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Microbiology of Reproductive tract Flashcards

1
Q

What are the main types of bacterial STIs?

A

Gonorrhoea,
Chlamydia (+ Lymphogranuloma Venereum),
Mycoplasma,
Ureaplasma,
Syphilis,
Anaerobes.

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2
Q

What is the common causative organism for Gonorrhoea?

A

Neisseria Gonorrhoea

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3
Q

What type of Agar does Gonorrhoea need to grow?

A

Chocolate Agar

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4
Q

What can Gonorrhoea causein patients?

A

Urethritis, Cervicitis, Disseminated disease, Pelvic inflammatory disease (PID), Pharyngitis, Proctitis.

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5
Q

What is the Treatment of Gonorrhoea?

A

Depends on Local resistance:
- Ceftriaxone 1g IM typically
or
- Azithromycin 2g single oral dose

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6
Q

What is the Causative bacterium in Chlamydia?

A

Chlamydia Trachomatis

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7
Q

What are the clinical signs of Chlamydia infection?

A

Increased vaginal discharge, Post-coital bleeding (bleeding after sex), Dysuria, Dyspareunia, Rectal pain.

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8
Q

What are some complications of untreated Chlamydia?

A

PID, Salpingitis, Endometritis, Tubal Infertility, ectopic pregnancy, Peri-hepatitis, Reactive arthritis.

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9
Q

What is the treatment of Chlamydia?

A

100mg Doxycycline for 7 days or Azithromycin.

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10
Q

What Type of testing is done to diagnose Chlamydia?

A

NAAT
(Nucleic Acid Amplification Testing)

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11
Q

What type of Bacteria is Neisseria Gonorrhoea?

A

Gram -ve Diplococci

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12
Q

Chlamydia is an Intracellular Bacterium, What does this mean?

A

It enters and replicates within cells before rupturing the cell and spreading to others.

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13
Q

In which infection are the majority of cases asymptomaic?

A

Chlamydia cases in women

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14
Q

What is Lymphogranuloma Venereum?

A

It is a condition affecting the lympoid tissue around the site of infection with Chlamydia. It occurs more commonly in MSM.

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15
Q

What is the first stage of Lymphogranuloma Venereum?

A

Primary stage involves a painless ulcer (primary lesion). Typically on penis, Vaginal wall or rectum after anal sex.

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16
Q

What is the Secondary stage of Lymphogranuloma Venereum?

A

Involves Lymphadenitis. This is swelling, inflammation and pain in the lymph nodes affected with the bacteria. The Inguinal and Femoral Lymph nodes are typically affected.

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17
Q

What is the Third stage of Lymphogranuloma Vereneum?

A

This involves Proctatitis (inflam of the rectum) and inflam of the anus. Poroctocolitis leads to anal pain and change in bowel habits. The feeling of needing to void bowels even after they are empty.

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18
Q

What is the Treatment for Lymphogranuloma Vereneum?

A

100mg Doxycycline for 21 days. Azithromycin, Erythromycin or Olfloxacin as alternatives.

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19
Q

What are some Obligate Anaerobes causing Bacterial vaginosis?

A

Gardnerella vaginalis, Prevotells sp., Mobiluncus sp.

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20
Q

Is Bacterial Vaginosis an STI?

A

No - it is caused by an overgrowth of anaerobic bacteria. It does increase the risk of developing an STI such as Chlamydia tho.

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21
Q

What is Bacterial Vaginosis?

A

Characterised by an increase in growth of anaerobic bacteria and loss of Lactobacilli. This changes normal vaginal pH and increases it to greater than 4.5.

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22
Q

What is the treatment of Bacterial Vaginosis?

A

Metronidazole oral 400mg twice a day for 5 - 7 days.
Or
Metronidazole gel 0.75% once a day for 5 days.
Or
Clindamycin cream 2% for 7 days (only in 2nd and 3rd trimester)

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23
Q

What should patients avoid in Bacterial Vaginosis?

A

Avoid Vaginal Douching

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24
Q

What does Mycoplasma Genitalium cause clinically?

A

Pelvic Inflammatory disease or Urethritis.
Can also cause Asymptomatic Miscarriage.

25
Q

What is the test for Mycoplasma Genitalium?

A

NAAT

26
Q

What is the Treatment for Mycoplasma Genitalium?

A

Doxycycline or Moxifloxacin

27
Q

What does Ureaplasma infection do to a patient?

A

Urethritis, Epididymitis, Prostatitis.

28
Q

What is the best investigation for Ureaplasma?

A

PCR.
Can also do liquid culture for sensitivity testing.

29
Q

What does Treponema Pallidum cause?

A

Syphilis - STI, Blood Transfusion or during pregnancy.

30
Q

What is the Incubation period from initial infection in Syphilis on average?

A

21 days

31
Q

What does the primary stage of Syphilis involve?

A

A painless ulcer called a Chancre at the original site of infection. (usually on genitals)

32
Q

What does the secondary stage of Syphilis involve?

