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15. Reproductive > 6. Infections of the Genital Tract > Flashcards

6. Infections of the Genital Tract Flashcards

1
Q

What are Genitourinary Medicine (GUM) Clinics for?

A

Open access to free, confidential sexual health services, including diagnosis and treatment of STIs.

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2
Q

What do communicable disease surveillance centres receive information about?

A

Gonorrhoea, genital chlamydia, genital herpes, and syphilis through voluntary or statutory reporting.

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3
Q

Who is at risk of STIs?

A

Young people, minority ethnic groups, poverty and social exclusion, low socio-economic status groups, poor educational opportunities, unemployed people, individuals born to teenage mothers.

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4
Q

What are the morbidities associated with STIs?

A

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.

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5
Q

What are the most common sexually transmitted infections?

A

HPV, herpes, chlamydia, gonorrhoea, syphilis, trichomoniasis.

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6
Q

What is the infecting organisms in cases of HPV?

A

Human papillomaviruses.

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7
Q

What is the infecting organisms in cases of herpes?

A

Herpes simplex virus types 1 and 2.

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8
Q

What is the infecting organisms in cases of chlamydia?

A

Chlamydia trachomatis.

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9
Q

What is the infecting organisms in cases of gonorrhoea?

A

Neisseria gonorrhoeae.

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10
Q

What is the infecting organisms in cases of syphilis?

A

Treponema pallidum.

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11
Q

What is the infecting organisms in cases of trichomoniasis?

A

Trichomonas vaginalis.

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12
Q

What are the differential diagnoses for genital skin and mucous membrane lesions?

A

Genital ulcers, vesicles or bullae, genital papules, anogenital warts.

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13
Q

What are the differential diagnoses for urethritis (discharge, dysuria, frequency)?

A

Gonococcal urethritis, chlamydial urethritis, non-specific urethritis, post-gonococcal urethritis, non-infectious urethrisis.

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14
Q

What are the differential diagnoses for vulvo-vaginitis and cervicitis?

A

Vulvo-vaginitis, cervivitis, bacterial vaginosis, bartholinitis.

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15
Q

What are the differential diagnoses for infection of the female pelvis?

A

Pregnancy-related, pelvic inflammatory disease.

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16
Q

What have been the recent trends in incidence of STIs considering gonorrhoea, chlamydia, syphilis, and generally GUM clinic workload?

A

Since 1995: gonorrhoea 102% increase, genital chlamydia 107% increase, infectious syphilis 57% increase, GUM clinic workload 34% increase.

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17
Q

What type of bacteria is Chlamydia trachomatis?

A

Gram negative obligate intracellular bacteria.

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18
Q

What is the clinical presentation of chlamydial infections in males and females?

A

Males - urethritis, epididymitis, prostatitis, proctitis.

Females - urethritis, cervicitis, salpingitis, perihepatitis.

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19
Q

How are chlamydial infections diagnosed?

A

Endocervical and urethral swabs.

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20
Q

How are chlamydial infections treated?

A

Doxycycline or azithromycin.

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21
Q

What type of bacteria is Neisseria gonorrhoea?

A

Gram negative intracellular diplococcus.

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22
Q

What is the clinical presentation of gonorrhoea in males and females?

A

Males - urethritis, epididymitis, prostatitis, proctitis, pharyngitis.
Females - asymptomatic, endocervicitis, urethritis, PID.

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23
Q

How are cases of gonorrhoea diagnosed?

A

Smear and culture.

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24
Q

How are cases of gonorrhoea treated?

A

Ceftriaxone (intramuscular injection).

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25
Q

What type of virus is herpes simplex virus?

A

Encapsulated, double stranded DNA virus.

26
Q

What is the clinical presentation of primary genital herpes?

A

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

27
Q

What is the clinical presentation of recurrent genital herpes?

A

Asymptomatic to moderate symptoms.

28
Q

How is genital herpes diagnosed?

A

Smear and swab of vesicle fluid and/or ulcer base.

29
Q

How is genital herpes treated?

A

Aciclovir.

30
Q

What type of virus is human papilloma virus (HPV)?

