Lecture 7.1: Infections of the Genital Tract Flashcards
Where are microorganisms commonly found in the male genitals?
Microorganisms commonly found at foreskin at the hood of the penis
Why is the female genitourinary tract so susceptible to infections?
- Many openings in one place (3)
- Short urinary tract (4 times shorter than males)
- No particular cleansing mechanisms
What does Venereal mean?
Relating to sexual desire or sexual intercourse
Infections of the Reproductive Tract: Non-Venereal
- Bacterial Vaginosis
- TSS
- Bartholin Gland Infections
- Vulvo-Vaginal Candidiasis (Thrush)
Infections of the Reproductive Tract: Venereal Types
- Bacterial
- Viral
- Parasitic
Infections of the Reproductive Tract: Venereal [Bacterial]
- Syphills
- Gonorrhoea
- Chlamydia
Infections of the Reproductive Tract: Venereal [Viral]
- HPV
- HIV
- Herpes
- Hep B
Infections of the Reproductive Tract: Venereal [Parasitic]
- Trichomoniasis
- Public Lice
- Scabies
What are some Vaginal Defences? (7)
- High oestrogen states cause proliferation of vaginal epithelium
- Increased glycogen encourages Lactobacilli to produce lactic acid.
- Normal vaginal pH 3.8-4.5
- Epithelial mucosal barrier
- Produces hydrogen peroxide
- Produces bacteriocins
- Normal vaginal discharge: Contains IgA and IgG, mucins
Risk Factors for Dysbiosis: Individual (6)
- Genetic
- Sexual Practices
- Diet
- Smoking
- Hygiene
- Race
Risk Factors for Dysbiosis: Relational (4)
- Sexual Network
- Social Network
- Housing Arrangement
- Behavioural Norms (polygamy…etc)
Risk Factors for Dysbiosis: Community (4)
- Built Environment
- Poverty
- Food Alert
- Stress
Risk Factors for Dysbiosis: Societal (3)
- Racism
- Politics
- Segregation
What is Bacterial Vaginosis?
- Vaginal inflammation caused by dysbiosis
- Most common cause is Gardnerella vaginalis
- Most prevalent cause of vaginal discharge or malodor
Bacterial Vaginosis: Signs and Symptoms (3)
- Fishy smell
- Thin grey/white discharge
- 50% asymptomatic
Bacterial Vaginosis: Investigation (4)
- History of new vaginal products
- Test the pH of the discharge
- Whiff test (add KOH to sample)
- High vaginal swab: Clue cells
Bacterial Vaginosis: Treatment and Management (4)
- Stop using products on vagina
- Oral metronidazole
- Intravaginal metronidazole gel
- STI screen – higher risk
What is Vulvo-Vaginal Candidiasis (Thrush)?
- A symptomatic inflammation of the vagina and/or vulva
- Caused by a superficial fungal infection, usually with Candida albicans
- Candida is opportunistic and competes with lactobacilli within the vagina
Vulvo-Vaginal Candidiasis (Thrush): Signs and Symptoms (5)
- Vulval/vaginal itching
- Vaginal soreness
- White ‘cheese-like’ discharge
- Dysuria
- Superficial dyspareunia
Vulvo-Vaginal Candidiasis (Thrush): Investigations (2)
- Diagnosis by examination
* Swabs done to EXCLUDE alternate diagnosis
Vulvo-Vaginal Candidiasis (Thrush): Treatment and Management (5)
- Avoid irritants on the vagina
- Loose fitting undergarments
- Topical antifungals: Clotrimazole Cream
- Oral Fluconazole
- Control underlying conditions? T2DM
What are Bartholin’s Glands?
