15. Genital Tract Infections Flashcards
In what ethnic group are STI’s more common in both men and women?
Black.
How does chlamydia present in males and females?
Males - symptoms may be mild, urethritis, dysuria, epididymis, proctitis, prostatitis.
Females - mostly asymptomatic, increased discharge, post coital and inter-menstrual bleeds, dyspareunia.
Ocular inoculation - manifests as conjunctivitis.
Pharyngeal infection - usually asymptomatic.
How is chlamydia diagnosed in males and females?
Males - first catch urine, rectal and pharyngeal swab.
Females - vulcovaginal/endocervical swab, rectal and pharyngeal swab.
How is chlamydia managed?
Doxycycline or azithromycin 1st line.
Erythromycin or ofloxacin 2nd line.
Doxycycline for rectal chlamydia.
How does gonorrhoea present in males and females?
Males - urethral discharge, dysuria, anal discharge, pharyngeal infection asymptomatic.
Females - asymptomatic, altered discharge, lower abdo pain, rectal and pharyngeal infections asymptomatic.
How is gonorrhoea diagnosed?
Microscopy of gram stained genital specimen, nucleic acid amplification testing.
How is gonorrhoea managed?
IM ceftriaxone plus oral azithromycin.
Spectinomycin as alternative in penicillin allergy.
How do genital warts present?
Benign, painless, epithelial or mucosal outgrowths on the penis, vulva, vagina, urethra, cervix and perianal skin.
How are genital warts diagnosed?
Clinically. Biopsy in atypical lesions or non-response to treatment.
How are genital warts managed?
No treatment - spontaneous resolution in up to 70% within 1 year.
Topical application.
Physical ablation.
How does genital herpes present?
Asymptomatic, painful ulceration, dysuria, vagina discharge, fever, myalgia.
How is genital herpes diagnosed?
Virus detection of vesicle fluid or ulcer base, type specific serology.
How is genital herpes managed?
General advice.
Aciclovir.
Suppressive treatment for recurrent herpes.
What organism causes chlamydia?
Chlamydia trachomatis.
What organism causes gonorrhoea?
Neisseria gonorrhoeae.
What organism causes herpes?
Herpes simplex viruses 1 and 2.
What organism causes anogenital warts?
Human papillomaviruses.
What are the main features of syphilis?
Multistage disease process - painless ulcer, progressing to rash, mucosal lesions, multi-system involvement. Then becomes latent and years later can cause neurosyphilis, parenchymous, cardiovascular syphilis, gummas.
How does trichomonas vaginalis present in males and females?
Males - infection mainly in the urethra, asymptomatic, or urethral discharge and/or dysuria.
Females - yellow frothy vaginal discharge, vulvitis, vaginitis, strawberry cervix.
Name 2 diseases spread sexually but not necessarily via penetrative sex.
Scabies.
Pubic lice.
How does bacterial vaginalis present?
Offensive fishy discharge with no itch or soreness.
How does vulvovaginal candidiasis present?
Vaginal discharge, typically curry and non offensive. Vulval itch, soreness, dyspareunia.
Name 3 risk factors for bacterial vaginosis.
Vaginal douching. Black race. Recent partner change. Smoking. Presence of STI. Receptive cunnilingus.
Name 3 risk factors for vulvovaginal candidiasis.
Pregnancy. Antibiotics. Oestrogen-oral contraceptives. Diabetes. Immunosuppression. History of atopy. Non-albicans species.
How would you diagnose bacterial vaginalis?
High vagina gram stained smear.
How would you diagnose vulvovaginal candidiasis?
High vaginal smear.
How is bacterial vaginosis treated?
Metronidazole.
How is vulvovaginal candidiasis treated?
Topical and oral azoles.
How is scabies treated?
Permethrin.
How are pubic lice treated?
Malathion.
What is pelvic inflammatory disease?
The result of infection ascending from the endocervix, causing endometriosis, salpingitis, parametritis, oophoritis, tuboovarian abscess and/or pelvic peritonitis.
What happens pathophysiologically in pelvic inflammatory disease?
Ascending infection from the endocervix and vagina. Infection causes inflammation, which causes damage to the tubal epithelium and adhesion formation. Some recovery of tubal epithelium does occur.
Name 2 sexually transmitted infections and one non-sexually transmitted infections that cause pelvic inflammatory disease.
Sexually transmitted - chlamydia and gonorrhoea.
Other - Gardnerella vaginalis.
How may a patient with pelvic inflammatory disease present?
Pyrexia, lower abdo pain, deep dyspareunia, abnormal discharge, abnormal vaginal bleeding.
How would you investigate a patient for pelvic inflammatory disease?
Pregnancy test, endocervical and high vaginal swabs, blood test for WBC and CRP, screening for STIs, diagnostic laparoscopy.
How is pelvic inflammatory disease treated?
Symptomatic management with analgesia and rest.
Management of sepsis.
Antibiotics, admission and observation for severe disease (possible surgical intervention).
Contact tracing.
Name 3 complications of pelvic inflammatory disease
Ectopic pregnancy. Infertility. Chronic pelvic pain. Fitz-Hugh-Curtis syndrome. Reiter syndrome.
