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Infection Flashcards

1
Q

What kind of organisms can cause infections?

A

Bacteria
Viral
Fungal
Parasites

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2
Q

What fungal infection can affect the reproductive system?

A

Candida

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3
Q

Is candida sexually transmitted?

A

Not really

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4
Q

What does candida cause in females?

A

Candidiasis

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5
Q

What is candidiasis normally called?

A

Vaginal thrush

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6
Q

What organism causes candida?

A

Candida Albicans

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7
Q

What can you see on microscopy of candida?

A

Buds

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8
Q

Is candida always pathogenic?

A

No- can be commensal

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9
Q

What are some risk factors for developing candidiasis?

A

Antibiotic treatment
High oestrogen levels- pregnancy/contraception
Poorly controlled diabetes
Immunocompromised

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10
Q

What are some symptoms of candidiasis?

A

Intense vulvar itch- Erethema and swelling

White vaginal discharge

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11
Q

How many episodes of candidiasis are needed in a year for it to be classed as recurrent?

A

4+

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12
Q

How is candidiasis diagnosed?

A

Clinically
High vaginal swab for culture
Microscope of swab for spores and mycelia
Rule out Trichomonas and bacterial for itch and discharge

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13
Q

How do you treat candidiasis first line?

A

Topical clotrimazole 500mg single dose

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14
Q

How do you treat recurrent candidiasis?

A

Fluconazole 100 mg weekly for 6 months

Clotrimazole pessary 500 mg weekly for 6 months

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15
Q

What is candida infection called in males?

A

Balanitis

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16
Q

What is balanitis?

A

Infection of the glans

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17
Q

What are some symptoms of balanitis?

A

Balanoposthitis
Self-limiting burning penile irritation immediately after sex with infected partner
Spotty rash on glans

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18
Q

What must you exclude before diagnosis balanitis?

A

Exclude diabetes

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19
Q

Name some bacterial causes of reproductive tract infection?

A 
Bacterial vaginosis
Prostatitis
Gonorrhoea
Chlamydia
Lymphogranuloma venereum (LGV)
Urethritis
Syphilis
Mycoplasma Genitalium
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20
Q

Is bacterial vaginosis sexually transmitted?

A

No

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21
Q

What causes bacterial vaginosis?

A

Change in vaginal flora

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22
Q

What are the bacterial changes in bacterial vaginosis?

A

Gardnerella vaginalis, anaerobes including Bacteroides, Mobiluncus spp. and Mycoplasma hominis replaces the normal lactobacilli

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23
Q

What does lactobacilli do in the vagina?

A

produce acid to keep vaginal pH at 4-4.5

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24
Q

What is the normal pH of the vagina?

A

4-4.5

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25
Q

What are some symptoms of bacterial vaginosis?

A

Can be asymptomatic
Thin, watery, fish-smelling vaginal discharge (pH>5)
No inflammation

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26
Q

What do you not get in bacterial vaginosis?

A

No inflammation

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27
Q

What can bacterial vaginosis cause in pregnancy?

A

Can cause premature birth

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28
Q

How do you diagnosis bacterial vaginosis?

A

Clinically

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29
Q

What things can be used to clinically diagnose bacterial vaginosis?

A

Vaginal discharge
Amine test
Fishy odor on mixing a drop of discharge with 10% potassium hydroxide
Clue cells

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30
Q

What is the amine test?

A

Raised vaginal pH using narrow-range indicator paper (>4.7)

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31
Q

What are clue cells?

A

Squamous epithelial cells from the vagina, which have bacteria adherent to their surface, giving a granular appearance to the cell. A Gram stain gives a typical reaction of partial stain uptake.

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32
Q

How do you treat bacterial vaginosis?

A

Oral Metronidazole 400mg 2x daily for 5-7 days

Topical 2% clindamycin cream 5 g intravaginally once daily for 7 days

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33
Q

Should you treat asymptomatic bacterial vaginosis?

