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Sexual and reproductive health > Infections > Flashcards

Infections Flashcards

1
Q

Is immunity common in sexually transmitted infections?

A

no it is rare

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2
Q

co-infections are

A

common

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3
Q

what is normal ph in the vagina?

A

4 to 4.5 (acidic)

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4
Q

what predominates flora in vagina?

A

lactobacillus spp

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5
Q

how is the lactobacillus spp protective?

A

produce lactic acid +/- hydrogen peroxide

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6
Q

which organism from the lactobacillus spp is not part of the normal vaginal flora?

A

L. acidophilus

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7
Q

what are the predisposing factors for candida infection?

A

recent antibiotic therapy
high estrogen levels (pregnancy, certain types of contraceptives)
poorly controlled diabetes
immunocompromised patients

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8
Q

how does candida infection present?

A

intensely itchy white vaginal discharge

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9
Q

how do you diagnose candida infection?

A

high vaginal swab for culture

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10
Q

most cases of candida infection are caused by?

A

c. albicans

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11
Q

what is the treatment for candida infection?

A

topical clotrimazole pessary or cream

oral fluconazole

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12
Q

non-albicans candida species are more likely to be..

A

azole resistant

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13
Q

what rash is typical of candida balanitis?

A

spotty

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14
Q

is candida balanitis common?

A

no

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15
Q

is candida balanitis an STI?

A

no

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16
Q

gonococcal pathogenesis - Attaches to host ———– cells and is ————- into the cell to ———- within the host cell and are ———- into the subepithelial space.

A

epithelial
endocytosed
replicate
sub epithelial

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17
Q

some gonococcal strains selectively cause……… genital infection?

A

asymptomatic

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18
Q

what type of organism I is neisseria gonorrhoeae?

A

gram negative intracellular diplococcus

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19
Q

what organism does not survive well in less than ideal growth conditions (i.e. outside the body)?

A

fastidious organism

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20
Q

what are the primary sites of infection in gonorrhoea?

A

mucous membranes of the urethra, endocervix, rectum and pharynx

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21
Q

what is the incubation period of urethral infection in men?

A

2-5 days

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22
Q

is it higher risk from infected women to male partner or from infected man to female partner?

A

50-90% risk from infected man to female partner

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23
Q

what is the first line investigation for gonorrhoea?

A

nucleic acid amplification testing (NAAT)

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24
Q

what is the next step if NAAT is positive for gonorrhoea?

A

take swabs for culture before prescribing antibiotics

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25
Q

what areas are swabbed for cultures?

A

endocervical, rectal and throat

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26
Q

presentation for gonococcal infection in men?

A

asymptomatic <10%
urethral discharge >80%
dysuria

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27
Q

pharyngeal/recta infections in gonococcal male and female infection are mostly?

A

asymptomatic

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28
Q

what is the presentation for gonococcal infection in females?

A

asymptomatic (up to 50%)
increased/altered vaginal discharge (40%)
dysuria
pelvic pain (<5%)

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29
Q

what is the first line treatment of gonorrhoea?

A

ceftriaxone 500mg IM

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30
Q

what is the second line treatment of gonorrhoea?

A

cefixime 400mg oral

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31
Q

does gonorrhoea require a test of cure?

A

yes in all patients

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32
Q

what are the advantages of NAAT?

A

ability to test urine specimens or self-obtained vaginal swabs
increased sensitivity over culture
can detect dead organisms

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33
Q

what are the disadvantages of NAAT?

A

inability to perform antimicrobial susceptibility testing

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34
Q

why should you wait for antimicrobial treatment in sexual contacts of those infected with gonorrhoea?

A

high antimicrobial resistance

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35
Q

what is the commonest bacterial STI in the UK?

A

chlamydia trachoma’s

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36
Q

what type of microorganism is chlamydia?

A

gram negative obligate intracellular bacterium

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37
Q

what is the mode of transmission of chlamydia?

A

vaginal, oral or anal

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38
Q

what does the cell wall lack in gram negative organism causing chlamydia?

A

peptidoglycan

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39
Q

what age has the highest incidence of chlamydia infection?

A

20-24 male or female

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40
Q

what percentage of women with chlamydia develop PID?

A

9%

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41
Q

episodes of PID increase the risk of?

A

ectopic pregnancy by 10 and carries a risk of tubal factor infertility of 15-20%

42
Q

what is the presentation in females with chlamydia? (4)

A

post coital or inter menstrual bleeding
lower abdominal pain
dyspareunia
mucopurulent cervicitis

43
Q

what is the presentation in males with chlamydia?(5)

A 
Urethral discharge
Dysuria
Urethritis
Epididymo-orchitis
Proctitis (LGV)
44
Q

when do you test for chlamydia diagnosis?

A

14 days following exposure

45
Q

how do you diagnose chlamydia in females?

A

NAAT (vulvovaginal swab)

46
Q

how do you diagnose chlamydia in males?

A

first void urine

47
Q

how do you diagnose chlamydia in MSM?

A

add rectal swans if has receptive anal intercourse

48
Q

how do you treat chlamydia?

A

azithromycin 1G stat followed by 500mg daily for 2 days if allergic to macrolide then doxycycline 100mg BD x 1 week

49
Q

what is now emerging as a sexually transmitted pathogen?

