Infections of Reproductive System

Question 1

What is Bacterial Vaginosis?

Answer 1

Symptoms:

• Thin, grey, white or green vaginal discharge
• Foul smelling ‘fishy’ odour
• Itching
• Dysuria

Caused by: Perturbed normal flora and anaerobes - after change in pH results in removal of protective lactobacilli

Diagnosed by: Clinically: Vaginal pH >5, KOH Whiff test.
Lab: High vaginal smear –> clue cells - (epithelial cells with gram -ve cococbacili)

Treatment: Metronidazole

Question 2

What is Chlamydia?

Answer 2

Symptoms: -abnormal discharge, dysuria, dyspareunia, PID
bleeding between periods (80% and 50% of women and men asymptomatic)

Caused by: Chlamydia trochomatis (-ve) (Obligate intracellular bacterium - does not grow on normal lab media)

Pathogenesis: Elementary body (infective agent) Infects columnar epithelium, becomes reticular body - which multiplies and is released as elementary bodies –> released to neighbouring cells. Damages genito-urinary tract

Diagnosised by: endocervical, vulvo-vaginal swabs (f) and urethral swabs (m), urine sample (m,f)
NAAT

Treatment; Doxycycline

Question 3

What is genital herpes?

Answer 3

Symptoms: Painful extensive genital ulcers, fever, dysuria inguinal lymphadenopathy, fever

Caused by: HSV1/HSV2

Pathogenesis: HSV-1 and HSV-2 access body via mucosa membrane. Replicate in the stratified squamous epithelium –> taken up by ramifying unmyelineated sensory nerve fibres. Undergo retrograde micro-tubule associated transport to the neuronal cell bodies in the dorsal root ganglia where acute infection is followed by lifelong latent infection.
Virus remains in dormant state within DRG.
Periodically virus becomes reactivated –> travels via anterograde microtubule transport back to epithelium of skin or mucosa –> replication occurs and virus is shed into genital or oral secretions.

Diagnosed by: smear and swab of vesicle fluid and/or base of ulcer –> send for viral PCR

Treatment: Symptomatic, Acyclovir

Question 4

What are Genital Warts?

Answer 4

Symptoms: Benign painless, verrucous epithelial or mucosal outgrowths on penis, vulva, vagina, urethra, cervix, perianal skin. Can be in a group ‘cauliflower cluster’

Caused by: HPV

Pathogenesis:
HPV invades basal layer of epidermis, penetrating skin and mucosal microabrasion in the genital.
A latency period of 3 weeks to 9months may ensue.
Following that period; viral DNA, capsids and particles are produced.
Infection stimulates cellular proliferation in the epithelium and infected cells display a broad range of spectrum of changes –> benign hyperplasia to dysplasia to invasive carcinoma

Treatment:  Spontaneously go away. 
Cryotherapy,
Intralesional interferon, 
Topical podophyllins,
Surgery

Question 5

What types of HPV are carcinogenic, which cancers are they associated with, and how do they cause cancer?

Answer 5

HPV16 and 18.
Cervical and anogenital cancers.

Over 50% of HPVs permenantly integrate into cells chromosomes.
‘Hijack’ cells to produce viral E6 and E7 proteins which are mutagenic –> cause cancer

Question 6

What is Gonorrhoea?

Answer 6

Symptoms:
Male: Epididymitis, prostatitis, proctitis (inflammation of lining of rectum), urethritis, pharyngitis,

Female: PID, endocervicitis, urethritis

MAY BE ASYMPTOMATIC.

Caused by: Neisseria gonorrhoeae (gonococcus) (-ve)

Pathogenesis: Bacteria uses fimbriae and capsule to facilitate attachment to host cell. Releases IgA protease enzyme to break down secretory IgA in mucosal cells. - prevents immune system reacting to organism.
Can survive phagocytosis & multiplies within phagocytes. Kills ciliated cells –> inflammatory response.
(Affects columnar epithelial cells)

Diagnosed by: Urethral & vaginal swab & culture, 1st catch urine

Treatment: single dose of Ceftriaxone

Question 7

Features of Disseminated Gonoccocal infection?(Repro)

Answer 7

Bacteraemia

Skin & joint lesions

Question 8

What is Syphilis?

Answer 8

There are 4 stages:
Primary - Present with painless genital ulcers (chancres)

Secondary - 6-8 weeks, present with diffuse non-pruritic rash, lymphadenopathy, fever

Tertiary: CVS syphilis - Aortic aneurysms, aortic regurgitation, congestive heart failure
Neuro syphilis - parathesia, demtnia, sensory losses

Gummatus syphilis - tumour like growths around the body

Latent stage: No symptoms - can last years

Caused by: Treponeum pallidum (helical spirochete)

Pathogenesis: -

Diagnosed by:
Specific antibody tests against antigens i.e. MHA-TP, silver stain or fluorescence, dark field microscopy, serology.

Treatment: Penicillin
Test of cure follow up

Question 9

What is Vulvo-vaginal Candidiasis?

Answer 9

Symptoms: Profuse white, curd like, itchy, vaginal discharge.

Caused by: Candida albicans (fungal)

Pathogenesis: part of normal flora - opportunistic

Risk Factors:
Remember DOOPAS
Diabetes
Oral contraceptives
Obesity
Pregnancy
Antibiotics
Steroids

Diagnosis: Tissue scraping or blood culture

Treatment: Oral fluconazoles, topical azoles.

Question 10

What is KOH whiff test?

Answer 10

Adding KOH (Potassium hydroxide) –> releases volatile amines with a fishy odour - positive test indicative of bacterial vaginosis

Question 11

Who is at risk for STIs?

Answer 11

1. Young people - 16-25
2. Ethnic minorities
3. Lower socioeconomic background

( - Poverty & Social exclusion

• Individuals born to teenage mothers
• Poor education
• Unemployed)

Sexual Behaviours:

• Multiple partners
• Sexual orientation
• Young at first coitus

Question 12

Best prevention against STIs?

Answer 12

Barrier contraception; Condoms etc.

Question 13

Anthropods that cause infection?

Answer 13

Scabies mite

Pubic louse

Question 14

What is Trichomonas Vaginitis? (Repro)

Answer 14

Symptoms: Thin frothy offensive discharge, dysuria, vaginal inflammation

Caused by: Flagellated protozoan - Trichomonas vaginalis

Diagnosed by: vaginal wet preparation +/- culture enhancement.

Treatment: Metronidazole

Question 15

Main difference between Vaginitis and Vaginosis?

Answer 15

Vaginosis is from perturbed normal flora and there is no inflammation present.