Infections Of The Genital Tract Flashcards
Which is the most common STI?
Chlamydia trachomatis - 209,000 cases
Accounts for nearly half of all cases of STIs
How many cases of STIs in the UK?
450,000
What are the at-risk groups for STIs?
Young people Some ethnic groups Age at first sexual intercourse Number of partners Sexual orientation Unsafe sexual activity
Why is there an increased incidence of STIs over recent years?
Increased transmission - changing sexual and social behaviour
Increasing density and mobility of population
Increased genitourinary medicine (GUM) clinic attendance
Greater public, medical and national awareness
Improved diagnostic methods including screening
What are the problems of STIs?
Stigma - impact of tracing contacts and diagnosis
Consequent pathology - pelvic inflammatory disease and infertility, repro tract cancers
Disseminated infections
Transmission to fetus/neonate
What are some differential diagnoses for genital skin and mucous membrane lesions?
Genital ulcers
Vesicles/bullae
Genital papules
Anogenital warts
What are the symptoms of urethritis?
Discharge, dysuria, frequency
What are some differential diagnoses of urethritis?
Gonococcal urethritis Chlamydial urethritis Non-specific urethritis Post-gonococcal urethritis Non-infectious urethritis
What are some differential diagnoses for the cause of vulvo-vaginitis and cervicitis which are not caused by STIs?
Bacterial vaginosis
Bartholinitis
Give the characteristics of Chlamydia trachomatis
Gram negative
Obligate
Intracellular bacterium
Presentation of a Chlamydia trachomatis infection?
Males
- urethritis
- epididymitis
- prostatitis
- proctitis
Females
- urethritis
- cervicitis
- salpingitis
- perihepatitis
Most cases asymptomatic
Presentation if there is ocular inoculation or neonatal infection with Chlamydia trachomatis?
Ocular inoculation - conjunctivitis
Neonatal infection - inclusion conjunctivitis, pneumonia
How to diagnose Chlamydia trachomatis?
Endocervical and urethral swabs
First void urine - NAAT (nucleic acid amplification test)
How to treat Chlamydia trachomatis?
Doxycycline or azithromycin
Erythromycin in children
What is the screening method for chamydia?
Nucleic acid amplification test
Features of the human papilloma virus?
DNA virus - over 100 types
Presentation of HPV virus?
Cutaneous, mucosal and anogenital warts
-benign, painless verrucous epithelial/mucosal outgrowth on penis, vulva, vagina, urethra, cervix, perianal skin
Which are the two high risk types of HYP which are oncogenic?
HPV 16 and 18
Which cancers is HPV associated with?
Cervical - more than 70% of cancer patients have evidence of HPV
Anogenital
How to diagnose HPV?
Clinical
Biopsy and genome analysis
Hybrid cancer
Treatment of HPV?
Spontaneous resolution Topical podophyllin Cryotherapy Intralesional interferon Inquimod Surgery
How is HPV screened?
Cervical Pap smear cytology
Cervical swab, HPV capture is positive in 40% of 20-24 year olds
What does the herpes simplex virus cause?
Primary genital herpes - extensive painful genital ulceration, dysuria, inguinal lymphadenopathy, fever
Which virus is primary genital herpes associated with?
HSV 2
HSV 1 causes cold sores
How is the HSV recurrent?
Lies latent in the dorsal root ganglia
How to diagnose herpes simplex virus?
PCR of vesicle fluid or ulcer base
Treatment of HSV?
Aciclovir for primary and severe disease
Aciclovir prophylaxis for frequent recurrences
Give the features of Neisseria gonorrhoeae
Gram negative
Intracellular
Diplococcus
How does Neisseria gonorrhoeae present?
Males
- urethritis with discharge
- epididymitis
- prostatitis
- pharyngitis
Females
- asymptomatic
- endocervicitis
- urethritis
- PID
Complication of Neisseria gonorrhoeae in females?
Infertility
Complication of Neisseria gonorrhoeae for both sexes?
Disseminated gonoccocal infection
-bacteraemia, skin and joint lesions
How to diagnose Neisseria gonorrhoeae?
Swab from the ureteha, cervix, throat, rectus, urine
Gram stain
It is a fastidious organ requiring special media
Treatment of Neisseria gonorrhoeae?
IM ceftriaxone
There is increasing resistance to many other agents including penicillin and ciprofloxacin
Also treated for chlamydia as a co-infection
-given azithromycin which may also prevent emergence of resistance to cephalosporins
What is the aetiological agent of syphilis
Treponema pallidum
Who is syphilis most common in?
MSM and men
What are the stages of syphilis?
Primary - indurated painless ulcer (chancre)
Secondary - 6-8 weeks later; fever, rash, lymphadenopathy, mucosal lesions
Then have latent, symptom-free years
Tertiary - neurosyphilis, CVS syphilis, gummas (destructive lesions of the skin)
What is congenital syphillis?
When it has spread from mother to baby
How is syphilis diagnosed?
Serologically using antibodies
Treatment of syphilis?
Penicillin and test of cure follow up
What infections can cause inguinal lymphadenopathy?
LGV - rapidly healing papule then inguinal bubo
Chancroid - (Haemophilus ducreyi) - painful genitak ulcers
Granuloma inguinale (Klebsiella granulomatis) - causes genital nodules leading to ulcers and lymphadenopathy
What is a chancre?
Syphilitic lesion
What type of microbe is Trichomonas vaginalis?
Flagellated protozoan
Presentation of Trichomonas vaginitis?
Thin frothy offensive discharge
Irritation
Dysuria
Vaginal inflammation
How to diagnose Trachomonas vaginitis?
Vaginal wet preparation
How to treat Trichomonas vaginitis?
Metronidazole
What can vulvovaginal candidiasis be caused by?
Candida albicans and other candida species
Risk factors for vulvovaginal candidiasis?
Antibiotics Oral contraceptives Pregnancy Obesity Steroids Diabetes
Presentation of vulvovaginal candidiasis?
Profuse, white, itchy, curd-like discharge
How to diagnose vulvovaginal candidiasis?
High vaginal smear
Treatment of vulvovaginal candidiasis?
Topical azoles or nyastin or oral fluconazole
Proper term for pubic lice and the crab louse?
Pubic lice - pediculosis pubis
Crab louse - phthirus pubis
What can cause bacterial vaginosis?
Gardenerella
Anaerobes
Mycoplasmas
Presentation of bacterial vaginosis?
Scanty but offensive fishy discharge
How to diagnose bacterial vaginosis?
Vaginal pH > 5
KOH whiff test
HVS Gram stain smear
- clue cells - epithelial cells studded with Gram variable coccobacilli
- reduced number of lactobacilli
- absence of pus cells
How to treat bacterial vaginosis?
Metronidazole
