Lecture 12- Infections of the reproductive tract Flashcards
STIs are more prevalent in
men than female
there has been an increase in……. and …….. but a decrease in
Increase chlamydia/gonorrhoea
Decrease genital warts
RFs
- Multiple sexual partners
- No barrier contraception
- Early age first intercourse
- Certain sexual practices
- Sexual acts that can tear or break the skin
which reproductive tract infections in males can cause urethral discharge
Chlamydia trachomatis
Neisseria gonorrhoea (gonococcus)
Chlamydia trachomatis
gram negative
obligate intracellular bacteria
Chlamydia trachomatis
- Obligate intracellular bacterium
- Chlamydia prevents fusion of phagosome and lysosome- so its not broken down and can stay within the cells- VF
- Has an outer membrane similar to gram negative bacteria (but lacks a peptidoglycan cell wall)
chlamydia symptoms
- Can be asymptomatic
- Testicular pain
- May have discharge
Neisseria gonorrhoea (gonococcus)
- Gram negative, unencapsulated – pilated
- Enhance attachment to mucosal surfaces= important VF
- Can cause disseminated infections e.g. reactive arthritis
Symptoms of gonorrhoea
- 90% of men are symptomatic
- Yellow discharge
- Increase dysuria
Non- gonococcal Urethritis (NGU)
Inflammation of the urethra with associated discharge
Can be caused by other organisms e.g. mycoplasma
Can be pathogen negative
Management of NGU
Test for other organisms
Prescribe Ab
Symptoms of NGU
Dysuria
associated discharge
investigations for men with discharge and other STI symptoms
- WBC
- FBC
- CRP
- Urine sample
- In gonorrhoea, chlamydia and NGU microscopy
- Exclude UTI
- In chlamydia- nucleic acid amplification test
- Urethral swab- gonnorhoea
STI causes of discharge in females
N. gonorrhoea
C. trachomatis
Trichomonas vaginalis
N-STI causes of discharge in females
Candida albicans (candidiasis)
Bacterial vaginosis – BV
with STIs women are more often
asymptomatic than men- screening
Chlamydia trachomatis can present in females with
- Can present with other symptoms like PCB – bleeding after sex and IMB- intermenstrual bleeding)
- Dyspareunia- recurring pain in the genital area or within the pelvis during sexual intercourse.
Trichomonas vaginalis
- Protozoa (flagellates)
- Propel cell through liquid environment- VF
- Optimal growth occurs at pH 6 (vaginal pH lower pH – 4/ therefore any condition which increases pH will increase risk of trichomoniasis)
Symptoms of trichomonas vaginalis
Yellow, offensive discharge
Treatment of trichomonas vaginalis
- metronidazole (even though not bacteria)
Candida albicans (candidiasis)
Thrush
Yeast
Normal flora
RF of thrush
Immunocompromised
Diabetes
Increased oestrogen (COCP)
Recent Abx use
Symptoms of thrush
Should ask if itchy
Thick, white discharge
BV caused by
gardnerella vaginalis
gardnerella vaginalis protected against by
- Lactobacillus is a protective factor–> creates acidic pH
- If reduced amounts e.g. if excessive vaginal cleaning can allows proliferation with other organisms
BV can make you
susceptible to other infections
Symptoms of BV
Offensive white discharge
other causes of discharge in women
physiological
Secretory phase (progesterone)
Thicker cervical mucus
Is it cyclical?
Other symptoms
Colour?
Investigations for women with vaginal discharge
- Vulvovaginal swabs and Endocervical swabs
- Chlamydia
- gonorrhoea
- High vaginal swabs
- Trichomoniasis
- BV
- Candida (microscopy rather than culture)
- Urine dip less sensitive in females
summary of discharge in women
general management of discharge
- Co-infections are common
- May be asymptomatic
- Consider screening for others
- Start with presenting complaint
STI management
if bacterial…..
- Azithromycin and ceftriaxone
- Target gonorrhoea and chlamydia
- One Abx can augment (make greater) the effect of the other
PATIENT EDUCATION- SAFE SEX
NSTI management of discharge in women
Candia= antifungals (fluconazole)
BV= antibiotics (metronidazole)
Patient education vaginal hygiene and COCP
Candia treatment
fluconazole
BV treatment
BV= antibiotics (metronidazole)
genital lesion can be caused by
- human papillomavirus (HPV)
- Herpes simplex virus
- treponema pallidum (syphillus)
Human papillomavirus (HV)
- DNA virus
- Non-enveloped
- Genital or cutaneous warts
- Type 6 and 11 give 90% of infections
- 16 and 18 cause cervical cancer
- Vaccination
- Gardasil
- Cervavix
- Investigations
- Swab/ biopsy- PCR
which HPV causes 90% of viruses and which cause cervical cancer
- Type 6 and 11 give 90% of infections
- 16 and 18 cause cervical cancer
Herpes simplex virus
HSV- multiple in epithelial cells of mucosal surfaces genital and oral herpes
Lifelong infection and recurrent (can be given to baby during delivery)
Herpes simplex virus Symptoms
genital lesions caused by herpes simplex virus can affect
- affect genital/ oral/ anus
- HSV 1
- Usually oral
- HSV 2
- More likely to be associated with HIV infection
diagnosis of herpes simplex virus
PCRT/ NAAT (nuceic acid amplifcation test)
Treatment of herpes simplex infection
Antiviral e.g. acyclovir
Decrease duration/ severity of current episode
Decrease frequency of future infections
Treponema pallidum (syphilis)
- Bacterial infection
- Direct and vertical transmission
- 40% co-infected with HIV
risk factors of syphillus
Stages of syphilis
- Primary syphilis- Painless ulcer (usually singular)
-
Secondary syphilis (Untreated- 25% )
- 9-10 weeks untreated
- Glomerulo nephritis
- Hepatitis
- Neuro problems
detection of syphilis
Detection- microscopy and PCR
pelvic inflammaotry disease
Inflammation of the uterus, fallopian tubes and ovaries
which infectons can cause PID
Chlamydia trachomatis
Neisseria gonorrhoea
Gardnerella vaginalis (non-STI)
causes of PID
- Unprotected sex
- Intrauterine devices (contraception)
- Uterine interventions
- Termination of pregnancy
- Hysterosalpingogram
symptoms of PID
- Lower abdominal pain
- Chronic
- Painful intercourse
- Discharge
- Abnormal uterine bleeding (PCB/IMB)
- +/- fever
- Bimanual vaginal examination
- Speculum (Discharge and cervicitis)
PID Differentials
- Appendicitis
- UTIs
- Ectopic pregnancy
- Ovarian cysts
- Endometriosis
complications of PID
- Chronic pelvic pain
- Abscess (tubo-ovarian)
- Subfertility
- Scarring = risk of ectopic pregnancy
- Peritonitis
- Fitz- high Curtis syndrome
Fitz- high Curtis syndrome
Perihepatitis- a rare disorder that happens when pelvic inflammatory disease (PID) causes swelling of the tissue around the liver.
Management of PID
- Prevention is better than cure
- Antibiotics- don’t wait for swab
- Broad spectrum
- Pyrexia or signs of peritonitis IV Abx
- Pain relief- analgesia
- Contact screening
- Laparoscopy is essential if patient fails to respond to treatment e.g. don’t wanna miss ectopic pregnancy or endometriosis
