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Dip GUM > Genital Infection In Infants / Children > Flashcards

Genital Infection In Infants / Children Flashcards

1
Q

Why is neonatal chlamydia infection important?

A

A significant cause of neonatal morbidity.

Can cause ophthalmia neonatorum and pneumonia

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2
Q

Mode of transmission of chlamydia to neonates

A

By direct contact with the infected maternal genital tract

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3
Q

What anatomical sites may be involved in neonatal chlamydia infection?

A

Eyes
Oropharynx
Urogenital tract
Rectum

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4
Q

What is the usual timeframe for the development of neonatal chlamydial conjunctivitis?

A

5–12 days after birth

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5
Q

What is the usual timeframe for the development of neonatal chlamydial pneumonia?

A

1 -3 months after birth

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6
Q

Why is neonatal chlamydial infection much less common now than previously? b

A

Increased screening of pregnant women

Increased treatment of pregnant women

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7
Q

How is neonatal chlamydia infection diagnosed?

A

Most frequently made on clinical grounds

Confirmed with NAATs testing - not validated but widespread use + should be effective

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8
Q

What sample should be taken to diagnose neonatal chlamydial conjunctivitis

A

NAATs specimen obtained from the everted eyelid
Use a dacron-tipped swab
or swab specified by manufacturer’s test kit
Should contain conjunctival cells
Not exudate alone

Specimen should also be tested for N. gonorrhoeae.

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9
Q

What sample should be taken to diagnose neonatal chlamydial pneumonia?

A

NAATs specimens collected from the nasopharynx.

Do not use NAATs for Chlamydophila pneumoniae as these DO NOT detect chlamydia trachomatis.

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10
Q

Treatment of neonatal chlamydia

A

Erythromycin PO 50mg/kg/day in four divided doses for 14 /7
(topical treatment is inadequate)

Alternative = Azithromycin 20mg/kg/day PO OD for 3/7

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11
Q

Why is ceftriaxone not licensed to be given to neonates under 41 weeks postmenstrual age

A

risk of precipitation in urine and lungs

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12
Q

What is the recommended medication for treating uncomplicated gonorrhoea in neonates under 41 weeks postmenstrual age

A

IV Cefotaxime
Expert paediatric advice is required regarding dosage

AVOID ceftriaxone under 41 weeks postmenstrual age

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13
Q

Recommended treatment for uncomplicated gonorrhoea in children aged 1 month to <2 years

A

Ceftriaxone 125mg IM STAT in children who weigh < 45kg

or Spectinomycin 40 mg/kg IM STAT [unreliable in pharyngeal infection]

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14
Q

Recommended treatment for uncomplicated gonorrhoea in children aged 2 to 12 years

A

Ceftriaxone
If <45kg - give 125mg IM STAT
If >45kg - give 250mg IM STAT

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15
Q

Recommended treatment for uncomplicated gonorrhoea in children aged >12 years

A

Ceftriaxone 500mg IM STAT plus Azithromycin 1g PO STAT

   **Guideline last updated 2013** - can't find new evidence re dosing

or Cefixime 400mg po stat (unlicensed) if patient refuses IM treatment/needle phobic
plus Azithromycin 1g po stat

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16
Q

Treatment of gonococcal PID in a child aged 2 -12 years

A

Ceftriaxone 125mg IM STAT - if weighing < 45 kg
AND Erythromycin 250mg BD PO 2/52
AND Metronidazole BD PO (dose by weight) 2/52

17
Q

Treatment of gonococcal PID in a child aged 2 -12 years

A

Ceftriaxone 500mg IM STAT
AND Doxycycline 100mg BD PO 2 weeks
AND Metronidazole 400mg BD PO 2 weeks

18
Q

What are the recommendations by BASHH for staff seeing under 16s in sexual health services?

