Obs. and Gynae. Forum

24/10/2022

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28/09/2022

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26/09/2022

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13/09/2022

Good morning family..For today guys

SYPHILIS
This is a Sexually transmitted infection caused by the bacterium Treponema pallidum.

AETIOLOGY
Transmission is by s*xual contact, blood-borne, or vertical (conge***al syphilis).

ASSOCIATIONS/RISK FACTORS
Unprotected s*x, multiple s*xual partners, HIV.

EPIDEMIOLOGY
Uncommon but increasing: 2680 cases in the UK in 2007.

HISTORY
Primary syphilis
Painless but infectious lesions on skin (chancres) develop after an incubation period of 10–90
days, disappear spontaneously after 1 week.
Secondary syphilis
1 to 10 weeks after appearance of the chancre, development of macular-papular skin rash,
sore throat, fever, headache, arthralgia.
Tertiary syphilis
1 to 20 years after initial infection, can develop into neurosyphilis (paresis, dementia,
psychosis, epilepsy, tabes doralis), cardiovascular syphilis (aortitis, aortic regurgitation, heart
failure, angina), gummatous syphilis (granulomatous lesions in skin, bone).

EXAMINATION
Primary: Painless ge***al chancre (papule, often ulcerated) with regional lymphadenopathy.
Secondary/tertiary: Examine skin, mucosal membranes, lymph nodes, neurological and
cardiovascular systems.

PATHOLOGY/PATHOGENESIS
Treponema pallidum is a spirochaete that survives only briefly
outside the body. Requires direct contact with an infected part of the body for transmission.
Invades abraded skin or mucous membranes and disseminates rapidly via blood or lymphaticsystem.

INVESTIGATIONS
Blood: RPR and VDRL, can give false positive results (e.g. with EBV, TB, lymphoma, malaria),
therefore combine with TPHA and FTA-ABS which are more specific based on monoclonal
antibodies and immunofluoresence.
Microbiology: Microscopy offluid from primary/secondary lesions(with dark-field illumination).

MANAGEMENT
Antibiotics: Penicillin G (first choice) or oral tetracycline or doxycycline (contraindicated in
pregnancy).
Follow-up: Clinically and serologically at 1, 2, 3, 6 and 12 months and then 6-monthly until
seronegative.
Other: Contact tracing, requires full STI screen
COMPLICATIONS
Cardiovascular disease, CNS disease, Jarisch–Herxheimer reaction (febrile
reaction to treatment with fever, chills, myalgia), conge***al syphilis, " susceptibility to HIV.

07/09/2022

Endometriosis
DEFINITION Presence of endometrial tissue outside the uterus.
AETIOLOGY Suggested theories include: (i) retrograde menstruation (Sampson�s theory), the
passage of endometrial tissue through the fallopian tubes into the pelvis during
menstruation; (ii) metaplasia of coelomic epithelium into endometrial glands (Meyer�s
theory); (iii) vascular and lymphatic dissemination; (iv) immune; (v) genetic.
ASSOCIATIONS/RISK FACTORS Nulliparity, family history, short menstrual cycle, long
periods.
EPIDEMIOLOGY Affects 10–15% of women of reproductive age.
HISTORY Cyclical dysmenorrhoea (starting premenstrually and reaching peak at onset of
menstruation), dyspareunia, chronic pelvic pain, infertility. Rarely symptoms of involvement
of other organs/distant sites: cyclical haematuria, PR bleed, epistaxis, haemoptysis.
EXAMINATION
Vaginal: (Often unremarkable) pelvic tenderness, immobile uterus, tender uterosacral
ligaments, palpable uterosacral nodules.
PATHOLOGY/PATHOGENESIS Ectopic endometrial tissue induces a chronic, inflammatory
reaction. Can cause fibrosis/adhesions. Classic ‘Powder-burn’ or ‘gun-shot’ lesions seen on
pelvic surfaces. On the o***y, an endometriotic cyst can form which enlarges with blood
during each menstrual cycle (endometrioma/chocolate cyst).
INVESTIGATIONS
USS: Endometrioma, differential diagnosis.
Laparoscopy: Gold standard for diagnosis.
MANAGEMENT
Medical: Analgesia (NSAIDs), suppression of ovulation (COCP, progestogens, Mirena IUS,
GnRH analogues).
Surgical: Laparoscopic ablation/excision of lesions, adhesiolysis, ovarian cystectomy, rarely
TAH/BSO (last resort).
COMPLICATIONS Ovarian cyst accident (endometrioma), infertility, chronic pelvic pain,
adhesions, s*xual dysfunction.
PROGNOSIS Medical management improves symptoms in 80–90%, but recurs if treatment
stopped. Symptoms subside in pregnancy and menopause.

