Infection (Gynae): Gonorrhoea, HPV, Syphilis

Question 1

What is Gonorrhoea?

Answer 1

Purulent infection of mucous membranes caused by Nesseria Ghonorreae.

Question 2

What is the aetiology of Gonorrhoea?

Answer 2

Sexual contact 75%, vertical (neonatal conjunctivitis). RF: unprotected sex, multiple partners, presence of other STI, HIV, <25y.

Question 3

What is the history/ exam of Gonorrhoea?

Answer 3

MANY PATIENTS ARE ASYMPTOMATIC! 50%.

PV discharge, IMB, PCB, dysuria, dyspareunia. Lower abdo pain.

· Abdomen: lower abdo tenderness

· Speculum: Mucopurulent endocervical discharge, easy to indunce endocervical bleeding.

· Vaginal: pelvic tenderness, cervical excitation

Question 4

What is the pathology of Gonorrhoea?

Answer 4

Highly infectious G- diplococcus affecting mucous membranes.

Question 5

What investigations do you do for Gonorrhoea?

Answer 5

Microbiology: endocervical swab/ HVS. Culture of specimen with DNA probe and PCR assay.

Patients with Disseminated Gonococcal Infection require culture form all mucosal sites and blod cultures.

Question 6

What is the management of Gonorrhoea?

Answer 6

Abx: cephalosporin, penicillin, tetracycline or quinolone single dose.

Advice to treat for both Ghonorrea and coinfection with Chlamydia.

Question 7

What are the complications/ prognosis of Gonorrhoea?

Answer 7

PID, pain, infertility, ectopic, conjunctivitis, Fitz-Hugh-Curtis syndrome (perihepatitis with Ngon infection), high susceptibility to HIV infection,

Dissemination of disease (DGI),-> fever, skin rash, septic arthritis, arthralgia, meningitis, endocarditis.

Vertical transmission: OPTHALMIA NEONATORUM (bilateral conjunctivitis)

Question 8

What is HPV?

Answer 8

Epithelial infection and tumor formation in skin and mucous membranes. Anogenital, congenital, or epidermodysplasia verruciformis.

Question 9

What is the aetiology of HPV?

Answer 9

Physical and sezual contact, RF: multiple, unprotected, immunosuppress, smoking.

Question 10

What is the epidemiology of HPV?

Answer 10

50% of sexually active adults have HPV.

Question 11

What is the history/ exam of HPV?

Answer 11

Warts on genitals, vulva, vagina, anus and cervix. Generally painless but may itch, bleed and become inflamed.

OE pink, red, browh papules. Single or multiple. Over time display a typical warty appearance.

4 types: small papular, cauliflower like, keratotoc, and flat papules (usually cervix)

Question 12

What is the pathology of HPV?

Answer 12

dsDNA virus highly infectious. Infects epithelial cells (skin, anogenital, respiratory) causing abnormal multiplication. 100 known subtypes.

Low risk tipes (6/11) cause benign genital warts. High risk types (16/18) cause CIN, Vin and incubation period varies form weeks to years.

Question 13

What investigations do you do for HPV?

Answer 13

Clinical, acetic acid and examination of lesions. Biopsy of lesion (histology)

CIN: Pap smear cervical to determine whether Metaplasia, HPV DNA test.

Question 14

What is the management of HPV?

Answer 14

Topical on non mucosal surfaces: imiquimoid and IFNa. NOT IN PREGNANCY!

Otherwise, topical 5FU.

Cryosurgery, E&C and excision are also options.

Vaccinations for 6/11/16/18.

Question 15

What are the complications/ prognosis of HPV?

Answer 15

Possible development into: anorectal cancer, cervical cancer (HPV 16/18). Aesthetic.

In the neonate, laryngeal papillomatosis (vertical transmission

Question 16

What is Syphilis?

Answer 16

Infectious venereal disease caused bt Treponema pallidum sphirocete.

Question 17

What is the aetiology of Syphilis?

Answer 17

Transmitted by sexual contact with infectious lesions, from mother to fetus in utero, blood, or breaks in the skin contact.

Risk factors: MSM, HIV, multiple partners.

4 stages: primary, secondary, latent and tertiary.

Question 18

What is the epidemiology of Syphilis?

Answer 18

4/100k n US after penicillin induction. MSM account for 87%.

Most common during age of peak sexual activity. (25/29)

Question 19

What is the history/ exam of Syphilis?

Answer 19

· Primary:

o 10-90 days after infection.

o Primary chancre: solitary, raised, firm red papules several cm in diameter. Ulcerative crater, with elevated edges. Heals in 4wk.

· Secondary:

o Cutaneous eruption 2-10wk after primary chancre. May be subtle.

o Mucocutaneous nonpurpuric and symmetrical rash. Nontender lymphadenopathy. Mild constitutional symptoms also arise.

· Latent: No symptoms, but still infective up to 1 year into latency.

· Tertiary syphillis:

o Slowly progressive and affecting any organ. May be accompanied by granulomatous superficial lesions.

o Manifests as paraesthesia, impaited balance, incontinence, impotence, focal neurological findings, dementia, chest/back/pain aortic aneurysms

· Congenital syphillis in first 2y of life.

o Rhinitis, soon followed by cutaneous lesions.

o Hearing and language development delay.

o Facial and dental abnormalities.

Question 20

What is the pathology of Syphilis?

Answer 20

T pallidum survives only briefly outside body. Requires direct contact for transmission. Inbades abrased skin or mucous membranes and dissemintes via blood or lymph.

Question 21

What investigations do you do for Syphilis?

Answer 21

Blood: PRP and VRDL. Can give false+ with EBV, lymphoma, TB, malaria. Combine with TPHA and FTA-ABS.

Microscopy of fluid from priamry or secondary lesions.

Question 22

What is the management of Syphilis?

Answer 22

Abx: Penicillin G (first) or oral tetracycline doxocycline (NOT pregnant). F/U at 1,2,3,12 mo and then 6mo until seronegative. Contact trace, require full STI screen.

Question 23

What are the complications/ prognosis of Syphilis?

Answer 23

CVs, neuro disease. Jasrisch-Herxheimer reaction (febrile reaction to tx with fever, chills and myalgia), congenital syphillis, HIV susceptibility.

Excellent prognosis with tx in primary or secondary stage.