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Reproductive Health (Y4) > 10- Sexually transmitted disease (bacterial) > Flashcards

10- Sexually transmitted disease (bacterial) Flashcards

1
Q

Bacterial vaginosis

A

overgrowth of anaerobic bacteria in the vagina
- Gardnerella vaginalis
- Mycoplasma hominis

can occur alongside other infections: candidiasis, chlamydia, gonorrrhoea

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2
Q

RF for BV

A
  • Multiple sexual partners (although it is not sexually transmitted)
  • Excessive vaginal cleaning (douching, use of cleaning products and vaginal washes)
  • Recent antibiotics
  • Smoking
  • Copper coil
    Bacterial vaginosis occurs less frequently in women taking the combined pill or using condoms effectively.
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3
Q

presentation of BV

A
  • grey/ white vaginal discharge
  • fishy smelling
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4
Q

investigations for BV

A
  • pH >4.5
  • vaginal swab for microscopy
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5
Q

findings on microscopy for BV

A

“clue cells’
epithelial cells from the cervix that have bacteria stuck inside them, usually Gardnerella vaginalis

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6
Q

management of BV

A

oral metronidazole

  • swab for chlamydia and gonorrhoea where appropriate
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7
Q

complications of BV

A

Bacterial vaginosis can increase the risk of catching sexually transmitted infections, including chlamydia, gonorrhoea and HIV.

It is also associated with several complications in pregnant women:

  • Miscarriage
  • Preterm delivery
  • Premature rupture of membranes
  • Chorioamnionitis
  • Low birth weight
  • Postpartum endometritis
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8
Q

cause of thrush

A

Candida albicans

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9
Q

risk factors for candiasisis

A
  • Increased oestrogen (higher in pregnancy, lower pre-puberty and post-menopause)
  • Poorly controlled diabetes
  • Immunosuppression (e.g. using corticosteroids)
  • Broad-spectrum antibiotics
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10
Q

presentation of thrush

A
  • Thick, white discharge that does not typically smell
  • Vulval and vaginal itching, irritation or discomfort
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11
Q

thrush complications

A

Erythema
Fissures
Oedema
Pain during sex (dyspareunia)
Dysuria
Excoriation

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12
Q

investigations for thrush

A

Testing the vaginal pH using a swab and pH paper can be helpful in differentiating between bacterial vaginosis and trichomonas (pH > 4.5) and candidiasis (pH < 4.5).

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13
Q

management of thrush

A
  • Antifungal cream (i.e. clotrimazole) inserted into the vagina with an applicator
  • Antifungal pessary (i.e. clotrimazole)
  • Oral antifungal tablets (i.e. fluconazole)
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14
Q

thrush and canestan duo

A

Canesten Duo is a standard over-the-counter treatment worth knowing. It contains a single fluconazole tablet and clotrimazole cream to use externally for vulval symptoms.

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15
Q

chlamydia background

A
  • Chlamydia trachomatis is a gram-negative bacteria.
  • It is an intracellular organism, meaning it enters and replicates within cells before rupturing the cell and spreading to others.
  • Chlamydia is the most common sexually transmitted infection in the UK and a significant cause of infertility.
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16
Q

RF for chlamydia

A
  • young
  • sexually active
  • multiple partners
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17
Q

presentation of chlamydia in women

A

majority are asymptomatic

  • Abnormal vaginal discharge
  • Pelvic pain
  • Abnormal vaginal bleeding (intermenstrual or postcoital)
  • Painful sex (dyspareunia)
  • Painful urination (dysuria)
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18
Q

presentation if chlamydia in men

A
  • Urethral discharge or discomfort
  • Painful urination (dysuria)
  • Epididymo-orchitis
  • Reactive arthritis
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19
Q

national chlamydia screening programme

A

Public Health England has set out a National Chlamydia Screening Programme (NCSP). This program aims to screen every sexually active person under 25 years of age for chlamydia annually or when they change their sexual partner. Everyone that tests positive should have a re-test three months after treatment. This re-testing is to ensure they have not contracted chlamydia again, rather than to check the treatment has worked.

