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(4) Reproductive System - Sessions > (4.1&2) Infections & PID > Flashcards

(4.1&2) Infections & PID Flashcards

1
Q

What are the names given to:
Inflammation of anus & rectal mucous?
Infection of ovaries
infection of Fallopian tubes

A
  • Proctitis = inflammation of anus & rectal mucous
  • Oophoritis = infection of ovaries
  • Salpingitis = infection of Fallopian tube
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2
Q

Why are mixed STI common?

A
  • Mostly asymptomatic & long term
  • Pathogens transmit in the same way
  • Common risk behaviours and factors
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2
Q

Why are the antibiotics prescribed for STIs have short duration with vey low side effect profile?

A

The groups most at risk are noted for their poor compliance

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3
Q

What are the morbidity associated with STI?

A
  • Pelvic Inflammatory Disease
  • Infertility
  • Reproductive cancers
  • Infection with blood-borne viruses
  • Congenital/peripartum infection of neonate
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4
Q

Why the incidence of STIs are increasing?

A

increased incidence due to

  • more awareness of symptoms
  • greater GUM presence and so attendance
  • better treatment regimes so more complacence
  • improved screening/diagnosis
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5
Q

Why are most antibiotic regimes (especially gonorrhoea) given alongside Doxycycline or Azithromycin?

A

Co-infection with chlamydia trachomatis is common

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7
Q

What is the pathogenic cause of chlamydia? What type of pathogen is it?

A

Chlamydia trachomatis
Gram -ve
Obligate intracellular bacteria

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8
Q

How is chlamydia infection presented clinically? What complication can a chlamydia infection cause?

A

Chlamydial urethritis - dysuria & frequency & discharge
pelvic inflammatory disease -> Fitzhugh-curtis syndrome -> perihapatitis -> RUQ pain

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9
Q

How is chlamydia diagnosed and managed?

A
  • Diagnosis: Endocervical (females) + urethral (males) swabs

- Antibiotics: Doxycycline & Azithromycin

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10
Q

What is the pathogenic cause of gonorrhoea? What type of pathogen is it?

A
  • Neisseria gonorrhoeae

- Gram -ve intracellular diplococcus

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11
Q

How does gonorrhoea present clinically?

A
  • Gonococcal urethritis - dysuria & frequency & discharge
  • Reddening
  • Pelvic inflammatory disease
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12
Q

How is gonorrhoea diagnosed and managed?

A
  • Diagnosis: Endocervival swab/smear & culture

- Management: Ceftriaxone intramuscular injection

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13
Q

What is the most COMMON pathogenic cause of genital herpes? What type of pathogen is it?

A
  • Herpes simplex Type A

- Encapsulated, double stranded DNA

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14
Q

How is genital herpes presented clinically?

A
  • painful ulceration
  • dysuria
  • inguinal lymphadenopathy (abnormal sized lymph nodes)
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15
Q

What is the pathogenic cause of genital warts? What type of pathogen is it?

A
  • Human papilloma virus

- small, double stranded DNA virus

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16
Q

What are the possible differential diagnosis of dysuria, frequency, discharge from genitalia?

A
  • gonococcal urethritis
  • chlamydial urethritis
  • non-specific urethritis
  • non-infectious urethritis
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17
Q

What are the possible differential diagnosis of genital skin and mucous membrane lesions?

A
  • Herpes simplex
  • Human papillomavirus
  • Genital papules
  • Syphilis
18
Q

Which are the most common types of HPV infection? What morbidity is it associated with? What intervention is taken?

A
  • HPV 16 &18
  • High risk of cervical cancer
  • HPV vaccines are offered to girls aged 12-13 - 2 injections within a year
18
Q

What is the prognosis of Syphilis?

A

ulcer -> latent -> granulomatous lesion

20
Q

Genital warts frequently spontaneous resolve. However if a squamous cell papilloma developed, how is it managed?

A
  • Topical Podophyllin
  • Cryotherapy (freeze them off)
  • Intralesional interferon
21
Q

How is Syphilis diagnosed and managed?

A
  • Diagnosis: dark field microscopy & serology

- Management: Penicillin

22
Q

What is the pathogenic cause of trichomonas vaginalis? How is it presented clinically? How can it be managed?

A
  • Flagellated protazoan
  • Thin, frothy, offensive discharge
  • Metronidazole
23
Q

What are the risk factors of Candida albicans causing non-venereal genital infections? What infection is it?

A
  • oral contraception, antibiotics, steroids, pregnancy -> changes to vaginal environment -> imbalanced normal flora -> Candida albicans overgrowth
  • Causing Vulvovaginal candidiasis (vaginal thrush)
24
Q

How does vaginal thrush present clinically? How is it diagnosed and managed?

A
  • Profused, white, curd-liked discharge & vaginal itch & erythema
  • Diagnosed: high vaginal smear
  • Management: Topic Azoles or Oral Fluconazole
25
Q

A widow presents to you with offensive, fishy discharge, what could be the diagnosis? Explain what it is.

A
  • Bacterial vaginosis - imbalance in normal flora -> overgrowth of of certain bacteria - not STI
26
Q

How is bacterial vaginosis diagnosed and managed?

A
  • KOH Whiff test
  • pH >5
  • High vaginal smear showing reduced Lactobacilli
  • Management: Metronidazole
26
Q

What are the clinical presentation and histories of PID?

