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Reproductive > Infections of the Reproductive System > Flashcards

Infections of the Reproductive System Flashcards

1
Q

What does cervical excitation upon bimanual examination indicate?

A

Potential upper genital tract infection.

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2
Q

What is screened for in a standard STI screen?

A

Chlamydia
Gonorrhoea
HIV
Syphillis

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3
Q

Alongside the standard screen, what should be tested for in a female presenting with discharge?

A

Bacterial vaginosis
Candida
Trichomonas vaginalis

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4
Q

In females, how is a sample for a gonorrhoea/chlamydia NAAT test obtained?

A

Vulvovaginal swab performed prior to speculum exam.

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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.

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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.

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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

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8
Q

What is a high WCC at the cervix suggestive of?

A

Pelvic inflammatory disease

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9
Q

How is chlamydia treated?

A

100mg bd doxycycline for 1 week OR azithromycin 1g and 0.5g for 2 days after.

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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.

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11
Q

What is the most common STI?

A

Chlamydia

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12
Q

How do most cases of chlamydia present?

A

Most don’t - usually asymptomatic.

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13
Q

What forms of sex can spread chlamydia?

A

Anal
Oral
Vaginal

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14
Q

How long do symptoms of chlamydia take to present?

A

20-24 days

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15
Q

What is pelvic inflammatory disease?

A

Infection of the upper genital tract.

Affects the uterus, uterine tubes and ovaries.

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16
Q

What increases following an episode of PID?

A

Risk of ectopic pregnancy

Tubal factor infertility

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17
Q

What are the symptoms of chlamydia experienced in males?

A

Milky urethral discharge
Abdominal pain
Dysuria

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18
Q

What are the symptoms of chlamydia experienced in females?

A

Irregular bleeding

Abdominal pain

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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

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20
Q

After how long should chlamydia testing be carried out following a potential exposure?

A

14 days

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21
Q

Does vaginal discharge present in all with chlamydia?

A

No

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22
Q

What % of women treated for chlamydia are reinfected within a year?

A

20%

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23
Q

What is lymphogranuloma venereum (LGV)?

A

Infection caused by serovars of chlamydia.

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24
Q

In which group is LGV most commonly seen?

A

MSM

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25
Q

What are the symptoms of LGV?

A

Rectal pain
Discharge
Bleeding

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26
Q

A patient presenting with a mucopurulent discharge is suggestive of what?

A

Gonorrhoea

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27
Q

What % of urethral gonorrhoea cases have discharge?

A

> 90%

Accompanied by dysuria.

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28
Q

If patient is suspected of having gonorrhoea, where else should be swabbed, regardless of symptoms?

A

Pharynx

Rectum

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29
Q

How is gonorrhoea investigated?

A

Chlamydia/Gonorrhoea NAAT test
Microscopy (if symptomatic)
Culture

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30
Q

What is microscopy?

A

The use of a microscope in order to view a sample.

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31
Q

In which gender is a culture more sensitive?

A

Males

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32
Q

What type of bacteria is gonorrhoea?

A

A gram negative intracellular diplococcus.

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33
Q

What is the treatment for gonorrhoea?

A

1g IM ceftriaxone

If unable to tolerate IM, give 400mg cefixime orally, plus 2g azithromycin.

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34
Q

After how long should gonorrhoea be re-tested to ensure clearance of infection?

A

2 weeks

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35
Q

Which gender most commonly suffers from chlamydia?

A

Females

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36
Q

Which gender most commonly suffers gonorrhoea?

A

Men

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37
Q

What are the presentations of mycoplasma genitarium?

A

Non-gonococcal urethritis
PID
Asymptomatic carriage

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38
Q

What STI is associated with high levels of macrolide resistance?

A

Mycoplasma genitarium

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39
Q

Are genital ulcers only of viral origin?

A

No - check for systemic symptoms

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40
Q

How are genital ulcers investigated?

