Genital Tract Infections Flashcards
What burdens can STIs cause
Carry a stigma
Have complications: PID, infertility, ectopic prengnacy
Cervical cancer risks
CV, neurological, ophthalmic and tissue damage
Foetal and neonatal transmission
How do gential infections commonly present
Urethritis, cervicitis
Abnormal discharge
Genital ulceration
Skin manifestations
Systemic presentation/complications
Name some common STIs - both sexually and non-sexually transmitted
Chlamydia trachomatis
Neisseria gonorrhoeae
Treponema pallidum
Anogential warts
Herpes simplex virus
Trichomonas vaginalis
Scabies
Pubic lice
Bacterial vaginosis (BV)
Vulvovaginal candidiasis/trush
Describe chlamydia, what complications it can cause and how it is treated
Chlamydia trachomatis is most common STI in UK. It is an obligate intracellular bacterium and does not show on gram staining
Complications: PID, conjunctivitis and pharyngeal infection
First line treatment: doxycycline or azithromycin or erythromycin in allergy/pregnancy
2nd line treatment: erythromycin
Doxycycline for rectal chlamydia
What are the symptoms of a chlamydia infection
Male - mild urethritis, dysuria, inflammation of other structures
Female - typically asymptomatic. Vaginal discharge, dyspareunia, post-coital bleeding
Describe gonorrhoea, what its complications are and how it is treated
Neisseria gonorrhoeae - gram -ve intracellular diplococcus
Commonly affects urethra, endocervix, rectum, pharynx and conjunctiva
Complications: epididymo-orchitis or prostatitis in men and PID in women
First line treatment is combined antibiotic therapy - ceftriaxone and azithromycin
Two antibiotics as chlamydia is often a co-infection
What are the types of syphilis and how is it treated
Primary - painless ulcer in genitals/other sites of sexual contact. Very infectious at this stage
Secondary - develops later as assocaited rash. Can affect other systems of the body
Tertiary - infection remains dormant and reactives later in life
Treated with penicillin though treatment depends on stage of infection
Describe anogential warts, how it presents and how it is treated
Anogenital warts are the most common viral STI caused by HPV
Typically presents as painless genital warts on penis, vulva, vagina, cervix and perianal skin
Treated with topical agents but typically regress
Describe herpes simplex virus, how it presents and how it is treated
HSV-1 - causes oral and gential herpes
HSV-2 - causes genital herpes
Can be primary, non-primary or recurrent infection
Presents with painful ulcers, dysuria, discharge or may be asymptomatic. May have fever and myalgia
Treated with antivirals, e.g. acyclovir
How are scabies and pubic lice treated
Scabies - permethrin
Pubic lice - malathion
How are STIs investigated for in men and which STIs are look for where
Investigated using gram staining and nucleic acid amplification tests (NAAT)
First catch urine for gonorrhoea/chlamydia
Mid-stream urine for cultures and sensitivities
Urethreal sampling if symptomatic
Rectal and pharyngeal sampling for MSM
Swabs at ulcer sites
How are STIs investigated for in women and which STIs are found where
Urine samples to rule out STIs and for culture and sensitivities
High vaginal swab for trichomonas, BV and candida
Endocervical for chlamydia and gonorrhoea
Vulvovaginal for chlamydia and gonorrhoea
Ulcer, rectal, pharyngeal swabs
Describe bacterial vaginosis, what the risk factors are and how it presents
Common cause of discharge in women caused by a pH imbalance resulting in growth of bacteria
Commonly caused by Gardnerella vaginalis
Risk factors: practices that disrupt vaginal flora, recent partner changes, smoking, STI presence
Typically presents with vaginal discharge without pruritis or pain
Treat with metronidazole
Describe vulvovaginal candidiasis, its risk factors, symptoms and treatment
Commonly caused by Candidiasis albicans
Risk factors: immunosuppression, diabetes, antibiotics, COCP, pregnancy
Symptoms: white/curdy, non-offensive vaginal discharge, pruritis, pain, dyspareunia
Treat with oral and topical agents
What complications can STIs cause
PID - if infection ascends from endocervix
Epididymo-orchitis - syndrome of pain, swelling and inflammation of epididymis +/- testes. Caused by STI or urinary pathology
Sexually acquired reactive arthritis (SARA) - inflammation of synovial membrane, tendons and fascia triggered by STI. Includes Reiter’s syndrome - conjunctivitis, urethritis and arthritis
Prostatitis - acute or chronic bacterial prostatitis
