Infectious diseases - Herpes + Chlamydia Flashcards
What are the classifications of neonatal herpes?
1) Disease localised to skin and eye/mouth
2) Localised CNS Disease (encephalitis alone)
3) Disseminated infection with multi organ involvement
What proportion is disease localised to the eye/mouth?
What % develop neurological or ocular morbidity?
30%
<2% with antiviral (best prognosis)
With local CNS disease
- what % develop neurological morbidity?
- What % mortality?
Neuro: 70%
Mortality: 6%
With disseminated infection with multi organ involvement
- What % develop neurological morbidity?
- What % mortality?
Neuro: 17%
Mortality 30%
Type 1 HSV– typically causes oro-labial herpes
What % T1 causes genital herpes?
1/3
What factors influence vertical transmission of HSV
- Primary/recurrent
- Prescence of maternal antibodies
- Duration of membrane rupture before delivery
- Use of fetal scalp electrode
How to manage 1st episode in 1st/2nd trimester?
Supportive measures (paracetamol and topical lidocaine)
Take viral PCR
Baldder catheterisation if signs retention
Acyclovir
Advise GUM clinic
Watch for signs of encephalitis/disssemintated infection
Offer suppression from 36 weeks
Manage expectantly - can have VD along does not deliver within 6 weeks
If disseminated infection occurs - higher risk of mortality
What can aciclorvir cause in the neonate when given to the mother?
Transient neonatal neutropenia
Does HVS in 1st/2nd increase risk miscarriage/congential abnormality?
No
How to manage 1st episode in third trimester?
- Commence acyclovir 500mg TDS until deliver
- Should deliver by CS, especially if within the last 6 weeks
The neonatal transmission risk if 1st episode in last 6 weeks?
41%
Risk of neonatal transmission if recurrent infection at time of delivery?
0-3%
If primary infection at onset of labour?
Take viral swap + inform neonates
Offer CS within 4 hours of SROM
If wants VD - IV aciclovir 5 mg/kg every 8 hours) and IV Abx to the neonate (20 mg/kg every 8 hours)
No invasive pressures: FSE/ARM/instrumental delivery
When should suppressive acilovir be given in recurrent infections?
36 weeks
When should supportive measures be given in HIV+ve and recurrent infection.
Mode of delivery?
32 weeks
MOD in line with BHIVA HIV guidelines
How to manage neonates born by CS with primary infection in 1st trimester?
Inform neonates
Swabs not required, no treatment required
PN education - reduce risk of PN transmission
How to manage neonates born by vaginal delivery and primary infection in 3rd trimester
- Inform neonates
- Swabs - skin, conductiva, oropharynx reaction
- IV acyclovir 20mg/kh 8 hourly
- Can breastfeed
- Educate parents - early sings of infection (poor feeding, leathery, lesions fever)
- Strict infection control measures
How to manage neonates if recurrent HSV +/- active lesion
Maternal IgG protective, risk infection is low
- inform neonates
- normal PN care
- educated parents
PPROM and active primary HSV
Limited evidence
CS if delivery within 6 weeks
consider initial management with IV acyclovir 5mg/kg
Consider steroids
What type of pathogen is chlamydia?
Obligate intracellular organism
What is the prevalence of chlamydia in pregnant women?
2-7%
What % of neonates delivered vaginally to a mother infected with chlamydia are colonised?
50-60%
Babies exposed to chlamydia, what are the most common fetal risks and how often do they occur?
Conjunctivitis - 50%, presented within 2 weeks
Pneumonia - 20%, within 2 months
What test is most sensitive for detecting chlamydia? Where is it collected from in males/females/
Nucleic acid amplification tests (NAATs)
Men - 1st void urine
Women - vaginal swab
What are the 3 treatment regimes for pregnancy women with chlamydia (NICE)?
- Azithromycin 1g PO 1 day, then 2 days 500mg PO
- Erythromycin 500mg QDS 7days or 500mg BD for 14 days
- Amoxicillin 500mg TDS 7 days
What is the treatment options for chlamydia in non-pregnancy persons >13years (NICE)
1st line
Doxycycline 100mg BD, 7 days (cannot use pregnancy or BF)
2nd line
- Azithromycin 1g PO 1 day, then 2 days 500mg PO
3rd line
Erythromycin 500mg QDS 7days or 500mg BD for 14 days
Ofloxacin 200mg BD 7 days or 400mg OD 7 days (CI pregnancy, children or growing adolescents)
What is the comments cause of vaginal discharge/infection in sexually active women?
Bacterial vaginosis - 20% pregnant women
What causes bacterial vaginosis?
Alteration in vaginal microbiome - less Lactobacillus and increase in G. vaginalis / Bactrroides sp / Mobiluncus
What associations does bacterial vaginosis have in pregnancy?
- Preterm labour
- Chorio
- Post partum endometritis
What cells are seen on wet mount discharge in BV?
Clue cells
Treatment of bacterial vaginosis in pregnancy (if symptomatic) NICE
- Avoid contributing factors (smoking, vaginal douching, soaps in bath)
- PO metronidazole 400mg BD for 5-7days
If women does not want tablets
3. Vaginal metronidazole gel 0.75% OD for 5 days or clindamycin cream 2% for 7 days
Repeat testing at 1 month if still symptomatic
