Disease of Reproductive System - Part 2 Flashcards
1
Q
What is pregnancy
A
conception to delivery
2
Q
What is puerperium
A
The few weeks following delivery during which the mothers tissues return to their non pregnant state (6-8 weeks)
3
Q
What are neonates
A
Newborns less than 4 weeks old
4
Q
Diseases that can be transmitted from mother to baby during pregnanct
A
VZV, CMV, Parvovirus, Toxoplasmosis, Syphilis, Mosquito
Reach via haematogenous
5
Q
How are VZV, CMV & Parvovirus spread
A
Respiratory/droplet secretions
6
Q
How is tozoplasmosis spread
A
Ingestion of an oocyte
7
Q
How it syphilis spread
A
Sexual
8
Q
How is zika spread
A
Mosquito bites
9
Q
What disease are transmitted from mother to baby during delivery
A
Group B streptococcus, HSV, gonorrhoea, chlamydia, HIV, Hep B
HSV Must be active to transmit
10
Q
What does gonorrhoea require to be transmitted during delivery
A
Mucosal contact
E.g. eyes causing conjunctivitis
11
Q
How does drugg handling differ in pregnancy
A
Increased GFR causes increased renal excretion of many antimicrobials - serum levels of antimicrobials generally lower hence many effectively underdosed
12
Q
Do antimicrobials appear in the breast milk
A
Usually all do
13
Q
What are 2 safe antimicrobials in pregnancy
A
Penicillin and cephalosporins
14
Q
What antimicrobials aren’t safe in pregnancy
A
Choloramphenicol
Tetracylcine
Fluoroguinolones (ciprofloxacin)
Trimethoprim - sulphamethoxazole
15
Q
2 teratogenic viruses
A
Rubella and zika
16
Q
How do we test for viral infections
A
Serology and PCR (PCR more reliable)
17
Q
Why do we treat asymptomatic bacteriruire
A
Can become sypmtomatic causing premature delivery and increased perinatal mortality
18
Q
How do we treat UTI’s in pregancny
A
7 days non-toxic antibiotics (amoxicillin or cefalexin or trimethoprim)
Trimethoprim is a folate antagonist so give folate - and avoid in 1st trimester
19
Q
What is chorioamnionitis
A
Inflammation of the umbilical cord, amniotic membrane, placents
Presents with a fever
20
Q
Presentation of chorioamnionitis
A
Sustained maternal fever Uterine tenderness Malodorous amniotic fluid Maternal/foetal tachycardia Increased WBC's
21
Q
Risk factors of chorioamnionitis
A
Prolonged rupture of membranes
Amniocentesis, cardiocentesis, cervical cirvlage, multivple vaginal examinatins, BV
22
Q
Causative organisms of chorioamnionitis
A
Group B Streptococcus (normal vaginal flora)
Enteroccoi, E, Coli (normal in GI)
23
Q
Rare haemoatogenous cause of chorioamnionitis
A
Listeria
24
Q
Treatment of chorioamnionitis
A
Antimicrobials and delivery of foetus - treat at diagnosis
25
What is puerperal endometritis
Infection of womb during puerperium
| Puerperium sepsis is a major cause of death
26
Risk factors of puerperal endometritis
Caesarean, prolonged labour, prolonged rupture of membranes, multiple vaginal examinations
27
Presentation of puerperal endometritis
Fever (over 38.5), uterine tenderness, purulent foul smelling lachia, High WCC, general malaise, ado pain, fl like sympotms
28
Causes of puerperal endometritis
E coli
Beta haemolytic Streptococi
Anarobes
29
Diagnose of puerperal endometritis
Blood cultures for systemic symptoms
| Swabs not usefl
30
Treatment of puerperal endometritis
Broad spectrum IV - co-amoxiclav
31
Clinical features of puerperal mastitis
```
5.5 weeks post delivery
Abrupt onset fever
Chills
Breast soreness
Redness
Warmth
Breast tenderness
```
32
What causes puerperal masitics
Staphylcoccus aureus
33
How to diagnose puerperal mastitis
Clinical and pus culture
34
How do we treat puerperal mastitis
Flucloaxcillin (hs activity against B-lactamase producing organsims)
35
Other causes of puerperal sepsis
Pneumonia, IV related infection, C section/wound infection
36
What does treat staph aureus
Amoxicillin as staph aureus produces beta lactamase
37
What is sepsis
Syndrome resulting from invasion of pathogenic bacteria into blood
Early onset within 2 weeks after birth
38
Clinical features of sepsis in neonates
```
Hypothermia/pyrexia
Dyspnoea, apnoea, cyanosis
Tachycardia, bradychardia, hypotension
Hepatomegaly, jaundice
Anorexia, vomitig, abdo distention, diarrhoea
Bleeding disorders
Lethargy/irritable
```