In general, when a patient attends a GUM clinic for STI screening, as a minimum, they are tested for:

  • Chlamydia
  • Gonorrhoea
  • Syphilis (blood test)
  • HIV (blood test)
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20
Q

investigations for chlamydia

A

Two types of swabs used in sexual health testing
- charcoal swabs
- nucleic acid amplification test (NAAT) swabs

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20
Q

investigations for chlamydia

A

Two types of swabs used in sexual health testing
- charcoal swabs
- nucleic acid amplification test (NAAT) swabs

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21
Q

charcoal swabs

A

allow for
- microscopy
- culture
- sensitivites

transport medium is called Amies transport medium, and contains a chemical solution for keeping microorganisms alive during transport.

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22
Q

microscopy involves

A

involves gram staining and examination under a microscope. A stain is used to highlight different types of bacteria with different colours

  • chlamydia gram staining
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23
Q

what can charcoal swabs be used for

A

Endocervical swabs and high vaginal swabs (HVS). Charcoal swabs can confirm:

  • Bacterial vaginosis
  • Candidiasis
  • Gonorrhoeae (specifically endocervical swab)
  • Trichomonas vaginalis (specifically a swab from the posterior fornix)
  • Other bacteria, such as group B streptococcus (GBS)
    *
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24
Q

Nucleic acid amplification tests (NAAT)

A
  • check directly for the DNA or RNA of the organism.
  • NAAT testing is used to test specifically for chlamydia and gonorrhoea.
    -They are not useful for other pelvic infections (except where specifically testing for Mycoplasma genitalium).
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25
Q

NAAT in women

A

In women, a NAAT test can be performed on a vulvovaginal swab (a self-taken lower vaginal swab), an endocervical swab or a first-catch urine sample. The order of preference is :
- endocervical
- vulvovaginal
- urine.

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26
Q

NAAT in men

A

In men, a NAAT test can be performed on a first-catch urine sample or a urethral swab.

It is worth noting that the NAAT swabs will specify on the packet whether the swabs are for endocervical, vulvovaginal or urethral use. A specific kit is used for first-catch urine NATT testing.

Rectal and pharyngeal NAAT swabs can also be taken to diagnose chlamydia in the rectum and throat. Consider these swabs where anal or oral sex has occurred.

Where gonorrhoea is suspected or demonstrated on a NAAT test, an endocervical charcoal swab is required for microscopy, culture and sensitivities.

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27
Q

exa mination findings for chlamydia

A
  • Pelvic or abdominal tenderness
  • Cervical motion tenderness (cervical excitation)
  • Inflamed cervix (cervicitis)
  • Purulent discharge
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28
Q

diagnosis of chlamydia

A

Nucleic acid amplification tests (NAAT) are used to diagnose chlamydia. This can involve a:

  • Vulvovaginal swab
  • Endocervical swab
  • First-catch urine sample (in women or men)
  • Urethral swab in men
  • Rectal swab (after anal sex)
  • Pharyngeal swab (after oral sex)
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29
Q

first line management for chlamydia

A

doxycycline 100mg twice a day for 7 day

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30
Q

management fo chlamydia during pregnancy and breastfeeding

A
  • Azithromycin 1g stat then 500mg once a day for 2 days
  • Erythromycin 500mg four times daily for 7 days
  • Erythromycin 500mg twice daily for 14 days
  • Amoxicillin 500mg three times daily for 7 days
31
Q

chlamydia ‘a test for cure’

A

A test of cure is not routinely recommended. However, a test of cure should be used for rectal cases of chlamydia, in pregnancy and where symptoms persist.

