Infection Flashcards
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
What causes bacterial vaginosis? What is a commonly
Imbalance of normal bacteria found in the vagina - reduction in lactobacilli and overgrowth of other bacteria
What bacteria are usually seen in increased quantities in bacterial vaginosis?
Anaerobes - e.g. Gardnerella vaginalis
State two complications of bacterial vaginosis infection
Early delivery in pregnant women
Increased risk of transmitting other STIs
What type of discharge is seen in bacterial vaginosis?
Fishy smelling, watery and grey discharge
Apart from fishy, watery and grey discharge what other symptom can be seen in bacterial vaginosis?
Dysuria
What vaginal pH will be seen in bacterial vaginosis?
What cells on microscopy suggest bacterial vaginosis?
High pH
Clue cells
What is the management of bacterial vaginosis? (3)
Vaginal swabs to exclude other STIs
Avoid vaginal irritation/soaps that could disrupt normal flora
METRONIDAZOLE
What is the first line antibiotic for bacterial vaginosis?
Metronidazole
What type of infection is candidiasis? What is another name for candidiasis?
Fungal infection
Thrush
Name two groups of patients in which candidiasis (thrush) is more common
Immunocompromised patients
Diabetics
What type of discharge is seen in candidiasis (thrush)?
Thick, white, cottage cheese discharge
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
What are the management options for candidiasis? (3)
Clotrimazole cream Clotrimazole pessary (one-off) Oral fluconazole (150mg, one-off)
What type of bacteria is Neisseria gonorrhoeae?
Gram negative diplococcus
HPV is the most common causes of ________ cancer
Cervical cancer
What other cancers is HPV linked to?
Anal Vulval Vaginal Penis Mouth Throat
How does HPV cause disease and cancer?
Invades cells and interrupts normal replication process by inhibiting tumour suppressor genes p53 and pRb
How is HPV transmitted?
Sexually tansmitted
What strains of HPV cause genital warts?
6, 11
What strains of HPV cause cervical cancer?
16, 18
What strains of HPV does the Gardasil vaccine work against?
6, 11, 16 and 18
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?
No
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?
NO
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
