L29- Dysuria: Urethritis, Cervicitis and testicular pain

Question 1

what is the cause of the discharge in urethritis?

Answer 1

urethral glands prodiuce a colloid secretion

Question 2

what are 5 causes of vaginal discharge?

Answer 2

physiological (cyclical or cervical mucous)

cervicitis

genital candiadiasis

bacterial vaginosis

Question 3

organism most responisble for chlamydia?

Answer 3

chlamydia trachomatis (trachoma referst to the eye which often occurs with chlamydia)

Question 4

what disease is often co-infected with chlamydia? why is this?

Answer 4

gonorrhoea
- similar risk factors (multiple partners and freq unprotected sex)
infection can make you more susceptiple to 2nd infection

Question 5

3 modes of transimission of chlamydia?

Answer 5

Sexual (oral, vaginal and anal)

childbirth

direct contact (very small portion because they can only survive for a very short period of time)

Question 6

chlamydia is intra or extracellular?

- what kind of cell?

Answer 6

vaginal or urethral epithelial cells

Question 7

pathophysiology of how chlamydia causes urethritis/cervicitis/vaginitis?

Answer 7

WBC notice bacterial infected cells- cause apoptosis –> cell death
- results in inflammation
(burning, welling and pain)

Question 8

what is the main difference in complications of chlamydia between m and F

Answer 8

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

Question 9

what is in the discharge in chlamydia?

Answer 9

pus- dead WBC, epithelial cells

Question 10

2 other parts of the body that chlamydia can migrate to and cause complications?

Answer 10

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)

Question 11

what are the symptoms of Reiters syndrome

Answer 11

cant see (trachoma), pee (dysuria) or climb a tree (dysarthria)

Question 12

potential sytmptoms of neonatal chlamydia?

Answer 12

conjunctivitis
pneumonia
premature labour
potentially death

Question 13

what are the 3 diagnostic test for chlamydia?

- potential adv and dis adv for each

Answer 13

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

Question 14

what is the treatment of chlamydia?

Answer 14

antibiotics- target sensitivity

Question 15

how is antibiotic sensitivity achieved?

Answer 15

by putting antibiotics onto the bacterial colony- looking for spots of no growth

Question 16

prevention of chlamydia?

Answer 16

protected sex

screening pregnant women

Question 17

3 antibiotic treatment options for chlamydia

Answer 17

doxycycline- 7 day period

azithromycin- single dose

Question 18

what is the treament plan for a pregnant/breast feeding wome nwith chlamydia?

Answer 18

azithromycin - 1g single dose
amoxycillin for 7 days

should be tested for sure after 3-4 weeks.

Question 19

azithromycin

• class
• mechanism
• potential side effects
• chlamydia resistance?

Answer 19

azalide (subclass of macrolide)

• works by inhibiting the translation of bacterial mRNA
• some GI side effcts, long QT syndrome
• very rare resistance

Question 20

what is the main organism causing gonorrhoea? what is shape/classification of the bacteria?

Answer 20

neisseria gonorrhoea

• gram negative cocci
• paired cocci

Question 21

complications of gonorrhoea?

Answer 21

pelvic inflmammatory disease (F)

arthritis

CNS- meningitis

Question 22

how does the gonococcus bacteria avoid the immune system?

Answer 22

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

Question 23

diagnosis of gonorrhoea

Answer 23

gram stain - gonococci have very distinct paired gram negative cocci appearance

Question 24

treatment for gonorrhoea

Answer 24

antibiotics- use culture to identify effective treatment

Question 25

what agar is good for nesseria culture growth?

Answer 25

Thayer Martin medium

Question 26

what specific antibiotics for gonorrhoea? if sensitivities are unknown or pregnant?

Answer 26

ceftrazone (broad spectrum) + azithromycin

Question 27

antibiotics for gonorrhoea is sensitivities are known>

Answer 27

ciprofloxacin + azithromycin

Question 28

what is pelvic inflammatory disease?

Answer 28

infection of the female genital tract

Question 29

2 most common causes of PID?

Answer 29

chlamydia and gonorrhoea

Question 30

triad of PID symptoms?

- other assc symptoms?

Answer 30

lower abdominal pain

adnexal tenderness

cervical motion tenderness (pain in the cervix)

also fever, nausea and discharge or vaginal bleeding

Question 31

what are the diagnostic tests for PID

Answer 31

diagnostic tests for causative bacteria

also bHCG pregnancy test to exclude ectopic preg

Question 32

treatment for PID?

Answer 32

antibiotics
(ceftriaxone + doxycycline +/- metronidazole)
- potenially surgery if the pelvis has ruptured