05/09/2022

Dyspareunia
DEFINITION Pain during in*******se.
AETIOLOGY May be organic or may have psychological elements.
ASSOCIATIONS/RISK FACTORS
Superficial dyspareunia
Infection (Candida, Trichomonas etc.), atrophy (e.g. menopause, breastfeeding), vaginismus
(involuntary contraction of the vaginal muscles preventing pe*******on), vulval vestibulitis
syndrome (chronic inflammation of the vestibule with pain and erythema), dermatological
disorders (e.g. lichen sclerosis, lichen planus), scarring (e.g. episiotomy), conge***ally narrow
hymenal ring, vaginal stenosis (e.g. postoperative), vaginal septum, s*xual inexperience.
Deep dyspareunia
PID, endometriosis, chronic interstitial cystitis, fixed uterine retroversion, pelvic congestion
syndrome, pelvic adhesions, ovarian cyst.
EPIDEMIOLOGY Difficult to estimate (under-reporting): >50% of women estimated to
experience occasional dyspareunia, 25% may experience it regularly.
HISTORY Superficial or deep pain during or after in*******se, may have symptoms of
underlying organic cause or psychos*xual issues.
EXAMINATION
Abdomen: Findings related to deep causes for example masses (rare).
Vulvovaginal inspection: Evidence of infection, evidence of dermatoses, scarring, hymenal
defects, anatomical abnormalities.
Vaginal: Uterine position, mobility, masses, rectovaginal/uterosacral nodules.
PATHOLOGY/PATHOGENESIS Dependent on cause.
INVESTIGATIONS
Microbiology: HVS, endocervical/Chlamydia swabs (exclude infection).
Imaging: Pelvic USS (deep dyspareunia).
Other: Diagnostic laparoscopy (endometriosis, adhesions).
MANAGEMENT Dependent on cause.
Superficial dyspareunia
Infection: Relevant antibiotics.
Dermatoses: For example lichen sclerosis may require topical steroids.
Atrophy: Topical oestrogens/HRT.
Anatomical abnormalities: Surgery.
Vulvar vestibulitis syndrome: Steroids, physiotherapy, low-dose amytriptyline,
vestibulectomy.
Vaginismus: Physiotherapy/dilator therapy psychos*xual counselling.
Deep dyspareunia
Adhesiolysis, ovarian cystectomy, treatment of endometriosis, treatment for interstitial
cystitis.
COMPLICATIONS Psychos*xual issues, relationship issues, complications related to organic
causes.
PROGNOSIS Dependent on cause, may respond to treatment (e.g. superficial infection and
atrophy). Persistent dyspareunia can be extremely difficult to manage.

04/09/2022

Dysmenorrhoea
DEFINITION Painful menstruation.
AETIOLOGY
Primary: Occurs in the absence of pathology
Secondary: Identifiable underlying pathology.
ASSOCIATIONS/RISK FACTORS
Primary: Time period shortly after menarche.
Secondary: Endometriosis, adenomyosis, PID, pelvic congestion syndrome, menorrhagia,
fibroids.
EPIDEMIOLOGY Affects 45–95% of women of reproductive age.
Primary: Commonly young girls soon after establishing me**es.
Secondary: Any time after menarche, commonly in 20s or 30s.
HISTORY Spasmodic cramping lower abdominal pain, may have radiation to thighs/lower
back.
Primary: Onset with menstruation or within 24 hours, resolves within 8–72 hours.
Secondary: May occur prior to and peak with onset of menstruation.
EXAMINATION
Primary: Abdominal/vaginal examination often unremarkable.
Secondary: Findings are specific to underlying cause.
PATHOLOGY/PATHOGENESIS
Primary: Prostaglandin F2a causes uterine hypercontractility and myometrial ischaemia,
uterine contractions cause further ischaemia.
Secondary: Dependent on cause (also likely to be related to prostaglandins).
INVESTIGATIONS
Microbiology: HVS, endocervical/Chlamydia swabs (exclude infection).
Imaging: Pelvic USS (?fibroids, assess endometrium if associated menorrhagia).
Other: Laparoscopy (endometriosis).
MANAGEMENT
Analgesia: NSAIDS (e.g. mefenamic acid), paracetamol and codeine preparations.
Hormonal methods: COCP, progestogens, GnRH analogues (e.g. severe endometriosis).
Surgery: Laparoscopic ablation of endometriosis, hysterectomy rare (severe intractable cases
if family complete).
COMPLICATIONS Limitation of activities of daily living.
PROGNOSIS Primary – excellent with simple methods; secondary – dependent on cause.

19/08/2022

Decreased Ovarian Reserve is another ovarian cause of female infertility.
It means decreased functioning follicles in the ovaries.
This can be accessed via ovarian reserve tests, which are to asses the quantity and quality of primordial follicles in a woman's o***y.
These tests include;
1. Day 3 serum FSH levels
2. Serum Inhibin B levels
3. Clomiphene citrate challenge test
4. Serum Antimullerian hormone (AMH)
5. Antral Follicular count.(AFC)

Note;. AFC is the best quantitative marker of ovarian reserve
AMH is the best overall marker of ovarian reserve

14/08/2022

Anovulation
This is a major the commonest ovarian cause of female infertility. It is easily treatable and reversible.
This can be diagnosed via the following
1. Endometrial biopsy
2. Hormone estimation
A. Day 21 serum progesterone levels Ina regular 28 days cycle
B. Serum LH estimation
3. Follicular monitoring on transvaginal scan

06/08/2022