A

Small, double stranded DNA virus.

31
Q

What are the highest risk HPV types?

A

HPV 16 and 18.

32
Q

What is the clinical presentation of HPV?

A

Cutaneous, mucosal, anogenital warts; benign, painless, verrucous epithelial or mucosal outgrowths; penis, vulva, vagina, urethra, cervix, perianal skin.

33
Q

How is HPV diagnosed?

A

Clinical, biopsy and genome analysis, hybrid capture.

34
Q

How is HPV treated?

A

None - frequent spontaneous resolution.

Topical podophyllin, cryotherapy, intralesional interferon.

35
Q

Describe the progression of syphilis.

A 
Indurated, painless ulcer - chancre.
6-8 weeks later - fever, rash, lymphadenopathy, mucosal lesions.
Latent - symptom free years.
Chronic granulomatous lesions.
Cardiovascular and CNS pathology.
36
Q

How is syphilis diagnosed?

A

Dark field microscopy, serology.

37
Q

How is syphilis treated?

A

Penicillin and ‘test of cure’ follow up.

38
Q

What type of microbe is trichomonas vaginalis?

A

Flagellated protozoan.

39
Q

What is the clinical presentation of trichomonas vaginitis?

A

Thin, frothy, offensive discharge. Irritation, dysuria, vaginal inflammation.

40
Q

How is trichomonas vaginitis diagnosed?

A

Culture.

41
Q

How is trichomonas vaginitis treated?

A

Metronidazole.

42
Q

What are arthropods?

A

Scabies mites, pubic lice.

43
Q

What causes vulvovaginal candidiasis?

A

Candida albicans or other candida species from normal GI and genital tract flora.

44
Q

What are the risk factors for candida?

A

Antibiotics, oral contraceptives, pregnancy, obesity, steroids, diabetes.

45
Q

What is the presentation of vulvovaginal candidiasis?

A

Profuse, white, curd-like discharge; vaginal itch, discomfort, and erythema.

46
Q

How is vulvovaginal candidiasis diagnosed?

A

High vaginal smear and culture.

47
Q

How is vulvovaginal candidiasis treated?

A

Topic azoles or oral fluconazole.

48
Q

What causes bacterial vaginosis?

A

Unsettled normal flora by anaerobes, enteric gram negative bacteroides.

49
Q

What is the presentation of bacterial vaginosis?

A

Scanty but offensive, fishy discharge.

50
Q

How is bacterial vaginosis diagnosed?

A

pH>5, KOH whiff test, high vaginal smear - gram variable coccobacilli, reduced numbers of lactobacilli.

51
Q

How is bacterial vaginosis treated?

A

Metronidazole.

52
Q

What is pelvic inflammatory disease?

A

Ascending infection from the endocervix causing: endometritis, salpingitis, oophoritis, pelvic peritonitis, with or without tuboovarian abscess.

53
Q

What are the risk factors for PID?

A

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.

54
Q

What are the causative organisms of PID?

A

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.

55
Q

What are the immediate sequelae of PID?

A

Tubo-ovarian abscess, pyo-salpinx.

56
Q

What are the long term sequelae of PID?

A

Ectopic pregnancy, infertility, dyspareunia (painful sex), chronic PID/pelvic pain, pelvic adhesions.

57
Q

What is the pathogenesis of PID?

A

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.

58
Q

What are the laboratory investigations performed in PID?

A

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.

59
Q

What are the differential diagnoses for PID?

A

Ectopic pregnancy, acute appendicitis, irritable bowel syndrome, ovarian cyst accidents, urinary tract infections, functional pelvic pain of unknown origin.

60
Q

What are the symptoms of chronic pelvic inflammatory disease?

A

> 6 months, pelvic pain, secondary dysmenorrhoea, deep dyspareunia, menstrual disturbance, recurrent acute painful exacerbations.

61
Q

What are the sequelae of chronic PID?

A

Infertility, ectopic pregnancy, chronic pelvic pain, pelvic adhesions/tubo-ovarian complex, abnormal/painful periods.

15. Reproductive (12 decks)

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