Infections Of The Reproductive Tract Flashcards
Risk factors for developing an STI
- multiple sexual partners
- not using physical contraception
- early age first intercourse
- sex workers
- men who have sex with men
- lack of immunisation
- low socio-economic status
- black Caribbean/African
List STIs
Chlamydia
Gonorrhoea
Genital herpes
Genital warts
HIV
Syphilis
Trichomoniasis
Describe physiological discharge in women
White or clear no offensive discharge that changes with the menstrual cycle
Describe changes in discharge in the phases of the menstrual cycle
- follicular + luteal phase: small amount of cervix mucus
- ovulation: abundant + elastic cervical mucus
Symptoms of vaginal thrush
- vulval itching
- vulval soreness + irritation
- vaginal discharge (cheese like, no odour)
- superficial dyspareunia
- dysuria
What is dyspareunia?
Painful sexual intercourse
What is bacterial vaginosis?
Overgrowth of predominantly anaerobic organisms
e.g. gardnerella vaginalis
Risk factor for bacterial vaginosis
- receiving oral sex
- vaginal washes/douching
- smoking
- higher in sexually active women
What is the normal organism that causes bacterial vaginosis?
gardnerella vaginalis
Investigation of bacterial vaginalis
Vaginal pH >4.5
Whiff test
Gram stain: clue cells
High vaginal swab
Symptoms of bacterial vaginosis
thin, grey/white fishy smelling discharge
WITHOUT itching
Treatment of bacterial vaginosis
Metronidazole orally
Clindamycin gel
Symptoms of chlamydia in women
- asymptomatic in 70%
- increased vaginal discharge
- post-coital or intermenstrual bleeding
- deep dyspareunia
- dysuria
Symptoms of chlamydia in men
- asymptomatic 50%
- urethral discharge
- dysuria
- epididymitis
What organism causes chlamydia?
chlamydia trachomatis
What organism causes gonorrhoea?
Neisseria gonorrhoeae
Describe Neisseria gonorrhoeae
Gram negative (pink) diplocci
Unencapulsated
Pilated
Symptoms of gonorrhoea in men
- thick yellow discharge
- dysuria
Symptoms of gonorrhoea in women
- 50% asymptomatic
- dysuria
- dyspareunia
- increased or altered discharge
- lower abdominal pain
- intermenstrual bleeding or Menorrhagia - rare
What organism causes trichomoniasis?
Trichomonas vaginalis
Describe trichomonas vaginalis
Protozoa
With flagella
Causes trichomonasis
Symptoms of trichomoniasis in females
- lots of yellow, frothy discharge with odour
- vulval itching/soreness
Treatment of trichomoniasis
Metronidazole
What is non-gonococcal urethritis in men?
What often casues it?
Inflammation of urethra with associated discharge
Caused by chlamydia trachomatis
Investigations of STIs in men
Urine sample
Urethral swap
Investigation of STIs in females
High vaginal swab
Endocervical swab
Vulvovaginal swab (self swab)
What do you use a high vaginal swab to test for?
Trichomonasis
Candida
BV
What do you use an endocervial swab to test for?
Chlamydia
Gonorrhoea
What do you use an vulvovaginal swab to test for?
Chlamydia
Gonorrhoea
Describe human papilloma virus
DNA virus
Non enveloped
Causes genital warts
What organism causes genital warts?
human papillomavirus
6 + 11
Importance of HPV 6+11
Cause genital infections
Importance of HPV 16+18
Association with cervical cancer
Describe herpes simplex virus
DNA virus
Enveloped
What organism causes cold sores?
herpes simplex 1
Management of herpes
Antivirals e.g. acyclovir
- cannot eradicate infection (no cure)
- reduce severity + duration of current episode
What organism causes syphilis?
treponema pallidum
Describe treponema pallidum
Bacteria
Spirochete
Causes syphilis
Describe primary syphilis
Painless ulcers
Treatment of syphilis
Penicillin
But depends on stage
Doxycycline or erythromycin if allergic
Management of bacterial STIs
Multiple antibiotics
e.g. azithromycin + Ceftriaxone
Treatment of vaginal thrush
Nystatin
Clotrimazole
What is pelvic inflammatory disease?