A

Assess competence and risk factors re-assessed at each visit with a new problem
Assess for risk factors for Child Sexual Abuse and exploitation
Use an ‘under-age attender proforma’
Give the YP opportunity to be seen alone
Encourage them to involve a parent / carer
Referr to a Health Adviser
STI screening and prevention advice
+/- STI diagnosis and treatment
Contraceptive advice

19
Q

Factors influencing the risk of infection in children and young people

A
  • prevalence of STIs in the local population
  • maternal STI during pregnancy - vertical transmission
  • type of sexual activity
  • injuries of the genital tract increase susceptibility
  • sexual maturity - young people have increased
    biological susceptibility to carcinogens and STIs due to physical and immunological immaturity of the genital tract
  • lack of use of barrier contraception.
  • age at first intercourse
  • previous sexual activity
  • increased number of partners.
  • co-existing other risk behaviours - drugs or alcohol
20
Q

Sample site suggested for STI screening in pre-pubertal girls

A

introital swabs inside labia minora
but avoiding the hymen

Trans-hymenal swabs can be used if it is possible to pass a swab without causing distress. (ENT swabs are smaller than traditional swabs)

First-pass urine - GC and CT NAAT - if swabs are not feasible

21
Q

Sample site suggested for STI screening in pre-pubertal boys?

A

First-pass urine - NAAT for GC and CT

Meatal swab - If urethral discharge

22
Q

Management of infants and children of HIV positive parents

A

Test children born to HIV positive parents - irrespective of their age if they may be at risk
Requires parental consent
If a parent refuses testing of the child - seek specialist advice

23
Q

Significance of gonorrhoea in children

A
  • Gonorrhoea is not often seen in pre-pubertal and pubertal children
  • Consider the possibility of sexual abuse
  • Consider the possibility of vertical transmission
  • Gonorrhoea is more likely to be due to sexual abuse in older children
  • Consider consensual sexual activity in adolescents
24
Q

Significance of chlamydia in children

A
  • Consider the possibility of sexual abuse
  • Consider the possibility of vertical transmission
  • CT more common in pubertal than pre-pubertal sexually abused girls
  • But also consider consensual sexual activity in adolescents
25
Q

Significance of chlamydia in children

A

BV can occur in pubertal girls regardless of sexual activity

BV is not necessarily suggestive of sexual assault or sexual activity

26
Q

Significance of syphilis in children

A

Clear history and examination
Syphilis serology for child and mother
- Consider vertical transmission or contaminated blood
- BUT a +ve diagnosis in the mother does not exclude child sexual abuse
- Consider sexual abuse

27
Q

Significance of ano-genital warts in children

A

A significant proportion of children with anogenital warts have been sexually abused

Consider vertical transmission

28
Q

Significance of genital herpes simplex in children

A

Consider

  • autoinnoculation
  • Child sexual abuse
29
Q

Significance of Hep B in children

A

Exclude vertical, perinatal or blood contamination as the route of transmission
Consider child sexual abuse

30
Q

Significance of HIV in children

A

A child with HIV with an uninfected mother = high possibility sexual abuse has occurred

HIV infection in the mother does not exclude the possibility of child sexual abuse

31
Q

Significance of Trichomonas in children

A
  • girls with a confirmed of TV = sexual abuse likely.
  • Consider consensual sexual activity
  • Consider vertical transmission (less likely once >2months old)
32
Q

What is ophthalmia neonatorium

A

conjunctivitis in first month of life

causes = GC / CT / HSV
or H. influenza / staph pneumonia / strep pneumonia / klebsiella / E. coli / Adenovirus

33
Q

features of neonatal GC

A 
disseminated disease
septic arthritis
neonatal sepsis
scalp abscesses
meningitis
endocarditis
pharyngitis
urethritis
vulvitis
vaginitis
proctitis
34
Q

complications of neonatal GC

A

Osteomyelitis
Aseptic necrosis of the femoral head
Death

35
Q

why is neonatal herpes simplex rare

A

transplacental antibodies from mother partially protect the new born

36
Q

features of neonatal HSV

A 
skin vesicles
scarring 
chorioretinitis
microcephaly
hydranencephaly
encephalitis
disseminated infection - multi-organ involvement
death

Dip GUM (27 decks)

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