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Reproductive System > Infections Of The Reproductive Tract > Flashcards

Infections Of The Reproductive Tract Flashcards

1
Q

Risk factors for developing an STI

A
  • 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
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2
Q

List STIs

A

Chlamydia
Gonorrhoea
Genital herpes
Genital warts
HIV
Syphilis
Trichomoniasis

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3
Q

Describe physiological discharge in women

A

White or clear no offensive discharge that changes with the menstrual cycle

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4
Q

Describe changes in discharge in the phases of the menstrual cycle

A
  • follicular + luteal phase: small amount of cervix mucus
  • ovulation: abundant + elastic cervical mucus
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5
Q

Symptoms of vaginal thrush

A
  • vulval itching
  • vulval soreness + irritation
  • vaginal discharge (cheese like, no odour)
  • superficial dyspareunia
  • dysuria
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6
Q

What is dyspareunia?

A

Painful sexual intercourse

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7
Q

What is bacterial vaginosis?

A

Overgrowth of predominantly anaerobic organisms
e.g. gardnerella vaginalis

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8
Q

Risk factor for bacterial vaginosis

A
  • receiving oral sex
  • vaginal washes/douching
  • smoking
  • higher in sexually active women
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9
Q

What is the normal organism that causes bacterial vaginosis?

A

gardnerella vaginalis

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10
Q

Investigation of bacterial vaginalis

A

Vaginal pH >4.5
Whiff test
Gram stain: clue cells
High vaginal swab

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11
Q

Symptoms of bacterial vaginosis

A

thin, grey/white fishy smelling discharge
WITHOUT itching

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12
Q

Treatment of bacterial vaginosis

A

Metronidazole orally
Clindamycin gel

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13
Q

Symptoms of chlamydia in women

A
  • asymptomatic in 70%
  • increased vaginal discharge
  • post-coital or intermenstrual bleeding
  • deep dyspareunia
  • dysuria
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14
Q

Symptoms of chlamydia in men

A
  • asymptomatic 50%
  • urethral discharge
  • dysuria
  • epididymitis
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15
Q

What organism causes chlamydia?

A

chlamydia trachomatis

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16
Q

What organism causes gonorrhoea?

A

Neisseria gonorrhoeae

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17
Q

Describe Neisseria gonorrhoeae

A

Gram negative (pink) diplocci
Unencapulsated
Pilated

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18
Q

Symptoms of gonorrhoea in men

A
  • thick yellow discharge
  • dysuria
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19
Q

Symptoms of gonorrhoea in women

A
  • 50% asymptomatic
  • dysuria
  • dyspareunia
  • increased or altered discharge
  • lower abdominal pain
  • intermenstrual bleeding or Menorrhagia - rare
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20
Q

What organism causes trichomoniasis?

A

Trichomonas vaginalis

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21
Q

Describe trichomonas vaginalis

A

Protozoa
With flagella
Causes trichomonasis

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22
Q

Symptoms of trichomoniasis in females

A
  • lots of yellow, frothy discharge with odour
  • vulval itching/soreness
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23
Q

Treatment of trichomoniasis

A

Metronidazole

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24
Q

What is non-gonococcal urethritis in men?
What often casues it?

A

Inflammation of urethra with associated discharge
Caused by chlamydia trachomatis

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25
Q

Investigations of STIs in men

A

Urine sample
Urethral swap

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26
Q

Investigation of STIs in females

A

High vaginal swab
Endocervical swab
Vulvovaginal swab (self swab)

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27
Q

What do you use a high vaginal swab to test for?

A

Trichomonasis
Candida
BV

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28
Q

What do you use an endocervial swab to test for?

A

Chlamydia
Gonorrhoea

29
Q

What do you use an vulvovaginal swab to test for?

A

Chlamydia
Gonorrhoea

30
Q

Describe human papilloma virus

A

DNA virus
Non enveloped
Causes genital warts

31
Q

What organism causes genital warts?

A

human papillomavirus
6 + 11

32
Q

Importance of HPV 6+11

A

Cause genital infections

33
Q

Importance of HPV 16+18

A

Association with cervical cancer

34
Q

Describe herpes simplex virus

A

DNA virus
Enveloped

35
Q

What organism causes cold sores?

A

herpes simplex 1

36
Q

Management of herpes

A

Antivirals e.g. acyclovir
- cannot eradicate infection (no cure)
- reduce severity + duration of current episode

37
Q

What organism causes syphilis?

