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YEAR 3 REPRO > Microbiology > Flashcards

Microbiology Flashcards

1
Q

what organism predominates normal vaginal flora

A

lactobacillus spp

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2
Q

give 2 examples of lactobacillus that are part of the normal vaginal flora

A

lactobacillus crispatus

lactobacillus gensenii

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3
Q

how are lactobacillus protective

A

produce lactic acid +/- hydrogen peroxide making the vagina acidic so pathogenic organisms dont grow

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4
Q

give 3 other examples of normal vaginal flora

A

group B b-haemolytic strep
small no of candida sp (mainly albicans)
strep viridans

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5
Q

give 4 PDFs for candida infection

A

recent antibiotic tx
high oestrogen levels
poorly controlled diabetes
immunocompromised (non-albicans)

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6
Q

how does candida infection present

A

intensely itchy white vaginal discharge

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7
Q

how is candida infection diagnosed

A

high vaginal swab of posterior fornix of vagina for culture

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8
Q

most candida infections are what type

A

albicans

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9
Q

how is candida infection treated

A 
topical clotrimazole pessary or cream (OTC)
oral fluconazole (one dose)
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10
Q

what is the issue with treating non-albicans candida infection

A

more likely to be azole resistant

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11
Q

what kind of candida would cause typical spotty rash on penis which is not an STI

A

candida balanitis

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12
Q

what kind of organism is gonorrhoea

A

gram negative diplococcus

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13
Q

gonorrhoea diplococci look like

A

2 kidney beans facing eachother

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14
Q

does gonorrhoea appear intra or extracellular on gram film

A

intracellular

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15
Q

how does gonorrhoea become intracellular

A

easily phagocytosed by polymorphs

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16
Q

gonorrhoea is a fastidious organism - what does this mean

A

doesn’t survive well in less than ideal conditions

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17
Q

where can gonorrhoea infect

A 
mucous membranes of the ...
urethra
rectum
throat
eyes
endocervix
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18
Q

how does gonorrhoea of the rectum or throat present

A

usually asymptomatic

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19
Q

how does gonorrhoea replicate

A

attaches to host epithelial cells and is endocytosed into the cell to replicate within the host and then released into subepithelial space

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20
Q

gonorrhoea is more/less common than chlamydia and is more common in women/men

A

less common than chlamydia

more common in men

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21
Q

how does gonorrhoea present in males

A

purulent urethral discharge

dysuria

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22
Q

what % of gonorrhoea in males in asymptomatic

A

10

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23
Q

how does gonorrhoea present in females

A

purulent urethral discharge
dysuria
pelvic pain

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24
Q

what % of gonorrhoea in females is asymptomatic

A

50

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25
Q

how is gonorrhoea diagnosed

A

NAAT screening test for C + G

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26
Q

what sample is used for gonorrhoea dx for NAAT in males

A

first pass urine

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27
Q

what sample is used for gonorrhoea dx for NAAT in females

A

vulvovaginal swab

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28
Q

gonorrhoea can also be cultured on what agar

A

selective agar plate - suppresses growth of normal flora - kills competitors

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29
Q

in what case would you not need to use selective agar

A

when no competing flora is expected e.g. synovium

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30
Q

why is culture not done in a GP

A

only done in SRHC as if in GP organism dies on way to lab

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31
Q

culture of gonorrhoea can be done of what samples

A

endocervical, rectal, throat swabs

not high vaginal swabs

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32
Q

what is an advantage of doing a culture

A

can test antibiotic susceptibility

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33
Q

what is the treatment for gonorrhoea

A

IM ceftriaxone + azithromycin

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34
Q

what is used if IM is CI to treat gonorrhoea

A

cefixime oral

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35
Q

when should a test of cure be done for gonorrhoea

A

at least 2 weeks later

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36
Q

there is a higher risk of ____ to ___ transmission of gonorrhoea than ____ to ____

