12) Infections of Genital Tract Flashcards
Which is the most common STI in UK?
Chlamydia
What STIs are rising in number of cases?
Gonorrhoea and syphilis
Why is data on STIs an underestimate?
Undetected cases due to asymptomatic cases
STIs seen in variety of settings but data from GUM clinics
Who are at risk groups for STIs?
Young people
Certain ethnic groups (blacks > Asians)
Low socio-economic status
Unsafe sex and number of partners
Why is there increasing incidence of STIs?
Increased transmission - changing sexual behaviour
Increased GUM attendance
Increased awareness
Improved diagnostic methods
What is the burden caused by STIs?
Acute and chronic infections Stigma Consequent pathology Disseminated infections Transmission to fetus
In general, how should STIs be managed?
Single does or short course treatment - max adherence
Contact tracing
Education
Screen for co-infections
What is the most common viral STI?
Human papillomavirus
What are the two sets of serotypes of human papillomavirus and what do they cause?
HPV6 and 11 - genital warts
HPV16 and 18 - oncogenic (cervical or anogenital)
How is human papillomavirus diagnosed?
Biopsy and genome analysis, hybrid capture
What is the treatment for infection with human papillomavirus?
Spontaneous resolution but may need medication
What can be done to lower the risk of cervical cancer?
Vaccine (girls 12-13)
Screening - cervical smear or swab
What organism causes chlamydia?
Chlamydia trachomatis
How does chlamydia present in females?
Commonly asymptomatic
Urethritis and can ascend to cause cervicitis, salpingitis and perihepatitis
How does chlamydia present in males?
Urethritis
Can cause epididymitis and prostatitis
How can chlamydia present in neonates?
Conjunctivitis and pneumonia
How is chlamydia diagnosed?
Endocervical and urethral swabs, 1st void urine
Then nucleic acid amplification or antigen detection
What is the treatment for chlamydia?
Doxycycline or azithromycin
Erythromycin in children
What does infection with herpes simplex virus 2 cause?
Genital herpes - painful genital ulceration, dysuria, fever and inguinal lymphadenopathy
How is genital herpes diagnosed?
PCR of vesicle fluid
How is genital herpes treated?
Aciclovir
How can the risk of being infected with herpes virus be decreased?
Barrier contraception
What organism causes gonorrhoea?
Neisseria gonorrhoea, gram neg diplococci
How does gonorrhoea present in males?
Urethritis and epididymitis
How does gonorrhoea present in females?
Asymptomatic
But can cause urethritis, endocervicitis and PID
What are the complications of gonorrhoea?
Disseminated gonococcal infection - skin and joint lesions
How is gonorrhoea diagnosed?
Swab from urethra, cervix, rectum or pharynx
Gram stain
What is the treatment for gonorrhoea?
Ceftriaxone (IM)
What organism causes syphilis?
Treponema pallidum
What is a risk factor for syphilis?
MSM
What are the stages of syphilis infection?
1st - painless ulcer
2nd - fever, rash, lymphadenopathy, mucosal lesions
Latent
3rd - neurosyphills, CV syphilis and gummas (local destruction)
How can syphilis be diagnosed?
Darkfield microscopy (organism can't be grown) EIA antibody test
What is the treatment for syphilis?
Penicillin
What is trichomonas vaginalis and what does it cause?
Flagellated protozoan causing vaginitis
How does vaginitis present?
Thin, frothy discharge, irritation, dysuria and vaginal inflamm
How can vaginitis be diagnosed?
Vaginal wet preparation and culture
How can vaginitis be treated?
Metronidazole
What organism causes vulvovagnial candidiasis?
Candida albicans
What are the risk factors for getting vulvovaginal candidiasis?
Antibiotics, oral contraceptives and pregnancy
How does vulvovaginal candidiasis present?
White, itchy discharge
How is vulvovaginal candidiasis diagnosed and treated?
High vaginal smear
Azoles, nystatin or fluconazole
What organisms can cause bacterial vaginosis?
Gardnerella, anaerobes and mycoplasms
How does bacterial vaginosis present?
Offensive, fishy discharge
How is bacterial vaginosis diagnosed?
Vaginal pH > 5
Whiff test or gram stain
How is bacterial vaginosis treated?
Metronidazole