A

No

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34
Q

What are the two types of prostatitis?

A

Acute

Chronic

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35
Q

What are the symptoms of acute prostatitis?

A

Lower back, perineum, or genital pain
Tender prostate on examination
UTI symptoms- Pain, Frequency, Hesitance, Blood
Generally unwell

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36
Q

What are the UTI symptoms?

A

Pain, Frequency, Hesitance, Blood

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37
Q

How do you diagnose acute prostatitis?

A

Clinical

Bacteria in blood or urine

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38
Q

How do you treat acute prostatitis?

A

4-6w Ciprofloxacin

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39
Q

How long do you need to have had symptoms for to have chronic prostatitis?

A

3 months

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40
Q

What are the symptoms of chronic prostatitis?

A 
Lower back, perineum, or genital pain
Tender prostate on examination
UTI symptoms- Pain, Frequency, Hesitance, Blood
Erectile dysfunction
Pain when ejaculating
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41
Q

How do you diagnose chronic prostatitis?

A

Urine culture

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42
Q

How do you treat chronic prostatitis?

A

4-8w Ciprofloxacin

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43
Q

What causes gonorrhoea?

A

Neisseria gonorrhoeae

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44
Q

Describe Neisseria gonorrhoeae

A

Gram-negative intracellular diplococcus

Looks like kidney beans facing each other

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45
Q

What does Neisseria gonorrhoeae look like under the microscope?

A

Looks like kidney beans facing each other

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46
Q

What is the only host of Neisseria gonorrhoeae?

A

Humans

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47
Q

What tissue does Neisseria gonorrhoeae infect?

A

Infects epithelium of urogenital tract, rectum, pharynx and conjunctiva.

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48
Q

What does Fastidious mean?

A

Doesn’t survive well outside of the body

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49
Q

How does gonorrhoea spread?

A

Intimate contact

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50
Q

Is it more likely for gonorrhoea to be spread from male to female or female to male?

A

Male to female

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51
Q

What is the incubation period for gonorrhoea?

A

2-14 days

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52
Q

What percentage of sufferers with gonorrhoea are asymptomatic?

A

50% women

10% men

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53
Q

Give some symptoms of gonorrhoea in males?

A

Urethritis- Dysuria
Urethral discharge
Rectal pain, discharge and itch

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54
Q

What is a complication of gonorrhoea in males?

A

Ascending infection- Epididymis, Prostate

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55
Q

What are some symptoms of gonorrhoea in females?

A 
Increased or altered vaginal discharge
Pelvic pain
Dysuria
Intermenstrual bleeding
Rectal and pharyngeal usually asymptomatic
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56
Q

What are some complications of gonorrhoea in females?

A

Bartholin’s abscesses
Infertility
Conjunctiva infection in neonates

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57
Q

What are some general symptoms of gonorrhoea?

A

Arthritis
Papular or pustular rash with an erythematous base
Fever/malase

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58
Q

How can you diagnose gonorrhoea?

A 
Culture from affected area
Microscopy of swab
Nucleic acid amplification tests (NAATs) 
Blood cultures
Synovial fluid examination
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59
Q

What areas can you take a swab from to culture gonorrhoea?

A

Endocervical, rectal and throat swabs

Not high vaginal

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60
Q

What sample is required for Nucleic acid amplification tests (NAATs)?

A

First void urine sample

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61
Q

What is a benefit of NAAT?

A

Very sensitive
Doesn’t matter if organism is dead
Quick- hours not days

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62
Q

What are some drawbacks to NAAT?

A

Can give false positives
Not good for antibiotic resistance
Will pick up organisms upto five weeks after treatment

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63
Q

When do you treat gonorrhoea?

A

Confirmed diagnosis

Sex with confirmed diagnosis

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64
Q

How do you treat gonorrhoea?

A

Single does Ceftriaxone i.m. (1g)

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65
Q

How many sexual partners should you test from someone with gonorrhoea?