A

Chlamydia/Gonorrhoea NAAT test
Viral swab
Amies swab
Serology for HIV/Syphilis

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41
Q

How is HSV1 treated?

A

Oral aciclovir
Consider lidocaine (patch test first) if very painful
Advise saline baths and analgesia

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42
Q

How long is genital herpes incubated for?

A

3-6 days

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43
Q

How long do the symptoms of genital herpes persist for?

A

2-3 weeks

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44
Q

What are the symptoms of genital herpes?

A 
Blistering/Ulceration
Pain
External dysuria
Vaginal/Urethral discharge
Local lymphadenopathy
Fever/Myalgia
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45
Q

Which form of herpes is often responsible for recurrent episodes?

A

HSV2

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46
Q

Which form of herpes is usually linked to first occurrence at the genitalia?

A

HSV1

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47
Q

Is treatment needed in HSV2?

A

Not always, usually just simple analgesia and rest.

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48
Q

What is viral shedding?

A

Expulsion of the virus following reproduction.

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49
Q

Which form of herpes is associated with a greater rate of viral shedding?

A

HSV2

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50
Q

How long does an episode of HSV2 normally last?

A

5-7 days.

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51
Q

What organism is responsible for syphilis?

A

Treponema pallidum

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52
Q

How can syphilis be transmitted?

A

Sexually

Trans-placental

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53
Q

What stages of syphilis encompass early infection?

A

Primary
Secondary
Early latent

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54
Q

How will both primary and secondary syphilis present?

A

Both present with signs and symptoms.

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55
Q

How does early latent syphilis present?

A

Patient will be asymptomatic however has a positive serology.

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56
Q

What are the late/non-infectious stages of syphilis infection?

A

Late-latent

Tertiary

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57
Q

How are the early-latent and late-latent phases of syphilis differentiated?

A

If infected in last 2 years - early latent.

If over 2 years since infection - late latent.

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58
Q

Why is it important to know whether syphilis is in the early latent or late latent phase?

A

As treatment schedules differ for the two.

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59
Q

How is latent syphilis staged?

A

Use of previous screening data.

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60
Q

How long following primary syphilis infection does it take to advance to tertiary infection?

A

20-40 years

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61
Q

How does tertiary syphilis present?

A

Aortic regurgitation
Stroke
CV disease

62
Q

What is the incubation time of syphilis?

A

9-90 days

Mean = 27 days

63
Q

What lesion is associated with primary syphilis?

A

A primary chancre

64
Q

How does primary syphilis present?

A

Painless primary chancre
Lesions at genitals/extra-genital sites
Non-tender local lymphadenopathy

65
Q

How long does secondary syphilis take to present?

A

6 weeks-6 months.

66
Q

Does secondary syphilis usually present the same from individual to individual?

A

No - it is called the ‘great pretender’.

67
Q

What are condylomata lata?

A

Wart-like lesions which are highly infectious.

Occur in syphilis.

68
Q

Which population is most commonly linked to syphilis?

A

MSM

69
Q

How is syphilis diagnosed?

A

Dark field microscopy
PCR
Serology

70
Q

What is the role of serology in the investigation of infection?

A

Looks for the presence of antibodies against a pathogen.

71
Q

How is early syphilis treated?

A

Single dose of 2.4mu benzathine penicillin.

72
Q

How is late syphilis treated?

A

Weekly dose of 2.4mu benzathine penicillin for 3 weeks.

73
Q

How long should syphilis be followed up serologically?

A

Until RPR is negative.

74
Q

What is the RPR test used in syphilis?

A

A measure of disease activity.

75
Q

What are potential differentials for a genital lump?

A 
Skin tags
Molluscum contagiosum
Spots of Fordyce
Pearly penile papules
Genital warts
76
Q

What is the most common viral STI in the UK?

A

HPV

80% risk during lifetime.

77
Q

What are the high-risk pro-oncogenic strains of HPV?

A 
HPV 16 (most common)
HPV 18

These are linked to cellular dysplasia.

