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Repro > Infections fo the genital tract > Flashcards

Infections fo the genital tract Flashcards

1
Q

Who gets affected by STI’s commonly?

A

-black african/carribean

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2
Q

What age groups get STI’s mostly?

A

15-24 yrs

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3
Q

What are the factors affecting genital tract infections?

A
  • lower age of first intercourse
  • not using barrier contraception
  • multiple sexual partners
  • homosexulatilty
  • anal sex
  • low socio-economic status (linked to poor education)
  • Lack of immunisation (HPV, Hep B)
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4
Q

What STI is the most common in the UK?

A

Chlamydia Trachomatis

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5
Q

What is chlamydia trachomatis and what is the mechanism of action?

A
  • obligate intracellular bacteria
  • lets itself get taken up by phagocytosis
  • inhibits formation of phagolysosome so prevents itself getting expelled (virulence factor)
  • unique cell wall
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6
Q

What are the symptoms of chlamydia in men?

A
  • typically asymptomatic in men
  • mild urethritis
  • dysuria
  • inflammation of other structures (epididymis/prostatis)
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7
Q

What are the symptoms of chlmydia in women?

A
  • typically asymptomatic in women
  • can present as vaginal discharge
  • dyspareunia
  • post-coital bleeding
  • on speculum examination a muco-purulent discharge and cervical motion tenderness will be seen
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8
Q

How is chylymdia investigated?

A

using NAAT

-VVS (vulvo vaginal swab) or endocervical swab

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9
Q

What is the first line treatment from chlymidai?

A

doxycycline

-IN PREGNANCY USE ERYTHROMYCIN

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10
Q

What is the most common cause of urethral discharge in males?

A

Neisseria gonnorhoeae

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11
Q

What is neisseria gonnorghoeae?

A
  • diploccocus

- has pili to help adhere to mucosal membranes

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12
Q

What are the symptoms of gonnorhaea in males?

A
  • thick yellow dischagre

- may have dysuria

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13
Q

What are the symptoms of gonnorhea in females?

A

typically asymptmatic but can cause vaginal discharge and lower abdominal pain

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14
Q

What are the complications of gonnorheae?

A
  • reactive arthritis (painful joints)
  • epidydimo-orchitis in men
  • PID
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15
Q

What is the first line treatment for gonorrhoea?

A

combined antibiotic therapy

-ceftriaxone and azithromycin to boost the effect of this antibiotic and reduce resistance risk

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16
Q

What is a common co-infection of gonnorhoea?

A

chlamydia

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17
Q

What other investigations can you do for gonnorhoea?

A

microscopy and cultures and NAATS

  • urethral swab
  • VVS or endocervical
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18
Q

What is important to exclude?

A

UTI’s - do a first catch urine sample

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19
Q

Is discharge in women pathological?

A

could be physiological - progesterone in the secretory phase causes thicker cervical mucus - usually clear and has no associated symptoms

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20
Q

What could a fetus get if a mother has chlmydia?

A

neo-natal conjunctivitis

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21
Q

What is trichomoniasis caused by?

A

Trichomoniasis vaginalis

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22
Q

What is Trichomoniasis vaginalis mode of action?

A
  • protazoa

- has flagella to aid motility in the female reproductive tract

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23
Q

What is its optimal growth?

A

is pH 6.0 (female is 4.0) so more alkaline environments are more at risk of it

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24
Q

What is the symptom of trichonomiasis in men?

A

often asymptomatic (can cause dysuria or discharge)

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25
Q

What are the symptoms of trichomoniasis in women?

A

-copous, yellow, odourous discharge

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26
Q

How is trichomoniasis treated?

A

metrondiazole

- need to do a high vaginal swab which includes looking at the posterior fornix

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27
Q

What are some complications of trichomoniasis?

A

in men - this Protozoa is a cause of non-gonococcal urethritis

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28
Q

What is non-gonococcal urethritis?

A

inflammation of the urethra with associated discharge that isn’t caused by gonnorhea

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29
Q

What are the culprits of NGU?

A
  • can be sexually transmitted
  • chlamydia trichomatis
  • mycoplasma genitalium
  • trichomoniasis vaginalis
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30
Q

When would NGU be non- pathogenic?

A

-older men but still is less common

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31
Q

What causes syphillis?

A

Treponema pallidum

-spirochete

32
Q

What age group and gender is syphillis most common in?

A

men aged 25-33

-those infected with HIV

33
Q

What is primary syphillis?

A
  • initially presents as a painless ulcer in the genitals
  • very infection
  • lesion will usually disappear
34
Q

What is secondary syphilis?

A
  • can develop weeks later as a rash or affect other body systems (liver)
  • symptoms will often disappear
35
Q

What is tertiary syphilis?

A
  • can remain latent and become reactivated later in life like pregnancy
  • can cause congenital syphilis
36
Q

How is syphilis diagnosed?

A
  • swabs taken and blood test to confirm the infection and monitor treatment
  • serology
37
Q

What is the treatment for syphilis?

A

depends on the stage of infection

-penicillin-based antibiotics

38
Q

What is mode of transmission of syphilis?