32
Q

other condsideration when chlamydia is diagnosed

A
  • Abstain from sex for seven days of treatment of all partners to reduce the risk of re-infection
  • Refer all patients to genitourinary medicine (GUM) for contact tracing and notification of sexual partners
  • Test for and treat any other sexually transmitted infections
  • Provide advice about ways to prevent future infection
  • Consider safeguarding issues and sexual abuse in children and young people
33
Q

Complications of chlamydia

A

There are a large number of complications from infection with chlamydia:

  • Pelvic inflammatory disease
  • Chronic pelvic pain
  • Infertility
  • Ectopic pregnancy
  • Epididymo-orchitis
  • Conjunctivitis
  • Lymphogranuloma venereum
  • Reactive arthritis

**Pregnancy-related complications include:
**
* Preterm delivery
* Premature rupture of membranes
* Low birth weight
* Postpartum endometritis
* Neonatal infection (conjunctivitis and pneumonia)
*

34
Q

Lymphogranuloma Venereum

A

Lymphogranuloma venereum (LGV) is a condition affecting the lymphoid tissue around the site of infection with chlamydia. It most commonly occurs in men who have sex with men (MSM).

LGV occurs in three stages:

1) The primary stage involves a painless ulcer (primary lesion). This typically occurs on the penis in men, vaginal wall in women or rectum after anal sex.

2) The secondary stage involves lymphadenitis. This is swelling, inflammation and pain in the lymph nodes infected with the bacteria. The inguinal or femoral lymph nodes may be affected.

3) The tertiary stage involves inflammation of the rectum (proctitis) and anus. Proctocolitis leads to anal pain, change in bowel habit, tenesmus and discharge. Tenesmus is a feeling of needing to empty the bowels, even after completing a bowel motion.

**Mangement **Doxycycline 100mg twice daily for 21 days is the first-line treatment for LGV recommended by BASHH. Erythromycin, azithromycin and ofloxacin are alternatives.

35
Q

Chlamydial Conjunctivitis

A

Chlamydia can infect the conjunctiva of the eye. Conjunctival infection is usually as a result of sexual activity, when genital fluid comes in contact with the eye, for example, through hand-to-eye spread. It presents with chronic erythema, irritation and discharge lasting more than two weeks. Most cases are unilateral.

Chlamydial conjunctivitis occurs more frequently in young adults. It can also affect neonates with mothers infected with chlamydia. Gonococcal conjunctivitis is a crucial differential diagnosis and should be tested.

36
Q

gonorrhea background

A
  • Neisseria gonorrhoeae is a gram-negative diplococcus bacteria.
  • It infects mucous membranes with a columnar epithelium, such as the endocervix in women, urethra, rectum, conjunctiva and pharynx.
  • It spreads via contact with mucous secretions from infected areas.
37
Q

RF for gonorrhoea

A
  • young
  • sexually active
  • multiple parnters
  • having other STIs such as chlamydia and IV
38
Q

why is gonorrhea concerning

A

There is a high level of antibiotic resistance to gonorrhoea. Traditionally ciprofloxacin or azithromycin was used to treat gonorrhoea. However, there are now high levels of resistance to these antibiotics.

39
Q

presentation of female gonorrhea

A
  • Odourless purulent discharge, possibly green or yellow
  • Dysuria
  • Pelvic pain
40
Q

presentation of gonorrhea in men

A
  • Odourless purulent discharge, possibly green or yellow
  • Dysuria
  • Testicular pain or swelling (epididymo-orchitis)
41
Q

rectal gonorrhea

A

may cause anal or rectal discomfort and discharge, but is often asymptomatic.

42
Q

pharyngeal gonorrhea

A

may cause a sore throat, but is often asymptomatic.

43
Q

prostatitis gonorrhea

A

causes perineal pain, urinary symptoms and prostate tenderness on examination.

44
Q

conjuctivitis gonorrhea

A

erythema and a purulent discharge.

45
Q

gonorhhea investigations

A

1) NAAT
2) charcoal endocervical swab

46
Q

gonorrhea and NAAT

A

is use to detect the RNA or DNA of gonorrhoea. Genital infection can be diagnosed with endocervical, vulvovaginal or urethral swabs, or in a first-catch urine sample.

Rectal and pharyngeal swab are recommended in all men who have sex with men (MSM), and in those with risk factors (e.g. anal and oral sex) or symptoms of infection in these areas.

47
Q

charcoal swabs and gonorrhea

A

A standard charcoal endocervical swab should be taken for microscopy, culture and antibiotic sensitivities before initiating antibiotics. This is particularly important given the high rates of antibiotic resistance.