A

All from past three months

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66
Q

What causes chlamydia?

A

Chlamydia trachomatis Serovars D-K

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67
Q

Describe Chlamydia trachomatis

A

Small obligate intracellular bacteria that doesn’t gram stain

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68
Q

How can chlamydia be transmitted?

A

Vaginal, anal and oral transmission

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69
Q

How many males with chlamydia are asymptomatic?

A

50%

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70
Q

What are some symptoms of chlamydia in males?

A

Urethritis with dysuria and discharge
Epididymitis
Rectal infection leading to proctitis

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71
Q

What percentage of females with chlamydia are asymptomatic?

A

80%

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72
Q

What are some symptoms of chlamydia in females?

A 
Vaginal discharge
Postcoital or intermenstrual bleeding 
lower abdominal pain
Infection and inflammation of the fallopian tubes
Reactive arthritis/Reiter's syndrome
Pelvic inflammatory disease
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73
Q

What can pelvic inflammatory disease cause?

A

infertility and and ectopic pregnancy

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74
Q

What can chlamydia cause in neonates?

A

Conjunctivitis

Pneumonia

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75
Q

How do you diagnose chlamydia?

A

Nucleic acid amplification test (NAAT)/PCR

Cell culture

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76
Q

What samples should be used for chlamydia NAAT?

A

Male- first pass urine/rectal swab/throat swab/eye swab

Female- High vaginal swab/vulvo-vaginal swab/endocervical swab/rectal swab/throat swab/eye swab

77
Q

What is an benefit of cell culture for chlamydia diagnosis chlamydia?

A

100% accurate

78
Q

WHat is a disadvantage of cell culture for chlamydia diagnosis?

A

Expensive and difficult

79
Q

Where is the best place to swab for chlamydia in women?

A

Endocervical swab

80
Q

What is the standard treatment for chlamydia?

A

Doxycycline 100 mg 12-hourly for 7 days

Azithromycin 1 g as a single dose

81
Q

How many partners should you notify about chlamydia?

A

All from last 6 months

82
Q

What causes Lymphogranuloma venereum (LGV)?

A

Chlamydia trachomatis types LGV 1, 2 and 3

83
Q

Where is Lymphogranuloma venereum (LGV) endemic to?

A

Tropics

84
Q

What are the stages of Lymphogranuloma venereum (LGV)?

A

Primary lesion
Regional lymphadenopathy
Nodes may become fluctuant (buboes) and can rupture

85
Q

What can chronic Lymphogranuloma venereum (LGV) cause?

A

Extensive scarring and abscess and sinus formation

86
Q

Describe the primary lesion in LGV

A

Painless ulcerating papule on the genitalia occurring 7–21 days following exposure

87
Q

How long after the primary lesion in LGV does regional lymphadenopathy start?

A

Days to weeks after it heals

88
Q

Describe the regional lymphadenopathy in LGV

A

lymph nodes are painful and fixed and the overlying skin develops a dusky erythematous appearance

89
Q

What can LGV mimic?

A

Anorectal Crohn’s- present as presents as proctitis with perirectal abscesses

90
Q

How do you diagnose LGV?

A

Clinical
NAAT
Isolation of C. trachomatis from clinical lesions

91
Q

What is the differential for LGV?

A

Syphilis and genital herpes

92
Q

How do you treat LGV?

A

Doxycycline (100 mg twice daily for 21 days)

Erythromycin (500 mg four times daily for 21 days)

93
Q

How long do you follow up LGV for?

A

Follow-up should continue until signs and symptoms have resolved

94
Q

How many partners should you inform about LGV?

A

Past month

95
Q

What is Urethritis?

A

Not STI as such but inflammation secondary to it.

96
Q

What are the three categories of urethritis?

