Microbiology Flashcards
Treatment for bacterial vaginosis
Metronidazole orally
Treatment for acute bacterial prostatitis (and treatment if you think there is a high C diff risk)
Ciprofloxacin for 28 days
Give trimethoprim if 28 days c. diff risk
Treatment for chlamydia?
Azithromycin
Treatment for gonorrhoea?
IM ceftrixone and oral azithromycin (co-treatment)
Treatment for syphilis
Penicillin (inject)
Treatment for genital warts
Cryotherapy
Podophyllotoxin
Treatment for genital herpes?
Not really any …
Aciclovir may be helpful if taken early enough
Diagnosis of candida
Clinical diagnosis
HVS
Diagnosis of bacterial vaginosis
Clinical diagnosis
High pH
Clue cells (HVS & microscopy)
Diagnosis of acute bacterial prostatitis
MSSU for C&S
Diagnosis of chlamydia/gonorrhoea
Combined NAATS/PCR
(first pass urine - male
hvs - female, or endocerival if having pelvic smear etc)
Screening test for syphilis?
Combined IgM and IgG ELISA
If combined IgM and IgG is positive, what further tests would you do?
IgM elisa
VDRL test
TPPA test
(VDRL test shows if you antibodies to current/past syphilis infection)
(TPPA also tests for antibodies - think they inject gelatin particles with treponema germs or something)
What samples do you need to take for chlamydia testing?
Males: first pass urine
Females: vulvovaginal swab
NAAT: nucleic acid amplification testing
Treatment for chlamydia
Azithromycin 1g (single dose) Or doxycycline 100mg BD for 1 week
Gram negative intracellular diplococcus
Gonorrhoea
Treponema pallidum
Syphilis
Which bacteria predominate in the “healthy” vagina and what does it produce
Lactobacillus
-produces lactic acid and hydrogen peroxide
High levels of which hormone increases chance of thrush?
High oestrogen levels e.g. pregnancy, certain type of contraceptives
Intensely itchy white vaginal discharge
Thrush
Diagnosis of thrush
Clinical
high vaginal swab can be done for culture
Treatment of candida (thrush) infection
Topical clotimazole pessary or cream (available OTC)
Oral fluconazole
Budding yeasts and hyphae
Candida (thrush)
Typical “spotty” rash on the end of the penis
Thrush
Diagnosis of bacterial vaginosis
- Clinical diagnosis
- Raised vaginal pH (more than 4.5)
- clue cells
Bacterial vaginosis diagnosis is made clinically but what lab test could you do?
High vaginal swab for clue cells
but this test is highly subjective and inaccurate
Symptoms of acute bacterial prostatitis?
Symptoms of UTI but may have lower abdominal pain/perineal/penile pain and tender prostate on examination
How do you diagnose acute bacterial prostatitis?
Clinical signs and MSSU for C&S
Non-sexually transmitted genital tract infections
- thrush
- bacterial vaginosis
- prostatitis
(trichomonas vaginalis IS sexually transmitted!!)
Obligate INTRAcellular parasite (cannot reproduce outside host cell)
Chlamydia
syphilis also doesn’t stain
Which bacterial STI does NOT stain with gram stain?
Chlamydia bc no peptidoglycan in the cell wall
Chlamydia
Serovars A-C
Trachoma (eye infection) (not an sti)
Chlamydia
Serovars D-K
Genital infection
Chlamydia
Serovars L1-L3
Lymphogranuloma venereum
Gram negative dipoloccus
Gonorrhoea
This organism is easily phagocytosed by polymorphs so often appears intracellulary on a Gram film
Gonorrhoea
Sample from male needed for NAATS and PCR (chlamydia)
Males - first pass uring
Female - HVS or VVS (only endocervical if having sepculum examination)
you can also take rectal and throat swabs and eye swabs
If you chose to do a culture - you could only do on endocervical, rectal and throat swabs (NOT vaginal swabs)
Why is the recommended treatment for gonorrhea IM ceftriaxone and oral azithromycin?
Many strains of gonorrhea are now resistant
How long do you have to wait to do test of cure for gonorrhea and why?
Have to wait 5 weeks because PCR/NAATS will still pick up dead organisms
-test of cure recommended for all patients
Name an STI you should do a test of cure for
Gonorrhoea
Why do you have to do blood test for syphilis?
Because it doesn’t stain with gram stain and you also can’t culture it
What is the 1y stage of syphilis?
Chancre (this will heal without treatment)
What is the 2y stage of syphilis?
When large numbers of the bacteria are in the blood and this can cause lots of symptoms:
e.g. “snail-track” mouth ulcers
Generalised rash
Flu-like symptoms
That is the latent stage of syphilis
When the patient has no symptoms but there is low level of multiplication in the intima of the small blood vessels
What is late stage syphilis?
When you get cardio/neurovascular complications may years later
What are non-specific syphilis tests useful for?
-VDRL, RDR
Good to see how active the disease is and to monitor the response to treatment
-may be falsely positive in SLE, malaria, pregnancy
What do the specific tests for syphilis confirm?
-TPPA, TPHA
Specific tests can confirm diagnosis, however antibody levels decrease very slowly even after treatment and often remain positive for life
Screening test for syphilis
IgM and IgG ELISA
Treatment for syphillis
Penicillin injection
Commonest bacterial STI
Chlamydia
Commonest viral sti
Genital warts
HPV associated with genital warts
6&11
HPV associated with risk of cervical cancer
16&18
Diagnosis and treatment for genital warts
Diagnosis - clinical
Treatment - cryotherapy, podophyllotoin cream/lotion
Enveloped virus containing double stranded DNA
Herpes simplex virus
Diagnosis and treatment of genital herpes
Take a swab of the deroofed blister for PCR test (this is highly sensitive and specific)
Acilovir may be helpful if taken early enough
Single celled protozoal parasite
Trichomonas vaginalis
Diagnosis of trichomonas vaginalis
High VAGINAL swab for microscopy
Treatment for pubic lice
Malathion lotion
