L11: infections of the reproductive tract and pelvic inflammatory disease Flashcards
Describe chlamydia trachomatis
Most common STI in the UK
Obligate intracellular bacterium (no gram staining – no cell wall)
In men: mild urethritis, dysuria or inflammation of other structures
In women: typically asymptomatic but can present as vaginal discharge, dyspareunia or post-coital bleeding
Can cause complications such as PID & infections at sites outside the genital tract
Investigations: nucleic acid amplification tests (NAAT)
First line treatment = doxycycline, except in pregnancy/allergy = erythromycin
Describe neisseria gonorrhoeae
Gram negative intracellular diplococcus
In men: discharge & dysuria
In women: typically asymptomatic but can cause vaginal discharge & lower abdominal pain
Complications: epididymo-orchitis in men and PID in women & also disseminated gonorrhoea infection
First line treatment = ceftriaxone (treat gonorrhoea) & azithromycin (boosts the effect of this antibiotic and reduce risk of resistance)
-giving two antibiotics: chlamydia is a common co-infection
Describe treponema pallidum
Spiral-shaped bacterium responsible for syphilis
Many who have this will be co-infected with HIV
Swabs can be taken, and blood tests to confirm the infection
Treatment itself depends on the stage of infection
Describe the stages of syphilis
Primary syphilis: initially presents as a painless ulcer in the genitals or other sites involved in sexual contact; very infectious at this stage – but lesion will usually disappear
Secondary syphilis: develops weeks later, as an associated rash or affect other systems of the body; symptoms will often disappear
Tertiary syphilis: infection can remain latent and become reactivated later in life (pregnancy) which can lead to congenital syphilis
Describe anogenital warts
Most common viral STI caused by HPV, commonly strains 6 & 11 (HPV 16 & 18 have oncogenic properties – vaccine against all 4 of these strains)
Typically present with painless genital warts on the penis, vulva, vagina, cervix and perianal skin
Diagnosis is usually clinical & the warts typically regress without treatment (topical treatments are available)
Describe herpes simplex virus
Two strands of HSV that can cause STIs
HSV-1: can cause oral and genital herpes
HSV-2: causes genital herpes & often leads to recurrent infection – particularly dangerous in pregnancy as vaginal delivery means the baby can develop complications of herpes
Can present with painful ulcer, dysuria/discharge or can be asymptomatic
Infection is identified through swabs & treated with acyclovir
Describe trichomonas vaginalis
Sexually transmitted protozoa
In men: often asymptomatic, but can cause dysuria or discharge
In women: commonly presents as vaginal discharge, typically yellow, & can cause irritation of the vulva and vagina
Diagnosed with swabs & treated with metronidazole
Describe investigating STIs in men
Most are done by collecting urine samples
-first catch urine: chlamydia/gonorrhoea
-mid-stream urine: culture & sensitivities
Urethral sampling can be carried out if patient is symptomatic
Rectal & pharyngeal sampling for men who have sex with men or take swabs at an ulcer site
Blood tests – syphilis & blood borne viruses
Describe investigating STIs in women
Urine samples only rule out UTIs, ineffective at diagnosing STIs
Take swabs:
-high vaginal – trichomonas
-endocervical – chlamydia/gonorrhoea
-vulvovaginal (if asymptomatic) – chlamydia/gonorrhoea
Describe management of STIs
Treatment is with antibiotics & antivirals
Important to be aware that co-infections are common, therefore important to screen for other STIs
STI prevention is important in terms of contact tracing
Describe bacterial vaginosis
Caused by pH imbalance in the vagina (risk factors for this condition include practices that could disrupt the vagina flora eg. washing the vagina)
Common cause – Gardnerella vaginalis
Typically presents with offensive vaginal discharge, without pruritis or pain
Diagnosed by high vaginal swabs & usually treated with metronidazole
Describe vulvovaginal candidiasis
Commonly caused by candida albicans
Risk factors = immunosuppression, diabetes, antibiotics & oestrogen-containing oral contraceptives
Symptoms = white, non-offensive vaginal discharge with pruritis, pain and/or dyspareunia
Investigated with high vaginal swabs & treated with oral and/or topical azoles
What is pelvic inflammatory disease?
Ascending infection from the vagina through the endocervix, leading to inflammation of the female reproductive tract
Endometritis – inflammation of the endometrial lining of the uterus and can be acute or chronic
Salpingitis – inflammation of the fallopian tubes; inflammatory exudate can cause the tubes to fill with pus leading to tubo-ovarian abscess formation
Describe the aetiology of PID
Most common infective organisms are Neisseria gonorrhoea and chlamydia trachomatis
Non-STI such as Gardnerella vaginalis can also cause PID, as well as IUCDs
May be multiple causative organism
Describe risk factors of PID
Most commonly affects sexually active women aged 20-30 Young age Multiple sexual partners Lack of barrier contraception Low socio-economic status
