Infections of the Reproductive System Flashcards
1
Q
What does cervical excitation upon bimanual examination indicate?
A
Potential upper genital tract infection.
2
Q
What is screened for in a standard STI screen?
A
Chlamydia
Gonorrhoea
HIV
Syphillis
3
Q
Alongside the standard screen, what should be tested for in a female presenting with discharge?
A
Bacterial vaginosis
Candida
Trichomonas vaginalis
4
Q
In females, how is a sample for a gonorrhoea/chlamydia NAAT test obtained?
A
Vulvovaginal swab performed prior to speculum exam.
5
Q
Why is a vulvovaginal swab carried out prior to a speculum exam?
A
As speculum lubricant can impair the sensitivity of the test.
6
Q
How is a sample for gonorrhoea/chlamydia NAAT test obtained in males?
A
A first void urine - must be held for atleast an hour.
7
Q
In addition to the first void urine, in MSM, what other area(s) are sampled for a gonorrhoea/chlamydia NAAT test?
A
Throat and/or rectal swab
Dependent on sexual history
8
Q
What is a high WCC at the cervix suggestive of?
A
Pelvic inflammatory disease
9
Q
How is chlamydia treated?
A
100mg bd doxycycline for 1 week OR azithromycin 1g and 0.5g for 2 days after.
10
Q
If chlamydia is accompanied by PID, what is given?
A
Ceftriaxone 1g IM
Doxycycline 100mg bd for 2 weeks
Metronidazole 400mg bd for 2 weeks
GIVE ALL THREE.
11
Q
What is the most common STI?
A
Chlamydia
12
Q
How do most cases of chlamydia present?
A
Most don’t - usually asymptomatic.
13
Q
What forms of sex can spread chlamydia?
A
Anal
Oral
Vaginal
14
Q
How long do symptoms of chlamydia take to present?
A
20-24 days
15
Q
What is pelvic inflammatory disease?
A
Infection of the upper genital tract.
Affects the uterus, uterine tubes and ovaries.
16
Q
What increases following an episode of PID?
A
Risk of ectopic pregnancy
Tubal factor infertility
17
Q
What are the symptoms of chlamydia experienced in males?
A
Milky urethral discharge
Abdominal pain
Dysuria
18
Q
What are the symptoms of chlamydia experienced in females?
A
Irregular bleeding
Abdominal pain
19
Q
What are the potential complications of chlamydia?
A
PID (chlamydia linked to 50% of all cases of PID).
Tubal damage
Chronic pelvic pain
Conjunctivitis/Pneumonia of the neonate (spread from the mother)
Reactive arthritis
20
Q
After how long should chlamydia testing be carried out following a potential exposure?
A
14 days
21
Q
Does vaginal discharge present in all with chlamydia?
A
No
22
Q
What % of women treated for chlamydia are reinfected within a year?
A
20%
23
Q
What is lymphogranuloma venereum (LGV)?
A
Infection caused by serovars of chlamydia.
24
Q
In which group is LGV most commonly seen?
A
MSM
25
What are the symptoms of LGV?
Rectal pain
Discharge
Bleeding
26
A patient presenting with a mucopurulent discharge is suggestive of what?
Gonorrhoea
27
What % of urethral gonorrhoea cases have discharge?
>90%
| Accompanied by dysuria.
28
If patient is suspected of having gonorrhoea, where else should be swabbed, regardless of symptoms?
Pharynx
| Rectum
29
How is gonorrhoea investigated?
Chlamydia/Gonorrhoea NAAT test
Microscopy (if symptomatic)
Culture
30
What is microscopy?
The use of a microscope in order to view a sample.
31
In which gender is a culture more sensitive?
Males
32
What type of bacteria is gonorrhoea?
A gram negative intracellular diplococcus.
33
What is the treatment for gonorrhoea?
1g IM ceftriaxone
| If unable to tolerate IM, give 400mg cefixime orally, plus 2g azithromycin.
34
After how long should gonorrhoea be re-tested to ensure clearance of infection?
2 weeks
35
Which gender most commonly suffers from chlamydia?
Females
36
Which gender most commonly suffers gonorrhoea?
Men
37
What are the presentations of mycoplasma genitarium?
Non-gonococcal urethritis
PID
Asymptomatic carriage
38
What STI is associated with high levels of macrolide resistance?
Mycoplasma genitarium
39
Are genital ulcers only of viral origin?
No - check for systemic symptoms
40
How are genital ulcers investigated?
Chlamydia/Gonorrhoea NAAT test
Viral swab
Amies swab
Serology for HIV/Syphilis
41
How is HSV1 treated?
Oral aciclovir
Consider lidocaine (patch test first) if very painful
Advise saline baths and analgesia
42
How long is genital herpes incubated for?
3-6 days
43
How long do the symptoms of genital herpes persist for?
2-3 weeks
44
What are the symptoms of genital herpes?
```
Blistering/Ulceration
Pain
External dysuria
Vaginal/Urethral discharge
Local lymphadenopathy
Fever/Myalgia
```
45
Which form of herpes is often responsible for recurrent episodes?
