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Microbiology Flashcards

1
Q

what STIs are commonly seen together

A

gonorrhoea and chlamydia

genital ulcers (syphilis, herpes) increase the probability of getting HIV

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2
Q

what are normal vaginal flora

A

lactobacillus (predominant and protective)
L. crispatus and L. jensenii (produce lactic acid)
group B strep
candida (in small numbers)
strep viridans

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3
Q

what is the normal vaginal pH

A

4-4.5

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4
Q

what are hypae

A

branches and buds seen on fungi

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5
Q

what is the most common cause of a candida infection

A

candida albicans

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6
Q

what are the predisposing factors to a candida infection

A

recent antibiotic therapy
high oestrogen levels (pregnancy, contraceptives)
poorly controlled diabetes
immunocompromised

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7
Q

what is the presentation of a candida infection

A

intensely itchy white thick ‘cottage cheese’ vaginal discharge

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8
Q

how do you diagnose candida infections

A

often clinical

can do high vaginal swab

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9
Q

what is the treatment for candida

A

topical clotrimazole pessary/ cream (OTC)

oral fluconazole

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10
Q

can men get candida infections

A

yes can get candida balanitis but less common

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11
Q

is candida sexually transmitted

A

no

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12
Q

what is the pathogenesis of a gonococcal infection

A

attaches to host epithelial cells
is endocytosed into the cells to replicate
released into subepithelial space
typically cause prominant inflammation due to release of toxic lipo-oligosaccharide factors and pepitoglycan fragments
some can be asymptomatic

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13
Q

what is seen on gram stain of gonorrhoea

A

gram -ve intracellular diplococcus

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14
Q

where can N gonorrhoeae infect

A

urethra, rectum, throat and eyes

endocervix in women

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15
Q

N gonorrhoea is fastidious, what does this mean

A

dies easily if not in ideal growth conditions

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16
Q

what is more common chlamydia or gonorrhoea

A

chlamydia

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17
Q

what tests for gonorrhoea

A

microscopy of swabs on selective agar plates (not for high vaginal swabs)

NAAT (higher sensitivity than culture, can test urine and vaginal swabs, cant test sensitivities to antibiotics, can detect dead organisms (wait 5 weeks for test of cure), only do if person at risk as false positives)

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18
Q

what is the commonest STI in the UK

A

Chlamydia Trachomatis

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19
Q

where can Chlamydia Trachomatis infect

A

urethra, rectum, throat, eyes and endocervix in women

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20
Q

what is the pathogenesis of Chlamydia Trachomatis

A

intracellular bacteria with biphasic life cycle

cannot replicate ouside a host cell

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21
Q

can you see Chlamydia Trachomatis on a gram stain

A

no has no peptidoglycan in the cell wall

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22
Q

what serological group of Chlamydia Trachomatis causes genital infections

A

serovars D-K

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23
Q

what is the treatment for Chlamydia Trachomatis

A

Doxycycline 100 mg bd x 7 days

erythromycin, ofloxacin are other options

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24
Q

what test can diagnose both chlamydia and gonorhoeae in one go

A 
NAATs or PCR
males- first pass urine sample 
female- HVS/ vulvo vaginal swab 
rectal and throat swabs 
eye swabs
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25
Q

what are the pros and cons of nucleic acid amplification tests

A

slight increase in sensitivity over culture, the ability to test urine specimens and self-obtained vaginal swabs

Inability to perform antimicrobial susceptibility testing and the poor or inadequately defined positive predictive value of some NAATs when they are used to test low-prevalence (<1%) populations

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26
Q

what is Trichomonas vaginalis

A

single cells protozoal parasite that infects human hosts only

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27
Q

how is Trichomonas vaginalis transmitted

A

sexual contact

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28
Q

what does a Trichomonas vaginalis cause

A

yellowish, frothy and purulent vaginal discharge and irritation in females
can cause urethritis in males

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29
Q

how is Trichomonas vaginalis diagnosed

A

high vaginal swab for microscopy

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30
Q

what is the treatment for Trichomonas vaginalis

A

oral metronidazole

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31
Q

what causes bacterial vaginosis

A

dont know, lots of different things
coccobacilli
lots of anaerobes

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32
Q

what is the presentation of bacterial vaginosis

A

fishy smelling, thin, homogenous discharge

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33
Q

what is bacterial vaginosis associated with

A

upper tract infections (endometritis, salpingitis)
premature ruptureof membranes and preterm delivery
increased risk of HIV acquisition

34
Q

what is the treatment for bacterial vaginosis

A

is drirected against the anaerobic flora

metronidazole for 7 days

35
Q

does treatment of male partners help in bacterial vaginosis

A

no, but can cause urethritis so if symptomatic yes

36
Q

what causes syphilis

A

spireochaete organisms treponema pallidum

37
Q

can you see syphilis on a gram stain

A

no

38
Q

how is syphilis diagnosed

A

dark ground microscopy, PCR or serological blood tests to look for antibodies

cannot be grown in artificial culture media

39
Q

what are the stages of illness in syphilis

A

primary lesion- painless chancre, organism multiplies at inoculation site (site of contact), gets into bloodstream, chanre will heal without treatment

secondary- large numbers of bacteria in blood with multiple manifestations (snail track mouth ulcers, generalised rah, flu like symptoms)

latent stage- no symptoms, low level multiplication in intima of small blood vessels

later stage syphilis- cardiovascular (aortic aneurysms), neurovascular complications many years later

some will self cure/ be treated co- incidentally

40
Q

what are non specific serological tests

A

e.g. VDRL, RPR
indicate tissue inflammation, used n syphilis
useful in monitoring response to therapy
usually become negative after successful treatment OR over time
can be falsely positive (SLE, malaria, pregnancy)

