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ESA 4 - The Reproductive System > Infections of the Genital Tract > Flashcards

Infections of the Genital Tract Flashcards

1
Q

What is the difference between a sexually transmitted infection and a sexually transmitted disease?

A

STI
- Includes both symptomatic and asymptomatic cases
STD
- Symptomatic cases only

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2
Q

Which groups are most at risk of STIs?

A 
Young people
Certain ethnic groups
Low socio-economic status groups
Specific aspects of sexual behaviour
   - Age at first sexual intercourse
   - Number of partners
   - Sexual orientation
   - Unsafe sexual activity
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3
Q

Why is there an increase in incidence of STIs?

A

Increased transmission
- Changing sexual and social behaviour
- Increasing density and mobility of populations
Increased GUM attendance
Greater public, medical and national awareness (e.g. campaigns)
Improved diagnostic methods including screening programs

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4
Q

What are some of the burdens of STIs?

A

Both acute and chronic/relapsing infections
Stigma - impact on diagnosis and tracing contacts
Consequent pathology
- Pelvic inflammatory disease & infertility
- Reproductive tract cancers
Disseminated infections
Transmission to foetus/neonate

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5
Q

What is the general diagnosis of STIs?

A

Patient presents with genital lesions/problems to GP or GUM clinic
- Ulcers, vesicles, warts, etc…
- Urethral discharge or pain
- Vaginal discharge
Clinician notes non-genital clinical features suggestive of STI
- Disseminated disease

Detection of asymptomatic cases - contact tracing/screening)

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6
Q

What is the general management of STIs?

A

Treatment preferably single dose/ short course
Co-infections are common - screen and consider empiric treatment for other STIs

Contract tracing - patient and public health management

Sexual health education, advice on contraception, and detailed instruction on the practice and need for safer sex

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7
Q

Describe the Human Papillomaviruses in terms of STIs

A

> over 100 types of this DNA virus
Most common viral STI (~4% young adults in their life)
Cutaneous, mucosal and anogenital warts
- mainly HPV 6 & 11
- Benign, painless, verrucous epithelial or mucosal
outgrowths on penis, vulva, vagina, urethra, cervix,
perianal skin
High-risk types (oncogenic) - HPV16 & HPV18
- Associated with cervical (>70%) and anogenital cancer
- 2500 cases cervical cancer in 2012 - most common
cancer in women 15-34

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8
Q

How do you diagnose Human Papillomaviruses?

A

Clinical, biopsy & genome analysis, hybrid capture

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9
Q

How do you treat someone with Human Papilloma virus?

A

No treatment - spontaneous resolution (70% 1 yr, 90% 2 yrs)

Topical podophyllin, cryotherapy, intralesional interferon, imiquimod, surgery

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10
Q

What screening is available for HPV?

A

Cervical Pap smear cytology (Use a different staining technique now)
Colposcopy + acetowhite test
Cervical swab - HPV hybrid capture (40% of 20-24 yr olds positive)

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11
Q

Are there vaccines available for HPV?

A

Yes
Two types
- Cervarix (HPV 16 & 18) initially used in UK
- Gardasil (HPV 6,11,16 & 18) from 2011
Vaccine offered to girls 12 - 13 (2 doses)
99% effective in preventing HPV 16 & 18 - related cervical abnormalities in those not already infected

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12
Q

Describe chlamydia in terms of STIs

A

Caused by chlamydia trachomatis
Obligate intra-cellular bacterium

Non-specific genital chlamydial infections
- Serotypes D -K

Males - urethritis, epididymitis, prostatitis, proctitis (anus)

Females - often asymptomatic, urethritis, cervicitis, salpingitis (fallopian tubes) perihepatitis (the covering of the liver, also known as fitz-hugh-curtiz syndrome.

Ocular inoculation - conjunctivitis

Neonatal infection - inclusion conjunctivitis, pneumonia

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13
Q

How do you diagnose chlamydia?

A

Endocervical and urethral swabs - NAAT

1st void urine - NAAT

Neonatal infection - conjuctival swab (NAAT)

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14
Q

What is the treatment for chlamydia?

A

Doxycycline or azithromycin

Erythromycin in children

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15
Q

Is there screening for chlamydia?

A

Yes
50% of all cases from chlamydia screening programme
- Targets sexually-active under 25s
- Urine (M&F) or swab (F)
- Nucleic acid amplification test (NAAT)
- Dual testing (with N. gonorrhoeae) available

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16
Q

Describe the herpes simplex virus in terms of STIs

A

Primary genital herpes - extensive painful genital ulceration, dysuria, inguinal lymphadenopathy, fever
Genital herpes is usually associated with HSV2 (HSV 1 causes cold sores)
Recurrent genital herpes - asymptomatic to moderate (latent infection in dorsal root ganglia)

17
Q

How do you diagnose the herpes simplex virus?

A

PCR of vesicle fluid and/or ulcer base

18
Q

What is the treatment for herpes simplex virus?

