Dysuria, urethritis, cervicitis and testicular pain

Question 1

Causes of vaginal discharge

Answer 1

Physiological: mucus

Cervicitis: endocervical infection of TZ, from gonorrhea, chlamydia.

Genital candidiasis; bacterial vaginosis; other such as retained tampon

Question 2

Chlamydia trachomatis bacterial characteristics (commonly asymptomatic, most common)

Answer 2

• bacterium
• Intracellular bacteria with 24-48 hourlife cycle (5 days antibiotics)
• Similar to gram - membrane
• Diff types, D-K GU disease, L cause LGV

Question 3

Disease spectrum chlamydia D-K can cause

Answer 3

Males: urethritis, epididymitis, proctitis, reiter’s
Female: cervicitis, sterile pyuria, PID and perihepatitis, infertility
Neonatal and paediatric: conjunctivitis, pneumonia, otitis media

Question 4

Chlamydia diagnosis

Answer 4

DNA amplification, NAAT
NAAT>culture>EIA

Specimens are collected: FVU (first voided urine) in males. Vulvovaginal swab for females

Question 5

Chlamydia treatment

Answer 5

Typically azithromycin 1g
More doxycycline 100g used now due to other organism resistance to azithromycin
In pregnant women, azithromycin or amoxycillin (but check for cure 3-4 days)

Needs to be used for about 5 days

Question 6

Azithromycin

____ antibiotic
inhibits bacterial ____ translation
Risk factor in ___ ____ ____
Resistance rare in ____

Answer 6

macrolide antibiotic
inhibits bacterial mRNA translation
Risk factor in long QT syndrome
Resistance rare in chlamydia

Question 7

Reiters syndrome

Answer 7

reactive arthritis caused by an STI

Question 8

Neisseria gonorrhoea features

Answer 8

Gram - diplococcus
Humans only natural host
infect non cornified epithelial cells
oxidase +
fastidious growth (needs specific conditions) (New York or Thayer Martin)

Question 9

Gonorrheoa defence

Answer 9

Pilin: adherence, neutrophil resistance
Opa proteins: adherence
LOS: tissue toxin
Serum resistance: sialylation of LOS
IgA1 protease

Question 10

Gonorrhoeal urethral infection. How does it appear and incubation

Answer 10

Most are symptomatic, and cause anterior urehtritis. Discharge and dysuria + meatal erythema)
Incubtion period of 1-14 days (2-5 is common).
Will go away

Question 11

Gonorrhoea treatment

Answer 11

If pregnant, ceftriaxone
Normally, ciprofloxacin 500mg with 1mg azithromycin.
try avoid azithromycin sole first line therapy

Question 12

Ciprofloxacin facts

Answer 12

2nd gen fluoroquinolone
broad spec
Inhibits DNA gyrase
Resistant organisms (like gonorrhoea) have topisomerases stopping binding

Question 13

Gonorrhoeal complications

Answer 13

Epididymitis: most frequent
Rectal infection
Pharyngeal: from fellatio
Endocervical in females, primary site of infection. - leads to PID (perihepatitis)

Question 14

PID (inflammation of tubal mucosa, endometrium etc) causes and treatment

Answer 14

Polymicrobial, primarily chlamydia then gonorrhoea.
Secondary: BV, other organisms

Activity against gonoccos,chlamydia, anaerobes. Ceftriaxone 500mg + doxycycline 100mg, sometimes metronidazole for about 2 weeks

Question 15

PID signs and symptoms

Answer 15

Symptoms: Vaginal discharge, bleedig, dysuria, nausea, vomiting
Signs: abdo tenderness, cervical motion tenderness, adnexal mass, fever in some, RUQ tenderness in very few

Question 16

NSU (Non specific urethritis)

Answer 16

Chlamydia and gonorrhea ruled out

Might be trichomonas vaginalis or mycoplasma genitalium

Question 17

trichomonas vaginalis

Inhibited by some ____ secretions. A ____ found in lower GU tract
Can cause_____ _____
In females, _____. Adverse ____ outcomes. May facilitate HIV transmission

Answer 17

Inhibited by some prostatic secretions. A protozoa found in lower GU tract
Can cause relapsing urethritis
In females, vaginitis. Adverse pregnancy outcomes. May facilitate HIV transmission