78
Q

What strains of HPV are linked to anogenital warts?

A

HPV 6

HPV 11

79
Q

Do anal warts mean anal sex has taken place?

A

No

80
Q

What is the first-line treatment for HPV?

A

Podophyllotoxin

81
Q

What is given to treat HPV if perianal lesions are present?

A

Imiquimod

Cryotherapy

82
Q

Is vaccination available against HPV?

A

Yes

Available for all individuals.

83
Q

What type of organism is HIV?

A

RNA retrovirus

84
Q

What is a retrovirus?

A

A virus which uses the enzyme reverse transcriptase to transcribe copies of itself.

85
Q

How quickly does HIV replicate?

A

Every 6-12 hours.

86
Q

What cells are involved in the transmission of HIV?

A

Langerhans cells

Dendritic cells

87
Q

What receptors are attacked by HIV?

A

CD4+ receptors

88
Q

What is the role of CD4+ T-helper cells?

A

Induction of the adaptive immune response.

Failure of these effects the whole immune system.

89
Q

What effect does HIV have on CD8+ cells?

A

Reduces activity as a result of absent CD4+ cells.

90
Q

Does HIV make infection risk greater?

A

Yes

91
Q

What CD4+ cell level puts the patient at highest risk of opportunistic infection?

A

<200 cells/mm3

92
Q

When does AIDS begin?

A

When CD4+ cell level falls below 200 cells/mm3, with the viral load rising again.

93
Q

What symptoms are experienced in primary infection of HIV?

A 
Fever
Rash
Myalgia
Pharyngitis
Headache/Septic meningitis

All non-specific due to the high viral load.

94
Q

Is the asymptomatic stage of HIV infection harmless?

A

No, ongoing replication, CD4+ cell depletion and ongoing immune activation.

Still risk of transmission if undiagnosed.

95
Q

Is AIDS still used as a term?

A

No - it is the symptomatic presentation of HIV, therefore can be called symptomatic HIV.

96
Q

What is defined as an opportunistic infection?

A

An infection caused by a pathogen that does not normally cause disease in a healthy individual.

97
Q

What is the most common opportunistic infection?

A

Pneumocystis jiroveci

Causes pneumocystis pneumonia.

98
Q

What is given prophylactically for those with CD4+ <200cells/mm3, to prevent pneumocystis pneumonia?

A

Low dose co-trimoxazole

99
Q

At which CD4+ cell level is cerebral toxoplasmosis commonly observed?

A

<150 cells/mm3.

Caught from cat faeces.

100
Q

What can reactivate with a CD4+ cell level below 50 cells/mm3?

A

Cytomegalovirus

101
Q

What causes neurocognitive impairment in HIV +ve patients?

A

HIV itself.

Due to affect on microglial cells.

102
Q

What do all cancers linked to AIDS have in common?

A

All of infectious aetiology.

103
Q

What virus causes Non-Hodgkin lymphoma?

A

Ebstein-Barr virus

104
Q

What virus causes cervical cancer?

A

HPV

105
Q

What factors increase risk of contracting HIV?

A

Anoreceptive sex
Trauma
Genital ulceration
Concurrent STI

106
Q

Is HIV a disease of PWIDs?

A

No

107
Q

What is the most common risk factor for HIV?

A

MSM

108
Q

If HIV is a potential diagnosis, should it be tested for, regardless of level of suspicion?

A

Yes

109
Q

What is the first marker to become positive following HIV infection?

A

Viral RNA

110
Q

What are 3 markers used in HIV testing?

A

Antibodies
p24
Viral RNA

111
Q

How long does it take for HIV antibodies to appear?

A

3 months.

112
Q

How should HIV testing be carried out?

A

Test for p24 and antibodies.

Will detect 6 weeks following infection - NOT before then.

113
Q

Following HIV infection diagnosis, what is carried out?

A

Staging

This checks for, and prophylactically manages, opportunistic infections.

Initiation of treatment also occurs.