- The Bartholin’s glands are a pair of pea-sized glands
* Located at entrance of the vagina at 5 o’clock and 7 o’clock
Abscess of Bartholin’s Glands
They are usually unilateral, tense, and nonpainful
Abscess of Bartholin’s Glands: Signs and Symptoms (4)
- Erythema
- Acute Tenderness
- Oedema
- Occassionally cellulitis of the surrounding subcutaneous tissue
Abscess of Bartholin’s Glands: Treatment (4)
- Classical surgical treatment – Marsipulisation
- Cut and drain abscess
- Stitch skin edges to form ‘kangaroo pouch’
- Allows for drainage
The Five P’s of Diagnosing STIs
1) Partners
2) Practices
3) Prevention of Pregnancy
4) Protection from STDs
5) Past history of STDs
What is Chlamydia? How does it cause Infection? (5)
- Chlamydia trachomatis
- Gram-negative bacterium
- Can only replicate WITHIN a host cell
- No cell wall, just two cell membranes
- Enters by breaks in mucous membranes
- 2 forms in its life cycle: Elementary body (EB) & Reticulate body (RB)
Chlamydia in Women: Signs and Symptoms (7)
- Purulent vaginal or cervical discharge
- Post-coital bleeding
- Intermenstrual bleeding
- Deep dyspareunia
- Dysuria
- Pelvic pain and tenderness
- Cervical motion tenderness
Chlamydia in Women: Investigations (4)
- Speculum – hypertrophic cervix
- Endocervical swab
- First catch urine sample
- Self-taken vulvo-vaginal swab
Why is Chlamydia so hard to diagnose?
- 70% Asymptomatic in Women
- 50% Asymptomatic in Men
Chlamydia in Men: Signs and Symptoms (5)
- Mucopurulent urethral discharge
- Urethritis
- Dysuria
- Epididymo-orchitis
- Reactive arthritis
Chlamydia in Men: Investigations (2)
- First catch urine sample
- Urethral swab
What is a Nucleic Acid Amplification Test (NAAT)?
A nucleic acid test is a technique used to detect a particular nucleic acid sequence and thus usually to detect and identify a particular species or subspecies of organism
Chlamydia: Treatment and Management (6)
- 7 days of oral doxycycline BD
- Or a single dose of azithromycin)
- Avoid intercourse and oral sex until treatment completed
- Treat patient AND partner(s)
- Reinforce healthcare education
- Offer repeat testing 3-6 months after treatment
Complications of Chlamydia (7)
- Lymphogranuloma Venereum
- Conjunctivitis
- Reactive Arthritis
- Pelvic Inflammatory Disease
- Infertility
- Peri-Hepatitis (Fitz-Hugh-Curtis Syndrome)
- Vertical Transmission in Pregnancy (Blindness, Pneumonia, Low Birth Weight)
What is Gonorrhoea?
- Gram- Negative Organism
- Neisseria Gonorrhoea
Gonorrhoea in Women: Signs and Symptoms (7)
- Asymptomatic in 50%
- Vaginal discharge
- Rarely dysuria
- Dyspareunia
- Rarely intermenstrual bleeding
- Bartolin gland infection
- PID – pain, infertility
Gonorrhoea in Men: Signs and Symptoms (3)
- Symptoms appear 2-5 days post-exposure
- Muco-purulent urethral discharge
- Dysuria
Gonorrhoea: Investigations
- Endocervical swab (women)
- First catch urine (men)
Gonorrhoea: Treatment and Management (6)
- Await cultures and sensitivities before prescribing
- Single dose Ciprofloxacin oral or IM Ceftriaxone
- Abstain till 7 days post-treatment
- Treat patient AND partner(s)
- Reinforce healthcare education
- Offer follow-up 7 days post treatment
Complications of Gonorrhoea: Disseminated Gonococcal Infection (6)
- Bacteria multiply in neutrophils
- Travel via blood stream
- Endocarditis
- Meningitis
- Septic arthritis
- Pustular/Petechial lesions
Complications of Gonorrhoea: During Pregnancy (6)
- 30% transmission rate
- Conjunctivitis
- Disseminated gonococcal infection
- Scalp abscess
- Vaginal and rectal infections
- Pharyngeal infections
What is Syphilis?
- Caused by Treponema pallidum bacterium
- Helical cell spirochete
- Too small for gram-staining
- Spread through contact with lesions
- Mother-to-baby transmission
Stages of Syphilis: First Few Years (1)
• No signs and symptoms
Stages of Syphilis: Primary Stage (2)
- Sore/chancre found in genital area
- Chancres do not result in pain and disappear without treatment
Stages of Syphilis: Secondary Stage (9)
- 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
Stages of Syphilis: Tertiary Stage
- Blood Vessel Problems
- Cardiac Problems
- Nervous System Problems
- Damaged Organs
- Gummatous syphilis
- Death
Stages of Syphilis: Latent Stage (2)
- Symptoms disappear for 1-20 years
- Relapse Symptoms
Syphilis: Investigations (3)
- Lesion Swabs
- Treponemal Enzyme Immunoassay (EIA)
- Blood Test
Syphilis: Treatment and Management (3)
- Penicillin
- Contact tracing
- Follow-up over 2 years
