12) Infections of Genital Tract

Question 1

Which is the most common STI in UK?

Answer 1

Chlamydia

Question 2

What STIs are rising in number of cases?

Answer 2

Gonorrhoea and syphilis

Question 3

Why is data on STIs an underestimate?

Answer 3

Undetected cases due to asymptomatic cases

STIs seen in variety of settings but data from GUM clinics

Question 4

Who are at risk groups for STIs?

Answer 4

Young people
Certain ethnic groups (blacks > Asians)
Low socio-economic status
Unsafe sex and number of partners

Question 5

Why is there increasing incidence of STIs?

Answer 5

Increased transmission - changing sexual behaviour
Increased GUM attendance
Increased awareness
Improved diagnostic methods

Question 6

What is the burden caused by STIs?

Answer 6

Acute and chronic infections
Stigma 
Consequent pathology 
Disseminated infections 
Transmission to fetus

Question 7

In general, how should STIs be managed?

Answer 7

Single does or short course treatment - max adherence
Contact tracing
Education
Screen for co-infections

Question 8

What is the most common viral STI?

Answer 8

Human papillomavirus

Question 9

What are the two sets of serotypes of human papillomavirus and what do they cause?

Answer 9

HPV6 and 11 - genital warts

HPV16 and 18 - oncogenic (cervical or anogenital)

Question 10

How is human papillomavirus diagnosed?

Answer 10

Biopsy and genome analysis, hybrid capture

Question 11

What is the treatment for infection with human papillomavirus?

Answer 11

Spontaneous resolution but may need medication

Question 12

What can be done to lower the risk of cervical cancer?

Answer 12

Vaccine (girls 12-13)

Screening - cervical smear or swab

Question 13

What organism causes chlamydia?

Answer 13

Chlamydia trachomatis

Question 14

How does chlamydia present in females?

Answer 14

Commonly asymptomatic

Urethritis and can ascend to cause cervicitis, salpingitis and perihepatitis

Question 15

How does chlamydia present in males?

Answer 15

Urethritis

Can cause epididymitis and prostatitis

Question 16

How can chlamydia present in neonates?

Answer 16

Conjunctivitis and pneumonia

Question 17

How is chlamydia diagnosed?

Answer 17

Endocervical and urethral swabs, 1st void urine

Then nucleic acid amplification or antigen detection

Question 18

What is the treatment for chlamydia?

Answer 18

Doxycycline or azithromycin

Erythromycin in children

Question 19

What does infection with herpes simplex virus 2 cause?

Answer 19

Genital herpes - painful genital ulceration, dysuria, fever and inguinal lymphadenopathy

Question 20

How is genital herpes diagnosed?

Answer 20

PCR of vesicle fluid

Question 21

How is genital herpes treated?

Answer 21

Aciclovir

Question 22

How can the risk of being infected with herpes virus be decreased?

Answer 22

Barrier contraception

Question 23

What organism causes gonorrhoea?

Answer 23

Neisseria gonorrhoea, gram neg diplococci

Question 24

How does gonorrhoea present in males?

Answer 24

Urethritis and epididymitis

Question 25

How does gonorrhoea present in females?

Answer 25

Asymptomatic | But can cause urethritis, endocervicitis and PID

Question 26

What are the complications of gonorrhoea?

Answer 26

Disseminated gonococcal infection - skin and joint lesions

Question 27

How is gonorrhoea diagnosed?

Answer 27

Swab from urethra, cervix, rectum or pharynx | Gram stain

Question 28

What is the treatment for gonorrhoea?

Answer 28

Ceftriaxone (IM)

Question 29

What organism causes syphilis?

Answer 29

Treponema pallidum

Question 30

What is a risk factor for syphilis?

Answer 30

MSM

Question 31

What are the stages of syphilis infection?

Answer 31

1st - painless ulcer 2nd - fever, rash, lymphadenopathy, mucosal lesions Latent 3rd - neurosyphills, CV syphilis and gummas (local destruction)

Question 32

How can syphilis be diagnosed?

Answer 32

``` Darkfield microscopy (organism can't be grown) EIA antibody test ```

Question 33

What is the treatment for syphilis?

Answer 33

Penicillin

Question 34

What is trichomonas vaginalis and what does it cause?

Answer 34

Flagellated protozoan causing vaginitis

Question 35

How does vaginitis present?

Answer 35

Thin, frothy discharge, irritation, dysuria and vaginal inflamm

Question 36

How can vaginitis be diagnosed?

Answer 36

Vaginal wet preparation and culture

Question 37

How can vaginitis be treated?

Answer 37

Metronidazole

Question 38

What organism causes vulvovagnial candidiasis?

Answer 38

Candida albicans

Question 39

What are the risk factors for getting vulvovaginal candidiasis?

Answer 39

Antibiotics, oral contraceptives and pregnancy

Question 40

How does vulvovaginal candidiasis present?

Answer 40

White, itchy discharge

Question 41

How is vulvovaginal candidiasis diagnosed and treated?

Answer 41

High vaginal smear | Azoles, nystatin or fluconazole

Question 42

What organisms can cause bacterial vaginosis?

Answer 42

Gardnerella, anaerobes and mycoplasms

Question 43

How does bacterial vaginosis present?

Answer 43

Offensive, fishy discharge

Question 44

How is bacterial vaginosis diagnosed?

Answer 44

Vaginal pH > 5 | Whiff test or gram stain

Question 45

How is bacterial vaginosis treated?

Answer 45

Metronidazole