Genital Tract Infections Flashcards
What factors affect the transmission of genital infections?
Age Ethnicity Socio-economic status Age at first sexual intercourse Number of partners Sexual orientation Condom use Menstrual cycle
Describe the epidemiology of sexually transmitted infections (STIs)
Chlamydia is the most common STI
Highest rates amount 20-24 year olds
Black men most likely to have chlamydia
Outline testing for STIs in men
Urine analysis = gonorrhoea/chlamydia, midstream urine for C+S
Urethral sampling = gonorrhoea cultures, gram stain
Rectal and pharyngeal samples = gonorrhoea and chlamydia
Swab of ulcer base = herpes, PCR for syphilis
Bloods = syphilis, blood borne
Outline testing for STIs in women
Vulvovaginal swabs = gonorrhoea and chlamydia
High vaginal swabs = trichomonas
Endocervical swabs = gonorrhoea
Urine = midstream urine for C+S
Rectal and pharyngeal samples = gonorrhoea NAAT
Swab ulcer base = herpes, PCR for syphilis
Bloods = syphilis, blood borne
Outline general management of STIs
Treatment = Abx
Screen for other STIs
Contact tracing
STI prevention
List the most common sexually transmitted infections, identifying the infecting organism in each case
Chlamydia = Chlamydia trachomatis
Gonorrhoea = neisseria gonorrhoea
Herpes = herpes complex ½
HIV = human immunodef virus
Syphilis = treponema pallidum
Genital warts = human papillomaviruses (HPV)
Describe recent trends in the incidence of sexually transmitted infections
Chlamydia = most common
Gonorrhoea increased, then a recent decline
Describe the clinical presentation, diagnosis and management of chlamydial infections
Chlamydia trachomatis
M = urethritis, dysuria, epididymitis, proctitis, prostatitis
F = mostly asymptomatic, increased discharge, bleeds
Diag = swabs (urethral, vulvovaginal, rectal, pharyngeal), NAAT
Treat = 1st doxycyline or azithromycin, 2nd erythromycin
Describe the clinical presentation, diagnosis and management of gonorrhoea
Neisseria gonorrhea
M = urethral discharge, dysuria, anal discharge
F = asymptomatic, altered discharge, lower abdo pain
Diag = gram stain, NAAT, cultures
Treat = IM ceftriaxone plus oral azithromycin, spectinomycin in penicillin allergy
Describe the clinical presentation, diagnosis and management of genital herpes
Herpes simplex 1/2
1 = most likely cause of oro-labial herpes
Asymptomatic, painful ulceration, dysuria, vaginal discharge
Diag = viral detection at ulcer base, serology
Treat = aciclovir
Explain the 3 reasons azithromycin is used on top of ceftriaxone
Azithromycin boosts activity of ceftriaxone
Lowers levels of resistance
35% of gonorrhoea cases also have chlamydia – treatment therefore for both
Describe the clinical presentation, diagnosis and management of genital warts
Human papillomaviruses
Benign painless ep or mucosal outgrowths on penis, vulva, vagina, urethra, cervix, perianal skin
Diag = biopsy
Treat = spontaneous resolution, topical treatment, physical ablation
HPV vaccination
High-risk = HPV 16 and 18
What is syphilis?
Treponema pallidum
Diag = PCR, microscopy
4 stages = primary, secondary, latent, tertiary
Chancre = firm, painless, non-itching skin ulceration
Diffuse rash
What is trichomonas vaginalis?
Flagellated protozoa
M = infect urethra, urethral discharge, dysuria
F = vaginal discharge (yellow, frothy)
Diag = cultures, NAAT
Treat = metronidazole
Outline bacterial vaginosis
Most common cause of abnormal discharge in women of childbearing age
Caused by anaerobic bacteria
Offensive fishy discharge
Risk factors = vaginal douching, black race, recent partner change, smoking
Diag = high vagina gram stain
Treat = metronidazole