48
Q

why are both NATT and charcoal swabs done

A

TOM TIP: It is worth remembering that NATT tests are used to check if a gonococcal infection is present or not by looking for gonococcal RNA or DNA. They do not provide any information about the specific bacteria and their antibiotic sensitivities and resistance. This is why a standard charcoal swab for microscopy, culture and sensitivities is so essential, to guide the choice of antibiotics to use in treatment.

49
Q

management of uncomplicated gonorrhea

A
  • A single dose of intramuscular ceftriaxone 1g if the sensitivities are NOT known
  • A single dose of oral ciprofloxacin 500mg if the sensitivities ARE known
50
Q

test of cure gonorrhea

A

All patients should have a follow up “test of cure” given the high antibiotic resistance. This is with NAAT testing if they are asymptomatic, or cultures where they are symptomatic. BASHH recommend a test of cure at least:
*
* 72 hours after treatment for culture
* 7 days after treatment for RNA NATT
* 14 days after treatment for DNA NATT

51
Q

other things to consider with gonorrhea

A
  • Abstain from sex for seven days of treatment of all partners to reduce the risk of re-infection
  • Test for and treat any other sexually transmitted infections
  • Provide advice about ways to prevent future infection
  • Consider safeguarding issues and sexual abuse in children and young people
52
Q

complication of gonorhhea

A
  • Pelvic inflammatory disease
  • Chronic pelvic pain
  • Infertility
  • Epididymo-orchitis (men)
  • Prostatitis (men)
  • Conjunctivitis
  • Urethral strictures
  • Disseminated gonococcal infection
  • Skin lesions
  • Fitz-Hugh-Curtis syndrome
  • Septic arthritis
  • Endocarditis
53
Q

key complication for gonorrhea in neonate

A

gonoccocal conjunctivitis- ophthalmia neonatorum
- contracted during childbirth
- emergency associated with sepsis, perforation of the ye and blindness

54
Q

Disseminated Gonococcal Infection

A

Disseminated gonococcal infection (GDI) is a complication of untreated gonococcal infection, where the bacteria spreads to the skin and joints. It causes:

  • Various non-specific skin lesions
  • Polyarthralgia (joint aches and pains)
  • Migratory polyarthritis (arthritis that moves between joints)
  • Tenosynovitis
  • Systemic symptoms such as fever and fatigue
55
Q

Trichomoniasis

A
  • Trichomonas vaginalis is a type of parasite spread through sexual intercourse.
  • Trichomonas is classed as a protozoan, and is a single-celled organism with flagella.
  • Flagella are appendages stretching from the body, similar to limbs. Trichomonas has four flagella at the front and a single flagellum at the back, giving a characteristic appearance to the organism. The flagella are used for movement, attaching to tissues and causing damage.

Trichomonas is spread through sexual activity and lives in the urethra of men and women and the vagina of women.

56
Q

Trichomonas can increase the risk of:

A
  • Contracting HIV by damaging the vaginal mucosa
  • Bacterial vaginosis
  • Cervical cancer
  • Pelvic inflammatory disease
  • Pregnancy-related complications such as preterm delivery
57
Q

presentation of trichomoniasis

A

50% asymptomatic
* Vaginal discharge- frothy and yellow/green
* Itching
* Dysuria (painful urination)
* Dyspareunia (painful sex)
* Balanitis (inflammation to the glans penis)

58
Q

examination of cervix and trichomoniasis

A
  • “Strawberry cervix” (also called colpitis macularis). A strawberry cervix is caused by inflammation (cervicitis) relating to the trichomonas infection. There are tiny haemorrhages across the surface of the cervix, giving the appearance of a strawberry.
  • Testing the vaginal pH will reveal a raised ph (above 4.5), similar to bacterial vaginosis.
59
Q

investigations for trichomoniasis

A
  • charcoal swab with microscopy
    Women
  • swab from posterior fornix of the vagina

