Lecture 29 - Urethritis, Cervicitis and Ball Pain

Question 1

Urethritis?

Answer 1

condition in symptomatic males (discharge, dysuria) w >5 PMNL per HPF

Question 2

Litre’s glands?

Answer 2

urethral glands releasing physiological discharge to protect epithelium against urine

Question 3

Abnormal causes of vaginal discharge?

Answer 3

cervicitis, genital candidiasis, bacterial vaginosis, foreign body

Question 4

Chlamydia physiology?

Answer 4

deficient in endogenous ATP so parasites the host, antibodies against major outer protein can neutralise the organism, short term immunity develops, recurrent infection produces severe inflammation, body develops immunity to chlamydial HSP w cross immunity to human HSP

Question 5

Nucleic acid test? NAAT

Answer 5

DNA amplification, high sensitivity and specificity, little false positive problems, fewer storage and handling problems, can be automated

Question 6

Specimen collection?

Answer 6

Male: FVU; Female: vulvovaginal swab for NAAT, speculum exam. for symptomatic

Question 7

Treatment of uncomplicated Chlamydia?

Answer 7

doxycycline 100mg 7 days, or Azithromycin 1g - treat for 2 reproductive cycles, little antimicrobial resistance

Question 8

Azithromycin?

Answer 8

inhibits translation of bacterial mRNA, GI side effects, risk of long QT syndrome, resistance rare

Question 9

Partner notification?

Answer 9

all partners of last 60-90 days, treat even if negative, advise safe sex during treatment

Question 10

Comoplications of chlamydia - males?

Answer 10

epididymitis and infertility, Reiter’s syndrome, conjunctivits

Question 11

Neisseria gonorrhea?

Answer 11

gram negative diplococcus, human only, oxidase positive

Question 12

Gonorrhea defense mechanisms?

Answer 12

pilin, opa proteins, LOS, serum resistance, IgA1 rotease

Question 13

Gonorrhea specimen collection?

Answer 13

from area of symptoms and areas at risk, can survive room temp 5h (but not drying), 4-8h growth on plate, Amies’ or Stuart’s transport only

Question 14

Gonorrhea growth conditions?

Answer 14

35-37C, 5% CO2, pH 6.5-7.5, Fe requirment, NYC medium (GU soure) or Thayer Martin medum (rectal)

Question 15

Urethral infection of males (G)?

Answer 15

symptomatic (discharge, dysuria), unsymptomatic in 6 mnth if untreated

Question 16

Gonorrhea treatment?

Answer 16

ceftriaxone 500mg (sensitivity unknown), ciprofloxacin 500mg w azithromycin (sensitive) - do not use azithromycin as first line to prevent resistance

Question 17

Gonnorhea complications in males?

Answer 17

epididymitis, lymphangitis, urethral stricture (rare)

Question 18

Rectal infection (G)?

Answer 18

symp or unsym, could be inoculation rather than anal (common in women due to gooch spread)

Question 19

Pharyngeal infection (G)?

Answer 19

oral sex, sore throat or unsym., treat w ceftriaxone and azithromycin

Question 20

Endocervical infection?

Answer 20

most common site, asymp. or discharge, dysuria and menorrhagia, 40% gram positive

Question 21

Pelvic inflammatory disease?

Answer 21

mild (urethritis partner, discharge and bleeding) or moderate/severe (mixed microbial), RUQ pain, LAP, maybe fever

Question 22

PID treatment?

Answer 22

ceftriaxone + doxycycline +/- metrodinazole

Question 23

Non-specific urethritis?

Answer 23

presence of symptoms/signs, ruled out G or C infection, potential causes: mycoplasma genitalium, HSV, or adenovirus

Question 24

Trichomoniasis?

Answer 24

protozoan caused vaginal infection likely in Africa