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

Infections of the Genital Tract Flashcards

1
Q

What does the term sexually transmitted infections include?

A

Both symptomatic and asymptomatic cases, where sexual activity is the principle mode of transmission

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2
Q

What does the term sexually transmitted disease include?

A

Symptomatic cases only

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3
Q

Give two examples of infections where sexual activity is a possible mode of transmission, but also have other routes of transmission?

A
  • BBV
  • Sexual transmission of intestinal pathogens
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4
Q

What intestinal pathogens can be transmitted sexually?

A
  • Salmonella
  • Shigella
  • Giardia
  • Entamoeba
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5
Q

What groups are at risk of sexually transmitted infections?

A
  • Young people
  • Certain ethnic groups
  • Low socio-economic status groups
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6
Q

Why are young people at an increased risk of STIs?

A

Because they are more sexually active

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7
Q

What do the groups at risk of STIs relate to?

A

Specific aspects of sexual behaviour

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8
Q

What specific aspects of sexual behaviour can cause an increased risk of STIs?

A
  • Age at first sexual intercourse
  • Number of partners
  • Sexual orientation
  • Unsafe sexual activity
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9
Q

What is happening to the incidence of STIs?

A

It is increasing

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10
Q

Why may the incidence of STIs be increasing?

A
  • Increased transmission
  • Increased GUM attendence
  • Improved diagnostic methods, including screening programmes
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11
Q

Why may there be an increased transmission of STIs?

A
  • Changing sexual and social behaviour
  • Increased density and mobility of populations
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12
Q

Why may increased GUM attendance give the impression that the incidence of STIs is increasing?

A

Leads to more diagnoses being made

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13
Q

Why is GUM attendance increasing?

A
  • Decreased stigma
  • Greater public, medical, and national awareness
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14
Q

How have diagnostic methods improved regarding STIs?

A

Better equipment makes it easier to detect organisms

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15
Q

What factors contribute to the burden of STIs?

A
  • Can be both acute and chronic/replapsing infections
  • Stigma
  • May be consequent pathologies
  • Disseminated infectins
  • Transmission to fetus/neonate
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16
Q

What does stigma regarding STIs have an impact on?

A
  • Diagnosis
  • Tracing
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17
Q

What consequent pathologies can arise from STIs?

A
  • Pelvic inflammatory disease and infertility
  • Reproductive tract cancers
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18
Q

Which STI in particular can cause reproductive tract cancers?

A

Papilloma viruses

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19
Q

What do disseminated STIs involve?

A

Multiple organ systems, over years and decades

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20
Q

How can STIs be diagnosed?

A
  • Patients present with genital lesions/problems to GP or GUM clinic
  • Clinician notes non-genital clinical features suggestive of STI
  • Asymptomatic cases may be detected with contact tracing or screening
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21
Q

What genital problems may a patient present to a GP or GUM clinic with?

A
  • Ulcers
  • Vesicles
  • Warts
  • Urethral discharge or pain
  • Vaginal discharge
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22
Q

When may a clinical note non-genital clinical features that are suggestive of STI?

A

If there are clues from the history

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23
Q

What may non-genital clinical features of an STI suggest?

A

Disseminated disease

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24
Q

What does contact tracing and screening for STIs look for?

A

High risk people

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25
Q

What is the purpose of identifying asymptomatic cases by contact tracing and screening?

A

Reduce risk of complications and transmission

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26
Q

How are STIs managed?

A
  • Treatment with antibiotics
  • Contact tracing
  • Education
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27
Q

What is preferable when giving antibiotics in STIs?

A
  • Single dose or short course
  • Delivered at time of diagnosis
  • Oral drug
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28
Q

Are co-infections common with STIs?

A

Yes

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29
Q

What is it important to do due to the fact that co-infection with STIs are common?

A
  • Screen
  • Consider empiric treatment for other STIs
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30
Q

What happens to treatment for some STIs?

A

It changes over time

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31
Q

Why does the treatment for some STIs change over time?

A
  • Drug availability
  • New formulations
  • Resistance
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32
Q

What is the purpose of contact tracing?

A

Patient and public health management

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33
Q

What education should be delivered regarding STIs?

A
  • Sexual health education
  • Advice on contraception
  • Detailed instruction on practice and need for safer sex
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34
Q

How many types of human papillomaviruses are there?

A

>100, but small number of particular concern

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35
Q

What kind of virus is HPV?

A

DNA virus

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36
Q

What % of young adults will experience HPV in their life?

