6) Infections of the genital tract Flashcards
What are the epidemiological data sources for STIs?
GUM clinics (Genitourinary medicine) Communicable disease surveillance centres
Why is data on STIs an underestimation?
Patients present via other settings
e.g. GPs
STI may be asymptomatic
Which groups are at risk of STIs?
Young people
Minority ethnic groups
Those affected by Poverty & social exclusion
Low socio-economic status groups
Those with poor educational opportunities
Unemployed
Individuals born to teenage mothers
What morbidities are associated with STIs?
PID Impaired fertility Repro tract cancers Risk of infection with BBV - HBV, HIV Risk of congenital or peripartum infection of neonate
What are the most common STIs and their infecting agents?
HPV - Human Papillomaviruses Herpes - Herpes simplex virus Types 1&2 Chlamydia - Chlamydia Trachomatis Gonorrhoea - Neisseria gonorrhoeae Syphilis - Treponema pallidum Trichomoniasis - Trichomonas vaginalis
What possible differential diagnoses could there be for the clinical sign of genital skin & mucous membrane lesions?
Genital ulcers
Vesicles or bullae
Genital papules
Anogenital warts
What possible differential diagnoses could there be for the clinical sign of urethritis - discharge, dysuria, frequency?
Gonococcal urethritis Chlamydial urethritis Non-specific urethritis Post-gonococcal urethritis Non-infectious urethritis
What possible differential diagnoses could there be for the clinical sign of vulvo-vaginitis & cervicitis?
Vulvo-vaginitis
Cervicitis
Bacterial vaginosis
Bartholinitis
What possible differential diagnoses could there be for the clinical sign of infections of the female pelvis?
Pregnancy-related
Pelvic Inflammatory Diease (PID)
What type of bacterium is Chlamydia trachomatis?
Gram -ve
Obligate intracellular bacterium
What is the clinical presentation of Chlamydia trachomatis in males & females?
Males - Urethritis, epididymitis, prostatitis, proctitis
Females - Urethritis, cervicitis, salpingitis, perihepatitis
How is Chlamydia trachomatis diagnosed & treated?
Endocervical & urethral swabs
Doxycycline or Azithromycin
What is the clinical presentation of Neisseria gonorrhoeae in males & females?
Males - Urethritis, epididymitis, prostatitis, proctitis, pharyngitis
Females - Asymptomatic, endocervicitis, urethritis, PID
What symptoms could you get with a disseminated gonococcal infection?
Bacteraemia
Skin & joint lesions
How is Neisseria gonorrhoeae diagnosed & treated?
Smear & culture
Ceftriaxone (intramuscular injection)
What type of bacterium is Neisseria gonorrhoeae?
Gram -ve
Intracellular diplococcus
What type of virus is the herpes simplex virus?
double stranded DNA virus
What is the clinical presentation of primary genital herpes?
Extensive, painful genital ulceration, dysuria, inguinal lymphadenopathy, fever
What is the clinical presentation of recurrent genital herpes?
Asymptomatic > Moderate
How is genital herpes diagnosed & treated?
Smear & swab of vesicle fluid and/or ulcer base
Aciclovir
What type of virus is the human papilloma virus?
Small, double stranded DNA virus
Over 100 types
Highest risk are types HPV 16 & 18
What is the clinical presentation of HPV?
Cutaneous, mucosal & anogenital (anus & genital) warts
Benign, painless, verrucous epithelial or mucosal outgrowths
Penis, vulva, vagina, urethra, cervix, perianal skin
How is HPV diagnosed & treated?
Clinical biopsy & genome analysis, hybrid capture
No treatment - frequent spontaneous resolution
Topical podophyllin, cryotherapy, intralesional interferon
What is the clinical presentation of Syphilis?
Multistage disease 1 - Indurated, painless ulcer (chancre) 2 - 6-8wks later Fever, rash, lymphadenopathy, mucosal lesions Latent symptom free years 3 - Chronic granulomatous lesions 4 - Cardiovascular & CNS pathology
What causes syphilis?
