Infections And PID Flashcards
What is the difference between an STI and an STD?
STIs can be symptomatic or asymptomatic
STDs are symptomatic cases only
Give some of the at risk groups for STIs
Young people More sexual activity Low socio-economic status Number of partners Unsafe sex
Give some complications of STIs
Pelvic inflammatory disease
Infertility
Reproductive tract cancers
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
What is the most common viral STI?
Human papilloma virus
Warts
What are the 2 types of HPV warts?
Benign (6 and 11) - painless
High risk/oncogenic (16 and 18)
When do we give HPV vaccine?
Girls 12-13 years (2 doses)
For prevention of 16 and 18 mainly
What is the most common bacterial STI?
Chlamydia trachomatis
Which gender is most commonly asymptomatic with chlamydia?
Females
What is the medical term for infection of Fallopian tubes?
Salpingitis
Which methods do we use to diagnose chlamydia?
Endocervical and urethral swabs
1st void urine
What is the treatment for chlamydia?
Doxycycline or azithromycin
If under 18 with chlamydia what treatment should be given?
Erythromycin
How do we diagnose herpes?
PCR of vesicle fluid
And/or ulcer base
What is the treatment for herpes?
Aciclovir
What would neisseria gonorrhoeae look like under gram stain?
Gram negative
Intracellular
Diplococcus
Which gender is more likely to be asymptomatic with gonorrhoea?
Females
How do we diagnose gonorrhoea?
Swab/urine
Gram stain
What is the treatment for gonorrhoea?
IM ceftriaxone
And treat them for chlamydia with azithromycin
What organism causes syphilis?
Treponema pallidum
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
