Genital Tract infections Flashcards
What is bacterial vaginosis
loss of lactobacilli and increase in anaerobic and highly specific BV-associated bacteria in the vagina
what bacteria are commonly associated with bacterial vaginitis
G.vaginalis
atrophium vaginae
what are the clinical features of bacterial vaginitis
grey-white discharge
fishy odour
how do you diagnose bacterial vaginitis
decreased vaginal pH (>4.5, usually around 7)
grey-white discharge
fishy-odour
‘clue cells’ on microscopy
how do you treat bacterial vaginitis
metronidazole
clindamycin cream
what is the common patient population for bacterial vaginitis
women of reproductive age
what are risk factors for vaginal candidiasis infection
pregnancy
diabetes
antibiotic use
what are clinical features of vaginal candidiasis infection
lumpy white ‘cottage cheese’ discharge
vulval irritation/itching
superficial dyspareunia
dysuria
how do you diagnose vaginal candidiasis infection
cultures
what is the treatment for vaginal candidiasis
topical imidazole
oral fluconazole
what is toxic shock syndrome
rare complication of keeping a tampon in for too long due to staph aureus toxin release
what are clinical features of toxic shock syndrome
high fever
hypertension
multisystem organ failure
how do you treat toxic shock syndrome
ICU admission and IV Abx
what are risk factors for STIs
number of partners (>3 within 6 months, or a newpartner in the last 3 months) concurrent partners not using condoms other STIs <20 sexual preference
what is the most common sexually transmitted disease in the world
Chlamydia
what proportion of women have genital symptoms with a chlamydia infection
<30%
what are some symptoms of chlamydia infection
altered vaginal discharge intermenstrual bleeding post-coital bleeding low abdominal pain dyspareunia
what is the main complication of chlamydia infection
pelvic infection leading to infertility
what atypical presentation is chlamydia associated with and what are its clinical features
sexually active arthritis, presenting with :
urethritis
conjunctivitis
arthritis
how do you diagnose a chlamydia infection
NAATs of vaginal swabs
how do you treat chlamydia
azithromyicin or doxycycline
what kind of bacteria is gonorrhea
gram negative diplococcus
how does gonorrhea present in men
urethritis
how does gonorrhea present in women
vaginal discharge urethritis bartholinitis cervicitis pelvic infection
what are the complications of gonorrhea infection (although they are rare)
septic arthritis
bacteraemia
how do you diagnose a gonorrhea infection
NAATs of vulvovaginal swabs
how do you treat gonorrhea
if not quinolone resistant: azithromycin or cefixime
2nd line: IM ceftriaxone
what is linked with causing genital warts
HPV (6,11,16,18)
how do genital warts spread
physical contact
how do you diagnose genital warts
clinical diagnosis
how do you treat genital warts
chemical application
podophyllin
podophyllotoxin
trichloroacetic acid
imiquimod
or cryotherapy
what is the recurrence rate of genital warts
25%
what causes gentital herpes
HSV1 and HSV2 - but more predominantly HSV2
which herpes simplex virus is associated with mouth infections (coldsores)
HSV1
what are common features of symptomatic Herpes infection
stinging/itching in affected area
small vesicles which then burst and crust over
dysuria
local lymphadenopathy
which herpes infections recur more/less
HSV2 + 6 recur more, HSV1 recurs less
what is the treatment for herpes infections
oral aciclovir for all first indications
IV aciclovir in severe infections
what causes syphillis
T.pallidum
what are the 3 types of syphillis and their clinical features
Primary
Only clinical feature is a single ulcer – called a chancre
Secondary Occurs only if there is an untreated primary Develops week later Rash Flu-ike illness Warty genital/perioral growths Systemic vasculitis Hepatitis Uveritis Alopecia
After this stage it can become latent for years and will progress to tertirary syphillis at some point
Tertiary
Rare
Develops years after the primary infection
Any organ can be affected, leading to Dementia Aortic regurgitation Tabes dorsalis Gummatis in the skin and bone
how do you diagnose syphillis infection
syphilis enzyme immunoassay
VRDL test
how do you treat syphillis infection
parenteral (IM) penecillin
what is trichomonas
a protozoa
what are the typical symptoms of a trichomonas infection
offensive green-grey discharge (70%) vulval irritation dysuria superficial dyspareunia asymptomatic in 50%
how do you diagnose trichomonas infection
NAATs
wet film microscopy may identify motile trichomonas in 60% of cases
how do you treat trichomonas infection
systemic metronidazole
what is endometritis
isolated infection of the endometrium
what commonly causes endometritis
birth complications - e.g. some placenta left in the uterus post birth
common orgnanisms are: e-coli staph aureus chlamydia gonorrhea clostridia
what are the clinical features of endometritis
persistent and heavy bleeding/pain
tender uterus
cervical os open
what is a complication of endometritis
sepsis
how do you treat endometritis
broad spectrum antibiotics
evacuation of retained products of conception if required
sepsis 6 if required
what is another name for pelvic inflammatory disease
salpingitis
what is the lifetime incidence for pelvic inflammatory disease
2%
what are risk factors for pelvic inflammatory disease
number of partners (>3 within 6 months, or a newpartner in the last 3 months) concurrent partners not using condoms other STIs <20 sexual preference
what is protective for pelvic inflammatory disease
COCP/IUS
what kind of infection causes pelvic inflammatory disease and name some common organisms
multimicrobial
chlamydia and gonorrhea
what is fitz-hugh-curtis syndrome
perihepatitis due to pelvic inflammatory disease
characterised by RUQ pain due to adhesions forming between anterior liver and peritoneal wall
what is the clinical presentation of pelvic inflammatory disease
deep dyspareunia
bilateral abdominal pain
abnormal bleeding discharge
subfertility if presenting for a long time
some acute cases may present with tachycardia, fever and peritonism with bilateral adnexal tenderness
what are differentials for acute pelvic inflammatory disease
ovarian torsion
ovarian cyst rupture
appendicit s
how should you investigate pelvic inflammatory disease
endovervical swab for STIs
WBC
CRP
pelvic USS - excludes abscesses and cysts
laproscopy - gold standard = fimbral biopsy and cultures
what is the treatment for pelvic inflammatory disease
parenteral cephalosporins (IM ceftriaxone) followed by doxycycline/ofloxacin and metronidazole
IV therapy reserved if patients severely unwelll
abscesses may need draining
what are complications of pelvic inflammatory disease
tubal obstruction infertility chronic pelvic infection chronic pelvic pain increased chance of ectopic pregnancy
what does chronic PID cause
dense pelvic adhesions with severe fallopian tube obstruction +/- fluid/pus retention
what are common symptoms of chronic PID
Chronic pelvic pain
Dysmenorrhoea
Deep dyspaerunia
Subfertility
Chronic vaginal discharge
Heavy and irregular menstruation
what might you find on examination in chronic PID
tenderness + fixed uterus
how do you investigate chronic PID
TV USS may identify any fluid in the tubes
Laporoscopy is best tool
Cultures are often negative
how do you treat chronic PID
Analgesia and antibiotics if active infection
Adhesion removal
Salpingectomy
