Microbiology

Question 1

Classify Chalmydia

Answer 1

Gram negative bacterium

Question 2

How does chlamydia present in females?

Answer 2

Post coital or intermenstrual bleeding
Lower abdominal pain
Dyspareunia
Mucopurulent cervicitis

Question 3

How does chlamydia present in males?

Answer 3

Urethral discharge
Dysuria
Urethritis
Epididymo-orchititis

Question 4

What are the Complications of Chlamydia?

Answer 4

Pelvic inflammatory disease
Tubal damage (inertility, ectopic pregnancy)
Chronic pelvic pain
Transmission to the neonate (17% conjuctivitis, 20% pneumonia)
Adult conjunctivits
Sexually acquired reactive arthritis/ Reiter’s syndrome
Fitz-Hugh-Curtis Syndrome (Perihepatitis)

Question 5

How is Chlamydia diagnosed?

Answer 5

Test 14 days following exposure
NAAT- female (vulvovaginal swab), males (first void urine)
MSM: add rectal swab if has receptive anal intercourse

Question 6

How is chlamydia treated?

Answer 6

Azithromycin 1g stat

Doxycycline 100mg BD x1 week

Question 7

Classify Gonorrhoea

Answer 7

Gram negative intracellular diplococcus

Question 8

What is the incubation period of gonorrhoea?

Answer 8

The incubation period of urethral infection in men is short (2-5days)

Question 9

How does gonorrhoea present in men?

Answer 9

Asymptomatic (10%)
Urethral discharge (>80%)
Dysuria
Pharyngeal/rectal (mosly asymptomatic)

Question 10

How does gonorrhoea present in females?

Answer 10

Asymptomatic (up to 50%)
Increased/altered vaginal discharge (40%)
Dysuria
Pelvic pain (<5%)
Pharyngeal and rectal infection are usually asymptomatic

Question 11

What are the complications of gonorrhoea?

Answer 11

Bartholinitis, tysonitis, periurethral abscess, rectal abscess, epididymitis, urethral strictures, endometritis, pelvic inflammatory disease, hydrosalpinx, infertility, ectopic pregnancy, prostatitis

Question 12

How is gonorrhoea diagnosed?

Answer 12

Microscopy- Urethral 90-95% sensitivity
Endocervical 37-50% sensitivity
Culture >95% sensitivity (male urethra)
80-92% sensitivity (female endocervix)
NAATs >96% sensitivity (both symptomatic +asymptomatic)

Question 13

How is gonorrhoea treated?

Answer 13

First line: Ceftriaxone 500mg IM
Second line: Cefixime 400mg oral (only if IM injection is contraindicated or refused)
Co-treatment: Azithromycin 1g (regardless of chlamydia result) given at the same time as gonorrhoea
Test of cure in all patients

Question 14

Classify Syphilis

Answer 14

Treponema pallidum

Spirochete

Question 15

How is syphilis transmitted?

Answer 15

Sexual contacted
Trans-placental/during birth
Blood transfusions
Non-sexual contact- healthcare workers