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Reproductive System > Infections of the reproductive tract > Flashcards

Infections of the reproductive tract Flashcards

1
Q

What is the most common STI in the UK?

A

Chlamydia Trachomatis

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2
Q

What ‘risky sexual behaviours’ are risk factors for developing an STI?

A
  • Multiple sexual partners
  • Not using barrier contraception
  • Early age 1st intercourse
  • Sexual practice (MSM and anal)
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3
Q

What factors, other than risk sexual behaviour, can lead to increased risk of STI?

A
  • Low socio- economic status
  • Race/ ethnicity
  • Lack of immunisation (Hep B, HPV)
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4
Q

What kind of bacterium is chlamydia trachomatis and what are its virulence factors?

A

Obligate intracellular bacterium

Unique cell wall. Gets taken up by phagocytosis but inhibits phagolysosome fusion so cannot be degraded

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5
Q

How does chlamydia trachomatis present in males and females?

A

Males: typically asymptomatic but may present with dysuria, discharge, testicular pain

Women: typically asymptomatic but may have discharge, post- coital bleeding or painful sex

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6
Q

What complications can arise from chlamydia infection?

A
  • Pelvic inflammatory disease
  • Conjuctivitis
  • Reactive arthritis
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7
Q

What kind of bacterium is Neisseria gonorrhoeae?

A
  • Gram negative
  • Intracellular
  • Diplococcus
  • Unencapsulated
  • Pilae
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8
Q

How does Gonorrhoeae present in males and females?

A

Males: 90% are symptomatic, causes thick, yellow discharge +/- dysuria

Females: typically asymptomatic but can cause vaginal discharge and lower abdominal pain

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9
Q

What complications can arise as a result of infection with Neisseria Gonorrhoeae?

A
  • Pelvic Inflammatory Disease (women)
  • Epididymo-orchitis i.e. testical inflammation (men)
  • Reactive arthritis
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10
Q

How would you treat an infection with Chlamydia Trachomatis?

A

1st line: antibiotics (doxycycline or axithromycin) or will use erythromycin if allergic or pregnant

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11
Q

How would you treat an infection with Neisseria Gonorrhoeae?

A

1st line treatment: antibiotic therapy mainly ceftriaxone or add azithromycin to boost the effect

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12
Q

What is Non-Gonococcal Urethritis?

A

Inflammation of the urethra with associated discharge

Anything that causes inflammation that is not gonorrhoeae

Can be pathogen negative or, chlamydia, mycoplasma gentalium, trichomonas vaginalis

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13
Q

How would you investigate a patient who presented with penile/ vaginal discharge?

A

Urine sample

  • Gonorrohoea: Microscopy & culture, NAATs (nucleic acid amplification test)
  • Chlamydia: NAATs
  • Urethritis: NAATs

Urethral Swab

For Gonorrhoea

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14
Q

What is a normal cause of vaginal discharge and how does this appear clinically?

A

Thickening of cervical mucus post ovulation due to progesterone

Features:

  • cyclical
  • clear
  • no other associated features
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15
Q

What clinical features might a woman with a Trichomonas Vaginalis infection present with?

A
  • Copious, yellow and odourous discharge
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16
Q

What is trichomonas vaginalis? How might a woman become infected with this organism?

A

A protozoa ‘flagellate’

Sexual transmitted and grows at optimal pH of 6

normal vagina pH 4, so anything that increases alkalinity favours aquisition of the disease

17
Q

How do you treat a Trichomoniasis infection?

A

Metronidazole

18
Q

How does a woman with candida albicans infection present and what kind of organism is this?

A

Candida albicans is a yeast, part of normal vaginal flora

Presents with:

  • very itchy
  • white discharge
  • typically odourless
19
Q

What things may increase the likelihood of an infection with candida albicans?

A
  • recent course of antbiotics
  • immunocompromised patients (including pregnancy, HIV)
  • Diabetes
  • Women on the COCP as yeast favours high oestrogen
20
Q

Explain what happens to the normal vaginal flora to cause a bacterial vaginosis infection

A

Normal vagina: lactobacillus produces lactic acid which lowers pH of vagina to protect against infection

Bacterial Vaginosis: Excessive washing or other causes a decrease in lactobacillus making the vagina less acidic allowing bacterial proliferation.