VARYING PRESENTATION
39
Causes of neonatal spsis
Group B Streptococci
E coli
Listeria (but rare)
40
Treatment of neontala sepsis
Broad spectrum antibiotics:
Amoxicillin (against listeria in high doses)
Gentamicin (against in E. Coli)TI
41
What is an STI
transmitted person - person by sexual contact - may be asymptomatic
42
What is an STD
Have evidence of a disease
43
What is a genital infectious disease
Not always acquired by sexual transmittion - can be normal vaginal & GI flora
44
Organisms causing local infection
Gonorrheae, HSV, HPV, Trichomonas Vaginalis
45
What causes mixed sites of infection
Syphilis, occasionally gonorrhea
46
Types of vertical transmission
In utero
Peri natal - through infected birth canal
Eye mucous membrane - Conjuntivits, Kertanitis
Present in breast milk
47
What type of bacteria is neisseria gonorrhea
gram -ve diplocci
48
Desrribe feature of neisseria gonorrhea
Pili on cell surface - can attach
| Intracellular
49
Deserve 3 layers of cell envelope of gram -ves
Outer cytoplasmic membrane - lipo-oligosaccharides
Thin peptidoglycan cell wall
Inner cytoplasmic membrane
50
Incubation period of gonorrhea
2-5 days
| 60% of women are asymptomatic
51
Symptoms of gonorrhea
Urethral discharge and dysuria
52
Local complications of gonorrhea
Epididymitis, prostatitis
| Barthonilitis, salpingitis, PID
53
What are 30% of people with gonorrhoea also infected with
Chlamydia
54
What happens in metastatic disseminated gonococcal infection
Occur in unto 13% if complement deficient
| Get bacteraemia, arthritis, dermatitis, meningitis
55
What happens in gonorrheae in pregnancy
Spontaneous abortion
Preamture
Labour
56
Neonatal gonorrhea
opthalmia neonatal
| Acute purulent conjunctivitis
57
Diagnosis of gonorrheae
Microscopy - urethral swabs
Culture - 48 hours. Do endocervical
NAAT
58
Treatment of gonorrhea
Cepaholsporins - cefataxime (oral), ceftriaxone (IV or IM)
| Highly resistant to ciprofloxacin and tetracycline also increasing to beta-lactams
59
What causes non-gonorrhoea urethritis
Chlamydia trochomatous types D-K Or Ureaplasma Urelyteum
Occurs 1-2 wk incubation
Test for with NAAT
60
Treatment of non-gonorrhoea urethritis
Doxycylcine and macrolide
61
Life cycle of chlamydia trachomatis
Obligate intracellular pathoden
Extracellular infection form - elementary body
Intracellular replicative form = reticulate body
62
Target cells of chlamydia
Squamocolumnar in endocervix/upper genital tract
Conjunctiva, urethra, rectum
Respiratory cells in infants
63
Symptoms of chlamydia
Often asymptomatic (more women than men)
Urethritis - but less purulent than gonorrhoea
Cervicitis
Dysuria/pregnancy
64
Complications of chlamydia
PID, perihepatitis, tubal infertility, extopic pregnancy, chornic pain, epidiymitis
65
Complications of chlamydia in neonates
Conjunctivitis - onset 5-12 days
Infacnt pneumonia (4-11 weeks)
Conjunctivitis
Reites Syndrome
66
Diagnosis of chlamydia
NAAT mainly
67
Treatment of chalmydia
Azithromycin or doxycycline
If paediatrics: erythromycin for conjunctivits/pneumonia
68
Complication of PID
High risk of infertility
| Diagnosse with laproscopy
69
Causes of PID
Gonorrhea/chlamydia
| Infection of anaerobes/enteric organisms following infection
70
What is condylomata
Epidermal manifestation/genital warts due to HPV
71
How to treat condylomatas
Burn, freeze, cut, imiquimad
72
What type of virus is HSV
Double stranded DNA virus
| HSV 2 is more common in women
73
Primary genital herpes symptoms
Pain, itching, dysuria, vaginal/urethral discharge
| Bilateral vesicles/ulcers accompanied by constitutional sympotms
74
Where does HSV go latent
In sensory neutron cells, sacral nerve ganglia
75
Diagnosing of genital herpes
Clinical, PCR, histology
76
How do we treat HSV
Aciclovir
| Consider suppresion if frequent recurrence
77
Complications of HSV
```
Dissemination
Meningitis
Encephalitis
Sacral nerve parasthesia
Urinary Retetnion
```
78
What causes syphilis
Spirochete - treponema pallidum
79
How does syphilis cause infection
Penetrates via abraded skin or intact mucous membranes
| Disseminates within days via lympathics and blood
80
Classic histological picture of syphilis
Obliterative endarteritis
