Infection Flashcards by Aleem Hussain

What is the function of lactobacilli in the vagina?

Produce lactic acid, keeping pH of the vagina low and preventing the overgrowth of other bacteria

How well did you know this?

Not at all

Perfectly

What causes bacterial vaginosis? What is a commonly

Imbalance of normal bacteria found in the vagina - reduction in lactobacilli and overgrowth of other bacteria

How well did you know this?

Not at all

Perfectly

What bacteria are usually seen in increased quantities in bacterial vaginosis?

Anaerobes - e.g. Gardnerella vaginalis

How well did you know this?

Not at all

Perfectly

State two complications of bacterial vaginosis infection

Early delivery in pregnant women

Increased risk of transmitting other STIs

How well did you know this?

Not at all

Perfectly

What type of discharge is seen in bacterial vaginosis?

Fishy smelling, watery and grey discharge

How well did you know this?

Not at all

Perfectly

Apart from fishy, watery and grey discharge what other symptom can be seen in bacterial vaginosis?

Dysuria

How well did you know this?

Not at all

Perfectly

What vaginal pH will be seen in bacterial vaginosis?

What cells on microscopy suggest bacterial vaginosis?

High pH

Clue cells

How well did you know this?

Not at all

Perfectly

What is the management of bacterial vaginosis? (3)

Vaginal swabs to exclude other STIs

Avoid vaginal irritation/soaps that could disrupt normal flora

METRONIDAZOLE

How well did you know this?

Not at all

Perfectly

What is the first line antibiotic for bacterial vaginosis?

Metronidazole

How well did you know this?

Not at all

Perfectly

What type of infection is candidiasis? What is another name for candidiasis?

Fungal infection

Thrush

How well did you know this?

Not at all

Perfectly

Name two groups of patients in which candidiasis (thrush) is more common

Immunocompromised patients

Diabetics

How well did you know this?

Not at all

Perfectly

What type of discharge is seen in candidiasis (thrush)?

Thick, white, cottage cheese discharge

How well did you know this?

Not at all

Perfectly

As well as a thick, white, ‘cottage cheese’ like discharge what other symptoms can be seen in candidiasis (thrush)? (2)

Itch

Vulval/vaginal irritation or pain

How well did you know this?

Not at all

Perfectly

What are the management options for candidiasis? (3)

Clotrimazole cream
Clotrimazole pessary (one-off)
Oral fluconazole (150mg, one-off)

How well did you know this?

Not at all

Perfectly

What type of bacteria is Neisseria gonorrhoeae?

Gram negative diplococcus

How well did you know this?

Not at all

Perfectly

HPV is the most common causes of ________ cancer

Cervical cancer

How well did you know this?

Not at all

Perfectly

What other cancers is HPV linked to?

Anal
Vulval
Vaginal
Penis
Mouth
Throat

How well did you know this?

Not at all

Perfectly

How does HPV cause disease and cancer?

Invades cells and interrupts normal replication process by inhibiting tumour suppressor genes p53 and pRb

How well did you know this?

Not at all

Perfectly

How is HPV transmitted?

Sexually tansmitted

How well did you know this?

Not at all

Perfectly

What strains of HPV cause genital warts?

6, 11

How well did you know this?

Not at all

Perfectly

What strains of HPV cause cervical cancer?

16, 18

How well did you know this?

Not at all

Perfectly

What strains of HPV does the Gardasil vaccine work against?

6, 11, 16 and 18

How well did you know this?

Not at all

Perfectly

Who is the HPV offered to? (2)

All girls from age 12

Boys with HIV

What is typically more symptomatic - chlamydia or gonorrhoea?

Gonorrhoea

Where is Neisseria gonorrhoea found in infected women?

Endocervix of women

What type of discharge is associated with gonorrhoea infection?

Odourless, green, purulent discharge

Apart from odourless, green, purulent discharge what other symptoms can be seen in gonorrhea infection? (3)

Dysuria Pelvic pain Testicular pain

How can gonorrhea be tested for in women/men?

NAAT (nucleic acid amplification testing) of... ``` Endocervical swabs (women) First pass urine (men) ```

What is the typical drug regimen for a gonorrhea infection?

Single dose of ceftriaxone 500mg IM and azithromycin 1g oral

What is the name of bacteria that causes a chlamydia infection?

Chlamydia trachomatis

What type of bacteria is chlamydia trachomatis?

Intracellular gram negative bacteria

What is the most common STI in the UK?

Chlamydia

Chlamydia infection is typically asymptomatic, but can present with which other symptoms?

PV discharge Pelvic pain Abnormal bleeding Dyspareunia

What signs can be seen on examination in a chlamydia infection?

Cervical motion tenderness (cervical excitation) Fever Purulent discharge Pelvic tenderness

How is chlamydia diagnosed in men/women?

NAAT (nucleic acid amplification testing) of... ``` Vulvovaginal swabs (women) First pass urine (men) ```

Is a test for cure typically required in the treatment of... Gonorrhoea infection Chlamydia infection

Gonorrhoea = usually required Chlamydia = not required

What is the medical management of a chlamydia infection? (2 options)

Doxycycline for 7 days OR single dose 1g azithromycin

What is lymphogranuloma venereum? What is the treatment?

Complication of chlamydia infection where lymphoid tissue around the site of infection becomes infected Same as chlamydia treatment (doxy 7 days or 1g azithromycin)

What are the three stages seen in lymphogrnauloma venereum?

1st = painless ulcer 2nd = lymphadenitis 3rd = inflammation of rectum and anus

What is the most common cause of pelvic inflammatory disease?

STI - infection spreading up through the cervix

What are two complications of PID?

Infertility - due to scarring and adhesions | Chronic pelvic pain

What are the two most common causative organisms for PID?

Chlamydia trachomatis | Neisseria gonorrhoeae

What are some symptoms of PID?

``` Pelvic pain Fever Dysuria Deep dyspareunia Discharge IMB/Post-coital bleeding/Menorrhagia ```

What signs can be seen on examination in a case of PID?

Cervical motion tenderness (extreme pain on bimanual exam) Uterine/adnexal tenderness on palpation

What are the NICE guidelines for medical management of PID? (2 options)

Oral ofloxacin 400mg BD + Oral metronidazole 400mg BD (14 days) IM ceftriaxone 500mg (single) + oral doxycycline 100mg BD + oral metronidazole 400mg BD (14 days)

What is Fitz-Hugh-Curtis syndrome? What are the symptoms?

Complication of PID where there is inflammation of the liver capsule and adhesions form between the liver and peritoneum RUQ pain Shoulder tip pain

What two conditions does herpes simplex virus cause?

Cold sores | Genital herpes

Which strain of HPV typically causes cold sores? Which strain of HPV typically causes genital herpes?

HSV-1 HSV-2

What are stomatitis herpetiformis?

Apthous ulcers (small, painful oral ulcers) that can be caused by HSV

What are the symptoms of genital herpes?

Labial ulceration/vesicular lesions Pain No discharge

How is genital herpes diagnosed?

Clinically Swab for viral PCR

What is the management of HSV infection?

Oral aciclovir (stomatitis herpetiformis/genital) Topical aciclovir (cold sores)

Is aciclovir contraindicated for the treatment of HSV in pregnant women?

Why is it important to treat genital herpes in pregnant women?

Neonatal herpes simplex infection carries high morbidity and mortality

Does genital herpes increase the risk of miscarriage?

How is mode of delivery managed in pregnant women with HSV infection?

Lesions appearing for first time after 28 weeks? —> Elective c-section at term Known recurrent genital herpes? —> start aciclovir, risk of transmission with vaginal delivery low