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Repro and Sexual Health > Microbiology of GU Tract > Flashcards

Microbiology of GU Tract Flashcards

1
Q

4 bacterial STIs?

A

chlamydia
gonorrhoea
mycoplasma genitalium
syphylis (treponema pallidum)

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2
Q

3 viral STIs?

A

HPV (genital warts)
genital herpes (PSV)
hepatitis and HIV

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3
Q

3 parasitic STIs?

A

trichomonas vaginalis
phthirus pubis (pubic lice)
scabies

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4
Q

what is present in normal vaginal flora?

A 
lactobacillus spp predominate and are protective
- L. crispatus 
- L. jensenii
\+/- group B strep
\+/- candida
\+/- strep viridans
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5
Q

normal vaginal pH in post puberty/pre menopausal female?

A

acidic - 4-4.5
produces lactic acid +/- hydrogen peroxide
L. acidophilus is not a significant part of flora

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6
Q

what does candida look like?

A

branches with buds

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7
Q

most common candida in female?

A

candida albicans

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8
Q

predisposing factors for candida?

A

recent antibiotics
high oestrogen
poorly controlled diabetes
immunocompromised

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9
Q

how does candida present?

A

intense itch and white vaginal discharge

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10
Q

diagnosis of candida?

A

high vaginal swab for culture

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11
Q

treatment of cadida?

A

topical clotrimazole pessary or cream
oral fluconazole
non-albicans candida more likely to be azole resistant

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12
Q

candida in males?

A

spotty rash

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13
Q

common presenting feature of ghonoorhoea in males?

A

tap like pus

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14
Q

how does ghonorrhoea cause infection?

A

attaches to host epithelial cells and in endocytosed into the cell to replicate within the host cell and are released into the subepithelial space

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15
Q

what is ghonorrhoea?

A

gram -ve intracellular diplococcus
looks like 2 kidney beans facing each other
easily phagocytosed by polymorphs so often appear intracellularly on gram film

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16
Q

pathogenesis of typical urethral ghonorrhoea infection?

A

prominent inflammation release of toxic lipo-oliigosaccharide and peptidoglycan fragments as well as the release of chemotactic factors that attract neutrophillic leukocytes

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17
Q

where can ghonorrhoea infect?

A

urethra
rectum
throat
eyes

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18
Q

gonorrhoea is very fastidious, what does this mean?

A

does not survive well outside the body, therefore difficult to culture

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19
Q

how is gonorrhoea cultured?

A

selective agar plate which suppresses other bacteria

done on endocervical, rectal and throat but not high vaginal swabs

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20
Q

what is NAAT?

A

microbiology test which has increased sensitivity over culture
can be done on urine and self obtained vaginal swabs
gold standard for gonorrhoea testing
only use when high suspicion as can give false positives

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21
Q

main antibiotic choice for gonorrhoea?

A

IM cephtraixone and azithromycin

most recent guidance = ceftriaxone alone

22
Q

most common STI in UK?

A

chlamydia

23
Q

features of chlamydia bacteria?

A

obligate intracellular bacteria with biphasic life cycle
“energy parasite”
does not reproduce outside of host cell
does not stain with gram stain (no peptidoglycan in cell wall)

24
Q

3 serological groups of chlamydia?

A

serovars A-C = trachoma (eye infection, not STI)
serovars D-K = genital infection
serovars L1-L3 - lymphogranuloma venereum (tropical and homosexual men)

25
Q

treatment of chlamydia?

A

azithromycin 1g oral dose then 500mg for 2 days (for uncomplicated)
doxycyline 100mg BD for 7 days = mainstay

26
Q

chlamydia life cycle?

A

attachment and entry > migration to perinuclear area and EB > RB transition
> inclusion biogenesis and bacterial replication > RB-EB transition and cell lysis

27
Q

diagnosis of chlamydia?

A 
combined NAATs or PCR tests for both organisms in one test
done on
- first pass urine in men
- HVS or vulvo-vaginal swab in females
- rectal and throat swabs
- eye swabs
28
Q

what is trichomonas vaginalis and what does it cause?

