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Woman's Health > 2.4 Genital Tract Infections > Flashcards

2.4 Genital Tract Infections Flashcards

1
Q

Physiological vaginal discharge is usually white/clear, non-offensive and varies cyclically:
• Contains _____________ (containing dead vaginal cells), ____________ (secreted by cervical glands), and _____________ (smaller amount)
• Lactobacilli in the vagina convert _______________ in the epithelium → acidifies the vaginal discharge (as transudate passes through) → pH 4 – 5 (inhibits multiplication of other microorganisms)

A

vaginal transudate;

cervical mucus;

endometrial gland secretions

glycogen to lactic acid

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2
Q

what is the clinical presentation of bacteria vaginosis?

A

60% of affected women are asymptomatic:

• Fishy-smelling, white/grey vaginal discharge (if symptomatic)

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3
Q

what are the complications of bacteria vaginosis?

A
  • Obstetric: preterm birth, preterm rupture of membranes, post-abortal or postpartum infections
  • Gynaecological: PID, acquisition of STIs, plasma-cell endometritis, post-hysterectomy vagina cuff cellulitis
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4
Q

What is the diagnostic criteria of bacteria vaginosis?

A

Fulfilling 3 out of 4 of the Amsel’s criteria:

  1. Greyish-white vaginal discharge
  2. Clue cells on saline wet mount involving > 20% of epithelial cells
  3. pH > 4.5
  4. Positive whiff test: 10% KOH applied to vaginal discharge sample on saline wet mount microscopy → fishy odour
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5
Q

What is the treatment of the bacteria vaginosis?

A

Metronidazole (anti-anaerobe spectrum of activity)

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6
Q

What is recurrent vulvovaginal candidasis?

A

≥ 4 episodes of symptomatic infection in 1 year

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7
Q

What is the clinical presentation of vulvovaginal candidasis?

A

Symptoms: vulvar pruritus (itching), vulva pain & irritation (may cause dysuria and dyspareunia)

Signs: curd-like discharge (on vaginal examination), erythematous vulva/vagina, vulva excoriation/fissure

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8
Q

What are the risk factors for vulvovaginal candiasis?

A

Diabetes mellitus, antibiotic use (wipes out bacterial flora → allows Candida to proliferate), increased oestrogen levels (e.g. OCP, pregnancy), immunosuppression (increased risk of fungal infections), sex

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9
Q

What is the diagnostic criteria of vulvovaginal candiasis?

A
  1. Presence of the characteristic clinical symptoms

2. Presence of Candida on microscopy (wet mount, Gram stain) or on vaginal culture

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10
Q

What is the treatment for uncomplicated infections (sporadic mild to moderate infections by C. albicans in normal hosts)

A

oral fluconazole (150mg x 1 dose), topical/vaginal antifungal agents (e.g. isoconazole, clotrimazole)

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11
Q

What is the treatment for complicated/recurrent infections (severe signs/symptoms, non-albicans species, immunocompromised state): multiple doses of oral antifungal agents for longer periods of time

A

3 doses of oral fluconazole 2 hours apart → followed by weekly maintenance doses

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12
Q

Group B Streptococcus (S. agalactiae) is a _____________ which frequently colonises the _______________.

Pathogenesis: Pregnant women: 20 – 40% maternal carriage (intermittently) → frequently affects the urinary system
• Causes ___________ (marker for heavy genital GBS colonisation; increased infection risk), cystitis, pyelonephritis
• Maternal infections (e.g. chorioamnionitis) associated with ____________ (e.g. endometritis)

Foetal: 80% maternal-to-foetal colonisation rate (0.5 in 1000 births with invasive neonatal disease)
• Most common onset of severe early onset infection in newborns
• Associated with _______________