A
  • direct contact

- vertical transmission

39
Q

What is the most common viral STI?

A

Human papilloma virus

(HPV) strains 6 + 11

40
Q

What is HPV?

A

non-enveloped DNA virus

41
Q

How does HPV present?

A

-genital warts on the penis, vulva, viagina, cervis and perianal skin

42
Q

What strains of HPV have the highest association with cervical and anal cancer?

A

HPV 16+18

43
Q

How is HPV prevented?

A

there is a vaccine against strains now (for women)

-smear tests should also be carried out regularly

44
Q

What is herpes?

A

cause by the herpes simplex virus (HSV)

45
Q

What type of virus is HSV?

A

enveloped DNA virus

-there are 2 types HSV 1 and HSV 2

46
Q

What does HSV 1 cause?

A
  • oral and genital herpes

- associated with cold sores

47
Q

What does HSV-2 cause?

A

genital herpes and often leads to recurrent infection

-associated with HIV

48
Q

When is HSV 2 most dangerous?

A

in pregnancy as vagincal delivery means that the baby can develop complications of herpes

49
Q

How does herpes present?

A
  • painful ulcers
  • dysuria
  • dischagre
  • OR asymptomatic
50
Q

How is herpes indenitified?

A

swabs and serology

51
Q

How is herpes treated?

A

antivirals like acyclovir

52
Q

What is “thrush”?

A 
a yeast (fungus) infection causes by candida alicans
-it is a normal vagincal flora and will present in people who have the risk factors
53
Q

What are the risk factors for thrush?

A
  • immunosuppression (pregnancy and HIV)
  • diabvtetes
  • antibiotics
  • COCP
54
Q

What are the symptoms of thrush?

A

-white, non-offensive vaginal discharge with pruritus, pain and dyspareunia

55
Q

How is thrush diagnosed?

A

high vaginal swabs

microscopy

56
Q

How is thrush treated?

A

clotrimazole (vaginal pessary or cream)

57
Q

What is the most common vaginal flora and what is its role?

A

lactobacillus- acts to decrease the pH in the vagina to help protect against bacteria proliferation

58
Q

WHat happens in BV?

A
  • bacterial vaginosis

- overgrowth of gardnerella vaginalis

59
Q

How do you get a decrease in the lactobacillus?

A

-anything that disrupts the vagina floor e.g. washing the vagina with strong soaps or washing inside the vagina

60
Q

If you have an altered flora what can this lead to?

A

-increased risk of contracting STI’s

61
Q

What does BV present with?

A

offensive vaginal discharge without pruritis or pain

62
Q

How is BV diagnosed?

A

high vaginal swabs

gram staining and KOH test

63
Q

What is BV treated with?

A

metronidazole

64
Q

What is PID?

A

pelvic inflammatory disease

- ascending infection of the uterus, fallopian tubes and ovaries

65
Q

What microorganisms can cause PID?

A

-c.trachomatis
-N.gonnorhoeae
-Gardenellla sp.
-Mycoplasma genitalium
(also inserting IUDs)

66
Q

What is inflammation of the fallopian tubes called?

A

salpingitis

67
Q

What are the clinical complications of salpingitis and PID?

A
  • long term damage to the ciliated epithelium of the tubes
  • inflammaotry exudate can cause the tubes to fill with pus leading to adhesions and obstruction of the tube
  • tubo-ovarian abscess formation
  • can lead to sub fertility
  • Fitz-hugh Curtis syndrome
68
Q

What are the risk factors of PID?

A 
young age
multiple sex partners
lack of barrier contracteption
low-socio economic status
IUD
69
Q

Who does PID most commonly affect?

A

sexually active women aged 20-30

70
Q

What are the symptoms of PID?

A
  • lower abdominal pain
  • dyspareunia
  • purulent discharge
  • AUB

WOMEN MAY BE ASYMPTOMATIC AND ONLY PRESENT WITH CHRONIC PELVIC PAIN / PROBLEMS WITH FERTILITY

71
Q

What are the signs of PID?

A
  • pyrexia
  • pain on palpation (bimanual vaginal examination)
  • evidence of discharge on speculum
72
Q

Why would a women have abnormal discharge or vaginal bleeding in PID?

A

due to endometriosis

73
Q

Why else could the women have pain in the lower abdomen? (think differential diagnosis)

A
  • constipation
  • ectopic pregnancy
  • appendicitis
  • IBD
  • UTI
  • endometriosis
  • ovarian cysts
74
Q

Why does PID lead to sub-fertility?

A
  • adhesions from chronic inflammation
  • increased risk of ectopic pregnancy
  • reduced likelihood of successful fertilisation
75
Q

What is fitz-hugh curtis syndrome?

A

inflammation of the liver capsule causes peri-hepatitis and RUQ pain and scarring between liver and diaphragm

76
Q

How is PID managed?

A

Prevention better than cure!!!

  • antibitotics (broad spectrum) for more than 14 days to ensure eradication
  • analgesia
  • screening to sexual partners
77
Q

What is the next step if a women fails to respond to treatment?

A

-laproscopy! essentail to confirm the diagnosis or make an alternative diagnosis

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