Genital Tract Infections Flashcards by Sophie Wakeling

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

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What are some complications of STIs?

PID (10x higher risk of infertility)
Epididymo-orchitis
Infertility
Ectopic pregnancy

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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

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In what ethnicity are STIs most common?

Black or black British or Mixed

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What are the four main ways genital infections can present?

Urethritis, cervicits, abnormal discharges

Genital ulceration

Skin manifestations

Systemic presentation / complications

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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

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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

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How do you test for STIs in women?

Vulvovaginal swabs

High vaginal swabs

Endocervical swabs

Urine

Rectal and pharyngeal samples

Bloods

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How do you manage STIs?

Treat -antibiotics
Co-infections are common so scree
Contact tracing
STI prevention -using many strategies

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What are the symptoms of Chlamydia trachomatis?

Males - mild, urethritis, dysuria, epididymitis, proctitis, prastatitis

Females - asymptomatic, increased discharge, post-coital and intermenstrual bleeds, dyspareunia

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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

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How do you treat Chlamydia trachomatis?

Doxycycline or axithromycin 1st line

Use antibiotics in line with trust guidelines.

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What type of bacteria is Neisseria gonorrhoea?

Gram negative intracellular diplococcus that is easily viewed under a microscope

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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

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What are complications of Gonorrhoeae?

Prostatitis
PID
Epididymo-orchitis
Disseminated gonococcal infection

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How do you diagnose Neisseria gonorrhoeae?

NAATS
Microscopy of gram stained genital specimens
Cultures - confirmation and antibiotic susceptibility testing

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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.