Microbiology: Infections in O&G

Question 1

How does the pH of the vaginal throughout a woman life & why does this occur?

Answer 1

At puberty under the influence of oestrogen the vagina changes from simple cuboidal to squamous epithelium and lactobacilli become the predominant organism, this drops pH to 3.5-4.5. After menopause changes back and pH rises to 7.0

Question 2

What % of vaginal candidiasis are due to C.albicans?

Answer 2

80-90%

remaining C glabrata, C krusei C tropicalis

Question 3

How many woman are colonised with candida (mostly asymptomatic)?
How does this change in pregnancy

Answer 3

20%

40%

Question 4

How does the Tx of candida change in pregnancy?

Answer 4

Do not use oral azoles

Creams or pessaries

Question 5

How can genuine recurrent infection with candida be Tx

Answer 5

6 month weekly fluconazole

Boric acid intravaginally

Question 6

Does candida effect pregnancy?

Answer 6

no

Question 7

What is the comment of cause of abnormal discharge? Prevelance in UK?

Answer 7

BV 12%

Question 8

What is the pathophysiology BV

Answer 8

Anaerobic organism normally in low concentration increase, taking over the predominant lactobacilli. pH rises from 4.5 tp 7.0

gardnerlla vaginalis, bacteroides,..

Question 9

What is the Amsel criteria to Dx BV?

Answer 9

vaginal pH >4,5
fish smell on addition of alkali
characterise discharge on examination
clue cells on microscopy

Question 10

Tx of BV

Answer 10

Metronidazole tablets or cream

Clindamycin cream

Question 11

Complications of BV in pregnancy

Answer 11

2nd trimester miscarriage, preterm delivery

Question 12

Transmission of Trichomonas

Answer 12

Sexually transmitted, asymptomatic for many months

Question 13

Clinical features of trichomonad

Answer 13

vulvovaginitis
green/yellow discharge +/- offensive smell
punctuate haemorrhage on cervix ‘strawberry’

Question 14

Trichomoniasis is detected on what swab?

Answer 14

NAAT

Question 15

Tx of trichomoniasis>

Answer 15

metronidazole

partner should also be Tx

Question 16

Complications of trichomoniasis in pregnancy

Answer 16

increased risk of preterm birth but asymptomatic tx not shown to improve outcome

Question 17

Tx for pubic lice and scabies

Answer 17

Topical malathion or permethrin

Question 18

Tubal factor infertility is how common after PID (1 episode, 3 episodes)

Answer 18

Tubal infertility rate following 1 episode PID 12%

Tubal infertility rate following 3 episodes PID 50%

Question 19

How common is chronic pelvis pain after PID

Answer 19

15%

Question 20

Chlamydia and gonorrhoea account for what % of PID

Answer 20

25-50%

Question 21

What % of women of childbearing age are infected with chlamydia

Answer 21

10% most common STI

highest <25

Question 22

What % of people infected with chlamydia are asymptomatic?

Answer 22

50% & 80%

Question 23

What form of chlamydia can cause severe proctitis?

Answer 23

Lymphogranuloa Venereum (LGV)

Question 24

What type of bacteria is chlamydia?

Answer 24

Obligate intracellular bacteria

Question 25

What abx are effective in uncomplicated chlamydia?

Answer 25

Azithromycin Doxycycline Ofloxacin erythromycin

Question 26

What % of women of child baring age are infected with gonorrhoea?

Answer 26

1%

Question 27

What % of people infected with gonorrhoea are asymptotic?

Answer 27

women 50% | men 10%

Question 28

What is the appearance of gonorrhoea on microscopy?

Answer 28

Gram -ve intracellular diplococci

Question 29

reccommeneded Tx fo gonorrhoea?

Answer 29

Single dose azithryomycin 1g PO (or doxycycline) | Ceftriaxone 500mg IM

Question 30

How does cervicitis present?

Answer 30

Post coital bleeding | purulent vaginal discharge

Question 31

Chronic cervicitis can lead to what?

Answer 31

nabothian follicles (cysts) and scarring

Question 32

What clinical features indicate PID

Answer 32

- hx pelvic pain and deep dyspareunia - cervical motion tenderness - lower UTI - pyrexia - adnexal ass (20%) clinical dx 70-80% accurate

Question 33

Gold standard Ix for diagnosis for PID

Answer 33

laproscopy

Question 34

Complications of PID

Answer 34

Tubal factor infertility Abscess Adhesions - chronic pelvic pIN pelvic peritonitis

Question 35

Standard Abx for PID

Answer 35

IM ceftriaxone 500mg Doxycycline 200mg BD - 14days Metronidazole 400mg BD - 14days

Question 36

What condition caused by chlamydia/gonnorea present with fever & RUQ pain

Answer 36

Fitz-high-curtis syndrome - requires 3 weeks abx

Question 37

Name of disseminated chlamydia that presents with asymmetrical oligoarthritis affecting large joints of lower limb, uveitis and a rash (similar to psoriasis)

Answer 37

Reiter syndrome | Associated with HLA B27

Question 38

How does disseminated gonorrhoea present?

