Lecture 10 - Infections Of The Repro Tract Flashcards by Callum Donoher

What are some important STIs?

Chlamydia
Gonorrhoea
Trichomoniasis
Genital Herpes
Genital Warts
Syphilis
HIV

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What are 2 non STI reproductive tract infections?

Thrush (candidia albicans)
Bacterial Vaginosis

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Who are more likely to get STIs, young or old people?

Young

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What ethnic group has a risk of STIs?

Black afrocarribean

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What are some risk factors for developing an STI?

Not using protection
Multiple sexual partners
Certain sexual practices
Sex workers
Early age first intercourse
Lack of immunisation
Being young

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What is the main symptom of STIs?

Discharge

Men = urethral
Women = vaginal

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Can vaginal discharge be normal?

Can urethral discharge be normal?

Vaginal discharge be normal

Urethral discharge in men never normal

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What does physiological vaginal discharge look like?

White or clear non offensive discharge

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What is the causative organism for Vaginal Thrush?

Candida albicans

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How does vaginal thrush infect a patient?

Candida albicans is normal vaginal flora but it gets “activated/overgrows” in immunocompromised states, diabetes or after antibiotics
High oestrogen favours it

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What increases the risk of developing of Vaginal Thrush/Candida albicans infection?

Immunocompromised
Diabetes (High sugar)
Post antibiotics (dec normal flora)
High oestrogen (combined oral contraceptive pill)

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What are the symptoms of Candida albicans?

Vulval/vaginal itching
White NON SMELLY cheese like vaginal discharge

Painful intercourse
Pain on urination

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What is the term for painful intercourse?

Dyspareunia

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What is the term for painful urination?

Dysuria

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How would you treat candidia albicans?

Antifungals:
Fluconazole
Clotrimazole

Given straight into vagina (Pessary)

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What is the main causative organism for bacterial vaginosis?

Gardnerella vaginalis

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What are the main risk factors for developing Bacterial Vaginosis?

Vaginal washes/douching
Receiving oral sex
Smoking

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What is the basic reason bacterial vaginosis develops?

Normal flora is overgrown by the anerobic orgaisms like Gardnerella vaginalis

Lactobacilli no longer around maintaining low pH

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What type of cells are seen on a gram stain for bacterial vaginosis?

Clue cells

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What are the symptoms of bacterial vaginosis?

Fishy smelling thin white discharge

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What is the treatment for bacterial vaginosis?

Oral metronidazole
Clindamycin gel

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What is the most common discharge causing STI?

Chlamydia trachomatis

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What type of organism is chlamydia trachomatis?

Obligate Intracellular bacterium with a unique cell WALL

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Why cant chlamydia trachomatis be gram stained?

Has a unique cell wall
It also prevents phagolysosome fusion

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What are the symptoms of Chlamydia in women?

70% asymptomatic Inc/smelly discharge Postcoital or intermentstrual bleeding Deep dyspareunia Dysuria

What are the symptoms of chlamydia in men?

50% asymptomatic Urethral discharge + urethritis Dysuria Epididymitis

What type of organism is Neisseria Gonorrhoeae?

Gram negative diplococci

what colour do gram negative bacteria stain?

Red

What are the symptoms of Neisseria Gonorrhoeae infection in men?

90% men symptomatic Thick yellow discharge Often dysuria

What are the symptoms of Neisseria Gonorrhoeae infection in women?

50% asymptomatic Dysuria Inc/altered discharge Dyspareunia Lower abdominal pain Intermenstrual bleeding

What do you treat if you suspect Chlamydia Trachomatis or Neisseria Gonorrhoeae?

Treat for both even if you only suspect 1

What 2 antibiotics are given to treat bacterial STIs (Neisseria Gonorrhoeae or Chlamydia Trachomatis)?

Azithromycin Ceftriaxone

What organism causes Trichomoniasis?

Trichomonas vaginalis (Protozoa)

How does Trichomoniasis present in women?

Thick very smell frothy discharge and lots of it Itching (way you can differentiate this from bacterial vaginosis is that BV doesn’t have itching)

What conditions does Trichomoniasis best develop in?

Alkaline conditions in vagina

How does trichomoniasis present in men?

Urethritis which then has discharge

What is the treatment for Trichomoniasis?

Metronidazole

What is non-gonococcal urethritis in men?

Inflammation of the urethra with associated discharge that’s not caused by gonorrhoea

What are the common causes of non-gonococcal urethritis in men?

Chlamydia trichomatis Trichomonas vaginalis Mycoplasma gentialium But can also be pathogen negative

What investigations are done in men when theres a disease causing discharge?