A
  • pyrexia
  • bilateral lower abdominal tenderness
  • adnexia (uterus surrounding tissues) tenderness
  • Chandelier sign - severe pain on touching cervix during a Bimanual examination
  • unprotected sign/STI history
  • deep dyspareunia - pain on deep sex
  • abnormal vaginal bleeding/discharge
27
Q

What is pelvic inflammatory disease? Describe its pathogenesis.

A

Ascending infection from the endocervix with the inflammation causing adhesion and damage to the tubal epithelium. Leading to:

  • Endometitis
  • Salpingitis
  • Oophoritis
  • Pelvic peritonitis
  • +/- Tubo Ovarian Abscess
29
Q

What are the risk factors of PID? What’s the most common group of patient?

A
  • Smoking
  • Drug/alcohol
  • IUDs - intrauterine contraceptive device
  • sexually active 20-24 women who live in urban areas
30
Q

What are the common (x2) and uncommon (x3) causes of PID?

A 
Common:
- Neisseria gonorrhoea
- Chlamydia trachomitis
Uncommon
- TB
- Anaerobes - eg bacterial vaginosis
- Garderella
31
Q

What are the complications of chronic PID?

A
  • Chronic recurring infections
  • Dyspareunia - pain on sex
  • Chronic pelvic pain
  • Pelvic adhesion -> Infertility / Ectopic pregnancy
31
Q

How is PID differentiated from other possible diagnosis?

A
  • Other tests (urine/blood) to exclude other causes
  • Triple swabs - high vaginal (Bacterial vaginosis bacteria) + endocervical (Chlamydia trachomitis) + endocervical (Neisseria gonorrhoea)
  • Ultrasound
  • Laprascopy
  • Chandelier sign - severe pain on touching cervix
  • Deep dyspareunia - pain on deep sex
  • Abnormal vaginal bleeding/discharge
  • Chandelier sign - severe pain on touching cervix
32
Q

A 21 year old woman presents to your Leicester city centre GP surgery with lower abdominal pain/tenderness and a history of heroin use and prostitution. Other than PID what could her diagnosis be?

A
  • Ectopic pregnancy
  • Polycystic ovaries
  • Irritable Bowel Syndrome / Inflammatory Bowel Disease
  • Appendicitis
  • Urinary tract infection
  • Bladder cysts/stones
  • Functional/psychological pain (she is having a bad time)
33
Q

A patient presents with a history of unprotected sex and a vaginal discharge that is thin, frothy and offensive. What condition do you suspect and what is the causative organism?

A

Likely to be an STI and with the type of discharge it is most likely trichomoniasis caused by the flagellated protozoan, trichomonas vaginalis.

34
Q

A female patient is having trouble with her wisdom teeth and is treated by her dentist. A few weeks later she presents to the GP with a profuse, white, curd-like vaginal discharge. What the fuck is going on here?

A

The dentist probably gave her antibiotics which led to the destruction of the normal flora of the vagina, including lactobacillus. This allowed for the overgrowth of Candida albicans as it had no competition, producing Vulvovaginal candidiasis.

36
Q

What organism causes syphillis?

A

Treponema pallidum

36
Q

What organism maintain the Vagina at its normal condition? How does it achieve it?

A
  • Lactobailli (Gram +ve facultative anaerobic bacilli)

- Produce glycogen that turns to lactic acid, maintaing low vaginal pH

37
Q

How is PID managed?

A
  • Analgesia (painkillers)
  • Antibiotics of 14 days course: Doxycycline (chlamydia) + Ceftriaxone (gonorrhea) + Metronidazole (bacterial vaginosis organisms)
  • Laparotomy if not repsonsive to antibiotics or tubo-ovarian cyst
38
Q

A guy has been diagnosed with Neisseria gonorrhoea, his regular sexual partner reported herself well. How would you manage her?

A
  • Detailed history
  • Physical examination
  • Diagnostic investigations
  • Endocervical swab for Neisseria gonorrhoea & Chlamydia trachomatis
  • Cervical swab & Hybrid capture for HPV
  • Serology & Darkfield microscopy for Treponema pallidum
  • Serology for blood & body-fluid infections e.g. HIV, HBV, HCV
  • Advice for return visit
  • Counselling, advice and basic sexual health education
39
Q

What key things will you need to known about someone’s history if was to be suspected with STI?

A
  • Past partners/changes
  • Nature/orientation of sexual behaviours
  • Use of contraceptive methods
  • Previous STIs/complications
  • Overseas travel/residence
  • Underlying diseases e.g. HIV, HBV, HCV
  • Recent antibiotic uses/history of allergies
40
Q

Julie, aged 27 noticed a slight increase in vaginal discharge, but otherwise well. On questioning, you revealed she had unprotected sex with a casual partner 5 days ago. What possible infecting organisms will you consider and how will you investigate?

A
  • High vaginal swabs for: Trichomonas vaginalis & Bacterial vaginosis & Candida albicans
  • Endocervical swabs for: Chlamydia trachomatis & Neisseria gonorrhoea
  • Cervical swab for: HPV
  • Mid-stream urine for microscopy and culture of UTI pathogens
41
Q

What natural and medical/therapeutic conditions in the vagina will promote growth of pathogens?

A
  • Moist & warmth
  • Hormonal changes (high Oestrogen) e.g. Oral contraceptives / Pregnancy / Menstrual cycle
  • High glucose e.g. Diabetes Mellitus
  • Disrupted normal flora (reduced Lactobacilli) e.g. antibiotics
  • Steroid therapy

(4) Reproductive System - Sessions (16 decks)

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