Infections Flashcards
What is the most prevalent genital infection in men?
genital worts
Which infection is increasing in prevalence and is almost only found in men?
symphilis
What is urethritis? What does it present with?
Inflammation of the urethra without an infection of the urethra. Presents with discharge, dysuria and increased urge to urinate.
What is vulvo-vaginitis?
vaginal inflammation leading to itching, discharge, soreness, burning or rawness, odour
Give some non infectious causes of vulvo- vaginitis?
eczema, psoriasis, carcinoma
What causes chlamydia? What is its gram stain
Chlamydia trachomatis - gram negative
What is the most common STI in the UK?
chlamydia
How may chlamydia present?
- usually asymptomatic and is picked up on screening - in males: urethritis, testicular pain +/- swelling
- in females: vaginal discharge, lower abdo pain (esp after sex), fever, post and intercoital bleeding and painful intercourse
- reactive arthirits
- May manifest as conjunctivitis or pharyngitis
How is chlamydia diagnosed in M and in F?
F: vulvovaginal swabs
M: first catch urine sample
How is chlamydia treated?
doxycyline
What is the gram stain for neisseria gonorrhoeae?
Gram negative diplococcus
What membranes may gonorrhoea affect?
cervix, vagina, urethra, ureter, fallopian tubes, ovaries, testis, rectum, throat, eyes
What is the incubation period of gonorrohea?
2-5 days (up to 10)
How do most men with gonorrohea present?
If urethral: 80% get discharge, some dysuria and 1 in 10 asymptomatic
If rectal: asymptomatic of 1 in 10 get bleeding, pain or discharge
Pharyngeal infections usually asymptomatic
How do women with gonorrhoea present?
if endocervical infection: 50% have discharge, 25% lower abdo pain, some intermenstrual bleeding
If urethra: most asymptomatic, some dysuria
Rectal and pharyngeal usually asymptomatic
How is gonorrhoea diagnosed in M and F?
F: vulvovaginal and endocervical swab and +ve gram stain
M: Swab tip of penis if discharge, urine sample if not
How is gonorrhoea treated?
IM ceftriaxone plus oral azithromycin
Where do herpes simplex virus 1 and 2 most commonly infect?
HSV1: oral region and cold sores on labia
HSV2: anogenital infections (penis, anus, vagina)
However, both can infect both regions
How may hepres present?
- oral or genital blisters
- painful ulcers
- dysuria
- discharge
- fever and malaise
- asymptomatic
How is herpes diagnosed?
Viral cultures of vesicular fluid or of ulcer base (PCR may also be used)
How is herpes treated?
Acyclovir, saline bathing, pain releif (lidocaine creams)
Which herpes simplex virus is recurrent
HSV2
What causes genital worts?
Human papillomavirus
Which HPV strains are most common and which are cancer causing?
HPV 16 and 18 are are neoplastic
HPV 6 and 11 most common and non neoplastic
How will genital worts present?
Painfuless lesions on genitalia, anus, cervix ect
Worts are usually soft and non keratinised on non hairy skin and keratinised and on hairy skin
The worts may be any colour
How are genital worts diagnosed and treated?
Diagnosis is clinical, biopsies are rarely necessary.
They usually regress on their own in 6 months, creams can be given or you can excise them, laser them or freeze them off (cyrotherapy) if persistant.
You need to check for co infections
What causes syphilis?
Treponema pallidum
How long is the incubation period of syphilis?
2-3 week for the primary infection and 6-12 weeks for the secondary
What is the characteristic finding of a primary syphilis infection?
Chancre- a painless papuple which rapidly forms a painless ulcer. In men theyre found on the penis, in MSM theyre in anal canal and sometimes mouth and genitalia and in women theyre mainly found on vulva, labia and sometomes cervix.
You may also find enlarged regional lymph nodes.