A

mycoplasma genitalium

50
Q

how do you test for mycoplasma genitalium?

A

NAAT

51
Q

what serovars cause trachoma ( eye infection)

A

A-C

52
Q

what serovars cause genital infection?

A

D-K

53
Q

what serovars cause lymphogranuloma venereum?

A

L1-L3

54
Q

what micro-orgaanims causing STI does not reproduce outside the host cell?

A

chlamydia trachomatis

55
Q

why does chlamydia trachoma’s not stain with gram stain?

A

no peptidoglycan in the cell wall

56
Q

what type of microorganism is trichomonad vaginalis?

A

single celled protozoal parasite

57
Q

how is trichomonas vaginalis transmitted?

A

sexual contact

58
Q

what are the symptoms of Trichomonas vaginalis in females?

A

vaginal discharge and irritation

59
Q

what are the symptoms of Trichomonad vaginalis in males?

A

urethritis

60
Q

how do you diagnose trichomonas vaginalis?

A

high vaginal swab for microscopy

61
Q

what is the treatment of trichomonad vaginalis?

A

metronidazole 400 mg bd (7 days) or 2g single dose

62
Q

what causes the fishy odour in discharge of bacterial vaginosis?

A

amines and 10% potassium hydroxide

63
Q

a wet mound reveals the absence of bacilli and their replacement with (BV)?

A

clumps of coccobacilli

64
Q

large number of leukocytes int he wet mount of a woman with BV suggests?

A

coincident infection possibly trichomoniasis or bacterial cervicitis

65
Q

what causes premature rupture of the membranes and preterm delivery?

A

BV

66
Q

what causes increased rate of upper tract infection (endometritis, salpingitis)?

A

BV

67
Q

treatment of male sexual partners in those infected with BV

A

no benefit

68
Q

what is the 1st line treatment of BV?

A

metronidazole 400mg bd (7 days) or 2g single dose

69
Q

what is the 2nd line treatment of BV?

A

clindamycin 2% vaginal cream 5g nightly for 7 nights or Dequalinium 10mg vaginal tablets daily for 6 days

70
Q

what causes syphilis?

A

Treponema pallidum

71
Q

what type of organism is treponema palladium?

A

spirochaete organism

72
Q

how do you diagnose syphilis?

A

PCR test or on serological blood tests to detect antibodies

73
Q

how many stages of illness in syphilis?

A

4

74
Q

what stage is this - organisms multiples at inoculation site and gets into blood stream. chancre will heal without treatment?

A

primary lesion (chancre)

75
Q

what stage of syphilis is this - large not. bacteria circulating in blood with multiple manifestations at different sites (“snail-track” mouth ulcers, generalized rash, flu-like symptoms etc.0

A

secondary stage

76
Q

what stage of syphilis is this - no symptoms but low-level multiplication of spirochaete in intimate of small blood vessels. can be divided into early latent and late latent periods

A

latent stage

77
Q

what stage of syphilis is this - cardiovascular or neuromuscular complications many years later?

A

late stage syphilis

78
Q

how is syphilis transmitted?

A

sexual contact
trans-placental/during birth
blood transfusions
non-sexual contact - health workers

79
Q

what is the incubation period of primary syphilis?

A

9-90 days

80
Q

what is the painlesss lesion founding primary syphilis?

A

chancre

81
Q

what is the incubation period for secondary syphilis?

A

6 weeks to 6 months

82
Q

how do you diagnose syphilis?

A

serological testing

83
Q

what is the screening test for syphilis?

A

ELISA/EIA (enzyme immunoassay)

84
Q

how do you treat early syphilis?

A

2.4 MU Benzathine penicillin x 1

85
Q

how do you treat late syphilis?

A

2.4 MU Benzathine penicillin x 3

86
Q

will when do you treat for syphilis?

A

until RPR is negative or serofast

87
Q

how should titles decrease in early syphilis/

A

four fold by 3-6 months

88
Q

what causes genital herpes?

A

hsV type 1 and 2

89
Q

what type of organism is HSV 1 and 2?

A

enveloped virus containing double stranded DNA

90
Q

how do you contract genital herpes?

A

close contact with someone who is shedding the virus

91
Q

how do you spread genital herpes?

A

genital/genital or oropharyngeal/genital contact

92
Q

where does HSV1 and 2 replicate?

A

in the dermis and epidermis

93
Q

what causes pain in genital herpes/

A

it gets into nerve endings or sensory and autonomic nerves

94
Q

what is the presentation of genital herpes?

A

multiple painful small vesicles

95
Q

what causes absence of symptoms?

A

intermittent virus shedding

96
Q

can you have latent genital herpes?

A

yes

97
Q

how do you diagnose genital herpes?

A

Swab in virus transport medium of deroofed blister for PCR test – highly sensitive and specific test

98
Q

what is the treatment for genital herpes?

A

Aciclovir may be helpful if taken early enough ( famciclovir/ valaciclovir )
Pain relief

99
Q

what is the treatment for pubic lice?

A

malathion lotion

100
Q

how is pubic lice acquired?

A

close genital skin contact

Sexual and reproductive health (5 decks)

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