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FHHD > M6 - Genitourinary Infections > Flashcards

M6 - Genitourinary Infections Flashcards

1
Q

What groups of people are mainly at risk

A
  1. Young heterosexuals
  2. Male homosexuals
  3. Minority ethnic groups
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2
Q

What are some of the underlying causes of increases of STD prevalence in the UK

A
  • More tolerance towards sexual diversity and behaviour
  • Inconsistent use of condoms, especially among the younger groups of people
  • High levels of asymptomatic infection
  • Poor access to GUM clinics and sexual health services
  • GUM clinics running at capacity
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3
Q

What bacteria causes gonorrhoea

A

Neisseria Gonorrhoeae

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4
Q

What are the characteristics of neisseria gonorrhoeae

A
  • Human pathogen spread by sexual contact, acute and relatively easy to treat
  • Gram -ve cocci
  • Aerobic
  • Catalase +ve
  • Oxidase +ve
  • Best growth in 5-10% CO2, moist atmosphere
  • Occur in pairs, spherical
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5
Q

How does gonorrhoea present

A
  • Purulent infection of the mucous membrane of the urethra and cervix (also rectal and pharyngeal)
  • Purulent discharge, dysuria
  • Microscope = bacteria seen inside polymorphonuclear cells of the inflammatory exudate
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6
Q

If gonorrhoea is left untreated, what complications can occur

A
  • Epididymitis, can spread to testicle - possibility of infarction (necrosis)
  • Salpingitis inflammation of the fallopian tube - can lead to pelvic inflammation disease and sterility
  • Purulent conjunctivitis in newborn - blindness possible
  • Disseminated gonorrhoea (fever, painful joints, skin lesions)
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7
Q

Describe the treatment of gonorrhoea

A

Penicillin - slow release intramuscular also tetracycline, ceftriaxone
N.B. Beta-lactamase mediated penicillin resistance

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8
Q

What are spirochaetes

A

Spiral bacteria

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9
Q

What is the causative organism of syphilis

A

Treponema Pallidum (spirochaete)

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10
Q

Describe the characteristics of treponema pallidum

A
  • Spiral shaped bacterium
  • Rigid cell
  • Motile - polar flagella enclosed in outer membrane
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11
Q

What can be used to observe treponema pallidum

A
  • Visible through dark ground microscopy, UV microscopy using anti-treponema antibodies linked to fluorescein
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12
Q

How does T.pallidum enter the body

A

Enters by penetration of intact mucosa or through abraded skin
N.B low no. of cells probably required for infection

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13
Q

Describe primary syphilis

A
  • Bacteria multiply at entry site
  • Lesion at approx 3 wks (painless) frequently on external genitalia
  • Chancre (lesion) heals after approx 6 wks.
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14
Q

Describe secondary syphilis

A

2-12 wks after primary infection

  • Macular or pustular lesion/rash esp on trunk and extremities
  • Highly infectious lesions
  • Also flu-like illness
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15
Q

What oral manifestation suggests secondary syphilis

A

Snail track ulcer

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16
Q

Describe Tertiary syphilis

A

3-30 years later if left untreated
- Slow, progressive destructive inflammatory disease that can affect any organ - neurosyphilis, CVS, gummatous (bones and skin lesions)

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17
Q

Describe the features of congenital syphilis

A

In-utero transmission of T.pallidum to baby after 3 months of pregnancy

  • Possible death of foetus
  • Congenital abnormalities/deformities
  • Facial and tooth deformities arising a few years later
18
Q

Name a tooth deformity associated with congenital syphilis

A

Hutchinson’s teeth - moon shaped edges to teeth/incisors

19
Q

Describe the diagnosis of syphilis and why its hard

A

Cant be grown on agar in lab

- Microscopy + serological (antibodies)

20
Q

Describe the non-specific diagnosis test for syphilis

A

Cardiolipin antibody test - screening - if positive will then take specific test

21
Q

Describe the specific diagnosis test for syphilis

A

Use treponemal antigens e.g. VDRL - T.Pallidum antibody tests - Treponema pallidum immobilisation test (TPI) live treponemes immobilised by antibodies in the patient’s serum

