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Yeah, hi everyone. Welcome to your first um lecture of the Ong series. And today we have Shagan with us a final year medical student at Imperial and she will be talking you through gyne infections today. So I'll hand over to her. Thank you, Ivy. Hello everyone. So as she just said, I'm sha um one of the final year medical students. So I'm uncovering gyne infections today. Just give me a moment. I'm gonna share my screen. Um If you guys have any questions at any point of time, just put it in the chart and I'm sure um we'll be able to get some answers to that. Um I do have like three questions, so I think we're gonna be putting up those and we can answer those as well. And I'm really sorry if there would be any technical difficulties. This is my first time doing a lecture on meal. So, you know, please bear with me if there are any. So I'm just gonna share my screen now and hopefully you guys can see that if someone can confirm for me. Yeah, we can see it. Perfect. Sounds good. So as I said, today's lecture is on gynae infections. Um It's basically um a very short topic so it shouldn't really take the full hour um to cover, but it is a very important topic because usually questions will come up on this and it's a, it's a very scoring, very easy topic to gain marks on as well because it's usually very buzz worthy. They usually don't try to trick you in this. Um and not just for fifth year, but also for final years on a KT S as well. It's a very, it's a very major hot topic. And the questions that I've tried to include have been a little bit a KT oriented so that you guys can start getting used to that as well. A little bit. OK? Um So I am man, as we just said, I'm finally your medical student at Imperial. This is my email. If anybody has any questions after the lecture as well, you can write me an email and I'll be happy to help you. OK? So this is just a session structure slide. These are the icons I will be using to guide you through the session. Um Let me know if I'm going too fast as well and I'll slow down or I'll stop at any point. Ok. So the main presentation that usually gyne infections cover is abnormal vaginal discharge. Um And usually it's caused by ST is Candida trichomonas or BB, which is bacterial vaginosis. Um These are the basically topics that we're gonna cover later on in the session. This is essentially just like uh what you're gonna achieve out of the session slide. So, don't worry too much about it. Um Usually you'll get tiny infections and vaginal discharge presenting with a change in color, smell, consistency of the discharge. So that's something very important that you need to elicit in the history in your basis exam. If that is the presenting complaint. um If it comes in your written as well, the buzzwords will usually be around the color smell or consistency of the discharge. So make sure you have a look out for that. Um One of the other things in the history would be new or multiple sexual partners. So it's very important to take a full sexual history for anybody who's coming in with an abnormal vaginal discharge in your bases. Um And also keep a look out for that in your questions stems as well because if it's new or multiple sexual partners, it's most like more likely to be um an sti as compared to something non ST like BB, OK, they can also present with pain or bleeding. This really depends upon um Ati to ati. So it's quite rare. Um It's probably the lesser important thing to ask, but again, because if they're coming with pain, um that you need to ask for bleeding because it could be ectopic pregnancy which presents in a very similar way sometimes as well. OK, for your investigations. Throughout this le uh throughout this lecture, we're gonna use the bedside bloods imaging approach, which is the approach that you need to basically use in your basis exams as well or um the clinical exams that you guys will have essentially at the end of this year. Um And so just make sure that the main things if it, if a station like this does come is that you keep in mind a speculate speculum exam with triple swabs and ph testing. Um That's the less important one, but speculum exam and triple swabs are definitely the two most important investigations for an abnormal vaginal discharge. Um bloods, it will depend upon whether the etiology asks for bloods or not. So we'll get through that in this lecture as well going forward and the management also will depend upon what's the cause of the discharge. So we'll go through that in more detail in the next few slides. So, coming up next, there's a question. Um So essentially the question asks, a 24 year old woman that comes into A&E complaining of severe pain in her abdomen. She also complains of experiencing some abnormal discharge after having unprotected intercourse with a new partner around three weeks ago. On examination, there is generalized tenderness in her lower abdominal region. What is the next most important step in her management? And these are the options. So the first option