Urine sample or swab of discharge

Once a urine sample has been obtained from a man, what tests are usually done?

NAATs (Nucleic Acid Amplification Test) basically a PCR

What are the 3 types of vaginal swab that can be done to investigate diseases causing discharge?

High vaginal swab Endocervical swab Vulvovaginal swab (self swab)

What infections is a high vaginal swab testing for?

Trichomonas Candida Bacterial Vaginosis

What do both endocervical and vulvovaginal swabs test for?

Chlamydia Gonorrhoea

Why is a vulvovaginal swab more favourable to an endocervical swab?

Vulvovaginal swab is done by the patient so more likely to actually have the swab done

What are the infections that can cause discharge?

Chlamydia (trichomatis) (Neisseria) Gonorrhoeae Trichomoniasis vaginalis Bacterial vaginosis Candidia albicans (thrush)

What are the 3 STIs causing discharge in women?

Chlamydia Gonorrhoea Trichomoniasis

What are the 2 non STI infections causing discharge in women?

Bacterial vaginosis Candidia albicans

What are the 3 conditions causing genital lesions?

HPV Herpes simplex virus 1 and 2 Syphilis

What causes Genital warts?

HPV (Human Papillomavirus)

Which 2 HPV viruses cause most genital infections?

HPV 6 HPV 11

Which 2 HPV viruses cause the most cervical cancer?

HPV 16 HPV 18

What HPV viruses does the Gardasil vaccine protect against?

HPV 6,11,16,18

What virus causes genital lesions?

Herpes Simplex Virus 1 and 2

Which Herpes simplex virus causes cold sores an genital lesions?

HSV 1

What herpes simplex virus only causes genital lesions?

HSV 2

What is a HSV infection like?

Lifelong infection, get initial then recurrent (first infection is worst)

What are the symptoms or HSV infection?

Can be aymptomatic initially Ulcers and blisters (genital, mouth and anus) Systemic symptoms

How do you test for HSV?

PCR/NAAT following a swab

How is HSV treated?

Acyclovir (antiviral) Doesn’t eradicate infection just reduces severity

What is the causative organism of syphilis?

Treponema pallidum

What type of organism is treponema pallidum (cause of syphilis)?

Coiled shaped bacteria (spirochete)

What are the types of syphilis?

Primary syphilis Secondary syphilis Tertiary syphilis

How does primary syphilis present?

Typically a single painless ulcer

Why is syphilis often dangerous?

Normally goes undiagnosed for a while so progresses to secondary and tertiary syphilis leading to neurological and cardiovascular damage

How is syphilis treated?

Penicillin

Why are coinefctions common with STIs?

All transmitted the same way Some often asymptomatic

How are patients educated when treating STIs?

Use protection Reduce number of sexual partners Avoid sex until course of treatment is complete

How are non STI infections managed?

Appropriate drugs (metronidazole) Remove precipitating features Patient education (vaginal hygiene)

What is pelvic inflammatory disease?

Infection of the upper genital tract

What are some of the pelvic inflammatory diseases? (Infections seceding from the endocervix)

Endometritis Salpingitis Parametritis Oophoritis Tubo-ovarian abscess Pelvic peritonitis

What is salpingitis?

Inflammation of the fallopian tubes

What is parametritis?

Inflammation of pelvic floor fascia

What is oophoritis?

Infection of ovaries

What is a tubo-ovarian abscess?

Collection of infection around the tubes

What is the main cause of Pelvic Inflammatory Disease?

STIs Chlamydia trichomatis Neisseria Gonorrhoeae Mycoplasma gentialium

What are the symptoms of Pelvic Inflammatory disease?

Pelvic/lower abdominal pain Discharge Post goital/Intermenstrual bleeding Fever Dyspareunia RUQ pain due to peri hepatitis (Fitz-Hugh-Curtis syndrome) 2ndary dysmenorrhoea

What are the signs of PID?

Lower abdominal tenderness Adnexal (low down in pelvis) tenderness Pain when moooved uterus on bimanual vaginal exam Discharge on speculum exam Fever

What are some complications of PID?

Sepsis Peritonitis Chronic pelvic pain Infertility (adhesions blocking tubes) Ectopic pregnancy Fitz-Hugh-Curtis syndrome caused by peri-hepatitis

How is PID managed?

Admit if unwell since risk of sepsis (peritonitis , fever etc…) Antibiotics

What antibiotics are used to treat pelvic inflammatory disease? What dose and time period?

Ofloxacin 400mg twice per day Metronidazole 400mg twice per day Both for 14 days

Lecture 10 - Infections Of The Repro Tract Flashcards

(81 cards)