What is a secondary syphilis infection like?
generally systemic-
generally polymorphic rash, malaise, fever, aches w/ multisystem involvement (meninges, heart, kidneys)
How may tertiary syphilis present? (3 syndromes)
up to 40 yrs after primary infection:
- neurological syphilis: demenita, demyelination ect
- cardiovascular syphilis: aeortic regurg, aneurysm, angina ect
- Gummata: destructive fibrotic nodules or plaques affecting bone and skin
How is syphilis diagnosed?
- serolgical tests for secondary and tertiary syphilis
- PCR of swabs for primary
How are primary, secondary and early latent syphilis treated?
- IM Benzathin penicillin G
Single dose
How is CVS syphilis or gummata treated?
Benzathin Penicillin G (3 doses IM)
How is neurological syphilis treated?
IM Procaine penicillin and probenecid
What is transmission and type of organism for trichomonas vaginalis infections?
Sexually transmitted flagellated protozoa
How may M and F with trichomonas present?
M: usually asymptomatic or dysuria and discharge
F: Most get yellow, throthy vaginal discharge w/ vaginitis (itching and odour) and cervicitis (strawberry cervix) and lower abdo discomfort
How is trichonmonas vaginalis diagnosed?
F: High vaginal swab and wet microscopy within 10 mins of sample collection
M: first void urine sample cultures
NAAT if technology is available
How is trichomonas vaginalis treated?
metronidazole
What is the difference in discharge between bacterial vaginosis, trichomonas vaginalis and thrush?
Thrush: curdly, non odourous and white
Bacterial vanginosis: fishy smell, thin and white
Trichomonas: yellow and throthy +/- odour
What is the most common cause of vaginal discharge in women of reproductive age?
Bacterial vaginitis
What causes bacterial vaginosis?
pH increasing, causing an over proliferation of gardnerella vaginalis, prevotella spp, mycoplasma hominis and other anerobes
Things which can trigger it are: douching, partner change, STIs, smoking, sexual activity
It is not sexually transmitted
How may bacterial vaginosis present?
Fishy, thin, white discharge without soreness or irritation
How is bacterial vaginosis treated?
metronidazole
How is bacterial vaginosis diagnosed?
Usually clinical diagnosis but may be done by high vaginal swab showing prescence of glue cells or a high vaginal pH
How may thrush present?
- curdly, non oderous, white discharge
- vulval itch and soreness
- vaginal soreness
- painful intercourse
- sometimes dysuria
How is trush treated?
topical azoles, intravaginal (pessaries) antifungals like fluconazole
What may cause thrush?
nothing
high oestogen in pregnancy or the pill
antibiotics
diabetes
immunosurpression
What is scabies?
An itchy papular rash caused by parasitic mites, it can be sexually transmitted.
How is scabies treated?
permethrin cream
What causes public lice and how does it present?
Phythrius pubis parasites. incubation is 5 days to several weeks, presents with itchy red papules and often visible lice.
How is pubic lice treated?
malathoin
What is pelvic inflammatory disease?
the result of an infection ascending from the endocervix causing endometrisis, salpingitis, parametritis, oophoritis, tubo- ovarian abcesses and/ or pelvic peritonitis
Which infections most commonly lead to PID?
chlamydia trachmatis or neisseria gonorrhoea
What are the risk factors for PID?
young age, lack of barrier contraception, multiple partners, lowe socioeconomic class
How may PID present?
Temp, pain in lower abdomen and pain on deep intercourse, vaginal/ cervical discharge, vaginal bleeding, STI in history, abdo tenderness, cervical discharge, cervicitis
How is PID investigated?
endocervical and high vaginal swabs
pregnancy test to exclude ectopic pregnancies and current pregnancies (bad for baby)
blood tests (WBC, CRP)
STI and HIV screening
Laparoscopy if needed to check for tuboovarian abcesses and salpingitis
How is PID treated?
- Rest and pain releif
- IM ceftriaxone and doxycyline and oral metronidazole if not too unwell
- If septic, admit to hospital
- laparotomy if no response to therapy, clinically severe or tubo- ovarian abcess
What organism can cause conjunctivitis in newborns?
Chlamydia trachomatis
What is the normal range for vaginal pH?
3.5-4.5
How does vaginal pH change after menopause?
it increases
