Genital tract infections Flashcards by Becks Wilson

What is the predominant bacteria in a reproductive woman’s vagina’s flora?

Lactobacilli

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What is the pH in a reproductive woman’s vagina? What about post-menopause?

<4.5 at reproductive age

6.5-7.5 when there is a lack of oestrogen

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What is the cause of bacterial vaginosis?

Loss of lactobacilli and an increase of anaerobic and highly specific fastidious BV-associated bacteria in the vagina. These produce enzymes which break down vaginal peptides into malodorous amine.

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What are the symptoms and signs of bacterial vaginitis?

White/grey discharge
Fishy odour 
Raised pH
Presence of 'clue cells'
A positive 'whiff' test - fishy odour when 10% potassium hydroxide is added to the secretions

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What is the treatment of bacterial vaginitis?

Metronidazole or clindamycin cream

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What are the risk factors of Candidiasis (thrush)?

Pregnancy, diabetes, immunosuppression and antibiotic use

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What are the symptoms of candidiasis?

Cottage cheese discharge
vulval irritation and itching
Superficial dyspareunia and dysuria can occur
Vagina/vulva may be inflamed and red

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What is the treatment for candidiasis?

Topical imidzoles (clotrimazole pessary) or oral fluconazole

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What is the main cause of toxic shock syndrome?

Retention of a tampon, which grows a toxin-producing Staphylococcus aureus.

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What are the symptoms of toxic shock syndrome?

High fever, hypotension and multi-systemic failure

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What causes chlamydia?

Chlamydia trachomatis (bacteria)

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What are the symptoms of chlamydia?

70% don't have symptoms.
The most common symptoms are:
1. altered vaginal discharge
2. intermenstrual bleeding
3. post-coital bleeding
4. low abdominal pain
5. dyspareunia

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What is a complication of chlamydia?

Pelvic infection - if this affects the tubules then it can cause subfertility and/or chronic pelvic pain.
It can also precipitate sexually acquired reactive arthritis (conjunctivitis, arthritis, urethritis).

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What is the treatment for chlamydia?

Azithromycin or doxycycline

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What type of bacterium causes gonorrhoea?

Nisseria gonorrhoea is a gram-negative diplococcus.

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What are the symptoms of gonorrhoea?

Vaginal discharge, urethritis, bartholinitis, cervicitis and pelvic infection can occur.

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What are some of the complications of a gonorrhoea infection?

Bacteremia, mono-articular or septic arthritis.

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What is the treatment for gonorrhoea?

Check for antibiotic sensitivities. IM ceftriaxone is usually required in combination.

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What causes genital warts?

HPV virus - mostly 6 and 11.

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What are the treatments for genital warts?

Chemical applications with podophyllin, podophyllotoxin, trichloroacetic with solution or imiquimod.
Cryotherapy

What does the HPV vaccination protect against?

Cervical neoplasm - mainly caused by HPV 16/18

What symptoms do you get with herpes?

Flu-like, fever, ulcers, tiredness, headache

How is a herpes outbreak treated?

Acyclovir

What organism causes syphilis?

Treponema pallidum

What is the risk with syphilis and pregnancy?

congenital infection

What is primary, secondary and tertiary syphilis?

Primary - characterised by a solitary painless genital ulcer (chancre). Secondary - may develop weeks later with a rash, flu-like symptoms and warty genital or perioral growth (condylomata lata) Tertiary - virtually any organ can be affected (aortic regurge, dementia, tabes dorsalis)

What is the treatment for any stage of syphilis?

Penicillin (parenteral, usually IM)

What are the symptoms of trichomoniasis?

Offensive grey-green discharge, vulval irritation, dysuria and superficial dyspareunia.

What is the treatment for trichomoniasis?

Metronidazole

What is the effect of HIV on the immune system?

Depletion of CD4 cells, which eventually puts patients at risk of opportunistic infections and tumours.

What are some of the symptoms of HIV infection?

Chronic skin problems, recurrent oral candida, fever and generalised lymphadenopathy. Genital infections, especially candidiasis.

How often do women with HIV have cervical smears?

Once a year because CIN is common in these women, affecting 1/3 of them.

How is vertical transmission of HIV prevented?

Antiretroviral therapy Elective caesarian Avoidance of breast feeding

What are some of the causes of endometritis?

Result of instrumentation of the uterus Complication in pregnancy Miscarriage/termination (retained products of conception) Common after C-section

What are the symptoms of endometritis?

Heavy bleeding Pain Tender uterus Cervical os is commonly open

What is the treatment for endometritis?

Broad-spectrum antibiotics. | Evacuation of retained products of conception if required.

What is pelvic inflammatory disease?

Sexually (or non-sexually) transmitted pelvic infection.

Who is more likely to have pelvic inflammatory disease?

Those who are young, sexually active and nulliparous.

What causes pelvic inflammatory disease?

Ascending infection of bacteria in the vagina and cervix is most common, although descending infections from the appendix is also possible. Spread of previously asymptomatic STIs to the pelvis is usually spontaneous but can be caused by uterine instrumentation and complications of childbirth/miscarriage.

What are the most common infections causing pelvic inflammatory disease?

Chlamydia and gonorrhoea

What are the consequences of PID?

Endometritis, salpingitis, perihepatitis. | Subfertility

What are the signs and symptoms of PID?

``` Abdominal pain Vaginal discharge Abnormal bleeding Dyspareunia Peritonism Cervical excitation and adnexal tenderness Fever ```

What is the gold standard diagnosis for PID?

Laparoscopy with biopsy and culture

What is the treatment for PID?

Analgesics and either a parenteral cephalosporin (IM ceftrixone followed by doxycycline and metronidazole) or ofloxacin with metronidazole are most effective.

What are the complications of PID?

``` Abscess or pyosalpinx (early) Tubal obstruction and subfertility Chronic pelvic infection or pain Ectopic pregnancy Tubal damage ```

What are the signs and symptoms of chronic PID?

``` Dense pelvic adhesions Fallopian tubes obstructed and dilated with fluid (hydrosalpinx) or pus (pyosalpinx). Chronic pelvic pain Dysmenorrhoea Deep dyspareunia Heavy and irregular menstrual bleeding Chronic vaginal discharge Subfertility ```

What is the best diagnostic tool for chronic PID?

Laparoscopy

What are the 3 common infections associated with discharge?

Bacterial vaginosis, trichomoniasis and candidiasis

What are non-infectious causes of discharge?

Mid-cycle | Ectropion