114
Q

What is the aim of HIV treatment

A

Suppress viral load to such an extent the individual becomes non-infectious.

115
Q

What is PrEp?

A

Prophylactic medication preventing development of an HIV infection.

116
Q

What is PEP?

A

Medication taken following a potential HIV exposure.

117
Q

Is vaginal birth ok in HIV positive mother?

A

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
Q

How is a Bartholin’s cyst treated?

A

Drain abscess.

If infectious, give a broad-spectrum antibiotic.

119
Q

How is HIV treated?

A

HAART

Involves 3 drugs from atleast 2 drug classes that the virus is susceptible to.

120
Q

Is rubella a bacterial infection?

A

No, it is a viral infection.

121
Q

What are features of rubella?

A

Fever
Rash
Lymphadenopathy
Polyarthritis

122
Q

What can material infection with rubella lead to?

A

Miscarriage
Still birth
Birth defects

123
Q

What are the most common birth defects seen in rubella?

A

Cataracts
Cardiac abnormalities
Deafness
Microcephaly

124
Q

What gestation is of highest risk for mother to be infected with rubella?

A

First 10 weeks.

125
Q

Can patients receiving the MMR vaccine get pregnant immediately?

A

No, as it is a live vaccine, patients are advised to avoid pregnancy for 4 weeks after vaccination.

126
Q

What is responsible for measles?

A

Paramyxoviruses

Highly contagious

127
Q

What presentation is used to differentiate measles from other viral infections?

A

The presence of koplik spots.

128
Q

Is measles teratogenic?

A

No, however can cause high fever, which may result in intra-uterine growth retardation.

129
Q

Where do chicken pox spots initially appear?

A

Chest and face, before spreading to the extremities.

130
Q

What organism causes chicken pox?

A

Varicella zoster virus

131
Q

How should maternal chicken pox be treated?

A

Treat supportively.

If over 20m weeks gestation, consider 5x daily 800mg oral aciclovir for 1 week.

132
Q

What is the foetal varicella syndrome?

A

A condition caused by VZV infection, between 7-28 weeks gestation, resulting in limb hypoplasia and microcephaly.

133
Q

What is a non-congenital cause of sensorineural deafness/disability?

A

Cytomegalovirus

134
Q

What can CMV cause?

A

Miscarriage
Still birth
Microcephaly

135
Q

How is CMV treated?

A

Valacyclovir

Can also give immunoglobulin therapy.

136
Q

Which trimester of pregnancy is worse affected by CMV?

A

3rd trimester (other infections usually affect the 1st trimester).

137
Q

How is CMV Infection diagnosed?

A

Serology - positive IgG and IgM.

138
Q

If mother has diagnosed case of CMV, what follow-up should be taken?

A

USS every 2-4 weeks

MRI of brain (check for microcephaly)

139
Q

What virus is associated with slapped cheek and fifth’s disease?

A

Parvovirus

140
Q

What effects can parvovirus have on a neonate?

A

Slapped cheeks
Anaemia
Congenital heart failure
Death

141
Q

How is foetal anaemia investigated?

A

A foetal MCA doppler

142
Q

What effect does pregnancy have on the immune system?

A

Produces immunosuppression.

143
Q

Does influenza affect the course of pregnancy?

A

No

144
Q

How is zika virus transmitted?

A

Mosquito bites

145
Q

Are vaccines available for zika virus?

A

No

146
Q

Is vaccination advised in pregnancy against flu/covid?

A

Yes

147
Q

What is the organism responsible for toxoplasmosis?

A

Toxoplasmosis gondii

148
Q

Why should women avoid soft cheese during pregnancy?

A

Listeria monocytogenes

149
Q

What effect can listeria monocytogenes have on pregnancy?

A

Miscarriage
Pre-term birth
Still birth

150
Q

How is listeria monocytogenes infection treated?

A

Ampicillin and gentamicin.

151
Q

Is the risk of UTI increased in pregnancy?

A

Yes

Reproductive (28 decks)

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