Most common causitive agent Gardnerella vaginalis

21
Q

How would someone with a bacterial vaginosis infection present?

A
  • Offensive smelling discharge
  • Typically watery
  • Without puritis or pain
22
Q

How do you diagnose and treat a BV infection?

A

Diagnose: vaginal swab

Treat: Metronidazole

23
Q

What kind of organism is Human Papillomavirus? Which different varieties cause different clinical manifestations?

A

A non-envaploped DNA virus

Types 6 & 11 cause 90% of genital / cutaneous wart infection

Types 16 & 18 associated with cervical cancer

24
Q

How can you identify an infection with HPV?

A

Diagnosis is usually clinical based on presence of painless genital warts

Can do a swab/ biopsy to perform PCR to identify high risk types

25
What organism causes **herpes**, and how does this differ clinically from an infection with **HPV**?
Herpes caused by **Herpes Simplex Virus** (HSV1 and HSV2) **HSV** causes **painful** ulcers, dysuria and discharge **HPV** causes **painless** blisters
26
What are the 2 strands of HSV and how are they different?
**HSV-1**: can cause **oral & genital** herpes **HSV-2**: Causes genital herpres and leads to **recurrent** infection. Particularly dangerous in pregnancy as vaginal delivery means baby can be born with herpes
27
How do you manage a patient with HSV infection?
* Perform Swabs for PCR/ NAAT to identify organism * Infection is **lifelong** therefore cannot be eradicated * Treatment focuses of reducing severity of current episode and reducing repeated infection by **antiviral** treatment e.g. **aciclovir**
28
Which organism is responsible for causing **syphilis?**
**Treponema pallidum**
29
There are 3 stages of syphilis infection, explain what happens in each
**Primary infection**: _painless_ genital ulcers **Secondary**: 4-6 weeks after initial infection. Associated **rash** and effect on other systems of the body; liver, kidney and skin **Tertiary syphilis**: Latent stage, can be reactivated in preganancy which can lead to congenital syphilis
30
How do you treat a syphilis infection?
**Penicillin based antibiotics**
31
Define **Pelvic Inflammatory Disease**
An infection of the **uterus, fallopian tubes** and **ovaries** Typically an **ascending** infection from the vagina that moves up the reproductive tract
32
What are the signs and symptoms of pelvic inflammatory disease?
**Signs:** * Lower abdo pain * Dyspareunia (painful sex) * Purulent discharge * Abdnormal uterine bleeding **Signs:** * Pyrexia (but not always) * Pain on palpation of the abdomen and during bimanual vaginal exam * Evidence of discharge/ cervicitis on speculum exam
33
A women presenting with abdominal pain may not have PID, what are some of the corss system differentials it could be?
**Gynaecolocial**: ectopic pregnancy, ovarian cysts, endometriosis **Gastrointestinal**: appendicitis, IBS **Urinary**: UTI
34
What are the complicaitons of PID?
* Chronic pelvic pain * Pelvic abscess (tubo-ovarian) * Can lead to **subfertility** * Peritonitis * Fitz-Hugh- Curtis Sydrome
35
Why can PID lead to subfertility?
* Adhesions from chronic inflammation * increased risk of ectopic pregnancy * reduced likelihood of successful fertilisation
36
What is **Fitz- Hugh- Curtis** syndrome?
Inflammation of the membrane lining the stomach (peritoneum) and the tissues surrounding the liver (perihepatitis) Caused as the fallopian tubes are **open to the peritoneum**, therefore infection can spread into the peritoneal cavity
37
How do you manage a woman with PID?
Main stay is patient education **before PID** * Give broad spec **antibitoics** to reduce long term complications * Take **s****wabs** and do full STI screen * Analgesia * Those who don't respond to treatment have **Laparoscopy** to confirm the diagnosis

Reproductive System (18 decks)

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