Lecture 10.2: Infections of the Reproductive Tract Flashcards
Common Endogenous Infections (2)
- Bacterial Vaginosis
- Candidiasis
Common STIs (7)
- Chlamydia trachomatis
- Neisseria gonorrhoea
- Genital warts (HPV)
- Genital herpes
- Syphilis
- Trichomonas vaginalis
- Mycoplasma genitalium
Sexual History (13)
- Pain: SOCRATES, dyspareunia, dysuria
- Discharge: colour, consistency, smell
- Bleeding: change, timing
- Skin: lumps, itchiness, irritation, lesions
- Systems Review
- Last menstrual period
- Last sexual intercourse
- Type of sexual intercourse
- Contraception / condom use
- Partners in the last 3mths
- STI history
- Travel history
- Smear history
What is Bacterial Vaginosis?
- Imbalance of vaginal bacteria
- Most common cause of abnormal discharge
Amsel’s Criteria
- Characteristic thin/watery, white/grey discharge
- Vaginal pH >4.5
- Clue cells
- Fishy odour on ‘whiff test’
Treatment of Bacterial Vaginosis (2)
- Lifestyle advice
- Antibiotics
What is Candidiasis/Thrush?
- Candida albicans
- Second most common cause of abnormal discharge
Symptoms of Candidiasis/Thrush (6)
- Cottage cheese-like / clumpy discharge
- Vulval itching
- Irritation
- Soreness
- Swelling
- Dysuria
Treatment of Candidiasis/Thrush (2)
- Clotrimazole fluconazole
- Emollients/aqueous cream
Laboratory Tests for Infections of the Reproductive Tract (4)
- NAAT: detect and amplify either RNA or DNA
- Microscopy, culture and sensitivity
- PCR
- Serological Testing
What is Chlamydia caused by?
Chlamydia trachomatis
Triad of …… can be triggered by chlamydial
infection
- Urethritis
- Arthritis
- Conjunctivitis
What can untreated Chlamydia and Gonorrhoea lead to?
- Epididymo-orchitis
- Pelvic inflammatory disease (~16% if untreated)
What is Epididymo-orchitis?
Pain and swelling in 1 or both testicles
What is Gonorrhoea caused by?
Neisseria gonorrhoea
What percentage of men and women have asymptomatic Gonorrhoea?
- > 90% of men are symptomatic
- > 50% of women are symptomatic
What is Pelvic Inflammatory Disease?
Pelvic inflammatory disease is an infection of the upper genital tract, including the womb, ovaries and connecting tubes
Signs and Symptoms of PID (9)
- Pelvic pain (usually bilateral)
- Painful intercourse (dyspareunia)
- New onset painful periods (secondary
dysmenorrhoea) - Fever
- Abnormal discharge
- Abnormal vaginal bleeding (PCB/IMB)
- Endometritis
- Oophoritis
- Salpingitis (inflamed fallopian tubes)
Complications of Epididymo-orchitis? (3)
- Reactive hydrocoele
- Abscess formation
- Infertility
Complications of PID? (7)
- Peritonitis
- Tubo-ovarian abscess
- Infertility: 1 in 10 with PID
- Increased risk of ectopic pregnancy
- Chronic pelvic pain
- Adhesions
- Perihepatitis (Fitz-Hugh Curtis syndrome)
What is Trichomoniasis?
Infection caused by a one-celled protozoan, a type of tiny parasite called Trichomonas vaginalis
Symptoms of Trichomoniasis (in Men & Women)
- Males: Dysuria
- Females: Abnormal Discharge (70%), Vulval Itching/
Pain, Dyspareunia
What is Syphilis cause by?
Caused by Treponema pallidum bacterium
Stages of Syphilis: First Few Years
No signs and symptoms
Stages of Syphilis: Primary Stage
Sore/chancre found in genital area
Chancres do not result in pain and disappear without treatment
Stages of Syphilis: Secondary Stage
- Skin Rash (reddish brown spots on back, palms and
soles of feet) - Mucous membrane lesions throughout body but no
itchiness - Fever
- Sore Throat
- Headache
- Swollen Glands
- Weight Loss
- Myalgia
- Fatigue
Stages of Syphilis: Tertiary Stage
- Blood Vessel Problems
- Cardiac Problems
- Nervous System Problems
- Damaged Organs
- Gummatous syphilis
- Death
Stages of Syphilis: Latent Stage
- Symptoms disappear for 1-20 years
- Relapse Symptoms
Management of all patients with an STI should include…? (5)
- Referral to a GUM clinic
- Partner notification
- Testing for other STIs
- Advice re safe sex practices
- Support, counselling and education as required
How to Treat Chlamydia?
Doxycycline 100mg twice a day for 7 days
How to Treat Gonorrhoea?
Ceftriaxone 1g IM
How to Treat PID?
Doxycycline 100mg twice a day for 14 days AND
metronidazole 400mg twice a day for 14 days AND
ceftriaxone 1g IM
How to Treat Epididymo-orchitis?
Ceftriaxone 500mg IM AND Doxycycline 100mg twice a day for 10-14 days
How to Treat Trichomonas vaginalis?
Metronidazole 400mg twice a day for 5-7 days
How to Treat Syphilis?
Benzylpenicillin G 2.4 MU IM
What are Genital Warts?
Benign, fleshy, irregular growths
What is Genital Herpes caused by?
Herpes Simplex Virus (HSV)
What does the average Herpes infection cycle look like?
- Small painful vesicles surrounded by a zone of
erythema (3-5 days after infection) - Vesicles become pustular and break down to form
superficial erosions that coalesce to form ulcers (24-
48hrs after initial vesicles) - Lesions heal, virus becomes latent (10-14 days after
pustular vesicles) - Lesions and/or abnormal sensation returns
(Reactivation)
Symptoms of Genital Herpes (7)
- Flu-like symptoms (fever, muscle aches)
- Tingling/itching sensation prior to outbreak
- Bilateral tender inguinal lymphadenopathy
- Painful lesions usually bilaterally
- Dysuria
- Discharge from the lesions
- Neuropathic symptoms due to inflammation of ganglia
Complications of Genital Herpes (3)
- Autonomic neuropathy – urinary retention
- Disseminated infection
- Psychological and psychosexual problems
What is HSV-1?
Average 1 recurrence in first 12 months
What is HSV-2?
Average 4-5 recurrences in first 12 months
Treatment of Genital Warts (6)
- Stopping smoking
- Cream
- Cryotherapy
- Electrocautery
- Laser
- Surgical excision
Treatment of Genital Herpes (5)
- 1st episode: aciclovir 400mg three times a day for 5
days if within 5 days of Sx, while new lesions are still
forming or if systemic Sx are persistent - Recurrence: episodic / suppressive treatment
- Saline bathing
- Oral analgesia
- Lidocaine gel
What is Mycoplasma genitalium? How can you diagnose & treat it?
- Often asymptomatic
- Common cause of nongonococcal urethritis in males
and PID in females - NAAT diagnosis
- Azithromycin treatment
What is Monkeypox?
A species of double-stranded DNA virus that causes mpox in humans and other mammals
Symptoms of Monkeypox (5)
- Blistering rash- the rash may start on the face or in the
genital area and may spread to other parts of the body - Inflammation of the rectum (proctitis)
- Pain or bleeding from anus
- Fever
- Headache
Death Rate of Monkeypox?
1-10% fatal