A

single celled protozoal parasite which is transmitted by sexual contact
causes vaginal discharge and irritation in females (possibly urethritis in males)

29
Q

diagnosis of trichomonas vaginalis?

A

high vaginal swab for microscopy

30
Q

management of trichomonas vaginalis?

A

oral metronidazole

31
Q

features of bacterial vaginosis?

A

homogenous, possibly bubbly discharge

may smell fishy

32
Q

how is bacterial vaginosis diagnosed?

A

whiff test
- add 10% potassium hydroxide to the discharge, will cause amine-like, fishy odour
wet mount
- discharge sample put in saline on slide

33
Q

how does BV alter pH?

A

makes it more alkaline

34
Q

associated risks with BV?

A

increased rate ot upper tract infection (endometritis, salpingitis etc)
premature rupture of membranes and preterm delivery
women with BV may have increased risk of HIV

35
Q

general description of BV?

A

not enough good bacteria
too much bad
microflora has changed

36
Q

how is BV managed?

A

treatment directed against anaerobic bacteria
- metronidazole for 7 days
(treatment of male partners has no benefit)

37
Q

features of treponema pallidum (syphilis)?

A

spiral
(spirochete)
does not stain on gram stain
cannot be grown in artificial media so diagnosis relies on PCR or serological blood tests to detect antibodies

38
Q

what are the 4 stages of syphilis infection?

A
  1. primary lesion (chancre) at site of inoculation and gets into blood (will heal without treatment)
  2. large numbers of bacteria circulating in blood with multiple sites affected (snail track mouth ulcers, rash, flue etc)
  3. no symptoms but low level multiplication of spirochete in intima of small blood vessels (latent stage)
  4. late stage - cardiovascular or neurovascular complications
39
Q

does everyone with syphilis get to late stage?

A

no

only 1/3

40
Q

non-specific serological tests for syphilis?

A

VDRL
RPR
non-specific tests that indicate tissue inflammation
may cause false positives in SLE, malaria or pregnancy
useful for monitoring response to therapy
usually become negative after successful treatment or over time

41
Q

how is syphilis diagnosed?

A

history and examination
caveats (treatment history, reinfection risk, history etc)
primary = dark ground microscopy, PCR, IgM
secondary = serology (specific and non-specific)
tertiary = serology (specific and non-specific)

42
Q

specific syphilis serology testing?

A

syphilis combined IgM and IgG screening test

  • negative = result goes out as negative
  • positive = further tests performed (IgM eliza - specific for acute), VDRL/RPR (activity), TPPA test (specific)
43
Q

how is syphilis managed?

A

injectable long-acting preparations of penicillin

penicillin desensitisation may be needed

44
Q

why are syphilis penicillins different from other penicillins?

A

syphilis only needs a small concentraiton of penicillin but has to be exposed for a very long time

45
Q

what causes genital herpes?

A

HSV1 (also causes cold sores - can cause genital herpes if oral sex)
HSV2
transmitted by close contact with someone shedding the virus

46
Q

pathogenesis of genital herpes?

A

asymptomatic primary infection
virus replicates in dermis and epidermis and gets into nerve endings of sensory and autonomic nerves
inflammation at nerve endings causes exquisitely painful multiple small vesicles which are easily de-roofed
virus migrates to sacral root ganglion and hides from immune system
virus can reactivate from there causing recurrent genital herpes attacks
intermittent virus shedding can occur in absence of symptoms

47
Q

how is genital herpes diagnosed?

A

swab in virus transport medium of deroofed blister for PCR
(no good test for HSV carriage between recurrences)
serology (IgG, not routine)

48
Q

how is HSV managed?

A

aciclovir

pain relief

49
Q

pathogenesis of pubic lice?

A 
acquired by close genital skin contact
lice bite skin and feed on blood causing itching in pubic area
female louses lay eggs on hair
males live for 22 days
females live for 17 days
50
Q

how is pubic lice managed?

A

malathion lotion

Repro and Sexual Health (63 decks)

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