Microbiology and STIs Flashcards by Imogen Smedley

What is the normal vaginal pH?

4-4.5 normal vaginal pH

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Name the main commensal bacteria of the vagina?

Lactobacillus

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What products does lactobacillus produce that suppress the growth of other bacteria?

Lactic acid +- hydrogen peroxide

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What fungi is a commensal in the vagina of some women?

Candida

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What is the infecting organism in genital thrush?

Candida albicans

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Elevated levels of what hormone is a risk factor for genital thrush?

Estrogen

in pregnancy and contraception

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Diabetes is a risk factor for genital thrush. T or F

F, poorly controlled diabetes is a risk factor for thrush

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How does genital thrush present in a male?

Spotty rash balantitis

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How does genital thrush present in a female?

Intense itch, white discharge

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What is the common method of diagnosing genital thrush?

Clinical Dx

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What are the Mx options for genital thrush?

1X PO fluconazole
OR
TOP clotramizole

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Bacterial vaginosis is an STI. T or F

False

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What is the main organism involved in bacterial vaginosis BV?

gardnerella vaginalis

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Is gardnerella vaginalis aerobic or anaerobic? What is its shape?

anaerobic coccobacilli

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What is the presentation of bacterial vaginosis?

Intense odour ‘fishy’

homogenous discharge

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Is the pH raised or lowered in bacterial vaginosis?

Raised pH

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Name an investigation for bacterial vaginosis?

Whiff test - 10% potassium hydroxide increases smell

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What is the management of bacterial vaginosis?

7day metronidazole

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30% of people with bacterial vaginosis have a recurrence. T or F

True

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In a women with bacterial vaginosis, should you offer treatment to her partner as well?

No since not considered an STI

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What condition presents with the S+S of a UTI plus lower abdo/ back/ perineal/ penile pain ONLY IN MEN?

Acute bacterial prostatitis

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What are the main infecting organisms in acute bacterial prostatitis?

e.coli
enterococcus
chlamydia
gonococcus

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What is the management of acute bacterial prostatitis?

28day ciprofloxacin

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What is the management of acute bacterial prostatitis in a patient with a high c. diff risk?

28day trimethoprim

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Which infections are tested for in a standard STI screen?

chlamydia, gonorrhea, HIV, syphilis

What is the incubation period of chlamydia?

2wk (hence don't test if UPSI more recent)

What is the incubation period of gonorrhoea?

2wk (hence don't test if UPSI more recent)

What is the incubation period of syphilis?

9day - 12wk

What is the incubation period of HIV?

4wk (hence don't test if UPSI more recent)

What is the incubation period of trichomonas?

4wk

Partner notification is voluntary. T or F

True

What gram stain is chlamydia?

Doesn't have one

Which parts of the body can chlamydia infect?

Urethra, rectum, pharynx, eyes

What is the commonest bacterial STI in the UK?

Chlamydia

Describe the methods of chlamydia transmission?

Oral sex, anal sex, vaginal sex

How does chlamydia present in 70-80% of female patients?

Asmptomatic

What % of males with chlamydia have no signs or symptoms?

50%

How can chlamydia present in females?

Lower abdo pain Dyspareunia Mucopurulent discharge Intermenstrual bleeding

How can chlamydia present in males?

Urethral discharge Dysuria Urethritis Epididymo-orchitis

What is the 1st line test for chlamydia?

NAAT (nucleic acid amplification test)

Where swabs taken from males and females for chlamydia Ix?

M - 1st pass urine sample | F - vulvo-vaginal swab or endocervical

What is the Tx of chlamydia?

1wk PO doxycycline

What rheumatological condition is a potential complication of chlamydia?

Reiter's synd - reactive arthritis

If chlamydia is passed from mother to neonate during childbirth, how may this present?

Conjunctivitis | Pneumonia

What gynae condition is a complication of chlamydia?

PID

Chlamydia trachomatis is an obligate intracellular organism. T or F

True

Neisseria gonnorrhea is an intracellular organism. T or F

True

What is the gram stain and shape of n. gonorrhea

gram -ve intracellular

How does n. gonorrhea appear on gram stain? (shape)

2 kidney beans facing each other

Which parts of the body can gonococcus infect?

urethra, rectum, pharynx, eye, endocervix

What gender is gonococcus more common in?

males

What part of the body does gonorrhoea infect in 3-7% of heterosexual men and 10-30% of MSM and females?

pharynx

Is gonnorrhea more likely to be asymptomatic in males or females?

