Genital Tract Infections Flashcards
What factors affect the transmission of genital tract infections?
Age (15-29 particularly 20-24) Ethnicity -Black more likely to get STI Socio-economic status -low Age at first sexual intercourse - Lower Number of partners Sexual orientation - Men who have sex with men Condom use Menstrual cycle - symptoms can only appear at certain times
What are some complications of STIs?
PID (10x higher risk of infertility)
Epididymo-orchitis
Infertility
Ectopic pregnancy
What STI diagnoses are most common? How does this differ in men and women?
Chlamydia is by far the most common.
Men: Warts Gonorrhoea Herpes Syphilis
Females: Warts Herpes Gonorrhoea Syphilis
In females, herpes is more common and syphilis hardly ever occurs
In what ethnicity are STIs most common?
Black or black British or Mixed
What are the four main ways genital infections can present?
Urethritis, cervicits, abnormal discharges
Genital ulceration
Skin manifestations
Systemic presentation / complications
What things do you consider when diagnosing an STI?
Patients could be asymptomatic
Good sexual and physical history
Diagnostic samples (correct sites)
Isolate / diagnose offending organism
Prompt treatment and partner notification
Advice, counselling and education
How do you test for STIs in men?
Urine analysis -first catch or midstream
Urethral sampling
Rectal and pharyngeal samples
Swab of ulcer base
Bloods
How do you test for STIs in women?
Vulvovaginal swabs
High vaginal swabs
Endocervical swabs
Urine
Rectal and pharyngeal samples
Bloods
How do you manage STIs?
Treat -antibiotics
Co-infections are common so scree
Contact tracing
STI prevention -using many strategies
What are the symptoms of Chlamydia trachomatis?
Males - mild, urethritis, dysuria, epididymitis, proctitis, prastatitis
Females - asymptomatic, increased discharge, post-coital and intermenstrual bleeds, dyspareunia
How do you diagnose chlamydia?
Women:
Vulvovaginal Swab
First catch urine
Rectal and pharyngeal NAATs for extragenital sampling
Men:
Urine NAAT - hold urine for 24 hours
Urethral swabs - less acceptable
Rectal and pharyngeal NAATs for extragenital sampling
How do you treat Chlamydia trachomatis?
Doxycycline or axithromycin 1st line
Use antibiotics in line with trust guidelines.
What type of bacteria is Neisseria gonorrhoea?
Gram negative intracellular diplococcus that is easily viewed under a microscope
What are the symptoms of Neisseria gonorrhoeae?
Women - asymptomatic, altered discharge, lower abdominal pain, rectal and pharyngeal infections
Men - Urethral discharge, dysuria, anal discharge, asymptomatic pharyngeal infection
What are complications of Gonorrhoeae?
Prostatitis
PID
Epididymo-orchitis
Disseminated gonococcal infection
How do you diagnose Neisseria gonorrhoeae?
NAATS
Microscopy of gram stained genital specimens
Cultures - confirmation and antibiotic susceptibility testing
How do you treat Neisseria gonorrhoeae?
IM Ceftriaxone and azithromycin (2 antibiotics to reduce resistance chance)
Test of cure
Partner notification
What bacteria causes syphilis?
Treponema pallium - spirochete bacterium
Who does syphilis most commonly infect?
White men who have sex with men ages 25-34
What are the stages of syphilis?
1st - Painless ulcer (chancre) - genital or extragenital (oral, anal, rectal -where ever site of infection was)
Latent - symptom free years
2nd- 4-10 weeks later- Rash, Mucosal lesions, multi-system involvement
Latent - symptom free years
3rd - Up to 40 years after initial infection - Neurosyphilis, Parenchymous, Cardiovascular syphilis, Gummas (local destruction)
Can also be congenital syphilis
How do you diagnose syphilis?
History and physical examination
Lab diagnosis:
- Dark ground microscopy
- PCR
Serological tests
How do you treat syphilis?
Depends on stage of infection
Early syphilis: Benzathine, Penicillin G single dose IM
Latent later, CVS or Gummatous: Ben Pen G x 3 doses
Neurosyphilis: Treat for 14 days. IM procaine Penicillin plus probenecid
Follow-up with partner notification and clinical and serological follow ups at 3,6 and 12 months.
What is the difference between Herpes Simplex Virus 1 and 2?
HSV 1 - usual cause of oro-labial herpes
HSV 2 - more likely to cause recurrent infections.
Both can be primary, non-primary or recurrent infections.
How do you diagnose HSV?
Virus detection of vesicle fluid or ulcer base
Type specific serology
How do you treat HSV?
general advice
Acyclovir
Supressive treatment for recurrent infections (more than 6 in 12 months)
What are the symptoms of Trichomonas vaginalis?
Flagellated protozoa
Men:
15-50% asymptomatic
Urethral discharge
Dysuria
Women:
70% vaginal discharge - classically yellowy and frothy
Vulvitis, vaginitis, strawberry cervix
How do you diagnose and treat TV?
Diagnose: vaginal wet preparation +/- cultures / NAATs
Treatment: - Metronidazole
How do you treat scabies?
Permethrin
How do you treat pubic lice?
Malathion
What are anogenital warts?
Benign lesions caused by HPV
What types of HPV are associated with cervical cancer?
HPV16 and HPV18
How do you diagnose warts?
Clinical.
Biopsy in atypical or non responsive lesions
How do you treat anogenital warts?
No treatment - up to 70% resolve
Topical application
Physical ablation - excision, cryotherapy, electrosurgery and laser treatment
Also vaccination - since 2012 for girls. 99% effective against HPV for 10 years.
What is bacterial vaginosis?
This is the commonest cause of abnormal discharge in women of childbearing age.
What are the risk factors for BV?
Vaginal douching Black race Recent partner change Smoking Presence of STI Receptive cunnilingus
How do you diagnose and treat BV?
Laboratory diagnosis: high vagina gram stain smear tests
Treatment: Metronidazole
What are the symptoms of candida albicans?
vaginal discharge typically curdy and non-offensive.
Vulval itchy soreness, dyspareunia
What are the risk factors for candida?
Pregnancy, Antibiotics, Oestrogen-oral contraceptives Diabetes Immunosuppression History of atopy (hayfever, asthma, dermatitis) Non-albicans species
How do you diagnose and treat candida?
Diagnose: High vaginal smear
Treatment: Topical and oral azaleas give a cure rate of 80% in uncomplicated cases
What are common complications of STIs?
PID -infection ascends from the endocervix
Epididymis-orchitis -clinical syndrome pain, swelling and inflammation of the epididymis. Can be caused by STI or urinary pathogens.
SARA -Sexually acquired reactive arthritis -inflammation of synovial membrane, tendons and fascia triggered by STI. Includes Reiters syndrome
Prostatitis - Includes acute or chronic bacterial prostatitis.