HSV2
46
Which form of herpes is usually linked to first occurrence at the genitalia?
HSV1
47
Is treatment needed in HSV2?
Not always, usually just simple analgesia and rest.
48
What is viral shedding?
Expulsion of the virus following reproduction.
49
Which form of herpes is associated with a greater rate of viral shedding?
HSV2
50
How long does an episode of HSV2 normally last?
5-7 days.
51
What organism is responsible for syphilis?
Treponema pallidum
52
How can syphilis be transmitted?
Sexually
| Trans-placental
53
What stages of syphilis encompass early infection?
Primary
Secondary
Early latent
54
How will both primary and secondary syphilis present?
Both present with signs and symptoms.
55
How does early latent syphilis present?
Patient will be asymptomatic however has a positive serology.
56
What are the late/non-infectious stages of syphilis infection?
Late-latent
| Tertiary
57
How are the early-latent and late-latent phases of syphilis differentiated?
If infected in last 2 years - early latent.
If over 2 years since infection - late latent.
58
Why is it important to know whether syphilis is in the early latent or late latent phase?
As treatment schedules differ for the two.
59
How is latent syphilis staged?
Use of previous screening data.
60
How long following primary syphilis infection does it take to advance to tertiary infection?
20-40 years
61
How does tertiary syphilis present?
Aortic regurgitation
Stroke
CV disease
62
What is the incubation time of syphilis?
9-90 days
| Mean = 27 days
63
What lesion is associated with primary syphilis?
A primary chancre
64
How does primary syphilis present?
Painless primary chancre
Lesions at genitals/extra-genital sites
Non-tender local lymphadenopathy
65
How long does secondary syphilis take to present?
6 weeks-6 months.
66
Does secondary syphilis usually present the same from individual to individual?
No - it is called the 'great pretender'.
67
What are condylomata lata?
Wart-like lesions which are highly infectious.
Occur in syphilis.
68
Which population is most commonly linked to syphilis?
MSM
69
How is syphilis diagnosed?
Dark field microscopy
PCR
Serology
70
What is the role of serology in the investigation of infection?
Looks for the presence of antibodies against a pathogen.
71
How is early syphilis treated?
Single dose of 2.4mu benzathine penicillin.
72
How is late syphilis treated?
Weekly dose of 2.4mu benzathine penicillin for 3 weeks.
73
How long should syphilis be followed up serologically?
Until RPR is negative.
74
What is the RPR test used in syphilis?
A measure of disease activity.
75
What are potential differentials for a genital lump?
```
Skin tags
Molluscum contagiosum
Spots of Fordyce
Pearly penile papules
Genital warts
```
76
What is the most common viral STI in the UK?
HPV
| 80% risk during lifetime.
77
What are the high-risk pro-oncogenic strains of HPV?
```
HPV 16 (most common)
HPV 18
```
These are linked to cellular dysplasia.
78
What strains of HPV are linked to anogenital warts?
HPV 6
| HPV 11
79
Do anal warts mean anal sex has taken place?
No
80
What is the first-line treatment for HPV?
Podophyllotoxin
81
What is given to treat HPV if perianal lesions are present?
Imiquimod
| Cryotherapy
82
Is vaccination available against HPV?
Yes
Available for all individuals.
83
What type of organism is HIV?
RNA retrovirus
84
What is a retrovirus?
A virus which uses the enzyme reverse transcriptase to transcribe copies of itself.
85
How quickly does HIV replicate?
Every 6-12 hours.
86
What cells are involved in the transmission of HIV?
Langerhans cells
| Dendritic cells
87
What receptors are attacked by HIV?
CD4+ receptors
88
What is the role of CD4+ T-helper cells?
Induction of the adaptive immune response.
Failure of these effects the whole immune system.
89
What effect does HIV have on CD8+ cells?
Reduces activity as a result of absent CD4+ cells.
90
Does HIV make infection risk greater?
Yes
91
What CD4+ cell level puts the patient at highest risk of opportunistic infection?
<200 cells/mm3
92
When does AIDS begin?
When CD4+ cell level falls below 200 cells/mm3, with the viral load rising again.
93
What symptoms are experienced in primary infection of HIV?
```
Fever
Rash
Myalgia
Pharyngitis
Headache/Septic meningitis
```
All non-specific due to the high viral load.
94
Is the asymptomatic stage of HIV infection harmless?
No, ongoing replication, CD4+ cell depletion and ongoing immune activation.
Still risk of transmission if undiagnosed.
95
Is AIDS still used as a term?
No - it is the symptomatic presentation of HIV, therefore can be called symptomatic HIV.
96
What is defined as an opportunistic infection?
An infection caused by a pathogen that does not normally cause disease in a healthy individual.
97
What is the most common opportunistic infection?
Pneumocystis jiroveci
Causes pneumocystis pneumonia.
98
What is given prophylactically for those with CD4+ <200cells/mm3, to prevent pneumocystis pneumonia?