A 
Gonococcal Urethritis (GU) 
Non- gonococcal urethritis (NGU)
Postgonococcal urethritis (PGU)
97
Q

What can cause Non- gonococcal urethritis (NGU)

A 
Chlamydia urethritis 
Trichomonas vaginalis
Mycoplasma genitilium
HSV
Syphilitic chancres 
Warts within the urethra
UTI
Prostitis
Foreign body
98
Q

What are some symptoms of urethritis?

A

Urethral discharge- Mucoid, Worse in the morning
Crusting at meatus- Stains on underwear
Discomfort/itch in penis
Dysurea
Reactive arthritis causing conjunctivitis with arthritis occurs, particularly in HLA B27-positive individuals

99
Q

How do you diagnose urethritis?

A

Look for chlamydia or gonorrhoea
If negative Smear when haven’t passed urine for 4h for microscopy
Five or more polymorphonuclear leucocytes is diagnostic

100
Q

How do you treat urethritis?

A

NGU- Azithromycin 1 g oral single does
Doxycycline 100 mg 12-hourly for 7 days
Avoid sexual intercourse

101
Q

How many partners should you notify for urethritis?

A

last month

102
Q

What is syphilis often coinfected with?

A

HIV

103
Q

What causes syphilis?

A

Treponema pallidum

104
Q

Describe Treponema pallidum?

A

Motile spirochete

Does not gram stain

105
Q

How does Treponema pallidum enter the human body?

A

Breaches in epithelium

106
Q

Can Treponema pallidum be cultured?

A

No

107
Q

How can syphilis be spread?

A

Sexual contact
Across placenta
Blood transfusion

108
Q

What are the four stages of syphilis?

A

Primary
Secondary
Latency
Tertiary

109
Q

What are the symptoms of primary syphilis?

A

Hard painless chancre at site of infection

Painless, regional lymphadenopathy

110
Q

How long does primary syphilis last?

A

2-3 weeks

111
Q

How long after primary syphilis heals does secondary syphilis start?

A

4-10 weeks

112
Q

What are some symptoms of secondary syphilis?

A

Nephritis
Hepatitis
Mucous membranes- Mucous patches, ‘snail-track’ ulcers in oropharynx and on genitalia
Skin- Painless, regional lymphadenopathy
General- Fever, Malase, Arthralgia, Sore throat, Lymphadenopathy

113
Q

What can secondary syphilis do to foetuses?

A

Infect them

114
Q

How long does secondary syphilis last?

A

3-12 weeks

115
Q

How long does the latency between secondary and tertiary syphilis last?

A

2 years

116
Q

What are some symptoms of tertiary syphilis?

A

Benign- Gummas (Granuloms on bone and viscera) Cardio- Aortitis and aortic regurgitation
Neurosyphilis- Meningovascular involvement, General paralysis of the insane (GPI), Tabes dorsalis

117
Q

What is Tabes dorsalis?

A

Slow degeneration of lateral dorsal tracts

118
Q

Describe congenital syphilis?

A

Apparent 2-6w after birth
Nasal discharge
Skin and mucous membrane lesions
Failure to thrive

119
Q

When does tertiary syphilis present in neonates?

A

2yo

120
Q

What can syphilis cause in neonates?

A

‘stigmata’ relating to early damage of developing structures, particularly teeth and long bones

121
Q

What is a complication of syphilis?

A

Jarisch–Herxheimer reaction

122
Q

What is Jarisch–Herxheimer reaction?

A

Caused by endotoxins

8h after first dose of treatment

123
Q

What are some symptoms of Jarisch–Herxheimer reaction?

A

Mild fever
Malase
Headache
Lasts several hours

124
Q

How do you diagnose primary syphilis?

A

Dark- ground microscopy from chancres and Mucous lesions

PCR

125
Q

How do you diagnose secondary and tertiary syphilis?

A

Serology:
Treponemal specific- T. pallidum enzyme immunoassay
Treponemal non-specific- Venereal Disease Research Laboratory (VDRL) or rapid plasma reagin (RPR)

126
Q

What is Treponemal specific serology good for?

