Genital Infections Flashcards

1
Q

How is vaginal pH maintained?

A
  1. Oestrogen / Progesterone stimulate secretion of glycogen.
  2. Lactobacilli convert glycogen into lactic acid.
  3. Lactic acid production maintains vaginal pH at 3.5-4.5.
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2
Q

Outline gram positive bacteria and how they stain.

A

Gram-positive bacteria have a thick meshlike cell wall made of peptidoglycan and as a result are stained purple by crystal violet.

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3
Q

Outline Gram-negative bacteria and how they stain.

A

Gram-negative bacteria have a thinner layer so do not retain the purple stain.

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4
Q

What is the condition described?

Offensive fishy smelling vaginal discharge, not associated with soreness, itching, or irritation.

Thin, white, homogeneous discharge, coating the walls of the vagina and vestibule.

A

Bacterial vaginosis

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5
Q

Summary of Bacterial vaginosis:

A
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6
Q

What bacteria cause bacterial vaginosis?

A

This condition is characterized by replacement of vaginal lactobacilli with predominantly anaerobic microorganisms such as Gardnerella vaginalis and Mobiluncus morphotypes.

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7
Q

What are the risk factors of bacterial vaginosis?

A

Vaginal douching Overwashing Receptive cunnilingus Black race Recent change of sex partner Smoking Presence of an STI e.g. chlamydia or herpes.

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8
Q

What is the likely condition described?

Itchy white discharge?

A

Vulvovaginal candidiasis (thrush)

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9
Q

What is the most common cause of Vulvovaginal candidiasis (thrush)?

A

Candida albicans >90%

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10
Q

What are the symptoms of Vulvovaginal candidiasis (thrush)?

A
  • Vulval itching
  • Vulval soreness
  • Vaginal discharge
  • Superficial dyspareunia
  • External dysuria
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11
Q

What is the likely diagnosis in a women with these symptoms?

  • 10-50% are asymptomatic
  • Profuse vaginal discharge
  • Vulval itching
  • Dysuria
  • Strawberry cervix
A

Trichomonas vaginalis

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12
Q

Trichomonas vaginalis

A

Trichomoniasis is a type of sexually transmitted infection caused by a tiny parasite.

Symptoms of trichomoniasis include pain when peeing, sore or itchy genitals, and abnormal discharge from your vagina or penis.

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13
Q

What are the symptoms of chlamydia?

A
  • Post coital / intermenstrual bleeding
  • PV discharge
  • Lower abdominal pain
  • Dysuria
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14
Q

What are the complications chlamydia can cause?

A
  • Cervicitis
  • Pelvic Inflammatory Disease
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15
Q

How does Pelvic inflammatory disease present?

A
  1. Lower abdominal pain, typically bilateral.
  2. Deep dyspareunia.
  3. Abnormal vaginal bleeding, including post coital, intermenstrual and menorrhagia.
  4. Abnormal vaginal or cervical discharge, often purulent.
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16
Q

How does chlamydia present in men?

A
  • Asymptomatic ~50%
  • Urethral discharge
  • Dysuria
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17
Q

What are the complications of chlamydia in men?

A
  • Epidydimo-orchitis
  • Non specific urethritis
  • Conjunctivitis (adult / newborn)

• Sexually Acquired Reactive Arthritis (SARA) (Reiter’s syndrome).

• LGV

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18
Q

LGV

A

Lymphogranuloma venereum (LGV) is an ulcerative disease of the genital area. It is caused by Chlamydia trachomatis.

19
Q

What is Sexually Acquired Reactive Arthritis (SARA) (Reiter’s syndrome).

A

Sexually acquired reactive arthritis ( SARA) is a reactive arthritis caused by an immune reaction to an infection, often a sexually transmitted infection. It is caused by immune complexes ( so antibodies that fight infection and proteins from the infection) being deposited in the joints.

20
Q

What gram stain is chlamydia?

A

Gram-negative bacteria

  • red
21
Q

What are the symptoms of LGV?

A

Within a few weeks of becoming infected, most people get painful inflammation in the rectum (known as ‘proctitis’) with bleeding, pus, constipation or ulcers.

You can also get a fever, rash and swelling in your groin, armpit or neck.

22
Q

What condition does this triad present in?

A

SARA - Sexually acquired reactive arthritis aka Reiter’s syndrome.

23
Q

What is the likely diagnosis in a male patient who presents with green offensive discharge?

  • gram negative stain
A

Neisseria gonorrhoeae

24
Q

What are the symptoms of Neisseria gonorrhoeae?

A

Urethral discharge

Dysuria and increased frequency

25
Q

What are the complications of Neisseria gonorrhoeae?

A

• Prostatitis • Epididymitis • Acute urethritis • Later urethral stricture • Sexually acquired reactive arthritis (SARA) • Disseminated gonococcal infection

26
Q

How does Neisseria gonorrhoea present in women?

A
  • Endocervical discharge – asymptomatic ~50%
  • Increased vaginal discharge in ~50%
  • Dysuria – 12%
  • Rectal (direct spread) – asymptomatic
  • Pharyngeal – asymptomatic >90%

Can lead to pelvic inflammatory disease in women.

27
Q

What is the likely diagnosis in a male presenting with clear discharge?

  • Gram negative bacteria.
A

Non gonococcal urethritis

28
Q

Non gonococcal urethritis

A

NGU is an infection of the urethra caused by pathogens other than gonorrhea.

29
Q

What pathogens can cause NGU?

A
30
Q

Treponema pallidum causes what condition?

A

Syphillis

31
Q

Treponema pallidum is gram what?

A

Gram negative

32
Q

What does syphilis effect?

A

Syphillis affects the skin and mucus membranes of the genitalia and mouth.

33
Q

How is syphilis transmitted?

A
  1. Acquired syphillis - T.pallidum enters the body through body fluids.
  2. Congenital syphillis - Mother has syphillis.
34
Q

What are the three stages of acquired syphilis?

A
  1. Primary - Early localized - spirochetes destroy skin leading to ulcer formation know as syphilitic chancres (painless).
  2. Secondary stage - spirochetes enter the blood stream causing generalised lymphadenopathy. Can present with a non-itchy maculopapular rash.
  3. Latent - dormant / assymptomatic phase.
    1. Early latent - within a year of infection.
    2. Late latent - After a year.
  4. Tertiary syphillis.
35
Q

What happens in the tertiary phase of syphillis?

A

Type IV Hypersensitivity reaction

Spirochetes in the blood cause a huge immune response from tcells.

T cells recruit macrophages causing release of pro-inflammatory cytokines.

This inflammatory response leads to swelling, warmth, edema, redness and a fever.

Tertiary syphillis can lead to organ damage.

36
Q

Cardiovascular syphilis:

A

Presents with endarteritis - inflammation of the vaso vasorum of the aorta. This leads to aortitis which can progress to aortic aneurysm.

37
Q

Presentation of syphilis:

A
38
Q

Congenital syphilis

A
39
Q

Syphilis summary:

A
40
Q

What is screened for in sexual health clinics for assymptomatic patients?

A
  • Chlamydia trachomatis
  • Neisseria gonorrhoeae
  • HIV
  • Syphilis
41
Q

What is screened for in symptomatic patients in a sexual health clinic?

A
42
Q

Identify!

A

Treoponema pallidum - the syphilis spirochete!

43
Q

Candida albicans gram stain?

A

Gram positive

44
Q

What is the bacteria shown in this gram stain?

A

Neisseria gonnorrhoea.