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Reproductive system > Lecture 12- Infections of the reproductive tract > Flashcards

Lecture 12- Infections of the reproductive tract Flashcards

1
Q

STIs are more prevalent in

A

men than female

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2
Q

there has been an increase in……. and …….. but a decrease in

A

Increase chlamydia/gonorrhoea

Decrease genital warts

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3
Q

RFs

A
  • Multiple sexual partners
  • No barrier contraception
  • Early age first intercourse
  • Certain sexual practices
  • Sexual acts that can tear or break the skin
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4
Q

which reproductive tract infections in males can cause urethral discharge

A

Chlamydia trachomatis

Neisseria gonorrhoea (gonococcus)

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5
Q

Chlamydia trachomatis

A

gram negative

obligate intracellular bacteria

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6
Q
A
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7
Q

Chlamydia trachomatis

A
  • 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)
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8
Q

chlamydia symptoms

A
  • Can be asymptomatic
  • Testicular pain
  • May have discharge
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9
Q

Neisseria gonorrhoea (gonococcus)

A
  • Gram negative, unencapsulated – pilated
  • Enhance attachment to mucosal surfaces= important VF
  • Can cause disseminated infections e.g. reactive arthritis
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10
Q

Symptoms of gonorrhoea

A
  • 90% of men are symptomatic
  • Yellow discharge
  • Increase dysuria
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11
Q

Non- gonococcal Urethritis (NGU)

A

Inflammation of the urethra with associated discharge

Can be caused by other organisms e.g. mycoplasma

Can be pathogen negative

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12
Q

Management of NGU

A

Test for other organisms

Prescribe Ab

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13
Q

Symptoms of NGU

A

Dysuria

associated discharge

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14
Q

investigations for men with discharge and other STI symptoms

A
  • WBC
  • FBC
  • CRP
  • Urine sample
    • In gonorrhoea, chlamydia and NGU microscopy
    • Exclude UTI
    • In chlamydia- nucleic acid amplification test
  • Urethral swab- gonnorhoea
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15
Q

STI causes of discharge in females

A

N. gonorrhoea

C. trachomatis

Trichomonas vaginalis

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16
Q

N-STI causes of discharge in females

A

Candida albicans (candidiasis)

Bacterial vaginosis – BV

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17
Q

with STIs women are more often

A

asymptomatic than men- screening

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18
Q

Chlamydia trachomatis can present in females with

A
  • 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.
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19
Q

Trichomonas vaginalis

A
  • 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)
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20
Q
A
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21
Q

Symptoms of trichomonas vaginalis

A

Yellow, offensive discharge

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22
Q

Treatment of trichomonas vaginalis

A
  • metronidazole (even though not bacteria)
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23
Q

Candida albicans (candidiasis)

A

Thrush

Yeast

Normal flora

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24
Q

RF of thrush

A

Immunocompromised

Diabetes

Increased oestrogen (COCP)

Recent Abx use

25
Q

Symptoms of thrush

A

Should ask if itchy

Thick, white discharge

26
Q

BV caused by

A

gardnerella vaginalis

27
Q

gardnerella vaginalis protected against by

A
  • Lactobacillus is a protective factor–> creates acidic pH
  • If reduced amounts e.g. if excessive vaginal cleaning can allows proliferation with other organisms
28
Q

BV can make you

A

susceptible to other infections

29
Q

Symptoms of BV

A

Offensive white discharge

30
Q

other causes of discharge in women

A

physiological

Secretory phase (progesterone)

Thicker cervical mucus

Is it cyclical?

Other symptoms

Colour?

31
Q

Investigations for women with vaginal discharge

A
  • Vulvovaginal swabs and Endocervical swabs
    • Chlamydia
    • gonorrhoea
  • High vaginal swabs
    • Trichomoniasis
    • BV
    • Candida (microscopy rather than culture)
  • Urine dip less sensitive in females
32
Q

summary of discharge in women

A
33
Q

general management of discharge

A
  • Co-infections are common
  • May be asymptomatic
  • Consider screening for others
  • Start with presenting complaint
34
Q

STI management

A

if bacterial…..

  • Azithromycin and ceftriaxone
  • Target gonorrhoea and chlamydia
  • One Abx can augment (make greater) the effect of the other

PATIENT EDUCATION- SAFE SEX

35
Q

NSTI management of discharge in women

A

Candia= antifungals (fluconazole)

BV= antibiotics (metronidazole)

Patient education vaginal hygiene and COCP

36
Q

Candia treatment

A

fluconazole

37
Q

BV treatment

A

BV= antibiotics (metronidazole)

38
Q

genital lesion can be caused by

A
  • human papillomavirus (HPV)
  • Herpes simplex virus
  • treponema pallidum (syphillus)
39
Q

Human papillomavirus (HV)

A
  • 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
40
Q

which HPV causes 90% of viruses and which cause cervical cancer

A
  • Type 6 and 11 give 90% of infections
  • 16 and 18 cause cervical cancer
41
Q

Herpes simplex virus

A

HSV- multiple in epithelial cells of mucosal surfaces genital and oral herpes

Lifelong infection and recurrent (can be given to baby during delivery)

42
Q

Herpes simplex virus Symptoms

A
43
Q

genital lesions caused by herpes simplex virus can affect

A
  • affect genital/ oral/ anus
  • HSV 1
    • Usually oral
  • HSV 2
    • More likely to be associated with HIV infection
44
Q
A
45
Q

diagnosis of herpes simplex virus

A

PCRT/ NAAT (nuceic acid amplifcation test)

46
Q

Treatment of herpes simplex infection

A

Antiviral e.g. acyclovir

Decrease duration/ severity of current episode

Decrease frequency of future infections

47
Q

Treponema pallidum (syphilis)

A
  • Bacterial infection
  • Direct and vertical transmission
  • 40% co-infected with HIV
48
Q

risk factors of syphillus

A
49
Q

Stages of syphilis

A
  • Primary syphilis- Painless ulcer (usually singular)
  • Secondary syphilis (Untreated- 25% )
    • 9-10 weeks untreated
    • Glomerulo nephritis
    • Hepatitis
    • Neuro problems
50
Q

detection of syphilis

A

Detection- microscopy and PCR

51
Q
A
52
Q

pelvic inflammaotry disease

A

Inflammation of the uterus, fallopian tubes and ovaries

53
Q

which infectons can cause PID

A

Chlamydia trachomatis

Neisseria gonorrhoea

Gardnerella vaginalis (non-STI)

54
Q

causes of PID

A
  • Unprotected sex
  • Intrauterine devices (contraception)
  • Uterine interventions
  • Termination of pregnancy
  • Hysterosalpingogram
55
Q

symptoms of PID

A
  • Lower abdominal pain
  • Chronic
  • Painful intercourse
  • Discharge
  • Abnormal uterine bleeding (PCB/IMB)
  • +/- fever
  • Bimanual vaginal examination
  • Speculum (Discharge and cervicitis)
56
Q

PID Differentials

A
  • Appendicitis
  • UTIs
  • Ectopic pregnancy
  • Ovarian cysts
  • Endometriosis
57
Q

complications of PID

A
  • Chronic pelvic pain
  • Abscess (tubo-ovarian)
  • Subfertility
  • Scarring = risk of ectopic pregnancy
  • Peritonitis
  • Fitz- high Curtis syndrome
58
Q

Fitz- high Curtis syndrome

A

Perihepatitis- a rare disorder that happens when pelvic inflammatory disease (PID) causes swelling of the tissue around the liver.

59
Q

Management of PID

A
  • 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

Reproductive system (28 decks)

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