A

Good for diagnosis but remains for lifetime after infection

127
Q

Give an example of Treponemal specific serology

A

T. pallidum enzyme immunoassay

128
Q

What is Treponemal non-specific serology good for?

A

Indicates how active the disease is

129
Q

Give an example of Treponemal non-specific serology

A

Venereal Disease Research Laboratory (VDRL)

rapid plasma reagin (RPR)

130
Q

Describe Treponemal non-specific serology

A

non-specific, becoming positive within 3–4 weeks of the primary infection

131
Q

How do you treat syphilis?

A

Long-acting penicillin
Benzathine penicillin G single intramuscular dose
Doxycycline 100 mg, taken orally twice daily for 14 days
1w longer in late stage

132
Q

How long must antibiotic levels be maintained to treat syphilis?

A

7 days

133
Q

How do you treat syphilis if the patient is penicillin allergic?

A

doxycycline 200 mg daily 2-4w

erythromycin 500mg four times daily 2-4w

134
Q

What antibiotic should not be given in syphilis and why?

A

Azithromycin- resistance

135
Q

How long should you follow up syphilis after treatment?

A

1 year

136
Q

How many partners should you notify with syphilis?

A

Primary- 90 days
Secondary- 2 years
Other infections- 3 months before most recent negative test

137
Q

What is Mycoplasma Genitalium associated with?

A

non-gonococcal urethritis

138
Q

What are the symptoms of Mycoplasma Genitalium?

A

Asymptomatic

139
Q

How do you diagnose Mycoplasma Genitalium?

A

NAAT

140
Q

Where can herpes infect?

A

Mucous membranes in genital tracts, rectum, mouth and oropharynx

141
Q

WHat causes herpes?

A

HSV Type 1- Mainly oral, less genital

HSV Type 2- Mainly genital

142
Q

Which type of HSV normally infects the genitalia?

A

HSV Type 2

143
Q

What is the peak age of contracting herpes?

A

16-24

144
Q

How is HSV transmitted?

A

Close physical contact

145
Q

How long is the incubation period for HSV?

A

3-6 days

146
Q

What are the two stages of HSV infection?

A

Primary

Recurrence

147
Q

What are some symptoms of primary herpes?

A 
Multiple painful shallow ulcers develop which may coalesce- develop crusts and dry over 10-14 days
Fever
Myalgia
Headache
Tender inguinal lymphadenopathy 
Aseptic meningitis 
Urine retention
Vaginal/urethral discharge
148
Q

What causes urine retention in herpes?

A

Involvement of the sacral autonomic plexus

149
Q

How long does primary herpes last?

A

2-3 weeks

150
Q

How long does recurrent herpes last?

A

5-7 days

151
Q

What are some symptoms of recurrent herpes?

A

Blisters

No systemic involvement

152
Q

How do you diagnose herpes?

A

Clinical

Genome detection analysis of lesion sample- Amp with PCR

153
Q

What is herpes often mistaken for?

A

Candida

154
Q

When are you infectious with herpes?

A

When asymptomatic and have lesions

155
Q

How do you treat primary herpes?

A 
5 day course: Aciclovir 200 mg 5x daily
Treat secondary bacterial infection
IV aciclovir for meningitis/encephalopathy
Analgesia- 5% topical lignocaine
Antipyretics
Salt water wash or warm bath to soothe
Rest
156
Q

How do you treat recurrent herpes?

A

Salt water bathing
Psyche help
Many reoccurrences give suppression therapy- Aciclovir 400 mg twice daily for 6–12 months significantly reduces the frequency of attacks

157
Q

How can herpes infect a neonate?

A

Birth canal- most common

Placenta- Rare

158
Q

How do you treat herpes in pregnant mothers?

