamydia 20% due to mycoplasma genitalium
25 Clinical Features Urethral discharge, dysuria, irritation (M) Vaginal discharge (usually asymptomatic) DIAGNOSISMicroscopy Swabs, check for chlamydia
26 TREATMENT Doxycycline 100mg bd for 7 days Azithromycin 1g as a single dose Treat contacts
27 GENITAL HERPES HSV 1/ 2 Common Incubation period 1-2 weeks Asymptomatic shedding Chronic condition Psychological aspects
28 CLINICAL FEATURES Painful ulceration, dysuria, vaginal or urethral discharge May be systemically unwell Blistering/ulceration external genitalia Inguinal lymphadenopathy COMPLICATIONS: urinary retention, aseptic meningitis
29 DIAGNOSIS Isolation of HSV from genital lesions Often a clinical diagnosis Serology, not routinely done
30 WHAT CAN I DO IN GENERAL PRACTICE? Take a viral culture swab General advice: saline bathing, analgesia, topical anaesthetic, petroleum jelly Start oral antiviral drugs (within 5 days) Aciclovir 200mg five times a day for 5 days Psychological support Arrange F/U GUM 3-4 weeks for full tests
35 GENITAL WARTS Human papillomavirus (HPV) >90 genotypes Nearly always sexually transmitted Common Difficult and time consuming to treat Certain types associated with cervical dysplasia Benign epithelial skin tumours
36 DIAGNOSIS Most cases naked eye examination Colposcope helps May need biopsy if dx uncertain
37 What can I do in General Practice? Refer GUM for full assessment Will not need urgent assessment if no other symptoms present You can give warticon lotion/cream if confident of dx
38 TREATMENT IN CLINIC All treatments have significant failure and relapse rates Podophyllin, trichloroacetic acid, cryotherapy Home treatments are warticon and aldara (imiquimod) (HPV vaccine)
43 TRICHOMONAS Flagellated protozoan Almost exclusively sexually transmitted Female symptoms: discharge, itching, odour, abdo pain. 10-50% are asymptomatic Male symptoms: urethral discharge/ dysuria. 10-50% asymptomatic
44 Diagnosis/Management (trichomonas) HVS Direct observation wet smear More difficult to culture in men Treat sexual partners simultaneously Metronidazole 400mg bd 5-7 days or 2g stat Refer GUM for full tests
46 Bacterial Vaginosis The commonest cause of vaginal discharge in women childbearing age Replacement of lactobacilli and raised Ph Not regarded as sexually transmitted
47 SYMPTOMS/SIGNS 50% women asymptomatic fishy vaginal discharge Thin/white discharge In pregnancy BV is associated with late miscarriage, preterm birth, preterm premature rupture of membranes, post partum endometritis
49 What shall I do in general practice? Treatment is indicated for symptomatic and pregnant women You do not have to treat asymptomatic women but can offer treatment General advice re vaginal douching, use of soap etc Treatment: metronidazole 400mg bd for 5-7 days or 2g stat Clindamycin cream 2% daily 7 days, metronidazole gel 0.75% daily 5 days
50 Vulvovaginal Candidiasis Candida. albicans approx 90%, candida.glabrata approx 10% 10-20% women of childbearing age may harbour candida species in the absence of symptoms. They do not require rx Symptoms/signs Beware the woman with recurrent thrush Do a HVS
51 Management Avoid local irritants/synthetic clothing Treat with topical and oral azole therapies (clotrimazole/fluconazole) Nystatin for non albicans species No evidence to support treatment of asymptomatic male partners Recurrent candidosis
55 CASE 1 Kylie is a 15yr old girl who complains of intermenstrual spotting for the last 2 months. You see from her records she attended surgery 3 months ago and was prescribed mercilon. How would you manage her? ( mercilon is a low strength COCP)
56 Case 2 Susan is a 45 year old lady married lady. She has had three prescriptions for clotrimazole and one for oral fluconazole for her thrush. She is quite upset that she is still symptomatic. What do you do?
57 CASE 3 Tina is a 48 year old lady who attends surgery with a 2 day history of vulval soreness. On examination you notice a crop of blisters to the vulva. How do you proceed?
58 Case 4 Delia is a 32 year old woman who presents with a 5 day history of abdominal pain, discharge and painful intercourse. The pain is now so severe she is unable to have intercourse. How would you manage her?
59 Case 5 Frank is a 28 year old man. In the last 2 weeks he has noticed some lumps on his penis. They are not sore are itchy. He was not going to bother the doctor, but his new boyfriend made him the appointment.