General term for infection of upper genital tract
What organism can cause PID?
chlamydia trachomatis
neisseria gonorrhoeae
mycoplasma genitalium
Normal vaginal flora
What can PID cause?
Endometritis - uterus
Saplpingitis - uterine tubes
Parametritis - pelvic floor
Oophoritis - ovaries
Turbo-ovarian abscess
Pelvic peritonitis
Symptoms of PID
- pelvic pain/lower abdominal pain
- discharge
- post-coital/intermenstrual bleeding
- fever
- dyspareunia
- right upper quadrant pain due to peri-hepatitis
- secondary dysmenorrhea
Signs of PID
- lower abdominal tenderness
- abnormal cervical or vaginal discharge
- pain on moving cervix or palpating uterus
- adnexal tenderness
- fever >38°
Early complications of PID
Sepsis
Peritonitis
Late complications of PID
- chronic pelvic pain
- pelvis abscess (tube-ovarian)
- infertility
- ectopic pregnancy
- Fitz-Hugh Curtis Syndrome (peri-hepatitis)
Management of PID
- antibiotics e.g. oral ofloxacin + oral metronidazole
- screen for STIs
- contract tracing
- advise
What antibiotics are given for PID?
oral ofloxacin + metronidazole
What STIs and non-STIs present with a change in discharge in women?
What is the change in each?
- vaginal thrush: non odorous cottage cheese-like white discharge WITH itching
- bacterial vaginosis: fishy white/grey vaginal discharge WITHOUT itching
- chlamydia: increased vaginal discharge
- gonorrhoea: increased discharge
- trichomoniasis: lots of frothy, yellow/green, odorous discharge WITH itching
Treatment of chlamydia
doxycycline or azithromycin
erythromycin in pregnancy/allergy
Investigation of chlamydia
NAAT
Nucleic acid amplification tests
Vaginal swabs
Treatment of gonorrhoea
- cefriaxone to treat
- azithromycin to boost the effect
Why is azithromycin used along side cefriaxone to treat gonorrhoea?
azithromycin:
- boosts the effects
- reduces risk of resistance
- treatment of chlamydia in case of co-infection
Describe secondary syphilis
- Can develop weeks later
- associated rash but symptoms will often disappear
Describe tertiary syphilis
- infection can remain latent and reactive later in life
- e.g. in pregnancy > Congential syphilis
Presentation of genital warts
Painless genital warts on penis, vulva, vagina, cervix or perianal skin
Presentation of herpes
- Painful ulcers
- dysuria
- discharge
Causes of PID which are not STI related
- gynaecological e.g. ectopic pregnancy, ovarian cyst, endometriosis
- GI e.g. appendicitis, IBS
- UTIs
What is Fitz Hugh Curtis syndrome?
Inflammation of liver capsules causes peri-hepatitis
RUQ pain + scarring
What is used for contact tracing for STIs?
GUM clinics
What STIs present with discharge in men?
Describe the discharge in each
- chlamydia: urethral discharge
- gonorrhoea: thick yellow discharge
- non-gonococcal urethritis: urethral discharge
What STIs + non STIs are treated with metronidazole?
- trichomoniasis
- BV
- PID (+ ofloxacin)
Gram stain of chlamydia trachomatis
Gram stain obligate intracellular bacterium
Describe chlamydia trachomatis
-Obligate intracellular bacterium
- Gram negative
- Unique cell wall (inhibits phagolysosome fusion)
Why is chlamydia trachomatis immune to penicllins?
It does not have a peptidoglycan layer
Penicillins work by inhibiting cell wall synthesis
Why can doxycycline not be given to a pregnant woman?
It is highly teratogenic