Answer 38

Septic oligoarthritis effecting hands and wrists + scanty papular rash

Question 39

How does infection with chlamydia/gonorrhoea effect pregnancy/newborn?

Answer 39

Pregnancy: chorioamnitis and 2-3 high risk of preterm birth Infant: Opthalmia neonatorum (may lead to corneal scarring and blindness), in chlamydia may develop pneumonitis

Question 40

What are the symptoms of genital tuberculosis?

Answer 40

In most cases, the disease is asymptomatic, infertility is the most common. Other symptoms reported are menstrual irregularities and abnormal vaginal discharge.

Question 41

Pelvic actinomycosis is associated with what iatrogenic cause?

Answer 41

IUCD

Question 42

Syphilis is caused by which bacteria?

Answer 42

Treponema Pallidum

Question 43

How & when does primary syphilis present?

Answer 43

Painless chancre and lymphadenopathy 3-90 days (women do no always see the chancre as often on cervix)

Question 44

How & when does secondary syphilis present?

Answer 44

Widespread rash typically affecting hands and soles of feet. Wart lesions (condyloma latum) of mucus membranes within 6 months

Question 45

What occurs after secondary syphilis?

Answer 45

Latent phase | No symptoms, +be serological testing, can transmit

Question 46

How & when does tertiary syphilis present

Answer 46

Gummas OR Neurosyphilis OR Cardiovascular syphilis 3+ year after primary infection

Question 47

Main Abx to Tx syphilis?

Answer 47

Penicillins

Question 48

By what gestation must syphilis be treated to prevent late congenital symphilis?

Answer 48

20 weeks

Question 49

How can syphilis effect the fetus

Answer 49

Fetal death long term - 8th nerve deafness, insteitial keratitis, abnormal teeth

Question 50

Infectious causes of genital ulcer diease

Answer 50

``` Herpes simplex Primary syphilis Lymphogranuloma venereum chancroid donovanosis HIV ```

Question 51

What is chancroid

Answer 51

Chancroid is a bacterial sexually transmitted disease (STD) caused by infection with Haemophilus ducreyi. It is characterized by painful necrotizing genital ulcers that may be accompanied by inguinal lymphadenopathy.

Question 52

What is granuloma inguinale (donovanosis)

Answer 52

Granuloma inguinale is a rare sexually transmitted disease caused by the bacteria Klebsiella granulomatis. It leads to chronic inflammation and scarring of the genitals. Granuloma inguinale typically causes a painless, red lump on or near the genitals, which slowly enlarges, then breaks down to form a sore.

Question 53

What are the common low risk HPV strains responsible for 90% genital warts?

Answer 53

HPV 6 & 11

Question 54

What are the common high risk HPV stains found in 70% of cervical cancer cases?

Answer 54

HPV 16&18

Question 55

Lifetime risk of infection with HPV?

Answer 55

80%

Question 56

Lifetime risk of cancer if infected with HPV 16 or 18

Answer 56

5% in unscreened | 1-2% in screened women

Question 57

Gardasil vaccinate against which strains

Answer 57

6,11,16,18

Question 58

Tx of genital warts

Answer 58

Physical methods - weekly cryotherapy podophyllotoxin applied BD for 3 days imiqimod TDS

Question 59

On average if untreated how long does HIV take to develop into AIDS

Answer 59

10 years

Question 60

How is HIV diagnosed, the monitored

Answer 60

Antibody to gp120 or p24 antigen Monitored by measuring CD4 lymphocytes Conc of Viral RNA

Question 61

Treatment of HIV

Answer 61

1) Antiretrovirals → NRTI + NNRTI or protease inhibitor | 2) Prophylaxis against opportunistic infections

Question 62

How often does vertical transmission happen in pregnancy of HIC if no interventions take place?

Answer 62

25-40% | With antiretrovirals 1.2%

Question 63

How often does transmission throughou the breastmilk occur?

Answer 63

15% | Breastfeeding should be avoided regardless of viral load

Question 64

Can women with HIV give birth vaginally?

Answer 64

Depend on 36 week viral load <50: Yes 50-400: consider other risk factors >400: ELCS or if taking zidovudine mono therapy

Question 65

When is infant Antiretroviral therapy(ART) given?

Answer 65

Depends on which risk group Very low risk: 2 weeks zidovudine Low risk: 4 week zidovudine high risk: PEP

Question 66

How often should women with HIV have cervical cytology?

Answer 66

Yearly - HPV flourishes and higher risk cervical cancer

Question 67

What contraception can be offered to women taking antiretrovirals?

Answer 67

Depot infection | IUCD

Question 68

What can be offered to women how experience frequency UTI after sexual intercourse?

Answer 68

3-6 months of low dose abx either every night or after intercourse (trimethoprim 100mg on)

Question 69

Which bacteria can cause a more severe puerperal fever?

Answer 69

Group A strep

Question 70

How many women a year die from puerperal sepsis?

Answer 70

10