A

˜4%

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37
Q

What are the most common types of HPV causing STIs?

A

HPV 6 and 11

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38
Q

What do HPV 6 and 11 cause?

A
  • Cutaneous, mucosal, and anogenital warts
  • Benign, painles, verrucous epithelial or mucosal outgrowths that can be on;
    • Penis
    • Vulva
    • Vagina
    • Urethra
    • Cervix
    • Perianal skin
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39
Q

What are the high risk type of HPV?

A

16 and 18

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40
Q

What are HPV 16 and 18 associated with?

A

Cervical (<70%) and anogenital cancer

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41
Q

Why is cervical cancer a major public health concern?

A
  • 2500 cases of cervical cancer in 2012
  • Most common cancer in women 15-34
  • Large % of cases are potentially preventable
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42
Q

What % of cervical cancers are associated with HPV 16 or 18?

A

<70%

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43
Q

How is a diagnosis of HPV infection made?

A
  • People likely to come forward with warts
  • Clinical diagnosis
  • Biopsy and genome analysis
  • Hybrid capture
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44
Q

What is the purpose of biopsy and genome capture in HPV viruses?

A

Gives specific nucleic viral section, so can tell if warts are caused by papilloma

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45
Q

How is HPV treated?

A
  • No treatment
  • Topical podophyllin
  • Cryotherapy
  • Intralesional interferon
  • Imiquimoid
  • Surgery
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46
Q

Why is HPV often given no treatment?

A

Spontaneous resolution in 70% of cases in 1 year, and 90% in 2 years

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47
Q

How is HPV screened for?

A
  • Cervical Pap smear cytology
  • Colposcopy and acetowhite test
  • Cervical swab
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48
Q

What does a cervical Pap smear cytology check for?

A

Early evidence of cervical cancer

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49
Q

What happens in a cervical swab for HPV?

A

HPV hybrid capture

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50
Q

What % of 20-24 year olds are positive for HPV hybrid capture?

A

40%

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51
Q

What are the types of HPV vaccine?

A
  • Cervarix
  • Gardisil
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52
Q

What does Cervarix protect against?

A

HPV 16 and 18

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53
Q

Why is cervarix no longer used in the UK?

A

There was a large backlash against decision to just protect against 2 HPV types when could protect against more

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54
Q

What does Gardasil protect against?

A

HPV 6, 11, 16, and 18

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55
Q

When was Gardasil introduced in the UK?

A

2011

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56
Q

Who is the Gardasil vaccine offered to?

A

Girls 12-13

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57
Q

How many doses of Gardasil are given?

A

2

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58
Q

How effective is Gardasil?

A

99% effective in preventing HPV 16 and 18 related cervical abnormaltiies in those not already infected

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59
Q

What is the most commonly detected STI?

A

Chlamydia Trichomatis

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60
Q

What kind of pathogen is C. Trachomatis?

A

An obligate intracellular bacterium

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61
Q

What is the diagnostic result of C. Trachomatis being an obligate intracellular bacterium?

A
  • Can’t grow on gram stains
  • Can’t grow on agar media
62
Q

What serotypes of C. Trachomatis cause non-specific genital chlamydial infections?

A

D-K

63
Q

What are different serotypes of C. Trachomatis associated with?

A

Different conditions

64
Q

What does C. Trachomatis infection cause in males?

A
  • Urethritis
  • Epididymitis
  • Prostatitis
  • Proctitis
65
Q

What does C. Trachomatis infection cause in females?

A
  • Urethritis
  • Cervicitis
  • Salpingitis
  • Perihepatitis
66
Q

What is salpingitis?

A

Inflammation of the fallopian tubes

67
Q

What are the symptoms of salpingitis?

A

Abdominal pain and referred shoulder pain from the liver

68
Q

What does ocular inoculation of C. Trachomatis cause?

A

Conjunctivitis

69
Q

What does neonatal infection of C. Trachomatis cause?

A
  • Inclusion conjunctivitis
  • Pneumonia
70
Q

How is a C. Trachomatis infection diagnosed?

A
  • Endocervical and urethral swabs
  • 1st void urine
71
Q

What is performed on samples taken for investigation of C. Trachomatis infection?

A

Nucleic acid amplification tests

72
Q

How is a neonatal infection if C. Trachomatis detected?

A

Conjunctival swab, followed by nucleic acid amplification tests

73
Q

How is a C. Trachomatis infection treated?

A
  • Doxycycline or azithromycin, can be given as a single large dose
  • Erythromycin in children
74
Q

Is C. Trachomatis ever asymptomatic?

