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6) Infections of the genital tract Flashcards

1
Q

What are the epidemiological data sources for STIs?

A 
GUM clinics (Genitourinary medicine)
Communicable disease surveillance centres
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2
Q

Why is data on STIs an underestimation?

A

Patients present via other settings
e.g. GPs
STI may be asymptomatic

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3
Q

Which groups are at risk of STIs?

A

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

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4
Q

What morbidities are associated with STIs?

A 
PID
Impaired fertility
Repro tract cancers
Risk of infection with BBV - HBV, HIV
Risk of congenital or peripartum infection of neonate
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5
Q

What are the most common STIs and their infecting agents?

A 
HPV - Human Papillomaviruses
Herpes - Herpes simplex virus Types 1&2
Chlamydia - Chlamydia Trachomatis
Gonorrhoea - Neisseria gonorrhoeae
Syphilis - Treponema pallidum
Trichomoniasis - Trichomonas vaginalis
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6
Q

What possible differential diagnoses could there be for the clinical sign of genital skin & mucous membrane lesions?

A

Genital ulcers
Vesicles or bullae
Genital papules
Anogenital warts

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7
Q

What possible differential diagnoses could there be for the clinical sign of urethritis - discharge, dysuria, frequency?

A 
Gonococcal urethritis
Chlamydial urethritis
Non-specific urethritis
Post-gonococcal urethritis
Non-infectious urethritis
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8
Q

What possible differential diagnoses could there be for the clinical sign of vulvo-vaginitis & cervicitis?

A

Vulvo-vaginitis
Cervicitis
Bacterial vaginosis
Bartholinitis

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9
Q

What possible differential diagnoses could there be for the clinical sign of infections of the female pelvis?

A

Pregnancy-related

Pelvic Inflammatory Diease (PID)

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10
Q

What type of bacterium is Chlamydia trachomatis?

A

Gram -ve

Obligate intracellular bacterium

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11
Q

What is the clinical presentation of Chlamydia trachomatis in males & females?

A

Males - Urethritis, epididymitis, prostatitis, proctitis

Females - Urethritis, cervicitis, salpingitis, perihepatitis

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12
Q

How is Chlamydia trachomatis diagnosed & treated?

A

Endocervical & urethral swabs

Doxycycline or Azithromycin

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13
Q

What is the clinical presentation of Neisseria gonorrhoeae in males & females?

A

Males - Urethritis, epididymitis, prostatitis, proctitis, pharyngitis
Females - Asymptomatic, endocervicitis, urethritis, PID

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14
Q

What symptoms could you get with a disseminated gonococcal infection?

A

Bacteraemia

Skin & joint lesions

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15
Q

How is Neisseria gonorrhoeae diagnosed & treated?

A

Smear & culture

Ceftriaxone (intramuscular injection)

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16
Q

What type of bacterium is Neisseria gonorrhoeae?

A

Gram -ve

Intracellular diplococcus

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17
Q

What type of virus is the herpes simplex virus?

A

double stranded DNA virus

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18
Q

What is the clinical presentation of primary genital herpes?

A

Extensive, painful genital ulceration, dysuria, inguinal lymphadenopathy, fever

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19
Q

What is the clinical presentation of recurrent genital herpes?

A

Asymptomatic > Moderate

20
Q

How is genital herpes diagnosed & treated?

A

Smear & swab of vesicle fluid and/or ulcer base

Aciclovir

21
Q

What type of virus is the human papilloma virus?

A

Small, double stranded DNA virus
Over 100 types
Highest risk are types HPV 16 & 18

22
Q

What is the clinical presentation of HPV?

A

Cutaneous, mucosal & anogenital (anus & genital) warts
Benign, painless, verrucous epithelial or mucosal outgrowths
Penis, vulva, vagina, urethra, cervix, perianal skin

23
Q

How is HPV diagnosed & treated?

A

Clinical biopsy & genome analysis, hybrid capture
No treatment - frequent spontaneous resolution
Topical podophyllin, cryotherapy, intralesional interferon

24
Q

What is the clinical presentation of Syphilis?

A 
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
25
Q

What causes syphilis?

A

Treponema Pallidum - spirochaete

May be contracted congenitally

26
Q

How is syphilis diagnosed & treated?

A

Dark field microscopy, serology

Penicillin & ‘test of cure’ follow-up

27
Q

What is Trichomonas vaginalis?

A

Flagellated protozoan

28
Q

What is the clinical presentation of Trichomonas vaginalis?

A

Thin, frothy, offensive discharge

Irritation, dysuria, vaginal inflammation

29
Q

How is Trichomonas vaginalis diagnosed and treated?

A

Culture

Metronidazole

30
Q

Name some STIs caused by arthropods

A

Scabies mite

Pubic louse

31
Q

Where is Candida albicans usually found in the body?

A

Normal GI & genital tract flora

32
Q

What are the risk factors for a genital tract infection caused by Candida albicans?

A 
Antibiotics
Oral contraceptives
Pregnancy
Obesity
Steroids
Diabetes
33
Q

What are the symptoms of a Candida albicans infection?

A

Profuse, white curd-like discharge

Vaginal itch, discomfort & erythema

34
Q

How is a Candida albicans infection diagnosed and treated?

A

High vaginal smear & culture

Topic azoles or oral Fluconazole

35
Q

What is bacterial vaginosis?

A 
Unsettled normal flora (anaerobes, enteric gram -ve bacteroides)
Not vaginitis (no inflammation of vaginal wall)
36
Q

What are the symptoms of a bacterial vaginosis infection?

A

Scanty but offensive, fishy discharge

37
Q

How is bacterial vaginosis diagnosed & treated?

A

pH>5, KOH whiff test
High vaginal smear - Gram variable coccobacilli, reduced lactobacilli
Metronidazole

38
Q

What is Pelvic Inflammatory Disease (PID)?

A

An ascending infection from the endocervix causing

  • Endometritis
  • Salpingitis
  • Oophoritis
  • Pelvic peritonitis
  • +/- tubo ovarian abscess
39
Q

What are the risk factors for PID?

A

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

40
Q

What are the causative organisms of PID?

A 
Neisseria gonorrhoea
Chlamydia trachomatis
Bacterial vaginosis
Streptococci
Haemophilis Influenzae
Cytomegalovirus
Mycobacterium tuberculosis
41
Q

What are the sequelae of PID?

A

Immediate - Tubo-ovarian abscess, Pyo-salpinx

Long term - Ectopic pregnancy, Infertility, Dyspareunia (painful sex), Chronic PID/Chronic pelvic pain, Pelvic adhesions

42
Q

Describe the pathogenesis of PID

A

Infection of cervix (endocervicitis)
spreads to endometrium, uterine tubes &pelvic peritoneum
Directly/lymphatic spread

43
Q

What factors are associated with the ascent of bacteria in PID?

A

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

44
Q

Which lab investigations take place to help diagnose PID?

A

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)

45
Q

What could be differential diagnoses for PID?

A 
Ectopic pregnancy
Acute appendicitis
Irritable Bowel Syndrome (IBS)
Ovarian cyst accidents (torsion, rupture, haemorrhage)
UTI
Functional pelvic pain of unknown origin
46
Q

What are the symptoms of Chronic PID?

A 
Symptoms >6months duration
Pelvic pain
Secondary dysmenorrhoea
Deep dyspareunia
Menstrual disturbance
Recurrent acute painful exacerbations
47
Q

What are the sequelae of Chronic PID?

A 
Infertility
Ectopic pregnancy
Chronic pelvic pain
Pelvic adhesions/tubo-ovarian complex
Abnormal/painful periods

Reproduction (13 decks)

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