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Repro > Infections Of The Genital Tract > Flashcards

Infections Of The Genital Tract Flashcards

0
Q

Which is the most common STI?

A

Chlamydia trachomatis - 209,000 cases

Accounts for nearly half of all cases of STIs

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1
Q

How many cases of STIs in the UK?

A

450,000

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2
Q

What are the at-risk groups for STIs?

A 
Young people
Some ethnic groups
Age at first sexual intercourse
Number of partners
Sexual orientation
Unsafe sexual activity
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3
Q

Why is there an increased incidence of STIs over recent years?

A

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

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4
Q

What are the problems of STIs?

A

Stigma - impact of tracing contacts and diagnosis
Consequent pathology - pelvic inflammatory disease and infertility, repro tract cancers
Disseminated infections
Transmission to fetus/neonate

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5
Q

What are some differential diagnoses for genital skin and mucous membrane lesions?

A

Genital ulcers
Vesicles/bullae
Genital papules
Anogenital warts

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6
Q

What are the symptoms of urethritis?

A

Discharge, dysuria, frequency

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7
Q

What are some differential diagnoses of urethritis?

A 
Gonococcal urethritis
Chlamydial urethritis
Non-specific urethritis
Post-gonococcal urethritis
Non-infectious urethritis
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8
Q

What are some differential diagnoses for the cause of vulvo-vaginitis and cervicitis which are not caused by STIs?

A

Bacterial vaginosis

Bartholinitis

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9
Q

Give the characteristics of Chlamydia trachomatis

A

Gram negative
Obligate
Intracellular bacterium

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10
Q

Presentation of a Chlamydia trachomatis infection?

A

Males

  • urethritis
  • epididymitis
  • prostatitis
  • proctitis

Females

  • urethritis
  • cervicitis
  • salpingitis
  • perihepatitis

Most cases asymptomatic

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11
Q

Presentation if there is ocular inoculation or neonatal infection with Chlamydia trachomatis?

A

Ocular inoculation - conjunctivitis

Neonatal infection - inclusion conjunctivitis, pneumonia

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12
Q

How to diagnose Chlamydia trachomatis?

A

Endocervical and urethral swabs

First void urine - NAAT (nucleic acid amplification test)

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13
Q

How to treat Chlamydia trachomatis?

A

Doxycycline or azithromycin

Erythromycin in children

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14
Q

What is the screening method for chamydia?

A

Nucleic acid amplification test

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15
Q

Features of the human papilloma virus?

A

DNA virus - over 100 types

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16
Q

Presentation of HPV virus?

A

Cutaneous, mucosal and anogenital warts

-benign, painless verrucous epithelial/mucosal outgrowth on penis, vulva, vagina, urethra, cervix, perianal skin

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17
Q

Which are the two high risk types of HYP which are oncogenic?

A

HPV 16 and 18

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18
Q

Which cancers is HPV associated with?

A

Cervical - more than 70% of cancer patients have evidence of HPV
Anogenital

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19
Q

How to diagnose HPV?

A

Clinical
Biopsy and genome analysis
Hybrid cancer

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20
Q

Treatment of HPV?

A 
Spontaneous resolution
Topical podophyllin
Cryotherapy
Intralesional interferon 
Inquimod 
Surgery
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21
Q

How is HPV screened?

A

Cervical Pap smear cytology

Cervical swab, HPV capture is positive in 40% of 20-24 year olds

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22
Q

What does the herpes simplex virus cause?

A

Primary genital herpes - extensive painful genital ulceration, dysuria, inguinal lymphadenopathy, fever

23
Q

Which virus is primary genital herpes associated with?

A

HSV 2

HSV 1 causes cold sores

24
Q

How is the HSV recurrent?

A

Lies latent in the dorsal root ganglia

25
Q

How to diagnose herpes simplex virus?

A

PCR of vesicle fluid or ulcer base

26
Q

Treatment of HSV?

A

Aciclovir for primary and severe disease

Aciclovir prophylaxis for frequent recurrences

27
Q

Give the features of Neisseria gonorrhoeae

A

Gram negative
Intracellular
Diplococcus

28
Q

How does Neisseria gonorrhoeae present?

A

Males

  • urethritis with discharge
  • epididymitis
  • prostatitis
  • pharyngitis

Females

  • asymptomatic
  • endocervicitis
  • urethritis
  • PID
29
Q

Complication of Neisseria gonorrhoeae in females?

A

Infertility

30
Q

Complication of Neisseria gonorrhoeae for both sexes?

A

Disseminated gonoccocal infection

-bacteraemia, skin and joint lesions

31
Q

How to diagnose Neisseria gonorrhoeae?

A

Swab from the ureteha, cervix, throat, rectus, urine
Gram stain
It is a fastidious organ requiring special media

32
Q

Treatment of Neisseria gonorrhoeae?

A

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

33
Q

What is the aetiological agent of syphilis

A

Treponema pallidum

34
Q

Who is syphilis most common in?

A

MSM and men

35
Q

What are the stages of syphilis?

A

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)

36
Q

What is congenital syphillis?

A

When it has spread from mother to baby

37
Q

How is syphilis diagnosed?

A

Serologically using antibodies

38
Q

Treatment of syphilis?

A

Penicillin and test of cure follow up

39
Q

What infections can cause inguinal lymphadenopathy?

A

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

40
Q

What is a chancre?

A

Syphilitic lesion

41
Q

What type of microbe is Trichomonas vaginalis?

A

Flagellated protozoan

42
Q

Presentation of Trichomonas vaginitis?

A

Thin frothy offensive discharge
Irritation
Dysuria
Vaginal inflammation

43
Q

How to diagnose Trachomonas vaginitis?

A

Vaginal wet preparation

44
Q

How to treat Trichomonas vaginitis?

A

Metronidazole

45
Q

What can vulvovaginal candidiasis be caused by?

A

Candida albicans and other candida species

46
Q

Risk factors for vulvovaginal candidiasis?

A 
Antibiotics
Oral contraceptives
Pregnancy
Obesity
Steroids
Diabetes
47
Q

Presentation of vulvovaginal candidiasis?

A

Profuse, white, itchy, curd-like discharge

48
Q

How to diagnose vulvovaginal candidiasis?

A

High vaginal smear

49
Q

Treatment of vulvovaginal candidiasis?

A

Topical azoles or nyastin or oral fluconazole

50
Q

Proper term for pubic lice and the crab louse?

A

Pubic lice - pediculosis pubis

Crab louse - phthirus pubis

51
Q

What can cause bacterial vaginosis?

A

Gardenerella
Anaerobes
Mycoplasmas

52
Q

Presentation of bacterial vaginosis?

A

Scanty but offensive fishy discharge

53
Q

How to diagnose bacterial vaginosis?

A

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
54
Q

How to treat bacterial vaginosis?

A

Metronidazole

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