Genital tract infections 2

Question 1

What is syphilis?

Answer 1

• Caused by Treponema pallidum (spirochaete)
• Sexual transmission occurs in the first 2 years of untreated infection, although transmission to the foetus may occur up to 10yrs after primary infection
• Primary or secondary syphilis during pregnancy carries a high risk of congenital infection

Question 2

What is primary syphilis?

Answer 2

characterised by a solitary painless genital ulcer (chancre)

Question 3

What is secondary syphilis?

Answer 3

untreated primary, develops weeks later, often with a rash, flu-like symptoms and warty genital/perioral growths (condylomata lata)- systemic vasculitis and can manifest in organs
o Hepatitis
o Uveitis
o Alopecia

Question 4

What is latent syphilis?

Answer 4

when symptoms from secondary syphilis resolve without treatment

Question 5

What is tertiary syphilis?

Answer 5

very rare, develops many years after initial infection and virtually any organ can be affected- possible complications
o	Aortic regurgitiation
o	Dementia
o	Tabes dorsalis
o	Gummata in skin & bone

Question 6

How is syphilis diagnosed?

Answer 6

syphilis enzyme immunoassay and Venereal Disease Research Laboratories (VDRL) tests

Question 7

How is syphilis treated?

Answer 7

all stages treated with parenteral (IM) penicillin

Question 8

What is trichomoniasis?

Answer 8

•	Caused by Trichomonas vaginalis (flagellate protozoan)
o	Offensive grey-green discharge- 70%
o	Vulval irritation
o	Dysuria
o	Superficial dyspareunia
o	Asymptomatic in 50%

Question 9

How is trichomoniasis diagnosed?

Answer 9

NAATs- although motile trichomonas will be seen on wet film microscopy in 60% of cases

Question 10

How is trichomoniasis treated?

Answer 10

systemic metronidazole

Question 11

What other infections can cause genital ulceration?

Answer 11

• Chancroid (Haemophilus ducreyi) and lymphogranuloma venereum

Question 12

What is early deterioration in HIV associated with?

Answer 12

o Chronic skin problems
o Recurrent oral candida
o Fever
o Generalised lymphadenopathy
• CIN is more common in affected women, yearly smears are recommended
• Genital infections- particularly candidiasis and menstrual disturbances are more common

Question 13

What is the treatment for HIV?

Answer 13

HAART treatment- considered as a chronic controllable condition in a similar manner to diabetes

Question 14

How does normal discharge range in appearance?

Answer 14

mucoid (ovulation) to opaque

increased around ovulation, during pregnancy and in women on COPC

Question 15

How can cervical eversion and ectropion be treated?

Answer 15

with cryotherapy or diathermy once infection has been excluded

Question 16

Which symptoms is abnormal discharge associated with?

Answer 16

o Malodour
o Itch
o Superficial dyspareunia

Question 17

What are the other causes fo abnormal discharge?

Answer 17

BV, trichomoniasis and candidiasis
o	Cervicitis
o	Aerobic vaginitis
o	Atrophic vaginitis
o	Mucoid cervical ectopy
o	Psychosexual & depression