- concentrial endothelial/fibroblastic proliferation
- microvascular compromise
81
Incubation of sypihlis
21 days median
| 3-90
82
Primary syphilis
Site of inoculation, painless indurated lesions
| Heals spontaneously within 3 to 6 weeks
83
Secondary syphilis
Maculopopular rash on trunk, limbs, palsm, soles
Condylomata lata - coalesce in warm body areas
Mucous Patches
Fever, malaise, w eight loss, lymphadenopathy, CNS involvement
Spontaneous resolvement after 3-12 weeks
84
What percentage of untreated people develop tertiary sypilis
30%
85
Describe tertiary syphilis
Neuro-syphilis:
Meningovascular
Parenchymatous - General paresis - personality changes and Argyll Robertson pupils
Tabes doralsis - spinal cord demyelination
Aorititis - regurgitation and sacular aneurysm
Late benign sypihlis gummas - non-sepcific granulomatous reactions
86
Tabes dosrsalis changes in tertiary sypihlis
Demyelination of the poster column, dorsal roots and dorsal root gaggle
Causes ataxic wide based gait
Lightening pain in eggs, loss of position/vibratory sense
87
Early signs of neonatal syphilis
Snuffles, rash, hepatosplenomegaly
88
Late signs of neonatal syphilis
Frontal bosses
Saddle nose
Sabre shings
Hutchinsons incisorsz
89
Diagnosis of Syphilid
Diret detection - Darkfield microscopy for primary or secondary lesions, PCR
Indirect: 2 types
a) Specific - anti-trepomonal antibodies
b) Non-specific - reagents antibodies versus lipoid antigens
90
Treatment of syphilis
Penicillin
| Amoxicillin, ceftraxione and doxycyline
91
When can Jarish-Herxheimer reaction occur
Occurs in treating syphilis
Most common in secondary sypihlis
Hypersensitivirt reaction - organism lysis causing release of heat stable proteins
Causes fever, chills and myalgia
92
What causes trichomonas vaginals
Protozoa
| Trophozite transmitted, no known cysts, humans are the only natural host
93
What does trichomonas cause
Mucousal inflammation
Greenish frothy vaginal disacharge
Males usually asymptomatic but can spread it
94
Treatment of trichomonas
Metronidazole
95
What causes bacteria (anaerboic) Vaginosis
Low vaginal lactobacilli
| High gardenia vaginalis and anaerobes
96
Symptoms of BV
+ve KOH - fish odour
| Vaginal pH >4.5
97
Treatment of BV
Metronidazole
Amoxycillin
Topical Clindamycin
98
What contributes to candidiasis - thrush/balantis
Oral contraceptives
Poorly controlled diabetes
Antibitoics - inibits normal flora
Bowel source/sexual transmission
99
Symptoms of candidiasis
Vulval, vaginal, penile erythema: itching/irritation
Thick/adherent discharge; white plaques
Maculopapular and disarming lesions
100
What causes the majority of candidiasis
Candidiasis albicans
101
Treatment of uncomplicated candidiasis
C. albicans - non recurrent - not sever
Use topical agent - clo-trimzaole
Fluconazole for systemic disease
102
Treatment of complicated candidiases
10-14 treatment topical or oral
| Consider partner treatment too
103
What is HIV
Retrovirus - posses reverse transcriptase
| Causes CD4/macrophage tropic - reducing host immunity
104
How does HIB gain cell entry
Viral protein gp120 interacts with cellular receptor CD4 ad chemokine receptor CCR5 for vision to gain host cell entry
Reverse transcription in the cytoplasm
105
Stages of HIV
```
Based of CD4 count
stage 1 - over 500
stage 2 - 349-499
stage 3 - 200-349
stage 4 - less than 200
```
106
Early stages of HIV
Pulmonary TB (test HIV in all new cases)
Persistent oral candidiass, unexplained chronic diarrhoea and persistent fever
Severe bacterial infection e.g. S. pneumoniae
107
Diagnosis of HIV
Antibody testing (sero-conversion
PCR - detects viral nucleic acid - quantitative to see the viral load
CD4 count
108
Treatment of HIV
Nucleoside reverse transcriptase inhibitors
Non-Nucleoside reverse transcriptase inhibitors
Protease inhibitors - sparkly protease required to cleave viral poly-proteins
Viral entry inhibitor
Integrase strand transfer inhibitors
109
examples of Nucleoside reverse transcriptase inhibitors
zidovudine, lamuvidine
110
examples of non-Nucleoside reverse transcriptase inhibitors
Efarenz
111
examples of protease inhibitors
Riotnovir, saquinovir
112
What converts natural resistance to HIV
CCR5 delta 32 mutation
