Microbiology Flashcards
Which bacteria make up the normal viginal flora?
- Lactobacillus spp. predominate in the “healthy” vagina and produce:
- Lactic acid ] these suppress growth
- +/- hydrogen peroxide ]of other bacteria
- Other organisms
+/-Strep “viridans” – different species within this group
+/- Group B beta-haemolytic Streptococcus
+/- Candida spp. (small numbers)
what is the main cause of thrush?
How is it treated?
•C. albicans
topical clotrimazole
or
oral fluconazole
what are the symptoms of bacterial vaginosis?
what is the main causitive organism?
How is the diagnosis made?
What is the treatment?
•Thin, watery, fishy-smelling vaginal discharge
Gardnerella Vaginalis
Diagnosis is Clinical, Ph is also raised over 4.5. Lab test unreliable but Clue cells (epithelial cells covered in Gardnerella) are detected.
Oral Metronidazole
For bacterial prostatitis what are the symptoms?
Causes?
Diagnoses?
And treatment?
- Symptoms of UTI, but may have lower abdominal pain/back/perineal/penile pain and tender prostate on examination
- Rare complication of UTI in men
- Same organisms as UTI (E. coli & other coliforms, Enterococcus sp., but check for STI in patients <35years (gonorrhoea, chlamydia)
- Diagnosis – Clinical signs + MSSU for C&S (+/- first pass urine for chlamydia/gonorrhoea tests)
- Rx – ciprofloxacin for 28 days (altered depending on culture result). Trimethoprim (28d) if high C. diff risk
what is the histological appearnace of a chlamydia infection?
Gram negative diplococci
where are the sites of infection for chlamydia?
Eyes, Throat, Vaginal, Anal
how could chlamydia present in men and woman?
In Males:
Urethritis
Epidiymo-orchitis
Urethral discharge
Dysuria
In Females:
Post coital or intermenstrual bleeding
Lower abdominal pain
Dyspareunia
Mucopurulent cervicitis
what is the diagnosis and treatment of chlamydia?
Test 14 days following exposure
NAAT- females (vulvovaginal swab), males (first void urine)
MSM (add rectal swab if has receptive anal intercourse)
Azithromycin 1G stat
Doxycycline 100mg BD x 1 week
what is the gram stain appearance of gonorrhoea?
gram negative diplococci
WHERE ARE THE SITES OF A GONORRHOEA INFECTION?
urethra, endocervix
rectum and pharynx
what are the symptoms of a gonorrhoea infection in males and females?
males:
Asymptomatic - ≤10%
Urethral discharge – >80%
Dysuria
Pharyngeal/rectal infections – mostly asymptomatic
Females:
Asymptomatic (up to 50%)
Increased/altered vaginal discharge (40%)
Dysuria
Pelvic pain (<5%)
Pharyngeal and rectal infection are usually asymptomatic
how is gonorrhoea diagnosed?
PCR
what is the treatment for gonorrhoea?
First-line: Ceftriaxone 500 mg IM
Second-line: Cefixime 400 mg oral (only if IM injection is contra-indicated or refused by patient)
Co-treatment: Azithromycin 1g (regardless of Chlamydia result) given at the same time as gonorrhoea treatment
Test of cure in all patients
what are the current tests in tayside for syphillus?
describe how IGM, VDRL and TPPA results would come back on different stages of siph.
describe the diagnoses of chlamydia and gonorrhoea?
- Combined nucleic acid amplification tests (NAATs) or polymerase chain reaction test (PCR) – tests for both organisms in 1 test
- Highly sensitive and specific tests
- Done on:
- Male patients – first pass urine sample (N.B. not MSSU)
- Female patients – HVS or vulvo-vaginal swab (VVS), which can be self-taken by patient or clinician-taken or endocervical swab (if patient is having speculum examination)
- Rectal and throat swabs
- Eye swabs (babies and adults)
how do you treat syphilis?
Early Syphilis
2.4 MU Benzathine penicillin x 1
Late Syphilis
2.4 MU Benzathine penicillin x 3
what is the follow up test for syphilis?
rpr
rapid plasma reagin
for antibodies
should go down 4 fold within 3-6 months
describe the symptoms and timing of a genital herpes infection
Incubation - 3-6 days
Duration - 14-21 days
lBlistering and ulceration of the external genitalia
lPain
lExternal dysuria
lVaginal or urethral discharge
lLocal lymphadenopathy
lFever and myalgia (prodrome)
how would you manage a herpes infection?
Swab base of ulcer for HSV PCR
Give oral antiviral Treatment (Aciclovir)
Consider topical Lidocaine 5% ointment if very painful
Saline bathing
Analgesia
what is are the HPV viruses that cause the most anogenital warts?
HPV 6 & 11
what is the treatment of anogenital warts?
podophyllotoxin cream
cryotherapy
what is trichomonas vaginalis?
what symptoms does it cause?
How is it diagnosed?
What is the treatment?
- Single celled protozoal parasite
- divides by binary fission (no cyst form is known) – human host only
- Transmitted by sexual contact
- Causes vaginal discharge and irritation in females (and ?urethritis in males)
- Diagnosis
- High vaginal swab for microscopy (PCR test also available, but not used in Tayside, so no good test for males)
- Treatment
- Oral metronidazole