A

Yes, many cases are, especially in women

75
Q

What does the fact that many causes of C. Trachomatis are asymptomatic have implications for?

A

Transmission

76
Q

How many cases of C. Trachomatis are diagnosed each year?

A

>200,000, nearly half of all STIs

77
Q

What % of C. Trachomatis cases are diagnosed at GUM clinics?

A

50%

78
Q

What % of C. Trachomatis cases are diagnosed from the chlamydia screening programme?

A

50%

79
Q

Who does the chlamydia screening programme target?

A

Sexually active under 25’s

80
Q

How is the chlamydia screening programme carried out?

A

Urine (M&F) or swab (F), followed by nucleic acid amplification test

81
Q

What is chlamydia sometimes screened for in conjunction with?

A

N. gonorrhoea

82
Q

What are the symptoms of primary genital herpes?

A
  • Extensive and painful genital ulceration
  • Dysuria
  • Inguinal lymphadenopathy
  • Fever
83
Q

What is the inguinal lymphadenopathy caused by in primary genital herpes?

A

Local inflammation

84
Q

What is primary genital herpes usually associated with?

A

HSV2

85
Q

What does HSV1 usually cause?

A

Cold sores

86
Q

How severe is recurrent genital herpes?

A

Can be asymptomatic to moderate

87
Q

What allows recurrent genital herpes to occur?

A

Due to latent infection in dorsal root ganglia

88
Q

How is a diagnosis of genital herpes made?

A

PCT of vesicle fluid and/or ulcer base

89
Q

How is genital herpes treated?

A

Aciclovir

90
Q

When is aciclovir prophylaxis given?

A

When a patient has frequent recurrences, to try and reduce frequency and severity

91
Q

What reduces the risk of transmission of genital herpes?

A

Barrier contraception

92
Q

What kind of pathogen is Neisseria gonorrheae?

A

Gram negative intracellular diplococcus

93
Q

What does N. gonorrhoae cause in males?

A
  • Urethritis and painful discharge
  • Epididymitis
  • Prostatitis
    Proctitis
  • Pharyngitis
  • May have referred pain to testes or prostate (felt in perineum)
94
Q

In whom does N. gonorrhoae cause proctitis and pharyngitis?

A

In MSM

95
Q

What does N. gonorrhoeae cause in women?

A
  • Asymptomatic
  • Endocervicitis
  • Urethritis
  • PID
96
Q

What does PID lead to?

A

Inflammation of the fallopian tubes, which causes them to block and may lead to infertility

97
Q

What can disseminated gonococcal infection lead to?

A
  • Bacteriaemia
  • Skin and joint lesions
98
Q

How is a gonorrhoea diagnosis made?

A
  • Swab from urethra, cervix, throat, or rectum, or urine sample
  • Gram stain of pus or normally sterile site
99
Q

What is the diagnostic difficulty with N. gonorrheae?

A

Fastidious organism requiring special media

100
Q

How is gonorrhoea treated?

A

Intramuscular ceftrixone

101
Q

Why must gonorrhoea be treated with IM ceftrixone?

A

Due to increasing resistance to many other agents

102
Q

What is the increasing antibiotic resistance of N. gonorrhoae partially due to?

A

Movement of strains between different parts of the world, particularly the Middle East

103
Q

What happens to all patients with gonorrhoea?

A

They are treated (and tested) for chlamydia with azithromycin

104
Q

What is the addition benefit of treating gonorrhoea patients with azithromycin for chlamydia?

A

May prevent emergence of resistance to cephalosporins

105
Q

What is the aetiological agent of syphilis?

A

Treponema pallidum

106
Q

Who are most cases of sphilis found in?

A

MSM

107
Q

What is the first stage of a syphilis infection?

A

Indurated, painless ulcer called chancre

108
Q

What happens to the chancre?

A

It gradually heals

109
Q

When does the second stage of a syphilis infection occur?

A

6 to 8 weeks later

110
Q

What happens in the second stage of a syphilis infection?

A
  • Fever
  • Rash
  • Lymphadenopathy
  • Mucosal lesions
111
Q

Describe the rash in stage 2 syphilis?

A

Can develop anywhere, in any shape/form

112
Q

Where is the lymphadenopathy in stage 2 syphilis?

A

Local area around the groin

113
Q

What is the third stage of syphilis?

A

Latent, with disease three years

114
Q

What may syphilis develop into in its final stage?

A
  • Neurosyphilis
  • Cardiovascular syphilis
  • Gummas
115
Q

What are gummas?