Treponema Pallidum - spirochaete
May be contracted congenitally
How is syphilis diagnosed & treated?
Dark field microscopy, serology
Penicillin & ‘test of cure’ follow-up
What is Trichomonas vaginalis?
Flagellated protozoan
What is the clinical presentation of Trichomonas vaginalis?
Thin, frothy, offensive discharge
Irritation, dysuria, vaginal inflammation
How is Trichomonas vaginalis diagnosed and treated?
Culture
Metronidazole
Name some STIs caused by arthropods
Scabies mite
Pubic louse
Where is Candida albicans usually found in the body?
Normal GI & genital tract flora
What are the risk factors for a genital tract infection caused by Candida albicans?
Antibiotics Oral contraceptives Pregnancy Obesity Steroids Diabetes
What are the symptoms of a Candida albicans infection?
Profuse, white curd-like discharge
Vaginal itch, discomfort & erythema
How is a Candida albicans infection diagnosed and treated?
High vaginal smear & culture
Topic azoles or oral Fluconazole
What is bacterial vaginosis?
Unsettled normal flora (anaerobes, enteric gram -ve bacteroides) Not vaginitis (no inflammation of vaginal wall)
What are the symptoms of a bacterial vaginosis infection?
Scanty but offensive, fishy discharge
How is bacterial vaginosis diagnosed & treated?
pH>5, KOH whiff test
High vaginal smear - Gram variable coccobacilli, reduced lactobacilli
Metronidazole
What is Pelvic Inflammatory Disease (PID)?
An ascending infection from the endocervix causing
- Endometritis
- Salpingitis
- Oophoritis
- Pelvic peritonitis
- +/- tubo ovarian abscess
What are the risk factors for PID?
Young age at 1st intercourse
Multiple sexual partners (polygyny)
High frequency of sexual intercourse
High rate of acquiring new partners within previous 30 days
Alcohol/drug use
Cigarette smoking (2x increased risk)
IUDs increase risk at point of insertion/removal for a few weeks
What are the causative organisms of PID?
Neisseria gonorrhoea Chlamydia trachomatis Bacterial vaginosis Streptococci Haemophilis Influenzae Cytomegalovirus Mycobacterium tuberculosis
What are the sequelae of PID?
Immediate - Tubo-ovarian abscess, Pyo-salpinx
Long term - Ectopic pregnancy, Infertility, Dyspareunia (painful sex), Chronic PID/Chronic pelvic pain, Pelvic adhesions
Describe the pathogenesis of PID
Infection of cervix (endocervicitis)
spreads to endometrium, uterine tubes &pelvic peritoneum
Directly/lymphatic spread
What factors are associated with the ascent of bacteria in PID?
Instrumentation - coil insertion, cervical dilation
Hormonal changes associated with menstruation
- Lowers bacteriostatic effect of cervical secretion
Retrograde menstruation
- Infection more common after a period
Virulence of organisms in acute chlamydial & gonococcal PID
Which lab investigations take place to help diagnose PID?
Pregnancy test
Triple & urethral swabs
- High vaginal swab (bacteria vaginosis organisms)
- Endocervical swab (Neiss. gon, Chlam. trich)
- Urethral swab (Chlam. trich males only)
Midstream urine (leucocytes & nitrates)
C-reactive protein (acute infection/inflammation marker)
What could be differential diagnoses for PID?
Ectopic pregnancy Acute appendicitis Irritable Bowel Syndrome (IBS) Ovarian cyst accidents (torsion, rupture, haemorrhage) UTI Functional pelvic pain of unknown origin
What are the symptoms of Chronic PID?
Symptoms >6months duration Pelvic pain Secondary dysmenorrhoea Deep dyspareunia Menstrual disturbance Recurrent acute painful exacerbations
What are the sequelae of Chronic PID?
Infertility Ectopic pregnancy Chronic pelvic pain Pelvic adhesions/tubo-ovarian complex Abnormal/painful periods