A

male to female than female to male

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37
Q

what is the commonest STI in the UK

A

chlamydia trachomatis

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38
Q

what kind of organism is chlamydia

A

gram negative obligate intracellular bacterium

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39
Q

what does obligate intracellular bacterium mean

A

cannot live/reproduce outside host cell

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40
Q

what word describes the life cycle of chlamydia

A

biphasic

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41
Q

what colour does chlamydia stain

A

doesnt stain

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42
Q

why does chlamydia not stain

A

no peptidoglycan in the cell wall - typical lipopolysacarhide

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43
Q

why does chlamydia not stain

A

no peptidoglycan in the cell wall - typical lipopolysaccharide wall of GN bacteria

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44
Q

what are the 3 serological groups of chlamydia

A

serovars A-C
serovars D-K
serovars L1-L3

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45
Q

A-C causes what

A

trachoma

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46
Q

D-K causes what

A

genital infection

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47
Q

L1-L3 causes what

A

lymphogranuloma venereum - infection of the lymph nodes

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48
Q

who gets LGV

A

MSM

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49
Q

how does LGV present

A

usually presents in MSM with proctitis

  • rectal pain/discharge/bleeding
  • tenesmus
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50
Q

with LGV there is a high risk of what

A

concurrent STI e.g. HIV

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51
Q

what can chlamydia infect

A 
urethra
rectum
throat
eyes
endocervix
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52
Q

what age group has the highest incidence of chlamydia

A

20-24 year olds

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53
Q

how does chlamydia present in males

A 
watery urethral discharge 
dysuria
urethritis
epididymo-orchitis
proctitis (LGV)
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54
Q

what % of males with chlamydia are asymptomatic

A

50%

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55
Q

what % of females with chlamydia are asymptomatic

A

70%

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56
Q

how does chlamydia present in females

A

post-coital or IM bleeding
lower abdominal pain
watery discharge
dyspareunia

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57
Q

the NAAT test is highly ____ and ____

A

sensitive and specific

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58
Q

what samples are taken for a NAAT test in females

A

vulvovaginal swab

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59
Q

what samples are taken for NAAT test in males

A

1st pass urine

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60
Q

what samples are taken for NAAT test in a symptomatic female (chlamydia)

A

high vaginal swab or endocervical swab

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61
Q

if chlamydia is transmitted to neonate it can cause

A

conjunctivitis

pneumonia

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62
Q

when can a NAAT test be done for chlamydia

A

2 weeks post exposure

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63
Q

what is the treatment for chlamydia

A

doxycycline 100mg bd x 7 days

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64
Q

what is the risk of tubal blockage after one episode of chlamydia

A

10%

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65
Q

what is the risk of tubal blockage after 3 episodes of chlamydia

A

50%

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66
Q

what % of PID is due to chlamydia

A

50%

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67
Q

what is mycoplasma genitalium

A

non-gonococcal STI that can cause PID

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68
Q

how is mycoplasma genitalium dx

A

NAAT - VVS or FPU

high levels of macrolide

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69
Q

mycoplasma genitalium presents how

A

usually asymptomatic carriage

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70
Q

what kind of organism is trichomonas vaginalis

A

single celled protozoal parasite

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71
Q

how does trichomonas vaginalis divide

A

binary fission (no cyst form is known

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72
Q

how is trichomonas vaginalis transmitted

A

STI or inanimate source e.g. sex toy

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73
Q

how does trichomonas vaginalis present in males

A

urethritis

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74
Q

how does trichomonas vaginalis present in females

A

vaginal discharge and irritation

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75
Q

how is trichomonas vaginalis dx

A

HVS for microscopy

no good test for males

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76
Q

how is trichomonas vaginalis treated

A

oral metronidazole

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77
Q

what is the pathogenesis of bacterial vaginosis

A

lack of balance - normal flora replaced by anaerobic bacteria

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78
Q

give 2 examples of anaerobic organisms that replace normal flora in bacterial vaginosis