A

Aciclovir (1° & severe disease)

Aciclovir prophylaxis for frequent recurrences

Barrier contraception - reduced risk of transmission

19
Q

Describe gonorrhoeae in terms of STIs

A

Caused by Neisseria gonorrhoeae
Gram negative intracellular diplococcus

Males - urethritis, epididymitis, prostatitis, proctitis, pharyngitis
Females - asymptomatic, endocervicitis, urethritis, PID which may lead to infertility

Disseminated gonococcal infection
- Bacteraemia, skin & joint lesions

20
Q

How do you diagnose gonorrhoeae?

A

Swab from urethra, cervix (throat, rectum) or urine (NAAT)
- Gram stain (pus or normally sterile site)
- Fastidious organism requiring special media ( need to
let lab now what you are looking for)

21
Q

What is the treatment for gonorrhoeae?

A

Ceftriaxone (IM), increasing resistance to many other agents

All patients treated (& tested) for chlamydia with azithromycin which also may prevent emergence of resistance to cephalosporins

22
Q

Describe syphilis in terms of STIs

A

Treponema pallidum
Spirochaete
Aetiological agent of syphilis - great mimicker of symptoms of many other diseases

Most cases men and MSM (men who have sex with men)

Multi-stage disease
- 1° - indurated, painless ulcer (chancre)
- 2° - 6 to 8 weeks later - fever, rash,
lymphadenopathy, mucosal lesions
- 3° - neurosyphilis (GPI tabes dorsalis), cardiovascular syphilis, gums (local destruction)

Congenital syphilis

23
Q

How do you diagnose syphilis?

A

Treponema pallidum cannot be grown
Dark-field microscopy needed

Serology
Initial screening with EIA antibody test then +ves
- Rapid Plasma Reagin RPR titre (cross-reacting antigen)
- TP particle agglutination TPPA
- Serologic pattern interpreted (false positives,
response to treatment, etc)

24
Q

What is the treatment for Treponema pallidum?

A

Penicillin & ‘test of cure’ follow up

25
Q

Name some less common STIs

A

They are mainly tropical

Inguinal lymphadenopathy may be cause by these:

LGV (lymphogranuloma venereum)
- C. trachoma serotypes L1, L2 & L3
- Rapidly healing papule (small defined bump) then
inguinal bubo (swelling of lymph nodes)
- Recent clusters in Europe in MSM

Chancroid (Haemophilus ducreyi)

  • Painful genital ulcers
  • Looks like syphilitic lesion but painful

Granuloma inguinale/Donovanosis (Klebsiella granulomatis)
- Genital nodules -> ulcers

26
Q

What are three most common causes of abnormal vaginal discharge?

A

Trichomonas vaginalis

Vulvovaginal candidiasis

Bacterial vaginosis

27
Q

Describe trichomonas vaginalis in terms of STIs

A

Predominantly sexually transmitted

Flagellated protozoan

Trichomonas vaginitis

  • Thin, frothy, offensive discharge
  • Irritation, dysuria, vaginal inflammation
28
Q

How do you diagnose trichomonas vaginitis?

A

Vaginal wet preparation +/- culture enhancement

29
Q

What is the treatment for trichomonas vaginalis?

A

Metronidazole

30
Q

Describe vulvovaginal candidiasis in terms of STIs

A

Often called vaginal thrush

Not often uniquely sexually transmitted but can be

Caused by candida albicans & other candida species
- May be part of normal GI & genital tract flora

Risk factors
- Antibiotics, oral contraceptives, pregnancy, obesity,
steroids, diabetes

Profuse, white, itchy curd-like discharge

31
Q

How do you diagnose vulvovaginal candidiasis?

A

High vaginal smear (+/- culture)

They stain gram positive

32
Q

What is the treatment for vulvovaginal candidiasis?

A

Topical azoles or nystatin

Or oral fluconazole

33
Q

Describe bacterial vaginosis (BV) in terms of STIs

A

Perturbed normal flora
- Gardnerella (probably not cause, just occurs with
change of flora), anaerobes, mycoplasmas

Scanty but often fishy discharge

34
Q

How do you diagnose bacterial vaginosis?

A

Vaginal pH >5, KOH whiff test

Laboratory diagnosis - HVS (High vaginal specimen)
gram stained smear
- ‘Clue’ cells - epithelial cells studded with gram
variable coccobacilli
- Reduced numbers of lactobacilli
- Absence of pus cells

35
Q

What is the treatment for bacterial vaginosis?

A

Metronidazole

36
Q

Describe briefly scabies and pubic lice in terms of STIs

A

Not exclusively sexually transmitted

Scabies can affect the genetalia and spread sexually

Pubic lice (pediculosis pubis)

  • Distinct from the other human (body) lice
  • The ‘crab louse’ (Phthirus pubis)
37
Q

What are some general important points in relation to genital tract infections?

A

Asymptomatic & symptomatic disease - common
Marked differences in worldwide epidemiology
Sexual and travel history important
Prompt diagnosis & early treatment

ADVICE, COUNSELLING AND EDUCATION
- role of GUM in contact tracing & other ppunlic health
measures

ESA 4 - The Reproductive System (24 decks)

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