Low dose co-trimoxazole
99
At which CD4+ cell level is cerebral toxoplasmosis commonly observed?
<150 cells/mm3.
Caught from cat faeces.
100
What can reactivate with a CD4+ cell level below 50 cells/mm3?
Cytomegalovirus
101
What causes neurocognitive impairment in HIV +ve patients?
HIV itself.
Due to affect on microglial cells.
102
What do all cancers linked to AIDS have in common?
All of infectious aetiology.
103
What virus causes Non-Hodgkin lymphoma?
Ebstein-Barr virus
104
What virus causes cervical cancer?
HPV
105
What factors increase risk of contracting HIV?
Anoreceptive sex
Trauma
Genital ulceration
Concurrent STI
106
Is HIV a disease of PWIDs?
No
107
What is the most common risk factor for HIV?
MSM
108
If HIV is a potential diagnosis, should it be tested for, regardless of level of suspicion?
Yes
109
What is the first marker to become positive following HIV infection?
Viral RNA
110
What are 3 markers used in HIV testing?
Antibodies
p24
Viral RNA
111
How long does it take for HIV antibodies to appear?
3 months.
112
How should HIV testing be carried out?
Test for p24 and antibodies.
Will detect 6 weeks following infection - NOT before then.
113
Following HIV infection diagnosis, what is carried out?
Staging
This checks for, and prophylactically manages, opportunistic infections.
Initiation of treatment also occurs.
114
What is the aim of HIV treatment
Suppress viral load to such an extent the individual becomes non-infectious.
115
What is PrEp?
Prophylactic medication preventing development of an HIV infection.
116
What is PEP?
Medication taken following a potential HIV exposure.
117
Is vaginal birth ok in HIV positive mother?
If viral load is undetectable at the time of delivery, yes.
If detectable, carry out C-section.
Baby should be given PEP for 2-4 weeks.
118
How is a Bartholin's cyst treated?
Drain abscess.
If infectious, give a broad-spectrum antibiotic.
119
How is HIV treated?
HAART
Involves 3 drugs from atleast 2 drug classes that the virus is susceptible to.
120
Is rubella a bacterial infection?
No, it is a viral infection.
121
What are features of rubella?
Fever
Rash
Lymphadenopathy
Polyarthritis
122
What can material infection with rubella lead to?
Miscarriage
Still birth
Birth defects
123
What are the most common birth defects seen in rubella?
Cataracts
Cardiac abnormalities
Deafness
Microcephaly
124
What gestation is of highest risk for mother to be infected with rubella?
First 10 weeks.
125
Can patients receiving the MMR vaccine get pregnant immediately?
No, as it is a live vaccine, patients are advised to avoid pregnancy for 4 weeks after vaccination.
126
What is responsible for measles?
Paramyxoviruses
Highly contagious
127
What presentation is used to differentiate measles from other viral infections?
The presence of koplik spots.
128
Is measles teratogenic?
No, however can cause high fever, which may result in intra-uterine growth retardation.
129
Where do chicken pox spots initially appear?
Chest and face, before spreading to the extremities.
130
What organism causes chicken pox?
Varicella zoster virus
131
How should maternal chicken pox be treated?
Treat supportively.
If over 20m weeks gestation, consider 5x daily 800mg oral aciclovir for 1 week.
132
What is the foetal varicella syndrome?
A condition caused by VZV infection, between 7-28 weeks gestation, resulting in limb hypoplasia and microcephaly.
133
What is a non-congenital cause of sensorineural deafness/disability?
Cytomegalovirus
134
What can CMV cause?
Miscarriage
Still birth
Microcephaly
135
How is CMV treated?
Valacyclovir
Can also give immunoglobulin therapy.
136
Which trimester of pregnancy is worse affected by CMV?
3rd trimester (other infections usually affect the 1st trimester).
137
How is CMV Infection diagnosed?
Serology - positive IgG and IgM.
138
If mother has diagnosed case of CMV, what follow-up should be taken?
USS every 2-4 weeks
| MRI of brain (check for microcephaly)
139
What virus is associated with slapped cheek and fifth's disease?
Parvovirus
140
What effects can parvovirus have on a neonate?
Slapped cheeks
Anaemia
Congenital heart failure
Death
141
How is foetal anaemia investigated?
A foetal MCA doppler
142
What effect does pregnancy have on the immune system?
Produces immunosuppression.
143
Does influenza affect the course of pregnancy?
No
144
How is zika virus transmitted?
Mosquito bites
145
Are vaccines available for zika virus?
No
146
Is vaccination advised in pregnancy against flu/covid?
Yes
147
What is the organism responsible for toxoplasmosis?
Toxoplasmosis gondii
148
Why should women avoid soft cheese during pregnancy?
Listeria monocytogenes
149
What effect can listeria monocytogenes have on pregnancy?
Miscarriage
Pre-term birth
Still birth
150
How is listeria monocytogenes infection treated?
Ampicillin and gentamicin.
151
Is the risk of UTI increased in pregnancy?
Yes