A

gerdernella vaginalis

mobiluncus

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79
Q

what cells are seen in bacterial vaginosis

A

clue cells

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80
Q

what are clue cells

A

absence of bacilli and replacement with clumps of coccobacilli which coat some vaginal epithelial cells obscuring edges (clue cells) and obscuring normally clear cytoplasm

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81
Q

how does bacterial vaginosis present

A

intensely smelly frothy bubbly vaginal discharge

positive whiff test

82
Q

what is the positive whiff test

A

adding 10% KOH to discharge elicits amine like fishy odour

83
Q

the vaginal pH in bacterial vaginosis becomes more

A

alkaline

> 4.5

84
Q

the vaginal pH in bacterial vaginosis becomes more

A

alkaline

> 4.5

85
Q

in bacterial vaginosis there is a ___ level of polymorphonuclear leukocytes

A

few

high number would suggest coincidental infection possibly trichomoniasis or bacterial cervicitis

86
Q

there is an increased risk of what with bacterial vaginosis

A

HIV contraction

PROM and preterm delivery

87
Q

what is the treatment of bacterial vaginosis

A

metronidazole 7 days

88
Q

what causes pubic lice

A

Phthirus pubis

89
Q

how is pubic lice contracted

A

close genital skin contact

90
Q

how long do male lice live for

A

22 days

91
Q

how long do female lice live for

A

17 days

92
Q

why are pubic lice itchy

A

bite skin and feed on blood

female lice lay eggs on hair

93
Q

how is pubic lice treated

A

malathion lotion

94
Q

how is sensitivity calculated

A

true positive / true positive + false negative

95
Q

how is specificity calculated

A

true negative / true negative + false positive

96
Q

how is positive predictive value calculated

A

true positive / true positive + false positive

97
Q

how is negative predictive value calculated

A

true negative / true negative + false negative

98
Q

gonococci that infect the male urethra produce an intense ______ response leading to purulent discharge

A

neutrophil

99
Q

STIs tend to

A

coexist

100
Q

is reinfection common

A

yes

101
Q

genital ulcers greatly increases risk of what

A

acquiring HIV

102
Q

what 2 STIs tend to co-exist

A

NG and CT

103
Q

what organism causes syphilis

A

treponema pallidum

104
Q

what kind of organism is treponema pallidum

A

spirochaete

105
Q

what 5 ways can syphilis be transmitted

A 
STI
during birth
trans-placental
blood transfusion
non-sexual transmission to health care workers
106
Q

what are the 4 stages of syphilis

A

primary lesion
secondary stage
latent stage
late stage

107
Q

what is chancre

A

painless ulcer that is a primary lesion in syphilis

108
Q

what is the incubation period of a primary syphilis lesion

A

21 days

109
Q

how does primary lesion of syphilis progress

A

organism multiplies at the innoculation site and gets into blood stream

110
Q

non-tender local lymphadenopathy is what stage of syphilis

A

primary lesion

111
Q

will chancre need treatment

A

will heal without treatment

112
Q

90% of primary syphilis lesions are found where

A

genital

113
Q

what happens in the secondary syphilis stage

A

large no of bacteria circulating in blood with multiple manifestations at different sites

114
Q

what happens in the secondary syphilis stage

A

large no of bacteria circulating in blood with multiple manifestations at different sites

115
Q

what are some examples of secondary lesions (6)

A 
snail track ulcers
generalised rash (macular, follicular or pustular)
flu like symptoms 
lesions of mucous membranes
generalised lymphadenopathy
patchy alopecia
116
Q

where is the generalised rash of secondary syphilis found

A

palms and soles mainly

117
Q

what is condylomata lata

A

highly infectious lesion in syphilis found on genitals - exudes a serum teaming with treponemes

