Lecture 10.2: Infections of the Reproductive Tract Flashcards
1
Q
Common Endogenous Infections (2)
A
- Bacterial Vaginosis
- Candidiasis
2
Q
Common STIs (7)
A
- Chlamydia trachomatis
- Neisseria gonorrhoea
- Genital warts (HPV)
- Genital herpes
- Syphilis
- Trichomonas vaginalis
- Mycoplasma genitalium
3
Q
Sexual History (13)
A
- 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
4
Q
What is Bacterial Vaginosis?
A
- Imbalance of vaginal bacteria
- Most common cause of abnormal discharge
5
Q
Amsel’s Criteria
A
- Characteristic thin/watery, white/grey discharge
- Vaginal pH >4.5
- Clue cells
- Fishy odour on ‘whiff test’
6
Q
Treatment of Bacterial Vaginosis (2)
A
- Lifestyle advice
- Antibiotics
7
Q
What is Candidiasis/Thrush?
A
- Candida albicans
- Second most common cause of abnormal discharge
8
Q
Symptoms of Candidiasis/Thrush (6)
A
- Cottage cheese-like / clumpy discharge
- Vulval itching
- Irritation
- Soreness
- Swelling
- Dysuria
9
Q
Treatment of Candidiasis/Thrush (2)
A
- Clotrimazole fluconazole
- Emollients/aqueous cream
10
Q
Laboratory Tests for Infections of the Reproductive Tract (4)
A
- NAAT: detect and amplify either RNA or DNA
- Microscopy, culture and sensitivity
- PCR
- Serological Testing
11
Q
What is Chlamydia caused by?
A
Chlamydia trachomatis
12
Q
Triad of …… can be triggered by chlamydial
infection
A
- Urethritis
- Arthritis
- Conjunctivitis
13
Q
What can untreated Chlamydia and Gonorrhoea lead to?
A
- Epididymo-orchitis
- Pelvic inflammatory disease (~16% if untreated)
14
Q
What is Epididymo-orchitis?
A
Pain and swelling in 1 or both testicles
15
Q
What is Gonorrhoea caused by?
A
Neisseria gonorrhoea
16
Q
What percentage of men and women have asymptomatic Gonorrhoea?
A
- > 90% of men are symptomatic
- > 50% of women are symptomatic
17
Q
What is Pelvic Inflammatory Disease?
A
Pelvic inflammatory disease is an infection of the upper genital tract, including the womb, ovaries and connecting tubes
18
Q
Signs and Symptoms of PID (9)
A
- 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)
19
Q
Complications of Epididymo-orchitis? (3)
A
- Reactive hydrocoele
- Abscess formation
- Infertility
20
Q
Complications of PID? (7)
A
- Peritonitis
- Tubo-ovarian abscess
- Infertility: 1 in 10 with PID
- Increased risk of ectopic pregnancy
- Chronic pelvic pain
- Adhesions
- Perihepatitis (Fitz-Hugh Curtis syndrome)
21
Q
What is Trichomoniasis?
A
Infection caused by a one-celled protozoan, a type of tiny parasite called Trichomonas vaginalis
22
Q
Symptoms of Trichomoniasis (in Men & Women)
A
- Males: Dysuria
- Females: Abnormal Discharge (70%), Vulval Itching/
Pain, Dyspareunia
23
Q
What is Syphilis cause by?
A
Caused by Treponema pallidum bacterium
24
Q
Stages of Syphilis: First Few Years
A
No signs and symptoms
25
Stages of Syphilis: Primary Stage
Sore/chancre found in genital area
Chancres do not result in pain and disappear without treatment
26
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
27
Stages of Syphilis: Tertiary Stage
* Blood Vessel Problems
* Cardiac Problems
* Nervous System Problems
* Damaged Organs
* Gummatous syphilis
* Death
28
Stages of Syphilis: Latent Stage
* Symptoms disappear for 1-20 years
* Relapse Symptoms
29
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
30
How to Treat Chlamydia?
Doxycycline 100mg twice a day for 7 days
31
How to Treat Gonorrhoea?
Ceftriaxone 1g IM
32
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
33
How to Treat Epididymo-orchitis?
Ceftriaxone 500mg IM AND Doxycycline 100mg twice a day for 10-14 days
34
How to Treat Trichomonas vaginalis?
Metronidazole 400mg twice a day for 5-7 days
35
How to Treat Syphilis?
Benzylpenicillin G 2.4 MU IM
36
What are Genital Warts?
Benign, fleshy, irregular growths
37
What is Genital Herpes caused by?
Herpes Simplex Virus (HSV)
38
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)
39
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
40
Complications of Genital Herpes (3)
* Autonomic neuropathy – urinary retention
* Disseminated infection
* Psychological and psychosexual problems
41
What is HSV-1?
Average 1 recurrence in first 12 months
42
What is HSV-2?
Average 4-5 recurrences in first 12 months
43
Treatment of Genital Warts (6)
* Stopping smoking
* Cream
* Cryotherapy
* Electrocautery
* Laser
* Surgical excision
44
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
45
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
46
What is Monkeypox?
A species of double-stranded DNA virus that causes mpox in humans and other mammals
47
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
48
Death Rate of Monkeypox?
1-10% fatal