Females (50%)

Is gonorrhoea or chlamydia more likely to be asymptomatic?

Gonorrhea

How does gonococcus present in males?

Dysuria | Purulent urethral discharge

How does gonococcus present in females?

Discharge Dysuria Pelvic pain

Proctitis is due to inflammation of the _____.

rectum

Proctitis is always infectious. T or F

False

What is the Ix of choice for gonorrhoea?

NAAT

MSM who present with STI type symptoms should be screened for rectal gonorrhoea, true or false.

True

What is the 1st line Mx of gonorrhoea?

IM ceftriaxone single dose

Is a test of cure indicated for chlamydia?

Is a test of cure indicated for gonorrhoea?

Yes

Where is a swab taken from in females when for gonorrhoea Ix?

Endocervix (double check)

What is the name of the infecting organism in syphilis?

Treponema pallidum

What shape and gram stain is the infecting organism syphilis?

spirochaete | no gram stain

What are the methods of syphilis transmission?

Sex Birth Blood product

How does primary syphilis present?

Chancre - painless ulcer at site of contact | Lymphadenopathy

Does a chancre heal without Tx?

Yes

Name the stages of syphilis infection in order?

Primary Secondary Latent Late/tertiary

How does someone present in the secondary stage of syphilis?

snail track mouth ulcers, generalised rash, flu like S+S, patchy alopecia

How does someone present in the latent stage of syphilis?

Asymptomatic

How does someone present in the late or tertiary stage of syphilis?

CVD or neuro comp

What is the 1st screening test for syphilis?

IgM and IgG ELISA

If syphilis IgM and IgG are positive, what test should you do next?

Serology, VDRL, TPPA | TPPA non-specific

What antibody is used to monitor syphilis response to Tx?

RPR

What is the treatment of syphilis?

IJ long acting penicillin

What is the commonest viral STI?

Genital warts

What is the infecting organism in genital warts?

HPV (subtypes 6 and 11)

What is the incubation period for genital warts?

3wk-9mth (but subclinical phase can last years)

Where is the most common location of genital warts in the male and female?

F - labia | M - glans

30% of genital warts clear without Tx. T or F

True

20% of genital warts persist despite Tx. T or F

True

What is the 1st line Mx of genital warts?

Podophyllotoxin

What is the 2nd line Mx of genital warts?

Imiquimod aldara

What is the 1st line management of genital warts affecting the anus?

Imiquimod aldara

What is the only method of genital wart treatment safe in pregnancy?

Cryotherapy

What is the name of he HPV vaccine?

Gardasil

Who is eligible for the HPV vaccine gardasil?

F 11-13yr | MSM <46yr

Which type of HSV is most likely in oral and genital presentations?

HSV1 oral | HSV2 genital

Which type of HSV has a higher recurrence rate and increased viral shedding?

HSV2

What is the incubation period of HSV?

3-6day

How long do S+S typically last in a genital herpes outbreak?

14-21day

'Where' is the HSV during asymptomatic periods between outbreaks?

Latent in sacral root ganglion

What is the method of HSV transmission?

Skin: skin

Do HSV attacks increase or decrease in intensity with time?

Decrease

How does the prodromal period of HSV infection present?

Fever, myalgia

How does genital herpes primary infection present?

Painful small vesicles Dysuria Vag/urethral discharge Lymphadenopathy

How is genital herpes most commonly diagnosed?

Clinical Dx

How is genital herpes definitively diagnosed?

PCR swab during outbreak

What is the management of genital herpes?

PO acyclovir

What is the management of pain in genital herpes?

TOP lidocaine

When is prophylaxis indicated in genital herpes?

If >6 attacks / year

What is phthirus pubis more commonly known as?

Pubic lice

What is the management of pubic lice?

Malathoin lotion

What type of organism is trichomonas vaginalis

single celled protozoa (parasite)

How does trichomonas vaginalis present in males and females?

M - urethritis | F - discharge/irritation

Trichomonas vaginalis Dx?

high vaginal swab microscopy

What is the Tx of trichomonas vaginalis?

PO metronidazole

What organism can cause a non-gonococcal urethritis or be asymptomatic? It is diagnosed by NAAT

mycoplasma genitalium

What is the name of chlamydia serovars L1-3?

LGV lymphogranuloma

67% of people with LGV infection also have what other STI?

HIV

Condyloma acuminatum aka _____

Genital warts

Koilocytosis indicates the presence of which organism

HPV