A

Gram-positive coccus;

genital and gastrointestinal tracts

asymptomatic bacteriuria;

pregnancy loss, preterm delivery, postpartum infections;

generalised sepsis, pneumonia, meningitis

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13
Q

What is the investigation for Group B Streptococcus (S. agalactiae

A

GBS screening at 35 – 37 weeks of gestation or 3 – 5 weeks before the anticipated delivery date (for vaginal births)

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14
Q

What is the treatment for Group B Streptococcus (S. agalactiae

A

Prevent transmission to foetus: intrapartum antibiotic prophylaxis Treatment: IV benzylpenicillin or clindamycin (if penicillin allergy) until delivery

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15
Q

Actinomyces is a _____________ which is a part of the normal GI flora and often present in the vagina without symptoms/sequelae:
• Actinomyces-like organisms seen in 0.26% of Pap smears without IUCD (intrauterine contraceptive device) and 7% of Pap smears with IUCD
• If Actinomyces is seen on Pap smear, evaluate the patient for symptoms of PID and perform a _______________

A

Gram-positive anaerobic rod;

cervical culture for Actinomyces

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16
Q

what is the treatment for asymptomatic for PID + culture negative for actinomyces?

A

Leave IUCD in place (no further treatment)

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17
Q

what is the treatment for asymptomatic for PID + symptomatic for PID and/or Actinomyces on cervical culture?

A

Penicillin/tetracycline + empirical treatment Remove IUCD after initiation of antibiotics

18
Q 
Neisseria gonorrhoeae (gonococcus) is a Gram-negative diplococcus which infects the mucous membranes of the \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 
• 40% of patients with gonorrhoea also have \_\_\_\_\_\_\_\_\_\_\_
A

endocervix, urethra, rectum, pharynx, and conjunctiva;

concurrent chlamydia

19
Q

What are the presentations of cervicitis due to neisseria gonorrhoea?

A
  • Typical: mucopurulent vaginal discharge, vaginal pruritus • Other symptoms: IMB, dyspareunia
  • Gonococcal cervical infection is indistinguishable from acute cervicitis of other causes
20
Q

what is the presentation of urethritis due to neisseria gonorrhoea?

A

Presents with dysuria, frequency and urgency

21
Q

what is the presentation of PID due to neisseria gonorrhoea?

A

Presents with abdominal pain, abnormal vaginal discharge/bleeding, dyspareunia, perihepatitis (Fitz-Hugh-Curtis syndrome) → inflammation of peritoneal coating of the liver)

22
Q

what is the extragenital presentation of neisseria gonorrhoea?

A

Conjunctivitis, pharyngitis, proctitis (inflammation of rectum and anus)

Disseminated gonococcal infection: purulent arthritis or triad of tenosynovitis (synovium surrounding tendon), dermatitis, polyarthralgias

23
Q

what are the complications of neisseria gonorrhoea?

A

Obstetric: chorioamnionitis, preterm birth, low birth weight

Foetal transmission: gonococcal ophthalmia neonatorum (neonatal conjunctivitis), other localised infections (neonatal vaginitis, proctitis, urethritis), disseminated infections, scalp abscess

24
Q

what are the investigations of neisseria gonorrhoea?

A
  • Nucleic acid amplification test on urogenital/ extragenital specimens
  • Gram stain and culture
  • Check for co-infection with Chlamydia trachomatis
25
Q

what are the treatments of neisseria gonorrhoea?

A

IM ceftriaxone 250mg stat (immediately) → alternatives include azithromycin or doxycycline
• Contact tracing and treatment of partner is important

26
Q

What are the presetations of chlamydia?

A
  • Cervicitis (> 85% asymptomatic): symptoms are non-specific; minority may exhibit classic cervicitis signs (mucopurulent endocervical discharge, easily inducible endocervical bleeding, oedematous ectopy)
  • Urethritis: dysuria, sterile pyuria
  • PID
  • Perihepatitis (Fitz-Hugh-Curtis syndrome)
  • Proctitis, conjunctivitis, pharyngitis
  • Lymphogranuloma venereum: non-painful genital ulcer → development of inguinal lymphadenopathy
27
Q

What are the complications of chlamydia?

