11 Infections of the Genital Tract

Question 1

Between what age range are STIs most prevalent?

Answer 1

15-24yrs

Question 2

What are some of the risk factors for developing STIs?

Answer 2

• Risky sexual behaviours
  
  • Multiple partners
  • Unprotected
  • Early eage intercourse
• Low socio-economic status
• Race/ethinicity
• Lack of immunisation (Hep B/ HPV)
• Anal sex- risk of damage (make no assumptions when taking history)

Question 3

What is the most common STI in the UK?

Answer 3

Chlamydia

Question 4

Describe the structure of chlamydia and how it works?

Answer 4

Obligate intracellular bacteria

Unique cell wall- taken up by phagocytosis but prevents itself being expelled

Question 5

What symptoms can chlamydia cause in men?

Answer 5

• Testicular pain
• Dysuria
• May have discharge

Question 6

Describe the structure of Neisseria Gonorrhoeae and how it works?

Answer 6

• Gram negative, diplococci, uncapsulated
• Pilated membrane so can attach to mucous membranes

Question 7

What symptoms can gonorrhoea cause in men?

Answer 7

• Thick, yellow discharge
• Dysuria
• Reactive arthritis

(90% men= symptomatic, 50% women=symptomatic)

Question 8

What is Non-gonococcal urethritis?

Answer 8

Inflammation of urethra with associated discharge

(can be sexually transmitted/pathogen negative)

Question 9

Identify some organisms that can cause NGU (Non-gonococcal urethritis).

Answer 9

Trachomatis not trichomatis

Question 10

What investigations should be carried out when investigating infections of the genital tract in men?

Answer 10

NAATs= nucleus acid amplification testing

Question 11

Women can have physiological discharge due to increased progesterone levels in the secretory phase where they might have thicker cervical mucus. What are the featrues of this discharge?

Answer 11

• Clear
• Cyclical
• No associated symptoms

Question 12

Identify some STIs that may cause vaginal discharge in women. What other symptoms might a patient have?

Answer 12

• Chlamydia trachomatis
• Neisseria gonorrhoeae
• Trochomonas vaginalis

Symptoms:

1. Discharge
2. Dyspareunia
3. Postcoital/intermenstrual bleeding

Question 13

If a woman is pregnant and she has chlamydia, what can this cause in the neonate?

Answer 13

Neonatal conjunctivitis

Question 14

Outline the structure, symptoms caused and treatment of Trichomonas vaginalis.

Answer 14

Question 15

Outline the structure, causes and symptoms caused by a Candida albicans infection.

Answer 15

Question 16

How is bacterial vaginosis caused and what are the symptoms of it?

Answer 16

• Caused:
  
  • Lactobacilli usually protective against other bacteria
    
    • Altered flora in vagina
      
      • Excessive washing
• Symptoms:
  
  • Offensive smelling, white discharge

Question 17

What investigations should be carried out if each of these infections is suspected:

• Chlamydia
• Gonorrhoea
• Trichomoniasis
• Bacterial vaginosis
• Candida albicans

Answer 17

Question 18

Summary of vaginal discharge for reference:

Answer 18

Question 19

Give examples of STIs that can cause gential lesions (in men and women).

Answer 19

• Viral
  
  • Human papilloma virus (HPV)
  • Herpes simplex virus
• Bacterial
  
  • Syphilis (Treponema pallidum)

Question 20

Outline the following with relation to the Human Papilloma virus:

• Structure
• Types causing significant pathology (many strains)
• Symptoms
• Investigation
• Vaccinations

Answer 20

• Structure
  
  • DNA virus- (non-enveloped)
• Types causing significant pathology (many strains)
  
  • 6&11 - genital infections
  • 16&18- highest association with cervical cancer
• Symptoms
  
  • Gential/cutaneous warts
• Investigation
  
  • PCR- biopsy/swab
• Vaccinations
  
  • Gardasil (6,11,16,18)
  • Cervarix (16,18)

Question 21

Outline the following with relation to the Herpes Simplex virus:

• Structure
• Length of infection
• Symptoms
• Strains
• Investigations
• Management

Answer 21

• Structure
  
  • DNA Virus enveloped
• Length of infection
  
  • Lifelong- has latent phase
• Symptoms
  
  • Initially asymptomatic
  • Painful ulcers/blisters + systemic symptoms
• Strains
  
  • HSV-1= cold sores
  • HSV-2= more likely to become infected with HIV
• Investigations
  
  • Swabs
    
    • PCR/NAATs
• Management
  
  • Reduce severity of episode- can’t eradicate virus
  • • require C-section

Question 22

Outline the following with relation to the Syphilis (Treponema Pallidum):

• Structure
• Transmission
• Length of infection
• Symptoms
• Strains
• Investigations
• Management

Answer 22

• Structure
  
  • Spirochete
• Transmission
  
  • Direct
  • Vertical (can cross placenta)
    
    • generally 40% co-infected with HIV
• Symptoms
  
  • Primary: Typically painless ulcer
  • Secondary: 4-10 weeks after iniital infection
    
    • can enter latent phase
• Investigations
  
  • Microscopy/PCR and Serology- look at antibody effects
• Management
  
  • Penicillin-based antibiotics

Question 23

What is the biggest risk factor for pelvic inflammatory disease?

Answer 23

Infection (causing inflammation)

Question 24

What are some sources of infections that cause pelvic inflammatory disease?

Answer 24

Question 25

What are the signs and symptoms of PID?

Answer 25

Question 26

What complications can arise as a result of PID?

Answer 26

Question 27

How is PID managed?

Answer 27

• Antibiotics
  
  • Don’t delay
  • Broad spectrum
  • Iv in severe cases
• Analgesia
• Screening for partners

If failling to respond to treatment- laparoscopy to confirm diagnosis

Question 28

Explain why taking the COCP can increase a patients chance of getting thrush.

Answer 28

COCP- promotes alkaline condition in vaginal canal/ cervical mucus

Changes in flora in vagina- increased likelihood of acquiring candida albicans (thrush)

Question 29

What STIs would you do a vulvovaginal swab for and what would you do a high vagnal swab for?

Answer 29

Vulvovaginal: chlamydia, gonorrhoea

High vaginal: thrush, trichomoniasis