L29- Dysuria: Urethritis, Cervicitis and testicular pain Flashcards
what is the cause of the discharge in urethritis?
urethral glands prodiuce a colloid secretion
what are 5 causes of vaginal discharge?
physiological (cyclical or cervical mucous)
cervicitis
genital candiadiasis
bacterial vaginosis
organism most responisble for chlamydia?
chlamydia trachomatis (trachoma referst to the eye which often occurs with chlamydia)
what disease is often co-infected with chlamydia? why is this?
gonorrhoea
- similar risk factors (multiple partners and freq unprotected sex)
infection can make you more susceptiple to 2nd infection
3 modes of transimission of chlamydia?
Sexual (oral, vaginal and anal)
childbirth
direct contact (very small portion because they can only survive for a very short period of time)
chlamydia is intra or extracellular?
- what kind of cell?
vaginal or urethral epithelial cells
pathophysiology of how chlamydia causes urethritis/cervicitis/vaginitis?
WBC notice bacterial infected cells- cause apoptosis –> cell death
- results in inflammation
(burning, welling and pain)
what is the main difference in complications of chlamydia between m and F
fallopian tubes connect to the abdominal cavity
- can lead to pelvic inflammatory disease in females
- males can get epididymitis and also lead to infertility in some cases
what is in the discharge in chlamydia?
pus- dead WBC, epithelial cells
2 other parts of the body that chlamydia can migrate to and cause complications?
eyes –> cause conjuncitivitis (eventually causing irritation of the eyes and trachoma- blindness if severe)
joints --> infective arthritis (dysarthria) reactive arthritis (Reiters syndrome) - antibodies against chlamydia accidentally attack the joint tissue)
what are the symptoms of Reiters syndrome
cant see (trachoma), pee (dysuria) or climb a tree (dysarthria)
potential sytmptoms of neonatal chlamydia?
conjunctivitis
pneumonia
premature labour
potentially death
what are the 3 diagnostic test for chlamydia?
- potential adv and dis adv for each
NAAT (nucleic acid amplification test)
- swabs from pus is amplified using PCR
- it is fast, sensitive and specific
gram stain (but chlamydia is an intracellular organism so hard to see)
petree culture growth- takes too long
what is the treatment of chlamydia?
antibiotics- target sensitivity
how is antibiotic sensitivity achieved?
by putting antibiotics onto the bacterial colony- looking for spots of no growth
prevention of chlamydia?
protected sex
screening pregnant women
3 antibiotic treatment options for chlamydia
doxycycline- 7 day period
azithromycin- single dose
what is the treament plan for a pregnant/breast feeding wome nwith chlamydia?
azithromycin - 1g single dose
amoxycillin for 7 days
should be tested for sure after 3-4 weeks.
azithromycin
- class
- mechanism
- potential side effects
- chlamydia resistance?
azalide (subclass of macrolide)
- works by inhibiting the translation of bacterial mRNA
- some GI side effcts, long QT syndrome
- very rare resistance
what is the main organism causing gonorrhoea? what is shape/classification of the bacteria?
neisseria gonorrhoea
- gram negative cocci
- paired cocci
complications of gonorrhoea?
pelvic inflmammatory disease (F)
arthritis
CNS- meningitis
how does the gonococcus bacteria avoid the immune system?
has small proteins (opa proteins) on the surface which bind to the WBC and so the immune system has to develop a new response each time
diagnosis of gonorrhoea
gram stain - gonococci have very distinct paired gram negative cocci appearance
treatment for gonorrhoea
antibiotics- use culture to identify effective treatment
what agar is good for nesseria culture growth?
Thayer Martin medium
what specific antibiotics for gonorrhoea? if sensitivities are unknown or pregnant?
ceftrazone (broad spectrum) + azithromycin
antibiotics for gonorrhoea is sensitivities are known>
ciprofloxacin + azithromycin
what is pelvic inflammatory disease?
infection of the female genital tract
2 most common causes of PID?
chlamydia and gonorrhoea
triad of PID symptoms?
- other assc symptoms?
lower abdominal pain
adnexal tenderness
cervical motion tenderness (pain in the cervix)
also fever, nausea and discharge or vaginal bleeding
what are the diagnostic tests for PID
diagnostic tests for causative bacteria
also bHCG pregnancy test to exclude ectopic preg
treatment for PID?
antibiotics
(ceftriaxone + doxycycline +/- metronidazole)
- potenially surgery if the pelvis has ruptured
