Infections And PID Flashcards by Maya White

What is the difference between an STI and an STD?

STIs can be symptomatic or asymptomatic

STDs are symptomatic cases only

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Give some of the at risk groups for STIs

Young people
More sexual activity 
Low socio-economic status 
Number of partners
Unsafe sex

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Give some complications of STIs

Pelvic inflammatory disease
Infertility
Reproductive tract cancers

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How do we manage an STI?

Abx treatment - preferable single dose/short course
Co-infections common so screen for others
Contact tracing
Education/advice on contraception

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What is the most common viral STI?

Human papilloma virus

Warts

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What are the 2 types of HPV warts?

Benign (6 and 11) - painless

High risk/oncogenic (16 and 18)

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When do we give HPV vaccine?

Girls 12-13 years (2 doses)

For prevention of 16 and 18 mainly

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What is the most common bacterial STI?

Chlamydia trachomatis

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Which gender is most commonly asymptomatic with chlamydia?

Females

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What is the medical term for infection of Fallopian tubes?

Salpingitis

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Which methods do we use to diagnose chlamydia?

Endocervical and urethral swabs

1st void urine

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What is the treatment for chlamydia?

Doxycycline or azithromycin

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If under 18 with chlamydia what treatment should be given?

Erythromycin

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How do we diagnose herpes?

PCR of vesicle fluid

And/or ulcer base

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What is the treatment for herpes?

Aciclovir

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What would neisseria gonorrhoeae look like under gram stain?

Gram negative
Intracellular
Diplococcus

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Which gender is more likely to be asymptomatic with gonorrhoea?

Females

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How do we diagnose gonorrhoea?

Swab/urine

Gram stain

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What is the treatment for gonorrhoea?

IM ceftriaxone

And treat them for chlamydia with azithromycin

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What organism causes syphilis?

Treponema pallidum

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Who is most likely to get syphilis?

Men

And MSM

Describe the stages of syphilis

Primary = painless ulcer (chancre)
Secondary = systemic illness, fever, rash, lymphadenopathy 
Latent = symptom free years 
Tertiary = neurosyphilis, CVS syphilis and gummas

How can we diagnose syphilis?

Dark field microscopy

Antibody testing

What is the treatment for syphilis?

Penicillin

What is trichomonas vaginalis?

A protozoa cause of vaginitis

Describe Sx of vaginitis

Thin, frothy, offensive discharge Irritation Dysuria Redness

What is the treatment for vaginitis?

Metronidazole

What are the risk factors for vaginal candida?

``` Abx use Oral contraceptives Pregnancy Obesity Steroids Diabetes ```

What are the Sx of vaginal candida?

Profuse, white, itchy, curd-like discharge

How do we diagnose candida?

High vaginal smear and culture

What is the treatment for vaginal candida?

Topical azoles or nystatin

What is bacterial vaginosis?

Perturbed normal flora

Which species are likely to cause bacteria vaginosis?

Gardnerella Anaerobes Mycoplasmas

How do we diagnose bacterial vaginosis?

KOH whiff test | Gram stain smear

What is the treatment for bacterial vaginosis?

Metronidazole

How does PID arise?

An infection ascending from the endocervix | Causing inflammation and damage

What are the most common problems with PID?

Endometritis Salpingitis Tube-ovarian abscess

What is the main presenting Sx of salpingitis?

Pain

How does a turbo-ovarian abscess occur?

Neutrophils invade submucosa Fills lumen with exudate Walls off to form abscess Exudate can become attached to pelvic side walls

What are the complications of PID?

``` Ectopic pregnancy risk Infertility Chronic pelvic pain (adhesions) Fits-Hugh-Curtis syndrome Reiter syndrome ```

What is Fitz-Hugh-Curtis syndrome?

RUQ pain and peri-hepatitis following chlamydia | Stringy adhesions

What is Reiter syndrome?

Disseminated chlamydia infection

What are the most common STIs to cause PID?

Chlamydia | Gonorrhoea

What are the risk factors for PID?

``` Young age (20-30) Lack of barrier contraception Multiple sexual partners Low socio-economic class IUCD (copper coil) ```

Describe a typical Hx for PID

Pyrexia, pain Abnormal discharge/vaginal bleeding Sexual Hx, prior STI

What could you find on examination for PID?

Fever Lower abdo tenderness - usually bilateral Bimanual exam - adnexal (tube) tenderness, cervical motion tenderness Speculum exam - lower genital tract infection, purulent discharge

What do we need to have in our differential diagnosis with suspected PID?

``` Ectopic pregnancy Endometriosis Ovarian cyst complications IBS Appendicitis UTI ```

What investigations might you do for suspected PID?

``` Pregnancy test Endocervical and high vaginal swabs Blood tests - WBC and CRP Screen for STIs Diagnostic laparoscopy ```

How do we treat mild PID?

Quickly (less chance of complications) | Sx management = rest and analgesics

How do we treat severe PID?

IV Abx for 14 days | Ceftriaxone and doxycycline and metronidazole

Give some factors that would cause us to think the PID was severe

Temp > 38 Signs of tube-ovarian abscess or peritonitis Not responding to therapy Increased risk group