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ESA 3 - Reproductive System > Genital Tract Infections > Flashcards

Genital Tract Infections Flashcards

1
Q

What factors affect the transmission of genital tract infections?

A 
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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2
Q

What are some complications of STIs?

A

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

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3
Q

What STI diagnoses are most common? How does this differ in men and women?

A

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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4
Q

In what ethnicity are STIs most common?

A

Black or black British or Mixed

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5
Q

What are the four main ways genital infections can present?

A

Urethritis, cervicits, abnormal discharges

Genital ulceration

Skin manifestations

Systemic presentation / complications

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6
Q

What things do you consider when diagnosing an STI?

A

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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7
Q

How do you test for STIs in men?

A

Urine analysis -first catch or midstream

Urethral sampling

Rectal and pharyngeal samples

Swab of ulcer base

Bloods

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8
Q

How do you test for STIs in women?

A

Vulvovaginal swabs

High vaginal swabs

Endocervical swabs

Urine

Rectal and pharyngeal samples

Bloods

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9
Q

How do you manage STIs?

A

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

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10
Q

What are the symptoms of Chlamydia trachomatis?

A

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

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

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11
Q

How do you diagnose chlamydia?

A

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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12
Q

How do you treat Chlamydia trachomatis?

A

Doxycycline or axithromycin 1st line

Use antibiotics in line with trust guidelines.

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13
Q

What type of bacteria is Neisseria gonorrhoea?

A

Gram negative intracellular diplococcus that is easily viewed under a microscope

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14
Q

What are the symptoms of Neisseria gonorrhoeae?

A

Women - asymptomatic, altered discharge, lower abdominal pain, rectal and pharyngeal infections

Men - Urethral discharge, dysuria, anal discharge, asymptomatic pharyngeal infection

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15
Q

What are complications of Gonorrhoeae?

A

Prostatitis
PID
Epididymo-orchitis
Disseminated gonococcal infection

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16
Q

How do you diagnose Neisseria gonorrhoeae?

A

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

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17
Q

How do you treat Neisseria gonorrhoeae?

A

IM Ceftriaxone and azithromycin (2 antibiotics to reduce resistance chance)

Test of cure

Partner notification

18
Q

What bacteria causes syphilis?

A

Treponema pallium - spirochete bacterium

19
Q

Who does syphilis most commonly infect?

A

White men who have sex with men ages 25-34

20
Q

What are the stages of syphilis?

A

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

21
Q

How do you diagnose syphilis?

A

History and physical examination

Lab diagnosis:

  • Dark ground microscopy
  • PCR

Serological tests

22
Q

How do you treat syphilis?

A

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.

23
Q

What is the difference between Herpes Simplex Virus 1 and 2?

A

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.

24
Q

How do you diagnose HSV?

A

Virus detection of vesicle fluid or ulcer base

Type specific serology

25
Q

How do you treat HSV?

A

general advice
Acyclovir
Supressive treatment for recurrent infections (more than 6 in 12 months)

26
Q

What are the symptoms of Trichomonas vaginalis?

A

Flagellated protozoa

Men:
15-50% asymptomatic
Urethral discharge
Dysuria

Women:
70% vaginal discharge - classically yellowy and frothy
Vulvitis, vaginitis, strawberry cervix

27
Q

How do you diagnose and treat TV?

A

Diagnose: vaginal wet preparation +/- cultures / NAATs

Treatment: - Metronidazole

28
Q

How do you treat scabies?

A

Permethrin

29
Q

How do you treat pubic lice?

A

Malathion

30
Q

What are anogenital warts?

A

Benign lesions caused by HPV

31
Q

What types of HPV are associated with cervical cancer?

A

HPV16 and HPV18

32
Q

How do you diagnose warts?

A

Clinical.

Biopsy in atypical or non responsive lesions

33
Q

How do you treat anogenital warts?

A

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.

34
Q

What is bacterial vaginosis?

A

This is the commonest cause of abnormal discharge in women of childbearing age.

35
Q

What are the risk factors for BV?

A 
Vaginal douching
Black race
Recent partner change
Smoking
Presence of STI
Receptive cunnilingus
36
Q

How do you diagnose and treat BV?

A

Laboratory diagnosis: high vagina gram stain smear tests

Treatment: Metronidazole

37
Q

What are the symptoms of candida albicans?

A

vaginal discharge typically curdy and non-offensive.

Vulval itchy soreness, dyspareunia

38
Q

What are the risk factors for candida?

A 
Pregnancy, 
Antibiotics, 
Oestrogen-oral contraceptives 
Diabetes
Immunosuppression
History of atopy (hayfever, asthma, dermatitis)
Non-albicans species
39
Q

How do you diagnose and treat candida?

A

Diagnose: High vaginal smear

Treatment: Topical and oral azaleas give a cure rate of 80% in uncomplicated cases

40
Q

What are common complications of STIs?

A

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.

ESA 3 - Reproductive System (20 decks)

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