A

treponema pallidum

38
Q

Describe treponema pallidum

A

Bacteria
Spirochete
Causes syphilis

39
Q

Describe primary syphilis

A

Painless ulcers

40
Q

Treatment of syphilis

A

Penicillin
But depends on stage
Doxycycline or erythromycin if allergic

41
Q

Management of bacterial STIs

A

Multiple antibiotics
e.g. azithromycin + Ceftriaxone

42
Q

Treatment of vaginal thrush

A

Nystatin
Clotrimazole

43
Q

What is pelvic inflammatory disease?

A

General term for infection of upper genital tract

44
Q

What organism can cause PID?

A

chlamydia trachomatis
neisseria gonorrhoeae
mycoplasma genitalium
Normal vaginal flora

45
Q

What can PID cause?

A

Endometritis - uterus
Saplpingitis - uterine tubes
Parametritis - pelvic floor
Oophoritis - ovaries
Turbo-ovarian abscess
Pelvic peritonitis

46
Q

Symptoms of PID

A
  • pelvic pain/lower abdominal pain
  • discharge
  • post-coital/intermenstrual bleeding
  • fever
  • dyspareunia
  • right upper quadrant pain due to peri-hepatitis
  • secondary dysmenorrhea
47
Q

Signs of PID

A
  • lower abdominal tenderness
  • abnormal cervical or vaginal discharge
  • pain on moving cervix or palpating uterus
  • adnexal tenderness
  • fever >38°
48
Q

Early complications of PID

A

Sepsis
Peritonitis

49
Q

Late complications of PID

A
  • chronic pelvic pain
  • pelvis abscess (tube-ovarian)
  • infertility
  • ectopic pregnancy
  • Fitz-Hugh Curtis Syndrome (peri-hepatitis)
50
Q

Management of PID

A
  • antibiotics e.g. oral ofloxacin + oral metronidazole
  • screen for STIs
  • contract tracing
  • advise
51
Q

What antibiotics are given for PID?

A

oral ofloxacin + metronidazole

52
Q

What STIs and non-STIs present with a change in discharge in women?
What is the change in each?

A
  • 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
53
Q

Treatment of chlamydia

A

doxycycline or azithromycin
erythromycin in pregnancy/allergy

54
Q

Investigation of chlamydia

A

NAAT
Nucleic acid amplification tests
Vaginal swabs

55
Q

Treatment of gonorrhoea

A
  • cefriaxone to treat
  • azithromycin to boost the effect
56
Q

Why is azithromycin used along side cefriaxone to treat gonorrhoea?

A

azithromycin:
- boosts the effects
- reduces risk of resistance
- treatment of chlamydia in case of co-infection

57
Q

Describe secondary syphilis

A
  • Can develop weeks later
  • associated rash but symptoms will often disappear
58
Q

Describe tertiary syphilis

A
  • infection can remain latent and reactive later in life
  • e.g. in pregnancy > Congential syphilis
59
Q

Presentation of genital warts

A

Painless genital warts on penis, vulva, vagina, cervix or perianal skin

60
Q

Presentation of herpes

A
  • Painful ulcers
  • dysuria
  • discharge
61
Q

Causes of PID which are not STI related

A
  • gynaecological e.g. ectopic pregnancy, ovarian cyst, endometriosis
  • GI e.g. appendicitis, IBS
  • UTIs
62
Q

What is Fitz Hugh Curtis syndrome?

A

Inflammation of liver capsules causes peri-hepatitis
RUQ pain + scarring

63
Q

What is used for contact tracing for STIs?

A

GUM clinics

64
Q

What STIs present with discharge in men?
Describe the discharge in each

A
  • chlamydia: urethral discharge
  • gonorrhoea: thick yellow discharge
  • non-gonococcal urethritis: urethral discharge
65
Q

What STIs + non STIs are treated with metronidazole?

A
  • trichomoniasis
  • BV
  • PID (+ ofloxacin)
66
Q

Gram stain of chlamydia trachomatis

A

Gram stain obligate intracellular bacterium

67
Q

Describe chlamydia trachomatis

A

-Obligate intracellular bacterium
- Gram negative
- Unique cell wall (inhibits phagolysosome fusion)

68
Q

Why is chlamydia trachomatis immune to penicllins?

A

It does not have a peptidoglycan layer
Penicillins work by inhibiting cell wall synthesis

69
Q

Why can doxycycline not be given to a pregnant woman?

A

It is highly teratogenic

Reproductive System (20 decks)

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