A

Local destruction

116
Q

How is congenital syphilis prevented?

A

Screen pregnant women to ensure that they don’t have undetected syphilis that could be passed on to child

117
Q

What is the problem with diagnosis of syphilis?

A

Organism can’t be grown, apart from in foot pads of various animals, and then must be looked at using dark-field microscopy

118
Q

How is syphilis diagnosed?

A

Serology; initial screening with EIA antibody test, and then for people who test positive;

  • Rapid Plasma Reagin (RPR) titre
  • TP particle agglutination (TPPA)
119
Q

What is done with the serology of a patient with suspected syphilis?

A

The serological pattern is interpreted, including false positives and response to treatment

120
Q

How is syphilis treated?

A

Pencillin and ‘test of cure’ follow up to ensure serology is improving

121
Q

How is syphilis screening conducted?

A

Detects possibility, then go on to do more specific test

122
Q

What may inguinal lymphadenopathy be caused by?

A
  • Lymphogranuloma venereum (LGV)
  • Chancroid (Haemophilus ducreyi)
  • Granuloma inguinale/donovanosis (Klebsiella granulomatis)
123
Q

What causes LGV?

A

C. trachoma serotypes L1, L2, L3

124
Q

What does LGV cause?

A

Rapidly healing papules (raised lumps) leading to inguinal bubo (abscess)

125
Q

Where have there been recent clusters on LGV?

A

Europe, with MSM

126
Q

What is Chancroid?

A

Painful genital ulcers

127
Q

What happens in granuloma inguinale/donovanosis?

A

Genital nodules leading to ulcers

128
Q

What kind of pathogen is trichomonas vaginalis?

A

Flagellated protozoan

129
Q

How is tricomonas vaginalis spread?

A

Normally by sexual route

130
Q

What is the relevance of males in trichomonas vaginalis?

A

They are involved in transmission, but not really affected by it

131
Q

What does trichomonas vaginalis cause?

A

Trichomonas vaginitis

132
Q

What are the symptoms of trichomonas vaginitis?

A
  • Thin, frothy, offensive discharge
  • Irritation
  • Dysuria
  • Vaginal inflammation
133
Q

How is trichomonas vaginitis diagnosed?

A

Vaginal wet preperation, with or without culture enhancement

134
Q

How is trichomonas vaginitis treated?

A

Oral metronidazole

135
Q

What is vulvovaginal candidiasis caused by?

A

Candida albicans, or other candida species

136
Q

Where may candida albicans, or other candida species, come from?

A

May be part of normal GI and genital tract flora, commonly present in very small numbers

137
Q

What are the risk factors for vulvovaginal candidiasis?

A
  • Antibiotics
  • Oral contraceptives
  • Pregnancy
  • Obesity
  • Steroids
  • Diabetes
138
Q

What does vuvlovaginal candidiasis cause?

A

Profuse, white, itchy, curd-like discharge

139
Q

How is a diagnosis of vulvovaginal candidiasis made?

A

Usually made by looking at discharge, and based on symptoms, but can also be made by a high vaginal smear, with or without culture

140
Q

How is vulvovaginal candidiasis treated?

A
  • Topical azoles or nystatin
  • Oral fluconazole
141
Q

What can scabies affect?

A

Genitalia

142
Q

How can scabies be spread?

A

Sexually

143
Q

Are pubic lice distinct from other human (body) lice?

A

Yes

144
Q

What causes bacterial vaginosis?

A

Pertubed normal flora

145
Q

Disruption to what normal flora can cause bacterial vaginosis?

A
  • Gardnerella
  • Anaerobes
  • Mycoplasmas
146
Q

What is the disruption of normal flora in bacterial vaginosis usually due to?

A

Change in pH

147
Q

What are the symptoms of bacterial vaginosis?

A

Scanty but offensive fishy discharge

148
Q

How is a clinical diagnosis of bacterial vaginosis made?

A
  • Vaginal pH >5
  • KOH whiff test
149
Q

How is a laboratory diagnosis of bacterial vaginosis made?

A

HVS Gram stained smear

150
Q

What features on a HVS gram stained smear are diagnostic of bacterial vaginosis?

A
  • ‘Clue cells’
  • Reduced number of lactobacilli
  • Absence of pus cells
151
Q

What are clue cells?

A

Epithelial cells studded with gram variable coccobacilli

152
Q

How is bacterial vaginosis treated?

A

Metronidazole

ESA 4 - Reproductive System (31 decks)

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