Infection Clinical features Complications
Chlamydia trochomatis - 70% asymptomatic
- Obligate - PCB or IMB
intracellular - Purulent vaginal
parasite discharge
- 3-5% sexually - Lower abdominal
active women and pelvic pain
- Cervicitis
- Dysuria
Neisseria gonorrhea - 50% asymptomatic
- Gram negative (female)
diplococcus - Mucopurulent vaginal
- discharge
- Lower abdominal
pain
- Men =
dysuria/urethral
discharge
Trichomonas vaginalis - Malodourous vaginal
- Flagellate discharge
protozoan - Vulval, vaginal itch
- Dysuria
- Cervicitis (strawberry
cervix”
Bacterial vaginosis - Fishy smelling grey
- Commonest vaginal discharge
cause of abnormal - Recurrence common
vaginal discharge
- Overgrowth of
anaerobic bacteria
- Gardnerella
Diagnosis Treatment
- PID (10-40%) - NAATs tests - Azithromycin single
- Tubal infertility (PCR) – gold dose 1g
- Ectopic pregnancy standard Or
- Chronic pelvic pain - 95% sensitivity - Doxycycline 100mg
- Perihepatic adhesions Suitable samples bd x 7 days
(Fitz-Hugh-Curtis - Endocervical Or
syndrome) swab - Erythromycin
- Reactive arthritis - Urine (first void 500mg bd x14 days
(Reiters syndrome) specimen) - Notifiable infection
- Vertical transmission - Vulvovaginal - Partner must be
from mother to baby in swab screened and
labour – neonatal treated
conjunctivitis and - Follow up to ensure
pneumonia negative
- PID - Endocervical swab - Ciprofloxacin or
- Epididymo-orchitis Ofloxacin
(men) - Full sexual health
- Vertical transmission screen
may occur – severe
neonatal conjunctivitis,
sepsis, arthritis
- Enhanced HIV - Swab from - Metronidazole 2mg
transmission posterior fornix stat or 500mg BD x
- Problems in pregnancy - Microscopy – 7 days
– preterm delivery flagellate
organisms seen
- Post-hysterectomy - Characteristic - Metronidazole (oral
vaginal cuff infection discharge or intravaginal)
- Infection following - Microscopy: clue - Can be
termination of cells administered if
pregnancy - Vaginal pH >4.5 detected on HVS in
- Preterm delivery - Fishy odour on pregnancy
- Chorioamnionitis adding alkali to
 Infection Clinical features Complications Diagnosis Treatment
vaginalis - Postpartaum slide
- Replace endometritis
lactobacilli and
alter pH of vagina
(7.0)
- Not sexually
transmitted
Candida albicans - Vulval itching, - Clotrimazole
(thrush) soreness (Canensten) –
- Very common – - White cheesy cream or pessary
yeast that can be discharge - Fluconazole
found as a - Superficial (Diflucan) – single
commensal dyspareunia oral dose
organism - Inflammed vulva and (contraindicated in
- May or may not be vagina pregnancy
sexually Risk factors
transmitted - Pregnancy
- May colonise - Diabetes
vagina by spread - COCP
form perineum - Antibiotics use
causing infection
Herpes simplex virus - Painful vulval - Typical vesicles Primary occurrence
(type 1 or 2) ulceration and ulcerations of - Antivirals only
- HSV2 commonly - Vaginal discharge vulva effective if started
affects genitals - Dysuria - Swab fluid form within 5 days of
- HSV1 – orolabial - Urinary retention vesicles – viral onset of attack
herpes - Flu-like symptoms culture - Acyclovir or
- 10% of population - Lymphodema Famcyclovir
has had genital - Recurrences less (reduce severity
herpes severe and become and duration of
- After primary less frequent over episodes)
infection virus time - Analgesia
remains dormant - May require
in local sensory hospitalization and
ganglia catheterization if
- Reactivates urinary retention
 Infection Clinical features Complications Diagnosis Treatment
periodically - May require
antibiotics if
secondary infection
Secondary occurrence
- COCP to avoid
menstruation
- Avoid tampon use
- Suppressive low
dose antiviral
treatment
Syphillis Primary Investigations - GUM clinic
- Veneral syphilis – - Local ulceration - Dark ground - Partner, children
contagious, (chancre) microscopy from screening
systemic disease - Highly infectious the ulcer - Benzathine
caused by - May be - Serological tests penicillin or
Treponema asymptomatic (on - Specific (TPPA, Procaine peniilin
pallidum cervix) TPHA) – used for - Penicillin allergy –
- Incubation 9-90 Secondary screening doxycycline
days - Systemic disease - Non specific - In pregnancy –
- Develops after 1-6 (VDRL, RPR) – penicillin effective in
months measure disease treatment of syphilis
- Skin involvement: activity, and prevention of
generalized, non- monitoring congenital syphilis
itchy lesions which treatment and
can be macular, diagnosing re-
papular and rarely infection
pustular
- Early latent – asymp
<2yrs
- Late latent – asymp.
>2yrs
Tertiary
- Late symptomatic
- Symptomatic
cardiovascular
syphilis
 Infection Clinical features Complications Diagnosis Treatment
- Neurosyphilis
- Gummatous syphilis
Congenital
- Vertical transmission
Genital warts - Painless lumps in - Association with - Clinical - Do nothing
- Condyloma anogenital area cervical neoplasia - Biopsy if unsure - Condom use
accuminata - Very important to do reduces
- Caused by HPB smear test 3-yearly transmission
(6,11) benign - Warts often increase in - Local treatment:
genital disease pregnancy – treatment podophyllin 0.5%
post partum bd x3/7
- Cryotherapy or
electrocautery
- Laser

Pelvic inflammatory - Lower abdominal - Chronic pelvic pain - High vaginal - May require
disease pain - Infertility swab hospitalisaion and
- Ascending - Dyspareunia - Ectopic pregnancy - Endocervical IV broad spectrum
infection from - Vaginal discharge swab antibiotics to cover
vagina to uterus - Abdominal bleeding - Early morning gonorrhea and
(endometritis), - Pyrexia >38oC urine for chlamydia
fallopian tubes - Bloods – increase Chlamydia PCR - May require
(salpingitis) and WCC CRP - Causative laprascopy – pelvic
peritoneal cavity - Lower abdominal organisms not adhesions,hydosalp
- Usually caused by tenderness always cultured inx, hydrosalpinx,
N.gonorrhoea or - Adnexal tenderness on swabs tuboovarian
C.trachomatis and cervical abscess
excitation - Patients and
Risk factors partners must have
- Age <25 full STI scnree
- Mutiple sexual
partners
- History of STO
- Termination of
pregnancy – septic
abortion
 Infection Clinical features Complications Diagnosis Treatment
- IUCD insertion in
preceeding 6 weeks
HIV - - Kaposi’s sarcoma - Investigation – - GUM clinic
- Retrovirus - Non-Hodgkin’s PCR (viral load = - HAART – indicated
- Transmission – lymphoma viral RNA), CD4 with low CD4 count
sexual, vertical, - Opportunistic infections count and high viral load,
parenteral - Neurological partner notification
- Causes immune complications Post-exposure prophylaxis
dysfunction as it – Triple ART x 1mo
infects T helper - Start as soon as
cells possible, ideally
within 1 h
- Follow up specialist
centres
- HIV testing at 3 and
6 months