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Repro > 4. Infections Of The Genital Tract > Flashcards

4. Infections Of The Genital Tract Flashcards

1
Q

What are the epidemiology data sources for STIs

A 
Genitourinary Medicine (GUM) Clinics 
(but data underestimates: patients present to other settings)

Communicable diseases surveillance centres:
Notified of aggregate data via returns from GUM clinics
Voluntary to statutory reporting

National Chlamydial Screening Programs

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2
Q

What are the at risk groups for STIs

A

Young (

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3
Q

What are the morbidities associated with STIs

A

Pelvic Inflammatory Disease
Impaired fertility
Repro tract cancers
Infection by blood Bourne viruses (e.g. HIV, HPV)
Congenital or peripartum infection of neonate

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4
Q

What are the most common STIs and what organism causes each

A

HPV (Human Papilloma viruses)
Herpes (Herpes Simplex virus, types 1&2)
Chlamydia (Chlamydia Trachomatis bacteria)
Gonorrhoea (Neisseria Gonorrhoae bacteria)
Syphillis (Treponema Pallidum bacteria)
Trichmomiasis (Trichromonas Vaginalis bacteria)

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5
Q

Why have there been recent increases in the number of diagnosed STIs?
(Since 1995: Gonorrhoea, Chlamydia, Syphillis)

A

Increasing attendance to GUM clinics
Changing sexual & social behaviours
Increasing density & mobility of populations
Greater public / medical / national awareness
Improved diagnostic methods e.g. Screening programs

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6
Q

Chlamydial Infections:
What kind of bacteria is Chlamydia Trachomatis?
What is the clinical presentation in males?
What is the clinical presentation in females?
What can the clinical presentation be in neonates?

A

Gram negative, obligate intracellular bacterium

Males:
Urethritis, epididymitis, prostatitis, proctitis

Females:
Often asymptomatic
Urethritis, cervicitis, salpingitis, perihepatitis

Neonates:
Inclusion conjunctivitis pneumonia

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7
Q

How is Chlamydia diagnosed

How is Chlamydia treated

A 
Nucleic acid methods:
1st void urine, endocervical/urethral swabs, 
conjunctival swab (neonates)

Doxycycline or Azithromycin
Erythromycin in children (systemic infection)

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8
Q

Gonorrhoea:
What is the infecting bacteria
What is the general presentation
What is the clinical presentation in males
What is the clinical presentation in females

A

Neisseria Gonorrhoeae: Gram negative, intracellular diplococcus

skin & joint lesions, bacteraemia

Males:
Urethritis, epididymitis, prestatitis, proctitis, pharyngitis

Females:
Often asymptomatic
Endocervicitis, urethritis, PID

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9
Q

How is gonorrhoea diagnosed

How is gonorrhoea treated

A

Smear & culture (gram stain)
Urine (nucleic acid technique)

Ceftriaxone (IM injection) & Azithromycin (treat likely concurrent Chlamydia)

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10
Q

Gential herpes:
What is the infecting virus
What is the clinical presentation: primary & recurrent

A

Herpes Simplex Virus: encapsulated, double stranded DNA
usually associated with HSV2

Primary genital herpes:
Extensive, painful genital ulceration
Dysuria
Inguinal lymphadenopathy
Fever

Recurrent genital herpes:
Asymptomatic to moderate
Latent infection lies dormant in dorsal root ganglion

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11
Q

How is genital herpes diagnosed

How is genital herpes treated

A

Smear & swab (PCR)

Aciclovir (primary & severe disease)
Barrier contraception (reduce risk of transmission)
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12
Q

HPV:
What is the infecting virus
What is the clinical presentation

A

Human Papilloma Virus: Small, double stranded-DNA

Cutaneous, mucosal & anogenital warts (benign)

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13
Q

How is HPV diagnosed
How is HPV treated
How is HPV prevented

A

Clinical biopsy & genome analysis, hybrid culture

Frequently resolves spontaneously (up to 2 yrs)
Topical podophyllin, cryotherapy etc

Screening: smear, swab, colposcopy
Vaccine: girls aged 12-13

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14
Q 
Describe the following common causes of vaginal discharge
(Description, diagnosis, treatment):
Bacteria vaginosis
Vulvovaginal candidiasis
Trichomonas vaginitis
A

Unsettled normal flora, no inflammation, scanty/offensive fishy discharge
Diagnosis: KOH whiff test (pH > 5), high vaginal smear
Treatment: Metronidazole

Gram positive candida (normal flora), profuse white thick discharge, itching
Diagnosis: high vaginal smear/culture
Treatment: topical azoles, nystatin, oral fluclnazole

Thin/frothy/offensive discharge, irritation/dysuria/inflammation
Diagnosis: vaginal wet preparation / culture
Treatment: metronidazole

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15
Q

Syphillis:
Clinical presentation
Diagnosis
Treatment

A

Multistage:
Primary: painless ulcer (chancre)
Secondary (6-8 weeks later): fever, itch, rash, mucosal lesions,
Latent: symptom-free years
Tertiary: neurosyphillis, CVS Syphillis, local tissue destruction

Diagnosis: dark field microscopy, serology (EIA antibody test, rapid plasma reacting titre)

Treatment: penicillin & test of cure follow up

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16
Q

What are the possible causes of inguinal lymphadenopathy

A

Lymphoma ulema venereum (LGV)
Chancroid (painful)
Granuloma inguinale / Donovanosis (genital nodules - ulcers)

17
Q

Define Pelvic Inflammatory Disease

A 
Ascending infection from endocervix & vagina
Causing inflammation (e.g. Salpingitis - Fallopian tube, endometriosis - uterus lining, peritonitis)
18
Q

What is the epidemiology & risk factors of PID

A

Underestimated epidemiology
Sexually active women, esp aged 20-30

Risk factors:
IUDs
Cigarette smoking
Alcohol/drugs
High rate of new partners
High frequency sexual intercourse
Young age @ 1st intercourse
19
Q

What are the immediate & long term sequelae of PID

A

Immediate:
Tubo-ovarian abscess
Pyo-salpinx

Long term:
Ectopic pregnancy
Infertility
Dyspareunia (painful sexual intercourse)
Chronic pelvic pain
Pelvic adhesions
20
Q

Describe assessment of someone with PID

A

History:
Pyrexia, pain, abnormal vaginal discharge / bleeding, sexual history, prior STI, contraception

Examination:
Fever, lower abdo tenderness, biannual exam (e.g. Cervical motion tenderness), speculum exam (discharge)

21
Q

Describe the lab investigations for PID

A 
Pregnancy test
Swabs: urethral, vaginal, endocervical
Blood tests: leuocytes & nitrates, CRP, 
Screen for other STIs e,g, HIV
midstream urine
22
Q

Describe the management of PID

A

Antibiotics 14 days
Surgical laparoscopy if no response to treatment: aspiration of pelvic collections

Education

23
Q

Distinguish between sexually transmitted diseases & infections

A

STI: symptomatic & asymptomatic infections
STD: symptomatic cases only

Repro (13 decks)

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