Men
- urethral swab or first catch urine

60
Q

management of trichomoniasis

A

Metronidazole

61
Q

Syphilis

A

caused by Treponema pallidum
- spirochete shaped
- STI
- incubation period is 21 days on average**

62
Q

transmission of syphilis

A
  • Oral, vaginal or anal sex involving direct contact with an infected area
  • Vertical transmission from mother to baby during pregnancy
  • Intravenous drug use
  • Blood transfusions and other transplants (although this is rare due to screening of blood products)
63
Q

stages if syphilis

A
  • primary
  • secondary
  • latent
  • tertiary
  • neurosyphillus
64
Q

primary syphilis

A

involves a painless ulcer called a chancre at the original site of infection (usually on the genitals).

  • A painless genital ulcer (chancre). This tends to resolve over 3 – 8 weeks.
  • Local lymphadenopathy
65
Q

secondary syphilis

A

Secondary syphilis involves systemic symptoms, particularly of the skin and mucous membranes. These symptoms can resolve after 3 – 12 weeks and the patient can enter the latent stage

Typically starts after the chancre has healed, with symptoms of:

  • Maculopapular rash
  • Condylomata lata (grey wart-like lesions around the genitals and anus)
  • Low-grade fever
  • Lymphadenopathy
  • Alopecia (localised hair loss)
  • Oral lesions**
66
Q

latent syphilis

A

Latent syphilis occurs after the secondary stage of syphilis, where symptoms disappear and the patient becomes asymptomatic despite still being infected. Early latent syphilis occurs within two years of the initial infection, and late latent syphilis occurs from two years after the initial infection onwards.

67
Q

tertiary syphilis

A

can occur many years after the initial infection and affect many organs of the body, particularly with the development of gummas and cardiovascular and neurological complications.
* Gummatous lesions (gummas are granulomatous lesions that can affect the skin, organs and bones)
* Aortic aneurysms
* Neurosyphilis

68
Q

neurosyphilis

A

occurs if the infection involves the central nervous system, presenting with neurological symptoms.
* Headache
* Altered behaviour
* Dementia
*** Tabes dorsalis **(demyelination affecting the spinal cord posterior columns)
* Ocular syphilis (affecting the eyes)
* Paralysis
* Sensory impairment

69
Q

argyll-robertson pupil (neurosyphilis)

A

It is a constricted pupil that accommodates when focusing on a near object but does not react to light.
- They are often irregularly shaped.
- It is commonly called a “prostitutes pupil” due to the relation to neurosyphilis and because “it accommodates but does not react“.

70
Q

what can be used to screen for syphilis

A

Antibody testing for antibodies to the T. pallidum bacteria can be used as a screening test for syphilis.

71
Q

diagnosis of syphilis

A

1) dark field microscopy
2) polymeradse chain reaction (PCR)
3) Rapid plasma reagin (RPR) and venreal diase research lab (VDRL) tests

72
Q

Rapid plasma reagin (RPR) and venreal diase research lab (VDRL) tests

A

non-specific but sensitive tests used to assess for active syphilis infection.

These tests assess the quantity of antibodies being produced by the body to an infection with syphilis. A higher number indicates a greater chance of active disease. These tests involve introducing a sample of serum to a solution containing antigens and assessing the reaction. A more significant reaction suggests a higher quantity of antibodies. The tests are non-specific, meaning they often produce false-positive results. There is a skill to both performing and interpreting the results of these tests.

73
Q

management of syphilis

A

All patients should be managed and followed up by a specialist service, such as GUM. As with all sexually transmitted infections, patients need:

  • Antibiotics- benzyl penicillin IM
  • Full screening for other STIs
  • Advice about avoiding sexual activity until treated
  • Contact tracing
  • Prevention of future infections
74
Q

tropical ulcer disease

A

mainly treated with macrolides

75
Q

Lymphogranuloma venereum

A
  • Endemic in S and W Africa, India and Caribbean
  • European outbreak since 2003
    ◦ MSM
    ◦ 80% HIV positive
    ◦ 14% HCV coinfection rate
    ◦ Predominantly L2b

Reproductive Health (Y4) (34 decks)

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