118
Q

what is the incubation period of secondary syphilis

A

6 weeks to 6 months

119
Q

what are the symptoms of the latent stage of syphilis

A

no symptoms

120
Q

the latent phase can be subdivided into early latent and late latent
of the 2 which is infectious

A

early latent - infectious

late latent - non-infectious

121
Q

what is seen in the late stage of syphilis

A

cardiovascular or neurovascular complications many years later

122
Q

what stages of syphilis are infectious

A

primary lesion
secondary stage
early latent

123
Q

what gait is seen in the late stage of syphilis

A

high stamping gate

124
Q

what causes the high stamping gate seen in the late stage of syphilis

A

loss of proprioception due to tarbes so rely on ears to find out where feet are

125
Q

what is tarbes

A

slow degeneration of neural tracts (particularly DCML) in syphilis - loss of touch, vibration and proprioception

126
Q

dissemination occurs early/late in syphilis

A

early

127
Q

what subspecies of treponema causes syphilis

A

pallidum

128
Q

what subspecies of treponema causes Yaws

A

pertenue

129
Q

what subspecies of treponema causes bejel

A

endemicum

130
Q

what subspecies of treponema causes pinta

A

carateum

131
Q

does syphilis stain with gram stain

A

no

132
Q

can syphilis be grown in artificial culture

A

no

133
Q

how is syphilis tested

A

PCR or serological blood test to detect antibodies

134
Q

what does the baseline blood test for suspected syphilis test for
(ELISA test)

A

syphilis IgM and IgG

135
Q

ELISA test is carried out on what specimen

A

clotted blood specimen

136
Q

what 3 ways can primary syphilis be tested

A

dark ground microscopy
PCR
IgM

137
Q

how can secondary and tertiary syphilis be tested

A

serology

138
Q

what are some specific serological tests for syphilis

A

TPPA
IgM ELISA
INNO-LIA
FTA-abs

139
Q

what test is +ve for life in syphilis

A

TPPA (treponema pallidum particle agglutination)

140
Q

what test screens for syphilis

A

IgM ELISA

141
Q

what is the treatment of syphilis

A

benzylpenicillin (injectable penicillin)

142
Q

can you check syphilis sensitivities

A

no because it cant be grown but syphilis remains very sensitive to penicillin

143
Q

what happens if someone is allergic to penicillin but has syphilis

A

desensitisation

144
Q

what is the dose time ratio of syphilis

A

very low dose but must be exposed for a long time

145
Q

what is the reason for the dose time ratio of syphilis

A

slow rate of replication

146
Q

what is a nick name for syphilis and why

A

the great imitator

mimics other diseases

147
Q

what is a nick name for syphilis and why

A

the great imitator

mimics other diseases

148
Q

what type of HSV causes cold sores

A

both can

Type 1 more common

149
Q

describe the herpes simplex virus

A

enveloped virus containing double stranded DNA

150
Q

how is HSV transmitted

A

close contact with someone shedding the virus (genital - genital or oropharyngeal - genital etc)

151
Q

describe the pathogenesis of HSV

A

virus duplicates in epidermis and dermis and gets into sensory nerve endings and autonomic nerve endings

152
Q

inflammation at nerve endings due to HSV causes what

A

intensely painful multiple small vesicles which are easily deroofed

153
Q

how may primary infection of HSV present

A

asymptomatic or very florid

154
Q

HSV migrates where

A

sacral root ganglion and hides from immune system

155
Q

HSV can ____ causing recurrent genital herpes attacks

A

reactivate

156
Q

can intermittent virus shedding occur in the absence of symptoms of HSV?

