Genital tract infections Flashcards
What is the predominant bacteria in a reproductive woman’s vagina’s flora?
Lactobacilli
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
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.
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
What is the treatment of bacterial vaginitis?
Metronidazole or clindamycin cream
What are the risk factors of Candidiasis (thrush)?
Pregnancy, diabetes, immunosuppression and antibiotic use
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
What is the treatment for candidiasis?
Topical imidzoles (clotrimazole pessary) or oral fluconazole
What is the main cause of toxic shock syndrome?
Retention of a tampon, which grows a toxin-producing Staphylococcus aureus.
What are the symptoms of toxic shock syndrome?
High fever, hypotension and multi-systemic failure
What causes chlamydia?
Chlamydia trachomatis (bacteria)
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
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).
What is the treatment for chlamydia?
Azithromycin or doxycycline
What type of bacterium causes gonorrhoea?
Nisseria gonorrhoea is a gram-negative diplococcus.
What are the symptoms of gonorrhoea?
Vaginal discharge, urethritis, bartholinitis, cervicitis and pelvic infection can occur.
What are some of the complications of a gonorrhoea infection?
Bacteremia, mono-articular or septic arthritis.
What is the treatment for gonorrhoea?
Check for antibiotic sensitivities. IM ceftriaxone is usually required in combination.
What causes genital warts?
HPV virus - mostly 6 and 11.
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
