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Repro > Microbiology of the Genital tract > Flashcards

Microbiology of the Genital tract Flashcards

1
Q

What is the predominate bacteria in the normal vaginal flora and what does it do?

A

lactobacillus spp. - produces lactic acid and hydrogen peroxide to suppress the growth of other bacteria

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2
Q

What other organisms are present in the normal vaginal flora?

A

Strep viridans
Group B-haemolytic Strep
Candida spp.

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3
Q

Name 3 non-sexually transmitted genital tract infections

A

Candida (thrush)
Bacterial vaginosis (fishy smell)
prostatitis

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4
Q

What % of woman are colonised by Candida but show no symptoms of a thrush infection?

A

30%

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5
Q

What are predisposing factors for a candida infection?

A

recent antibiotic therapy
High oestrogen levels (pregnancy, some contraceptives)
Poorly controlled diabetes
Immunocompromised patients

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6
Q

What is the presentation of thrush?

A

Intensely itchy white vaginal discharge

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7
Q

How do you clinically diagnose thrush?

A

High vaginal swab for culture

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8
Q

What organism causes most cases of thrush?

A

Candida albicans

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9
Q

What is the treatment of Candida infections?

A

Topical clotrimazole pessary or cream

Oral fluconazole

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10
Q

What organisms can cause Bacterial vaginosis?

A

Gardnerella vaginalis
Mobiluncus sp.
Others include anaerobes

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11
Q

What are the predisposing factors of Bacterial vaginosis?

A

Uncertain

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12
Q

What are the symptoms of bacterial vaginosis?

A

Thin, watery, fishy smelling vaginal discharge

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13
Q

How do you diagnose bacterial vaginosis?

A

Raised vaginal pH >4.5

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14
Q

What is looked for in a laboratory sample of suspected bacterial vaginosis?

A

CLUE CELLS

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15
Q

What scoring system estimates the proportion of clue cells to epithelial cells and lactobacilli?

A

Hay-lyson scoring system

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16
Q

What is the treatment for bacterial vaginosis?

A

Metronidazole orally

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17
Q

What are the 3 classifications of Prostatitis?

A
  1. Acute bacterial prostatitis
  2. Chronic bacterial prostatitis
  3. Chronic prostatitis / chronic pelvic pain syndrome (CP/CPPS)
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18
Q

What are the organisms involved with acute bacterial prostatitis?

A

Same as a UTI, E.coli and other coliforms, enterococcus sp.

Always check for STI’s

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19
Q

What is acute bacterial prostatitis?

A

A rare complication of a UTI in men

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20
Q

What are the symptoms of acute bacterial prostatitis?

A

Symptoms of a UTI, may have lower abdo/back/perineal/penile pain
Tender prostate on examination

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21
Q

How is acute bacterial prostatitis diagnosed?

A

Clinical signs
MSSU for C&S
tests for STI’s

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22
Q

What is the treatment for acute bacterial prostatitis?

A

Ciprofloxacin for 28 days

Trimethoprim for 28 days if high C.diff risk

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23
Q

Name 3 bacterial STI’s

A

Chlamydia tachomatis
Neisseria gonorrhoeae
Treponema pallidum (Syphilis)

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24
Q

Name 3 viral STI’s

A

Human papilloma virus (genital warts)
Herpes simplex virus (Genital herpes)
Hepatitis and HIV

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25
Q

Name 3 parasitic STI’s

A

Trichomonas vaginalis
Phthirus pubis (Pubic lice/crabs)
Scabies

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26
Q

What parts of the body does Chlamydia effect?

A 
urethra
rectum
throat
eyes
endocervix
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27
Q

Describe Chlamydia trachomatis

A

Obligate intracellular bacteria with biphasic life cycle - “energy parasite”

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28
Q

What colour does Chlamydia trachomatis stain with gram stain?

A

It doesn’t, no peptidoglycan in the cell wall

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29
Q

What are the 3 serological groupingsof Chlamydia trachomatis?

A

Serovars A-C = Trachoma (eye infection) (no an STI)
Serovars D-K = Genital infection
Serovars L1-L3 = Lymphogranuloma venereum

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30
Q

What is the treatment for Chlamydia trachomatis?

A

Azithromycin (1g oral dose) for uncomplicated chlamydia

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31
Q

What is the infectious cysle of Chlamydia?

A

0hrs - attachment and entry
2-12hrs - Migration to perinuclear area and EB–> RB transition
12-24hrs - inclusion biogenesis and bacterial replication
24-48hrs - RB–> EB transition and cell lysis

32
Q

Where does Neisseria gonorrhoeae effect?

A 
Urethra
Rectum
Throat
Eyes
Endocervix
33
Q

Describe Neisseria gonorrhoeae

A

Gram -ve diplococcus
Like two kidney beans facing each other
Easily ohagocytosed by polymorphs, so often appear intracellularly on a gram film

34
Q

What does the term ‘Fastidious organism’ mean?

A

does not survive well in less than ideal growth conditions

i.e. outside the body

35
Q

How can you diagnose both chlamydia and gonorrhoea?