22
Q

What is the treatment route for syphilis

A

Penicillin or Tetracyclines, erythromycin, chloramphenicol

23
Q

What is the causative agent of chlamydia std infection

A

Chlamydia. trachomatis

there are other chlamydias that cause other forms of chlamydia infection

24
Q

Describe the basic morphology of chlamydia bacteria

A
  • Small bacteria

- Obligate intracellular parasites

25
Q

Describe the basic life cycle of chlamydia organisms

A
  1. Elementary bodies (EB) - live outside body of host and initiate infection
  2. Attachment + entry to host
  3. Reticulate bodies (RB) - non-infectious for intracellular multiplication, new EB’s produced to invade adjacent cells
26
Q

Describe the clinical manifestations of chlamydia infection

A

They indicate damage from cell destruction and inflammatory response and give rise to urethritis, cervicitis, epididymitis, conjunctivitis etc.

NB - asymptomatic infection in women is common

27
Q

How is lab diagnosis of chlamydia infections carried out

A
  • Cell culture growth as they are obligate intracellular pathogens (parasites)
  • Immunofluorescent staining
  • Direct Ag (antigen) detection in smears
28
Q

What is chlamydia usually treated with

A

Tetracycline

29
Q

AY BAWS CAN I HABE DE NOTE PLZ

A

Chlamydia is often asymptomatic and can lead to pelvic inflammatory disease, ectopic pregnancy etc

30
Q

Describe the aetiology of UTIs

A

Usually an ascending bacterial infection:
Urethra -> bladder -> kidney -> urinary tract
Occasionally will continue to invade the blood stream and cause septicaemia
Much less commonly bacteria can each the kidney by the haematogenous route

31
Q

What are some of the predisposing factors of UTI

A
  • Disruption of urine flow, e.g. catheterisation, pregnancy, prostratic hypertrophy
  • Shorter urethra in females than males
  • UTI incidence is higher amongst sexually active populations
  • Male infants; due to faecal organisms
  • Prevention of complete bladder emptying makes person more susceptible to infection
  • Reflux of urine from bladder to ureters predisposes to ascending infection and kidney damage
  • Diabetes can mean more severe infections
32
Q

AY BAWS CAN I HABE DE NOTE PLZ

A

Women more likely to get UTIs than men

33
Q

What is a common bacteria type that causes UTIs

A

E.Coli due to faecal contamination

34
Q

Why are E.Coli bacteria a common UTI causative agent

A
  • Have particular types of antigen pili from adherence to urethral and bladder epithelium
  • Capsular polysaccharides (K antigens) are associated with ability to cause pylonephritis and resist host phagocytosis
  • Haemolysin production: membrane damaging
35
Q

Name another faecal organism besides E.Coli than can cause UTIs

A 
Proteus Mirabilis (very motile)
- Urease production is significant in pyelonephritis
36
Q

What are some of the host defences against UTIs

A
  • Urinary tract is generally resistant to colonisation
  • pH, chemical composition and flushing action of urine helps to dispose of bacteria in urethra and prevents growth of commonly urethral bacteria
37
Q

What are the clinical features of lower urinary tract infections

A
  • Acute infections: dysuria, pain
  • Cloudy urine: due to cells and bacteria often with catheterised patients. Possibility of chronic inflammatory changes in the bladder, prostate and periurethral glands
  • Prostatitis: acute, chronic
38
Q

What are the clinical feature of Upper Urinary tract infections

A
  • More difficult to diagnose as distinct from lower UTIs
  • Symptoms as lower UTI + fever often as kidney is involved (pyelonephritis)
  • Recurrent pyelonephritis leads to renal damage
39
Q

Describe the Lab diagnosis of UTIs

A

All about finding high levels of bacteria in urine:
Bacteruria defined as significant when a midstream urine sample has >10^5 bacteria per ml
Infected urine will likely have only one species of bacteria in the urine as well
Also >10 WBCs per ml of urine is abnormal and may indicate infection

40
Q

What methods of urine collection are there

A
  • Midstream urine
  • Catheter
  • Supra pubic (from bladder)
41
Q

What bacteriological media are commonly used in lab diagnosis of UTIs

A
  • Blood agar (non-selective medium)
  • MacConkeys agar (selective medium for GI tract bacteria)
  • 35-37C for 18 hours
42
Q

Describe the treatment of UTIs

A
  • Uncomplicated case = Trimethoprim or ampicillin (5 days)

- If organism is resistant (50% amp. resistance incidence) then cephaloxin

FHHD (21 decks)

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