15. Genital Tract Infections

Question 1

In what ethnic group are STI’s more common in both men and women?

Answer 1

Black.

Question 2

How does chlamydia present in males and females?

Answer 2

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.

Question 3

How is chlamydia diagnosed in males and females?

Answer 3

Males - first catch urine, rectal and pharyngeal swab.

Females - vulcovaginal/endocervical swab, rectal and pharyngeal swab.

Question 4

How is chlamydia managed?

Answer 4

Doxycycline or azithromycin 1st line.
Erythromycin or ofloxacin 2nd line.
Doxycycline for rectal chlamydia.

Question 5

How does gonorrhoea present in males and females?

Answer 5

Males - urethral discharge, dysuria, anal discharge, pharyngeal infection asymptomatic.
Females - asymptomatic, altered discharge, lower abdo pain, rectal and pharyngeal infections asymptomatic.

Question 6

How is gonorrhoea diagnosed?

Answer 6

Microscopy of gram stained genital specimen, nucleic acid amplification testing.

Question 7

How is gonorrhoea managed?

Answer 7

IM ceftriaxone plus oral azithromycin.

Spectinomycin as alternative in penicillin allergy.

Question 8

How do genital warts present?

Answer 8

Benign, painless, epithelial or mucosal outgrowths on the penis, vulva, vagina, urethra, cervix and perianal skin.

Question 9

How are genital warts diagnosed?

Answer 9

Clinically. Biopsy in atypical lesions or non-response to treatment.

Question 10

How are genital warts managed?

Answer 10

No treatment - spontaneous resolution in up to 70% within 1 year.
Topical application.
Physical ablation.

Question 11

How does genital herpes present?

Answer 11

Asymptomatic, painful ulceration, dysuria, vagina discharge, fever, myalgia.

Question 12

How is genital herpes diagnosed?

Answer 12

Virus detection of vesicle fluid or ulcer base, type specific serology.

Question 13

How is genital herpes managed?

Answer 13

General advice.
Aciclovir.
Suppressive treatment for recurrent herpes.

Question 14

What organism causes chlamydia?

Answer 14

Chlamydia trachomatis.

Question 15

What organism causes gonorrhoea?

Answer 15

Neisseria gonorrhoeae.

Question 16

What organism causes herpes?

Answer 16

Herpes simplex viruses 1 and 2.

Question 17

What organism causes anogenital warts?

Answer 17

Human papillomaviruses.

Question 18

What are the main features of syphilis?

Answer 18

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.

Question 19

How does trichomonas vaginalis present in males and females?

Answer 19

Males - infection mainly in the urethra, asymptomatic, or urethral discharge and/or dysuria.
Females - yellow frothy vaginal discharge, vulvitis, vaginitis, strawberry cervix.

Question 20

Name 2 diseases spread sexually but not necessarily via penetrative sex.

Answer 20

Scabies.

Pubic lice.

Question 21

How does bacterial vaginalis present?

Answer 21

Offensive fishy discharge with no itch or soreness.

Question 22

How does vulvovaginal candidiasis present?

Answer 22

Vaginal discharge, typically curry and non offensive. Vulval itch, soreness, dyspareunia.

Question 23

Name 3 risk factors for bacterial vaginosis.

Answer 23

Vaginal douching.
Black race.
Recent partner change.
Smoking.
Presence of STI.
Receptive cunnilingus.

Question 24

Name 3 risk factors for vulvovaginal candidiasis.

Answer 24

Pregnancy.
Antibiotics.
Oestrogen-oral contraceptives.
Diabetes.
Immunosuppression.
History of atopy.
Non-albicans species.

Question 25

How would you diagnose bacterial vaginalis?

Answer 25

High vagina gram stained smear.

Question 26

How would you diagnose vulvovaginal candidiasis?

Answer 26

High vaginal smear.

Question 27

How is bacterial vaginosis treated?

Answer 27

Metronidazole.

Question 28

How is vulvovaginal candidiasis treated?

Answer 28

Topical and oral azoles.

Question 29

How is scabies treated?

Answer 29

Permethrin.

Question 30

How are pubic lice treated?

Answer 30

Malathion.

Question 31

What is pelvic inflammatory disease?

Answer 31

The result of infection ascending from the endocervix, causing endometriosis, salpingitis, parametritis, oophoritis, tuboovarian abscess and/or pelvic peritonitis.

Question 32

What happens pathophysiologically in pelvic inflammatory disease?

Answer 32

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.

Question 33

Name 2 sexually transmitted infections and one non-sexually transmitted infections that cause pelvic inflammatory disease.

Answer 33

Sexually transmitted - chlamydia and gonorrhoea.

Other - Gardnerella vaginalis.

Question 34

How may a patient with pelvic inflammatory disease present?

Answer 34

Pyrexia, lower abdo pain, deep dyspareunia, abnormal discharge, abnormal vaginal bleeding.

Question 35

How would you investigate a patient for pelvic inflammatory disease?

Answer 35

Pregnancy test, endocervical and high vaginal swabs, blood test for WBC and CRP, screening for STIs, diagnostic laparoscopy.

Question 36

How is pelvic inflammatory disease treated?

Answer 36

Symptomatic management with analgesia and rest.
Management of sepsis.
Antibiotics, admission and observation for severe disease (possible surgical intervention).
Contact tracing.

Question 37

Name 3 complications of pelvic inflammatory disease

Answer 37

Ectopic pregnancy.
Infertility.
Chronic pelvic pain.
Fitz-Hugh-Curtis syndrome.
Reiter syndrome.