6. Infections of the Genital Tract Flashcards
What are Genitourinary Medicine (GUM) Clinics for?
Open access to free, confidential sexual health services, including diagnosis and treatment of STIs.
What do communicable disease surveillance centres receive information about?
Gonorrhoea, genital chlamydia, genital herpes, and syphilis through voluntary or statutory reporting.
Who is at risk of STIs?
Young people, minority ethnic groups, poverty and social exclusion, low socio-economic status groups, poor educational opportunities, unemployed people, individuals born to teenage mothers.
What are the morbidities associated with STIs?
Pelvic inflammatory disease (PID), impaired fertility, reproductive tract cancers, risk of infection with blood-borne viruses (HBV, HIV), risk of congenital or peripartum infections of neonate.
What are the most common sexually transmitted infections?
HPV, herpes, chlamydia, gonorrhoea, syphilis, trichomoniasis.
What is the infecting organisms in cases of HPV?
Human papillomaviruses.
What is the infecting organisms in cases of herpes?
Herpes simplex virus types 1 and 2.
What is the infecting organisms in cases of chlamydia?
Chlamydia trachomatis.
What is the infecting organisms in cases of gonorrhoea?
Neisseria gonorrhoeae.
What is the infecting organisms in cases of syphilis?
Treponema pallidum.
What is the infecting organisms in cases of trichomoniasis?
Trichomonas vaginalis.
What are the differential diagnoses for genital skin and mucous membrane lesions?
Genital ulcers, vesicles or bullae, genital papules, anogenital warts.
What are the differential diagnoses for urethritis (discharge, dysuria, frequency)?
Gonococcal urethritis, chlamydial urethritis, non-specific urethritis, post-gonococcal urethritis, non-infectious urethrisis.
What are the differential diagnoses for vulvo-vaginitis and cervicitis?
Vulvo-vaginitis, cervivitis, bacterial vaginosis, bartholinitis.
What are the differential diagnoses for infection of the female pelvis?
Pregnancy-related, pelvic inflammatory disease.
What have been the recent trends in incidence of STIs considering gonorrhoea, chlamydia, syphilis, and generally GUM clinic workload?
Since 1995: gonorrhoea 102% increase, genital chlamydia 107% increase, infectious syphilis 57% increase, GUM clinic workload 34% increase.
What type of bacteria is Chlamydia trachomatis?
Gram negative obligate intracellular bacteria.
What is the clinical presentation of chlamydial infections in males and females?
Males - urethritis, epididymitis, prostatitis, proctitis.
Females - urethritis, cervicitis, salpingitis, perihepatitis.
How are chlamydial infections diagnosed?
Endocervical and urethral swabs.
How are chlamydial infections treated?
Doxycycline or azithromycin.
What type of bacteria is Neisseria gonorrhoea?
Gram negative intracellular diplococcus.
What is the clinical presentation of gonorrhoea in males and females?
Males - urethritis, epididymitis, prostatitis, proctitis, pharyngitis.
Females - asymptomatic, endocervicitis, urethritis, PID.
How are cases of gonorrhoea diagnosed?
Smear and culture.
How are cases of gonorrhoea treated?
Ceftriaxone (intramuscular injection).
What type of virus is herpes simplex virus?
Encapsulated, 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 to moderate symptoms.
How is genital herpes diagnosed?
Smear and swab of vesicle fluid and/or ulcer base.
How is genital herpes treated?
Aciclovir.
What type of virus is human papilloma virus (HPV)?
Small, double stranded DNA virus.
What are the highest risk HPV types?
HPV 16 and 18.
What is the clinical presentation of HPV?
Cutaneous, mucosal, anogenital warts; benign, painless, verrucous epithelial or mucosal outgrowths; penis, vulva, vagina, urethra, cervix, perianal skin.
How is HPV diagnosed?
Clinical, biopsy and genome analysis, hybrid capture.
How is HPV treated?
None - frequent spontaneous resolution.
Topical podophyllin, cryotherapy, intralesional interferon.
Describe the progression of syphilis.
Indurated, painless ulcer - chancre. 6-8 weeks later - fever, rash, lymphadenopathy, mucosal lesions. Latent - symptom free years. Chronic granulomatous lesions. Cardiovascular and CNS pathology.
How is syphilis diagnosed?
Dark field microscopy, serology.
How is syphilis treated?
Penicillin and ‘test of cure’ follow up.
What type of microbe is trichomonas vaginalis?
Flagellated protozoan.
What is the clinical presentation of trichomonas vaginitis?
Thin, frothy, offensive discharge. Irritation, dysuria, vaginal inflammation.
How is trichomonas vaginitis diagnosed?
Culture.
How is trichomonas vaginitis treated?
Metronidazole.
What are arthropods?
Scabies mites, pubic lice.
What causes vulvovaginal candidiasis?
Candida albicans or other candida species from normal GI and genital tract flora.
What are the risk factors for candida?
Antibiotics, oral contraceptives, pregnancy, obesity, steroids, diabetes.
What is the presentation of vulvovaginal candidiasis?
Profuse, white, curd-like discharge; vaginal itch, discomfort, and erythema.
How is vulvovaginal candidiasis diagnosed?
High vaginal smear and culture.
How is vulvovaginal candidiasis treated?
Topic azoles or oral fluconazole.
What causes bacterial vaginosis?
Unsettled normal flora by anaerobes, enteric gram negative bacteroides.
What is the presentation of bacterial vaginosis?
Scanty but offensive, fishy discharge.
How is bacterial vaginosis diagnosed?
pH>5, KOH whiff test, high vaginal smear - gram variable coccobacilli, reduced numbers of lactobacilli.
How is bacterial vaginosis treated?
Metronidazole.
What is pelvic inflammatory disease?
Ascending infection from the endocervix causing: endometritis, salpingitis, oophoritis, pelvic peritonitis, with or without tuboovarian abscess.
What are the risk factors for PID?
Young age at first intercourse, multiple sexual partners, high frequency of sexual intercourse, high rate of acquiring new partners within previous 30 days, alcohol/drug use, cigarette smoking, IUDs at insertion/removal.
What are the causative organisms of PID?
Neisseria gonorrhoea - gram negative intracellular diplococci.
Chlamydia trachomatis - gram negative extracellular organism.
Bacterial vaginosis - anaerobes, enteric gram negative bacteroides.
Streptococci, haemophillis influenzae, cytomegalovirus, mycobacterium tuberculosis.
What are the immediate sequelae of PID?
Tubo-ovarian abscess, pyo-salpinx.
What are the long term sequelae of PID?
Ectopic pregnancy, infertility, dyspareunia (painful sex), chronic PID/pelvic pain, pelvic adhesions.
What is the pathogenesis of PID?
Infection of endocervix spreads directly or via lymphatic to endometrium, uterine tubes, and pelvic peritoneum. Associated with: cervical dilation, coil insertion, hormonal changes (lower bacteriostatic effect of cervical secretion), retrograde menstruation.
What are the laboratory investigations performed in PID?
Pregnancy test, triple and urethral swabs (high vaginal, endocervical for N. gonorrhoea then for C. trachomatis, urethral for C. trachomatis for males), midstream urine for leucocytes and nitrates, C-reactive protein.
What are the differential diagnoses for PID?
Ectopic pregnancy, acute appendicitis, irritable bowel syndrome, ovarian cyst accidents, urinary tract infections, functional pelvic pain of unknown origin.
What are the symptoms of chronic pelvic inflammatory disease?
> 6 months, 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.