A

Treat as normal in 1st/2nd trimester
3rd trimester- 400mg aciclovire 3x daily
Primary at 3rd trimester- Deliver by CS
Reoccurrence- Low chance to pass on unless active at time of birth

159
Q

What causes genital warts?

A

HPV types 6 and 11

160
Q

What strains of HPV cause cervical cancer?

A

Types 16 and 18

161
Q

How id HPV transmitted?

A

Catch by sex with someone in sub/clinical infection

Infected birth canal

162
Q

What is the incubation period of HPV?

A

2w-8m

163
Q

What are the symptoms of genital warts?

A

Warts around genitalia
Can get them on cervix too
Penile shaft, subpreputial space, urethra, meatus
Can involve rectum

164
Q

What are genital warts associated with?

A

Cervical intraepithelial neoplasia

165
Q

How do you diagnose genital warts?

A

Clinical

Biopsy if in doubt

166
Q

What is a differential for genital warts?

A

Condylomata lata of secondary syphilis

167
Q

What are the two main categories of treatment for genital warts and when should they be used?

A

Local- non-keratinised warts

Physical- keratinised warts

168
Q

Give some examples of local treatments for genital warts

A 
Podophyllin extract (15–25% solution, once or twice weekly)
Podophyllotoxin (0.5% solution or 1.5% cream in cycles) 
Trichloroacetic acid
169
Q

When should local agents not be used for genital warts?

A

Pregnancy

Keratinised lesions

170
Q

What are some physical therapies used to treat genital warts?

A

Cryotherapy
electrocautery
Laser ablation

171
Q

What is Imiquimod and what is it used for?

A

Immune response modifier- induces cytokine response

Genital warts

172
Q

With regards to genital warts who should get regular cervical screening?

A

Females with warts

Female partners of males with warts

173
Q

How can genital warts be prevented?

A

Use condom for 8m after treatment
Vaccine: Old affective against- HPV 16 and 18
New affective against- HPV 6,11,16,18

174
Q

What causes Trichomoniasis?

A

Trichomonas vaginalis

175
Q

Describe Trichomonas vaginalis

A

Flagellated protozoon

176
Q

How does Trichomonas vaginalis infect you

A

Sexually transmitted
Mother to child
Attaches to squamous epithelium
Infects vagina and urethra

177
Q

What are some symptoms of Trichomoniasis in women?

A

Offensive vaginal discharge- Frothy yellow
Local irritation- erythematous vaginal walls
Strawberry cervix- small haemorrhagic areas on cervix

178
Q

What are some symptoms of trichomoniasis in men?

A

Often asymptomatic
Urethral discharge
Irritation
Urinary frequency

179
Q

What can trichomoniasis cause in pregnancy?

A

Preterm

Low birth weight

180
Q

How do you diagnose trichomoniasis?

A

Phase-contrast, dark-ground microscopy of a drop of vaginal discharge shows TV swimming
High vaginal swab for microscopy
Many polymorphonuclear leucocytes
Culture

181
Q

How do you treat trichomoniasis?

A

Oral Metronidazole for 7 days
Nimorazole if resistant
Topical therapy- intravaginal tinidazole
Treat asymptomatic partners

182
Q

How many partners should you inform of trichomoniasis infection?

A

Last 4 weeks

183
Q

What is Pediculosis pubis?

A

Pubic lice infestation

184
Q

What causes pediculosis pubis?

A

Phthirus pubis

185
Q

How is Phthirus pubis transmitted?

A

Close physical contact

186
Q

What are some symptoms of a pubic lice infection?

A

Can be asymptomatic

Itch

187
Q

How do you diagnose a pubic lice infection?

A

Clinical: Look for lice. Resemble small freckles but move

Blue macules may be seen at the feeding sites

188
Q

How do you treat a pubic lice infection?

A 
Lice and eggs must be killed:
  0.5% Malathion
  1% permethrin 
  0.5% carbaryl
Apply to all areas of the body below the neck and wash off after 12h. May need further application after a week.

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