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Repro > Fertility And Infections Of The Reproductive Tract > Flashcards

Fertility And Infections Of The Reproductive Tract Flashcards

1
Q

Why are clotting factors and proteolytic enzymes both found in semen?

A

Clotting factors ensure deposition of semen in the female reproductive tract, while proteolytic enzymes then break down the clots to allow the motile sperm to make their way to the ampulla for fertilisation

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2
Q

What nervous innervation is erection controlled by?

A

Somatic and autonomic efferent of the parasympathetic nervous system.
Pelvic nerve - parasympathetic
Pudendal nerve - somatic

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3
Q

What three physiological processes are required to sustain erection?

A

Sinusoidal relaxation,
Arterial dilation,
Venous compression.

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4
Q

what chemical mediator controls erection?

How is it released?

A

Nitric oxide.
1.Post ganglionic fibres release Ach
2. Ach binds to M3 receptors and activates nitric oxide synthase
3. NO diffuses into vascular smooth muscle and causes vasodilation.
(NO can also be released directly by nerves)

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5
Q

Where are some causes of erectile dysfunction?

A

Descending inhibition of spinal reflexes eg spinal nerve compression,
Tears in corpora cavernosa,
Vascular disease,
Drugs.

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6
Q

How does viagra cause prolonged erections?

A

Slows rate at which cGMP degrades, causing vasodilation to continue long after exposure to nitric oxide

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7
Q

Which branch of the nervous system controls ejaculation?

A

Sympathetic nervous system

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8
Q

Why does the internal sphincter of the bladder close during ejaculation?

A

Prevent retrograde ejaculation into the bladder

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9
Q

How can quality of mucus indicate female fertility?

A

Thick and acidic likely less fertile, as progesterone is actively attempting to prevent entry of sperm

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10
Q

What is capacitation?

A

Further maturation of sperm in the female reproductive tract.
Tail changes to whip like motion, sperm cell membrane changes to allow the acrosome reaction and fusion with the oocyte.

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11
Q

What is the fertile window for spermatozoa in the female reproductive tract?

A

48-72 hours, meaning fertile period includes sperm deposition up to 3 days before day of ovulation

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12
Q

What is the acrosome?

A

Outer shell of sperm derived from golgi, containing enzymes necessary for fertilisation

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13
Q

What is the acrosome reaction?

A

Sperm push through corona radiata and bind with the surface protein ZP3 to the zona pellucida, causing release of enzyme ps and digestion.

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14
Q

After penetration, what mechanism ensures no more sperm enter the oocyte?

A

Calcium dependant exocytosis of protease containing cortical granules from the ovums plasma membrane, digest other sperm. Called the cortical reaction.

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15
Q

What effect do calcium waves following fusion have on the pronuclei?

A

Pronuclei move together and meiosis 2 occurs, forming mitosis spindle for cleavage.

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16
Q

After the first differentiation, forming inner and outer cell masses, what does the zygote become?

A

Blastocyst. This hatches from the zona pellucida and implants upon the uterine surface

17
Q

What makes chlamydia an obligate intracellular bacterium?

A

Able to prevent fusion of phagosome after phagocytosis so can replicate within the phagocyte

18
Q

What are common signs of chlamydia infection?

A

Males - testicular swelling and pain, dysuria

M+F - dyspareunia, discharge, often asymptomatic.

19
Q

What are common symptoms associated with gonorrhoea?

A

Thick yellow discharge
Dysuria in men
Only 50% of women present with symptoms compared to 90% men

20
Q

How are gonorrhoea and chlamydia investigated?

A

Screening,
Gonorrhoea- urethral swab in men or urine cultures
Chlamydia - NAAT - nucleic amplification studies

21
Q

When might discharge in a woman be physiological?

How would you be able to tell?

A

Secretory phase under the influence of progesterone, cervical mucus is thickened.
Ask - cyclical? Colour? No other symptoms suggesting systemic infection?

22
Q

What is trichomonas vaginalis?

A

Protozoa found in the vagina at higher than normal physiological pH. Cause yellow offensive smelling discharge, eradicated by metronidazole.

23
Q

What causes bacterial vaginosis?

A

Gardnerella vaginalis or other organism proliferation following a decrease in normal lactobacillus levels. Often brought about by excessive cleaning

24
Q

What may predispose a woman to developing infection with Candida albicans?

A

Immunosuppressants
Diabetes
Rise in oestrogen (oral contraceptive)
Antibiotic use.

25
Q

What are the symptoms of Candida albicans infection?

A

Thick, white discharge

Itching.

26
Q

What investigations can be done in women for Infections?

A

Vulvovaginal swabs - chlamydia and gonorrhoea.
Endocervial swabs.
High vaginal swabs - trichomoniasis, BV, candida.

27
Q

Why can urine dipsticks not be used to effectively diagnose infections of reproductive tract in women?

A

The vagina and bladder are separate openings, unlike in the man. These can however be used to rule out UTI.

28
Q

Why is screening important?

A

Many patients with STIs are often asymptomatic.

29
Q

What are the risk factors for STIs?

A 
Young age (15-24),
Multiple sexual partners,
No barrier contraception, 
Early age of first intercourse,
Coexisting infections.
30
Q

Which antibiotics are often used to treat gonorrhoea and chlamydia and why?

A

Azithromycin + ceftriaxone - antibiotics augment the effect of each other. Effective against gram negative species

31
Q

Which human papillomaviruses are associated with cervical cancer?
Which vaccines helps prevent these?

A

16 and 18
Gardasil
Cervanix

32
Q

Which papillomaviruses are responsible for 90% of infections?
Which vaccine helps prevent these?

A

6 + 11

Gardasil

33
Q

Which herpes virus has associations with HIV?

A

HSV-2

34
Q

What are the symptoms of herpes simplex infection?

A

Genital, oral and anal lesions that ulcerate,
Possible systemic symptoms,
Recurrent and lifelong.

35
Q

What causative organism causes syphilis?

A

Treponema pallidum.

36
Q

How does primary syphilis manifest?

What about secondary syphilis?

A

Primary - single painless ulcer
25% develop secondary - multi system involving hepatitis, glomerulonephritis, CNS symptoms.
May become latent.

37
Q

How is syphilis diagnosed and treated?

A

Investigated with microscopy and PCR. Treated with penicillins.

Repro (11 decks)

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