6.1 Infections Flashcards
Give 2 sources of epidemiological data for genital infections and STIs
Genitourinary medicine clinica
(Underestimation as patients may present via other settings)
Communicable disease surveillance centres
Give at rid groups 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 mother
What morbidity is associated with STIs?
PID Impaired fertility Repro cancers Risk of infection with BBVs HBV/HIV Congenital infection of neonate
Differential diagnosis for genital skin and mucous membrane lesions.
• Genital ulcers o Herpes Simplex Virus (HSV) o Syphilis o Chanchroid • Vesicles or bullae o HSV • Genital papules o Transient manifestations of STIs • Anogenital warts o Number, size, tenderness, base, edge
Differential diagnosis and symptoms of urethritis.
Discharge, dysuria and frequency
- Gonococcal urethritis
- Chlamydial urethritis
- Non-specific urethritis
- Post-gonococcal urethritis
- Non-infectious urethritis
Differential diagnosis of vulvo-vaginitis
o Candidiasis, trichomoniasis, staphylococcal, foreign body, HSV
Differential diagnosis of cervicitis
o C. trachomatis, N. gonorrhoeae, HSV, HPV
Differential diagnoses of pelvis infections
• Pregnancy-related
o Post-partum endometriosis
• Pelvic Inflammatory Disease (PID)
Describe recent trends in incidence of STIs. Explain
Plateau before 1995 reflecting changes in sexual behaviour in response to HIV epidemic
Gradual and sustained increase in no of diagnosed STIs since 1995 due to:
Increased transmission
Acceptability of GUM services
Greater public awareness
Development in diagnostic methods.
What is the clinical presentation of chlamydia in females?
Commonly asymptomatic Endometriosis (ectopic uterine growth) Salpingitis Cervicitis Urethritis Dysuria Frequency
Clinical presentation of chlamydia in males? Complications?
Urethritis
Acute epididymitis
Reiters syndrome:
Urethritis, conjunctivitis, arthritis
What is the most common infection in neonates? How does this progress?
Chlamydia trachomatis
Neonatal conjunctivits
Pneumonia
How are specimens collected in males, females and neonates to diagnose chlamydia?
M - Urethral swag or first catch urine
F - endocervical swab
N - Eye swab
How is chlamydia diagnosed?
Antigen detection:
Immunofluoresnce
Enzyme immunoassay
PCR
What is the treatment for chlamydia?
Macrolides (azithromycin)
Tetracycline (doxycycline)
Clincal presentation of gonorrhoea in males and females?
M Urethritis
F Acute cervicitis with vaginal discharge, urethral syndrome, asymptomatic
How is gonorrhoea diagnosed?
M - urethral/rectal/pharyngeal swab
F - endocervical/urethral/rectal/pharyngeal swab
Gram stain - gram negative diplococci
Culture
What is the treatment for gonorrhoea?
Ceftriaxone
+ azithromycin for chlamydia to prevent emergence of resistance to cephalosporins
Mixed infections common.
What is the clinical presentation of primary and recurrent genital herpes? Where can herpes lie dormant?
Primary:
• Extensive, painful genital ulceration, dysuria, inguinal lymphadenopathy, fever
Recurrent:
• Asymptomatic → Moderate
• Latent infection in dorsal root ganglia
How is genital herpes diagnosed?
Smear and swab of vesicle fluid
PCR
Treatment for herpes?
Aciclovir
Prophylaxis for frequent recurrences
Barrier contraception
Which HPVs have highest risk?
16 and 18
What is the clinical presentation of HPV?
- Cutaneous, mucosal and anogenital (anus and genital) 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
