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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
Symptoms of thrush
Should ask if itchy Thick, white discharge
26
BV caused by
gardnerella vaginalis
27
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
28
BV can make you
susceptible to other infections
29
Symptoms of BV
Offensive white discharge
30
other causes of discharge in women
physiological ## Footnote Secretory phase (progesterone) Thicker cervical mucus Is it cyclical? Other symptoms Colour?
31
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**
32
summary of discharge in women
33
general management of discharge
* Co-infections are common * May be asymptomatic * Consider screening for others * Start with presenting complaint
34
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
35
NSTI management of discharge in women
Candia= antifungals (fluconazole) BV= antibiotics (metronidazole) Patient education vaginal hygiene and COCP
36
Candia treatment
fluconazole
37
BV treatment
BV= antibiotics (metronidazole)
38
genital lesion can be caused by
* human papillomavirus (HPV) * Herpes simplex virus * treponema pallidum (syphillus)
39
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
40
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
41
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)
42
Herpes simplex virus Symptoms
43
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
44
45
diagnosis of herpes simplex virus
PCRT/ NAAT (nuceic acid amplifcation test)
46
Treatment of herpes simplex infection
Antiviral e.g. acyclovir Decrease duration/ severity of current episode Decrease frequency of future infections
47
Treponema pallidum (syphilis)
* Bacterial infection * Direct and vertical transmission * 40% co-infected with HIV
48
risk factors of syphillus
49
Stages of syphilis
* **Primary** syphilis- Painless ulcer (usually singular) * **Secondary** syphilis (Untreated- 25% ) * 9-10 weeks untreated * Glomerulo nephritis * Hepatitis * Neuro problems
50
detection of syphilis
Detection- microscopy and PCR
51
52
pelvic inflammaotry disease
Inflammation of the uterus, fallopian tubes and ovaries
53
which infectons can cause PID
Chlamydia trachomatis Neisseria gonorrhoea Gardnerella vaginalis (non-STI)
54
causes of PID
* Unprotected sex * Intrauterine devices (contraception) * Uterine interventions * Termination of pregnancy * Hysterosalpingogram
55
symptoms of PID
* Lower abdominal pain * Chronic * Painful intercourse * Discharge * Abnormal uterine bleeding (PCB/IMB) * +/- fever * Bimanual vaginal examination * Speculum (Discharge and cervicitis)
56
PID Differentials
* Appendicitis * UTIs * Ectopic pregnancy * Ovarian cysts * Endometriosis
57
complications of PID
* Chronic pelvic pain * Abscess (tubo-ovarian) * Subfertility * Scarring = risk of ectopic pregnancy * Peritonitis * Fitz- high Curtis syndrome
58
Fitz- high Curtis syndrome
Perihepatitis- a rare disorder that happens when pelvic inflammatory disease (PID) causes swelling of the tissue around the liver.
59
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

Reproductive system (28 decks)

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