41
Q

how do you diagnose primary syphilis

A

dark ground microscopy, PCR, IgM

42
Q

how do you diagnose secondary syphilis

A

serology (specific and non specific)

43
Q

how is teriary syphilis diagnosed

A

serology (specific and non specific)

44
Q

what is the pathway for syphilis serological testing

A 
syphilis combined IgM and IgG screening test (ELISA test on clotted blood specimen) 
= if negative no more tests
= if positive: 
IgM ELISA (specific)
VDRL/ RPR (non specific)
TPPA (specific)
45
Q

what is the treatment for syphilis

A

injectable long acting penicillin

46
Q

why does penicillin have to be long acting to treat syphilis

A

as syphilis has slow rate of replication

47
Q

what causes genital herpes

A

herpes simplex virus type 1 (usually cause mouth cold sores) and 2

48
Q

what type of organism is HSV

A

enveloped virus containing double stranded DNA

49
Q

how is genital herpes transmitted

A

close contact with someone shedding the virus

genital/ genital or oropharyngeal/ genital contact

50
Q

what is the pathogenesis of genital herpes

A

primary infection may be asymptomatic (or very florid)
virus replicates in dermis and epidermis
gets into nerve endings (sensory and autonomic)
inflammation at nerve endings (v painful multiple small vesicles, easily deroofed)
virsu migrates to sacral root ganglion where it becomes latent, can reactivate at any time
intermittent virus shedding can occur in the absence of symptoms

51
Q

how is herpes diagnosed

A

swab in virus transport medium of deroofed blister for PCR

serology - for partner wanting to know risk of getting it from partner

52
Q

what treatment for genital herpes

A

aciclovir

pain relief

53
Q

what organisms is pubic lice

A

phthirus pubis

54
Q

how are pubic lice spread

A

close genital skin contact

55
Q

what is the pathogenesis of pubic lice

A

lice bite skin and feed on blood - itching in pubic area

female louse lays eggs on hair

56
Q

what is the treatment for pubic lice

A

malathion lotion

57
Q

what is the treatment for gonorrhoea

A

swab every site infected for culture

IM ceftriaxone

58
Q

how are gonorrhoea and chlamydia primarily diagnosed

A

PCR (NAATs) testing

59
Q

what other infections should you test for in a patient with gonorrhoea

A

HIV, syphilis, hep B and C

60
Q

after exposure when do you know if they have HIV

A

4 weeks

61
Q

when do you need to retest gonorrhoea after treatment- why

A

6 weeks- as lots of resistance

62
Q

what general advice for thrush (candida infection)

A 
avoid irritants (soaps, emollients) 
wear cotton nickers 
if recurring maybe change contraceptives if high oestrogen pill
63
Q

what candida is an aids defining infection

A

oesophageal candida

64
Q

what specific is needed from females to test for chlaymdia and gonorrhoea

A

vulvovaginal (self taken) swan

65
Q

how is bacterial vaginosis acquired

A

sexual intercourse

66
Q

why is it important to diagnose HSV

A

To offer appropriate counselling. If lesion was mimicking a dermatomal distribution (recurring HSV can go on buttocks) so to differentiate it from herpes varicella zoster. Also if pregnant need to know so can prevent baby getting herpes encephalitis

67
Q

was causes genital warts

A

human papilloma virus types 6 and 11

68
Q

what treatment for genital warts

A

nothing, 30% will resolve in 3 months
podophyllotoxin cream
iminquimod
cryotherapy

69
Q

what vaccine can reduce incidence of genital warts

A

HPV

70
Q

what are the specific syphilis serological tests

A

TPPA
TPHA (not used in tayside)
specific for syphilis but remain positive for life

IgM and IgG ELISA
combined and used as screening test for syphilis

71
Q

can you use specific serological tests to monitor response of syphilis to treatment

A

TPPA, TPHA no- stay positive for life

72
Q

what is IgM ELISA a marker of

A

recent, untreated infection

should be viewed as indication of active syphilis infection

73
Q

what is TPPA a marker of

A

positive for life in anyone who has/ has had syphilis

74
Q

what is VDRL a marker of

A

untreated active infection

75
Q

what does positive IgG mean in syphilis

A

can be active, latent, treated or congenital

76
Q

IgG + IgM +
IgM +
TPPA +
VRDL +

A

primary/ secondary syphilis

77
Q

IgG + IgM +
IgM -
TPPA +
VRDL +/-

A

latent syphilis

78
Q

IgG + IgM +
IgM -
TPPA +
VRDL +/-

A

latent untreated syphilis

79
Q

IgG + IgM +
IgM -
TPPA +
VRDL -

A

old treated syphilis

80
Q

IgG + IgM +
IgM +
TPPA +
VRDL +

A

congenital

Reproduction (51 decks)

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