A

Premature rupture of membranes, preterm delivery, neonatal conjunctivitis/pneumoniasite

28
Q

What are the investigations for chlamydia?

A

NAAT or PCR on urogenital or extragenital specimens

29
Q

What are the treatments for chlamydia?

A

Azithromycin or doxycycline + contact tracing & treatment:

• Test of cure recommended for all pregnant women ≥ 3 weeks after treatment

30
Q

What is the presentation for Trichomonas vaginalis?

A

Symptoms: malodorous vaginal discharge, pruritus, burning sensation, dysuria, frequency of urination, lower abdominal pain, dyspareunia, PCB

Signs: vaginal discharge (green-yellow, frothy, malodorous), “strawberry” cervix (erythematous cervix)

31
Q

What is the investigation for Trichomonas vaginalis?

A

Microscopy showing motile trichomonads on wet mount (NAAT is expensive)

32
Q

What is the treatment for Trichomonas vaginalis?

A

Metronidazole (antiprotozoan spectrum)

33
Q

What are the stages of syphyllis?

A

Primary (1st image): painless chancre (genital ulcer) usually in the cervix of women and the penis of men → ~90 days post-exposure

Secondary (2nd image): reddish maculopapular rash involving trunk and extremities, sore throat, malaise, fever → 2 – 10 weeks (resolves in 6 wks)

Tertiary (3rd image): affects 1/3 of infected people without treatment (affects brain, nerves, eyes, heart, bones) → dementia, stroke, blindness, tabes dorsalis (syphilitic myelopathy; slow degeneration of dorsal columns and roots, general paresis) → 3 – 15 years post-initial exposure

34
Q

How is syphyllis diagnosed?

A

Darkfield examination: detect directly from lesion exudate/tissue

Validated PCR: non-treponemal (VRDL, RPR), treponemal (FTA-ABS, TPPA)

35
Q

How is syphyllis treated?

A

Penicillin G (duration of treatment depends on stage and clinical manifestation of disease)

36
Q

HPV is a large family of DNA viruses with numerous subtypes that predispose/cause cervical cancer and genital warts:
• Infect _________________ → proliferative lesions

A

basal cells of the cervical squamous epithelia

37
Q

Pelvic inflammatory disease occurs due to ________________ causing pelvic inflammation (e.g. endometritis, salpingitis, tubo-ovarian abscess, pelvic peritonitis):
• Caused by _________________ (in 25%), and also Gardnerella vaginalis, anaerobes, Mycoplasma genitalium
o Less than 50% of patients with PID test positive for these organisms
• Many episodes of PID tend to go unrecognised

A

ascending infections from the endocervix;

Neisseria gonorrhoeae and Chlamydia trachomatis

38
Q

What is the presentation of PID?

A

Symptoms: lower abdominal pain (typically bilateral), deep dyspareunia, abnormal vaginal bleeding (e.g. IMB, PCB), abnormal vaginal discharge (often purulent)

Signs: lower abdominal tenderness, adnexal tenderness (areas next to uterus containing ligaments, tubes, ovaries), cervical excitation, fever

39
Q

What are the complications of PID?

A

Perihepatitis (Fitz-Hugh-Curtis syndrome), chronic pelvic pain, hydrosalpinges, tubo-ovarian abscesses, subfertility (secondary to tubal factors), ectopic pregnancy
• Women with mild/asymptomatic PID are still at risk for infertility → important to maintain the low threshold for diagnosis of PID

40
Q

What are the investigations for PID?

A

Clinical diagnosis
Testing for gonorrhoea and chlamydia + inflammatory markers
US pelvis (if tubo-ovarian abscesses are suspected)

41
Q

What are the DDx of PID?

A

For lower abdominal pan in young women: ectopic pregnancy, acute appendicitis, endometriosis, ovarian cyst accidents, UTIs

Woman's Health (29 decks)

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