A

yes

157
Q

what is the incubation period of primary HSV infection

A

3-6 days

158
Q

what is the duration of primary HSV infection

A

14-21 days

159
Q

how does primary HSV present

A 
blistering and ulceration of external genitalia
pain
external dysuria
vaginal or urethral discharge
local lymphadenopathy
160
Q

what are the HSV prodromal symptoms

A

fever and myalgia

161
Q

recurrent infection is seen more with HSV

A

2

162
Q

how often does HSV 2 recur

A

every 2-3 months

163
Q

how often does HSV 1 recur

A

every 1-2 years

164
Q

HSV recurs more/less as time goes on

A

less

165
Q

recurrent HSV infection presents as

A

unilateral small blisters and ulcers

minimal systemic symptoms that resolve within 5-7 days

166
Q

how is HSV diagnosed

A

swab of base of deroofed blister in viral transport medium for PCR

167
Q

how is HSV diagnosed between recurrences

A

no good test - serology IgG but not routinely used

168
Q

what is the treatment of HSV

A

aciclovir PO 400mg TDS 5 days

famciclovir/valaciclovir

169
Q

what can be used for pain relief in HSV

A

topical lidocaine 5% ointment

saline bathing

170
Q

viral shedding is higher with HSV

A

2

171
Q

viral shedding is more frequent during which year of HSV infection

A

1st year

172
Q

viral shedding occurs more in people with more/less frequent recurrences

A

more

173
Q

what is done if primary attack of HSV occurs in 3rd trimester of pregnancy

A

c section

174
Q

what is the risk of transmission if primary attack of HSV occurs in 3rd trimester of pregnancy

A

50%

175
Q

HSV transmitted to a neonate would cause what

A

localised CNS or diseminated disease (latter more common in preterm infants and exclusively in primary infection)

176
Q

do transplacental antibodies stop HSV spreading to brain of neonate

A

no

177
Q

what is done for pregnant women with recurrent HSV attacks

A

suppressive therapy and advised risk of transmission is very low

178
Q

what is the most common viral STI in the UK

A

HPV

179
Q

what is the lifetime risk of acquiring HPV

A

80%

180
Q

describe HPV

A

major capsid protein (L1) surrounds viral nucleic acid (DNA)

181
Q

how many types of HPV are there

A

over 200

182
Q

how many types of HPV infect anogenital epithelium

A

> 40

183
Q

what types of HPV cause anogenital warts

A

6 and 11

184
Q

what types of HPV cause palmar and plantar warts

A

1 and 2

185
Q

what types of HPV cause cellular dysplasia / intraepithelial neoplasia

A

16 and 18

186
Q

can you get HPV from asymptomatic carrier

A

yes

187
Q

is transmission of more than 1 type common

A

yes

188
Q

what is the incubation period of HPV

A

3 weeks - 9 months (average 3 months)

189
Q

what % of HPV warts spontaneously clear

A

20-35%

190
Q

what % of HPV clears with treatment

A

60%

191
Q

what % of HPV persists

A

20%

192
Q

what types are vaccinated against

A

6 11 16 and 18

193
Q

who is vaccinated

A

girls ages 11-13
boys S1 and S2
MSM

194
Q

what is the 1st line treatment of HPV

A

podophyllotoxin (warticon)

195
Q

what is the 2nd line treatment of HPV

A

imiquimod (aldera)

196
Q

what is the 3rd line treatment of HPV

A

cryotherapy/electrocautery

197
Q

how is HPV diagnosed

A

clinically

198
Q

how does acute bacterial prostatitis present

A

symptoms of UTI but may also have lower abdo pain/ back perineal pelvic pain and tender on prostate exam

199
Q

what UTI organisms cause acute bacterial prostatitis

A

e coli and other coliforms

enterococcus sp

200
Q

what STI organisms cause acute bacterial prostatitis

A

chlamydia

gonorrhoea

201
Q

how is acute bacterial prostatitis diagnosed

A

clinically
MSSU (mid stream specimen of urine) for culture and sensitivity
FPU if think STI

202
Q

what is the treatment of acute bacterial prostatitis

A

ciprofloxacin or trimethoprim 28 days

YEAR 3 REPRO (11 decks)

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