is arrange a transvaginal ultrasound. The second one is arrange triple swabs of her vagina and cervix. Uh You can also conduct a bimanual examination to check for cervical excitation. You can arrange a urine pregnancy test and you can also arrange blood tests to check for inflammatory markers and white cell count. But essentially what the question is asking is, what is the next most important step in her management? So I think there'll be a pool in the chart coming up that you guys can select your answer on. And then if somebody is able to tell me what the most popular answer is, then we can move on. So I'll give you guys 30 seconds after the pool is live, do on. So that we have D as the most common answer. And also some people are choosing B as well. B Yeah, but D is the most common D is the most common answer. OK. So like let's have a look. So D is the correct answer so well done to all of you who selected D um The reason why this is the correct answer is that in the questions time, you can see that she's presenting with severe pain and she's also had unprotected intercourse with a new partner three weeks ago. So when there is pain and unprotected intercourse, the first thing in any gyne presentation, you'll definitely arrange a urine pregnancy test because it could be an ectopic pregnancy, which is a medical emergency. She also has generalized tenderness in her lower abdominal region, which also could be an ectopic pregnancy. And I know that this is um a a Gyne infections lecture. But this question is just to uh reinforce the fact that in your finals and in your AKT S as well, even if the question stem does try to lead you towards an abnormal discharge infectious type situation. The next most important step or the first most important step is a urine pregnancy test. So you're always going to select that before going down the infectious side of things. Um Just to make sure if it's uh an ectopic pregnancy or not because if it is an ectopic pregnancy, it can be extremely dangerous. It can also lead to mortality. So you need to rule that out first um after you're done with the pregnancy test and yes, you're gonna go ahead and you're gonna do a, a bimanual examination or you can do a triple swab or all of those things. All of the correct, all of the answers are correct here. You will do all of this for this presentation. It's just asking for the next most important step, which is why we arranged a urine pregnancy test. Is that clear? Does anybody have any questions about that? No, we don't have any questions in the chat. Perfect. So yeah, just, just a takeaway message from this is no matter what Gyne presentation you're thinking of the first test that you're always going to select in your SBS is a urine pregnancy test if that is one of your options. And then after that, you can do all the other tests that you want to do just to make sure that, that the woman you're treating is not pregnant. Because also, even if it's not that relevant to the presentation itself, if she's pregnant, the management might change as well. So you need to know whether she's pregnant or not. Ok. Ok. Now we're gonna start talking about pelvic inflammatory disease. This is the most important topic um of all in the gyne infections sort of presentation, um and conditions as well. So make sure you know your pelvic inflammatory disease really well. Um So just to give some background into pelvic inflammatory disease or PID, as I'll start calling it, it's essentially infection or inflammation of the female reproductive tract, which usually ascends from the lower genital tract. So, anything that causes an infection of the lower genital tract can then ascend upwards towards your uterus, which can cause endometrial or your fallopian tubes causing chest salpingitis or your ovaries causing ovaritis. Um and also in your peritoneum, which is the last stage of PID, which is the most extensive one as well and presents with systemic symptoms. It's most commonly caused by STIs s as you can imagine. So, gonorrhea or chlamydia, um and the risk factors include previous bid. So, in all gyne presentations and conditions, if they've had it once before they have a higher chance of having it again. So that would be a first risk factor. Um vaginal do IUD insertion because sometimes people cannot follow the sterile technique properly. Or sometimes um even if you do follow the sterile technique properly, you can introduce an infection that has been indwelling in your vagina, that's not been causing any symptoms. But because you're inserting the IUD through the endocervix, it can then introduce that infection into your uterus. Essentially, it can be iatrogenic. So make sure you ask about whether they've had any gyne surgeries in the past, especially any termination of pregnancy. Um because that can introduce the infection as well from the vagina into the uterus. Um and it can also be any retained products of conception. So, after delivery or after a miscarriage, then you know, those things can cause endometritis as well. So you need to ask whether they