A

Systemic Symptoms, Particularly of the skin and mucous membranes. Symptoms can resolve after 3-12 wks.

33
Q

What stage comes after the Secondary stage in Syphilis?

A

The latent stage - Symptoms disappear, patient becomes asymptomatic - STILL INFECTED. Early latent Syphilis occurs within 2 yrs. Late is > 2 yrs.

34
Q

What does tertiary Syphilis involve?

A

Can occur after many years and may affect many organs of the body, Particularly with the development of GUMMAS and Cardio and Neuro complications.

35
Q

What is Neurosyphilis?

A

Infection involving the CNS and presenting with Neurological Symptoms.

36
Q

What does Secondary Syphilis typically present with?

A

Maculopapular rash,
Condylomata lata (grey wart-like lesions around genitals and anus),
Low grade fever,
Lymphadenopathy,
Alopecia.

37
Q

What does Tertiary Syphilis usually present with clinically?

A

Differs depending on affected organs - look out for:
Gummatous lesions (Gummas are granulomatous lesions that can affect the skin),
Aortic Aneurysms,
Neurosyphilis.

38
Q

How do you test for Syphilis?

A

Antibody testing for T.Pallidum - Screening test.
Samples from infection sites to confirm presence of T.Pallidum using Dark field microscopy or PCR.

39
Q

What is the treatment of Syphilis?

A

Single deep IM dose of Benzathine Benzylpenicillin.

Alternative regimes and types of penicillin are used in different scenarios (Late Syphilis and Neurosyphilis). Ceftriaxone, Amoxicillin and Doxycycline are alternatives.

40
Q

What Types of HSV are there and Which is associated with what?

A

HSV-1 - Associated with cold sores, contracted before 5 yrs, dormant in Trigeminal nerve ganglion.

HSV-1 - Genital herpes, Contracted through oro-genital sex, Person with oral infection causes other to develop genital lesion.

HSV-2 - Genital herpes that is mostly Sexually Transmitted.

41
Q

How does Genital Herpes present?

A

May have no symptoms, or develop them mnths - yrs after initial infection.

Symptoms of Initial infection usually appear within 2 wks. Initial episode most severe, recurrent ones milder.

42
Q

What are the signs and Symptoms of Genital Herpes?

A

Ulcers of Blistering lesions,
Neuropathic type pain (burning, tingling),
Flu-like symptoms (fatigue, headache,
Dysuria,
Inguinal Lymphadenopathy.

43
Q

How is Genital Herpes diagnosed?

A

Diagnosis can be made clinically.
A viral PCR swab can confirm diagnosis and causative organism

44
Q

What is the Management of Genital Herpes?

A

Aciclovir (alternatives Valaciclovir, Famciclovir)

45
Q

What Type of cancers does HPV cause?

A

Cervical cancer (most common cause),
Anal, Vulval, Vaginal, Penile, Mouth and Throat cancers.

46
Q

What are the types of HPV most commonly associated with Cervical Cancers?

A

Type 16 and 18 (they are also the strains targeted with the HPV vaccine)

47
Q

What is the management for HPV?

A

No Management - most cases will resolve spontaneously within 2 yrs, whilst some persist.

Vaccines available.

48
Q

Which types of HPV cause Genital Warts?

A

Types 6 and 11.

49
Q

What is the Treatment of Varicella Zoster?

A

Treatment only required for severe cases (Aciclovir)

Vaccination available.

50
Q

What does Varicella zoster cause?

A

Chickenpox (usually children <10 yrs).
First chickenpox then Zoster.

51
Q

What are some complications of Primary Infection of Varicella zoster?

A

Pneumonia, Encephalitis and Foetal injury in pregnancy.

52
Q

What are some complications of Recurrent Infection of Varicella Zoster?

A

Lasting Nerve Damage.
Visual Impairment.

53
Q

Is Varicella Zoster an STI?

A

No - its contagious via droplets and Aerosols.

54
Q

What causes Vulvovaginal Candidiasis? (Genital Thrush)

A

Typically Candida Albicans (Gram +ve Fungi)

55
Q

What is the Treatment for Vulvovaginal Candidiasis?

A

Firstline: Oral Fluclonazole single dose 150mg.

Advise clotrimazole 500 mg intravaginal pessary as a single dose if oral therapy is contraindicated.

56
Q

What is Trichomoniasis?

A

An STI caused by a unicellular parasite called Trichomonas Vaginalis (TV).

57
Q

What are the symptoms of Trichomoniasis?

A

Around 70% of patients will not have any symptoms.
Clinically: Smelly, Thin Discharge with vulval itching, Dysuria, Prostatitis.

58
Q

How is Trichomoniasis Diagnosed?

A

Microscopy from Vaginal Swab.
NAAT

59
Q

How is Trichomoniasis treated?

A

Metronidazole

Reproduction (17 decks)

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