Infections of the reproductive tract

Question 1

Describe the epidemiology of STIs

Answer 1

• data from GUM clinics, although this may underestimate
• at risk groups include: young people, minority ethnic groups, lower SES, unemployed, those born to teenage parents
• associated morbidities include: PID, infertility, cancers, infection/ inflammation, blood-borne viruses

Question 2

List some common STIs and the associated microorganisms

Answer 2

• HPV - human papilloma virus
• Herpes - herpes simplex virus 1 & 2
• Chlamydia - chlamydia trachomatis
• Gonorrhoea - niesseria gonorrhoea
• Syphilis - treponema pallidum
• Trichomoniasis - trichomonas vaginalis

Question 3

What are some differential diagnoses for genital skin lesions?

Answer 3

• genital ulcers
• bullae
• papules
• warts (anogenital warts)

Question 4

What are some differential diagnoses for urethritis?

Answer 4

• gonococcal/ chlamydial urethritis
• non infectious urethritis
• non-specific urethritis

Question 5

What are some differential diagnoses for vaginitis and cervicitis?

Answer 5

• vaginitis, cervicitis
• bartholinitis
• bacterial vaginosis

Question 6

Describe recent trends in STI incidence

Answer 6

• all increased, chlamydia and gonorrhoea the most

Question 7

Describe the presentation and management of chlamydia

Answer 7

• presentation: urethritis, epididymitis, prostatitis, cervicitis, salpingitis, perihepatitis
• diagnosis with urethral and endocervical swabs
• Tx with doxycycline or azithromycin (broad spectrum tetracycline)

Question 8

Describe the clinical presentation and management of gonorrhoea

Answer 8

• urethritis, prostatitis, pharyngitis and epididymitis in males. May be asymptomatic in females, or PID, urethritis, endocervicitis
• smear and cultures (for bateraemia)
• Tx with ceftriaxone (cephalosporin)

Question 9

Describe the clinical presentation and management of genital herpes

Answer 9

• extensive and painful genital ulceration, dysuria, inguinal lymphadenopathy, fever
• smear and swab
• Tx with acyclovir (antiviral)

Question 10

Describe the presentation and management of genital warts

Answer 10

• cutaneous, mucosal or anogenital warts
• usually benign and painless
• may appear on the penis, vagina, urethra, cervix etc
• diagnosis with biopsy, genome analysis or hybrid capture
• no formal Tx, often spontaneous resolution

Question 11

Describe the presentation and management of trichomonas vaginitis

Answer 11

• thin, frothy and offensive discharge
• vaginal irritation, discharge and inflammation
• diagnosis with culture
• Tx with metronidazole (anaerobe microbial)