A

Combined nucleic acid amplification tests (NAATs) or polymerase chain reaction test (PCR)
tests for both organisms in 1 test

36
Q

What other tests are available for Neisseria gonorrhoeae?

A

Microscopy of urethral / endocervical swabs

Culture on selected agar plate

37
Q

What are some advantages for PCR/NAATs over culture?

A

Less invasive specimens required
More sensitive than cultures
+ve even if organism has died in transit to the lab
Takes hours, not days

38
Q

What are disadvantages of PCR/NAATs over culture?

A

Cannot test antibiotic sensitivities without culture, so difficult to track resistance
Will detect dead organism (have to wait 5 weeks to do “test of cure” tests

39
Q

What is the recommended treatment for Neisseria gonorrhoeae?

A

Intramuscular ceftriaxone + oral azithromycin

40
Q

What organism causes Syphilis?

A

the spirochaete organism that is Treponema pallidum

41
Q

What colour does Treponema pallidum gram stain?

A

It doesn’t

42
Q

How do you test for Treponema pallidum?

A

PCR or serology tests for antibodies. No culture as it can’t be grown in artificial culture media

43
Q

Describe the 1st stage of syphilis

A

1 y lesion (chancre) - organism multiplies at inoculation site and gets into bloodstream. Chancre will heal without treatment

44
Q

Describe the second stage of syphilis

A

2y stage - large nos. bacteria circulating in blood with multiple manifestations at different sites (snail-track mouth ulcers, generalised rash, flu-like symptoms)

45
Q

Describe the 3rd stage of syphilis

A

Latent stage - no symptoms, but low-level multiplication of spirochaete in intima of small blood vessels. Can be divided into early latent and late latent periods

46
Q

Describe the 4th stage of syphilis?

A

Late stage - cardiovascular or neurovascular complications many years later

47
Q

How do you diagnose syphilis?

A

Dark ground microscopy to look for lesions for spirochaetes in exudate from 1y to 2y lesions
Swab of 1y and 2y lesions for PCR
Serology for specific and non-specific antibodies to Treponema pallidum

48
Q

What are the non-specific tests for Treponema pallidum for?

A

Tests indicate how active the disease is and are useful to monitor the response to treatment

49
Q

What are the specific tests for Treponema pallidum for?

A

Confirm the diagnosis, but antibody levels decrease very slowly even after successful treatment, ad often remain for life

50
Q

When may non-specific tests for Treponema pallidum give a false positive?

A

SLE
Malaria
Pregnancy

51
Q

What are specific serological tests for Treponema pallidum?

A

TPPA - Treponema pallidum particle agglutination assay

TPHA - Treponema pallidum haemagglutination assay

52
Q

What two antibodies are looked for in the ELISA screening test for syphilis?

A

IgG and IgM

53
Q

What is Treponema pallidum very sensitive to?

A

Penicillin

54
Q

What are genital warts?

A

Non-enveloped icosohedral virus containing double stranded DNA

55
Q

What strands of HPV cause genital warts?

A

6 and 11

56
Q

What strands of HPV cause cervical cancer?

A

16 and 18

57
Q

What is the diagnosis of genital warts?

A

Mainly clinical

58
Q

What is the treatment for genital warts?

A

Cryotherapy
Podophyllotoxin
Cream/lotion

59
Q

What age group is the quadrivalent vaccine given to?

A

11-13 year olds girls

60
Q

What does the quadrivalent vaccine protect against?

A

HPV type 6,11,16 and 18

61
Q

Describe genital herpes?

A

Enveloped virus containing double stranded DNA

62
Q

What causes genital herpes?

A

HSV-1

HSV-2

63
Q

How may the primary infection present?

A

Asymptomatic or very florid

64
Q

Where does the virus in genital herpes replicate?

A

In the dermis and epidermis

65
Q

Where do genital herpes viruses get into?

A

Into the nerve endings of sensory and autonomic nerves

Causes inflammation, exquisitely painful, multiple small vesicles which are easily deroofed

66
Q

Where does the virus in genital herpes migrate to?

A

The sacral root ganglion and “hides” from the immune system

67
Q

How is genital herpes diagnosed?

A

Swab for virus transport medium of deroofed blister for PCR testing

68
Q

What is the treatment for genital herpes?

A

Aciclovir helpful if taken early

Pain relief

69
Q

Are the vaccines for genital herpes?

A

Yes, but they have been dissapointing

70
Q

What is Trichomonas vaginalis?

A

Single celled protozoal parasite.

divides by binary fission (no cyst form is known) and it’s only host is human

71
Q

What does Trichomonas vaginalis?

A

Vaginal discharge and irritation in females (and urethritis in males

72
Q

How do you diagnose Trichomonas vaginalis?

A

High vaginal swab for microscopy PCR

73
Q

What is the treatment for Trichomonas vaginalis?

A

Oral metronidazole

74
Q

What is Phthirus pubis?

A

Pubic lice

Lice bite skin and feed on blod, which causes itching in pubic area

75
Q

How do pubic lice replicate?

A

Female louse lays eggs on hair next to skin

76
Q

How long do pubic lice live for?

A

Males for 22 days, females for 17 days

77
Q

What is the treatment for pubic lice?

A

malathion lotion

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