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Microbiology of the genital tract Flashcards

1
Q

How are the majority of infections in the genital tract transmitted?

A

Through sex.

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2
Q

What are the common bacterial STI’s?

A

Chlamydia- chlamydia trachomitis
Gonorrhoea -Neisseria gonorrhoea
Syphilis- Treponema pallidum

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3
Q

What are the common viral STI’s?

A

HPV- genital warts
Herpes simplex- genital herpes
Hepatitis and HIV

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4
Q

What are the common parasitic STIs?

A

Trichomonas vaginalis
Phthirus pubis- pubic lice
Scabies

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5
Q

What sign will you see if gonococci infect the male urethra and explain why?
How would chlamydia differ?

A

Purulent discharge will occur- due to the high neutrophil infiltration. Also have pain on urination.

Chlamydia affects the same tissue but is likely to produce a watery discharge, mild symptoms or no symptoms at all.

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6
Q

What determines the efficacy of an STI?

A

Concentration and phenotype of the organism in the genital tract.
Susceptibility of the sexual partner
Resistance of the host.

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7
Q

Can you have a candida infection without symptoms?

A

Yes- 30% of woman have this.

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8
Q

Name some predisposing factors for candida infection?

A

Recent antibiotic therapy
High oestrogen levels e.g. pregnancy, certain types of contraceptive.
Poorly controlled diabetes.
Immunocompromised patients

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9
Q

How does symptomatic candida infection present?

A

Intensely itchy, white vaginal discharge.

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10
Q

How would you diagnose candida infection?

A

Clinical diagnosis

Can do a high vaginal swab for culture.

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11
Q

What is the most common cause of candida infection?

A

C. albicans

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12
Q

How would you treat candida infection?

A

Topical co-trimazole pessary or cream

Oral fluconazole

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13
Q

How would a gram film of candida infection look?

A

Budding yeasts and hyphae

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14
Q

How can prostatitis be classified?

A

Acute bacterial prostatitis
Chronic bacterial prostatitis
Chronic prostatitis/chronic pelvic pain syndrome

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15
Q

How does acute bacterial prostatitis present?

A

Symptoms of a UTI- pain on urination, may also have lower abdominal pain/back/perineal/penile pain and a tender prostate on examination

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16
Q

What are the likely causative organisms of acute bacterial prostatitis?

A

Check for UTI organisms e.g. E coli, coliforms etc

In men under 35- check for STI- gonorrhoea and chlamydia

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17
Q

Treatment of acute bacterial prostatitis?

A

Trimethoprim is the preferred treatment (28 days). Also used in high C diff risk. However if resistant give ciprofloxacin (28 days).

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18
Q

What is positive predictive value?

A

When a screening test comes back positive for the disease and the person actually is positive for the disease.

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19
Q

What is negative predictive value?

A

Subjects with a negative screening test actually are negative for the disease.

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20
Q

You are likely to be infected by a singular STI. True or false?

A

False- they tend to come in ‘packs’.

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21
Q

What test can be used to test for both gonorrhoea and chlamydia in the same sample?

A

Nucleic acid amplification tests.

Or PCR

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22
Q

On NAAT, how does gonorrhoea appear?

A

Gram negative intracellular diplococci.

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23
Q

What organisms are present on the normal vaginal flora?

A

Lactobacillus predominate
Strep viridans
Group B- beta haemolytic streptococci
Candida spp- in small numbers.

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24
Q

What do lactobacillus produce? What is their function?

A

Lactic acid and hydrogen peroxide

They suppress growth of other bacteria.

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25
Q

What is meant by the term bacterial vaginosis?

A

Overgrowth of bacteria in the vagina.

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26
Q

Name specific species of lactobacilli that produce the lactic acid?

A

Lactobacillus crispatus

Lactobacillus jensenii

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27
Q

What is the normal vaginal pH?

A

4-4.5.

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28
Q

What occurs in bacterial vaginosis?

A

The normal vaginal flora is replaced with Gardrenella Vaginalis and many species of anaerobic bacteria.

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29
Q

Describe the discharge of bacterial vaginosis?

A

Homogenous and may contain bubbles.

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30
Q

What test can be done to confirm bacterial vaginosis- describe?

A

Whiff test- add potassium hydroxide to the discharge and it will produce a fishy odour.

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31
Q

What is a wet mount?
What does it reveal?
What are clue cells?

A

A vaginal wet mount is where vaginal discharge is looked at under wet mount microscopy.
Reveals the absence of bacilli and replacement of them with coccobacilli.
Microscopy will show- lots of coccobacilli obscuring the edges- known as clue cells (clue to BV).

32
Q

What does a large number of leukocytes on a wet mount suggest?

A

Suggests an coincidental infection- possibly trichomoniasis or bacterial cervicitis

33
Q

What are some consequences of bacterial vaginosis?

A

Increased rate of upper tract infection.
Premature rupture of the membranes and preterm delivery
Increased risk of acquisition of HIV.

34
Q

What would you treat bacterial vaginosis with?

A

Metronidazole for 10 days.

35
Q

Which area of the body can chlamydia affect?

A 
Eyes
Rectum
Urethra
Throat
Also endocervix in females.
36
Q

What three serological groupings can chlamydia be divided into? What do they cause?

A

Serovars A-C- trachomatis- effects eyes (not an STI)
Serovars D-K- genital infection
Servers L1-L3- lymphogranuloma venereum. Long term chronic infection of the lymphatic system.

37
Q

Does chlamydia take up a gram stain? Explain why?

A

Nope.

The basis of gram stain is that you have to have peptidoglycan to retain it- chlamydia does not have this.

38
Q

How do you treat chlamydia?

A

Azithromycin 1g orally for uncomplicated.

Doxycycline BD 100mg for 7 days.

39
Q

Describe chlamydias infectious cycle?

A

Attaches and enters
Migrates to perinuclear area. EB to RB transition occurs.
Inclusion biogenesis and bacterial bioreplication
RB to EB transition and cell lysis (takes 48 hours to get to this stage).

40
Q

What samples are collected for testing for combined chlamydial and gonorrhoeal infection?

A

Male patients- first pass urine sample
Female patients- HVS or vulvo-vaginal swab. Or clinician taken endocervical swab.
Rectal and throat swabs can be taken
Eye swabs

41
Q

Describe the pathogenesis of gonococcal infection?

What do typical urethral infections result in?

A

Attaches to host epithelial cells and is endocytose into the cell to replicate, before being released into the tubepithelial space.
Result in prominent inflammation, release of toxic oligo-saccharide and peptidoglycan fragments as well as the release of chemotactic factors that attract neutrophilic leukocytes.
Some cause asymptomatic infection

42
Q

Where in the body can gonorrhoea affect?

A

Infects urethra, rectum, throat and eyes in men and females, and then the endocervix in just females.

43
Q

What shape is gonorrhoea under gram stain?

A

Gram negative diplococcus. Looks like two kidney beans facing one another. Often is intracellular on gram film due to it being phagocytosed.

44
Q

What other tests can you do for gonorrhoea?

A

Microscopy or urethral/endocervical swabs.

Culture on selective agar plates- not really done on vaginal swabs.

45
Q

Compare culture vs PCR/NAATs for testing for gonorrhoea?

A

NAATs- slight increase in sensitivity
NAATs- can also test urine and vaginal swabs
However can’t perform antimicrobial susceptibility testing. Or antibiotic resistance testing.
PCR- will be positive even if organism has died on the way to the lab
Takes hours not days

46
Q

How would you acquire pharyngeal gonorrhoeal infection?

How does it present?

A 
Orogenital exposure (oral sex). 
Generally an asymptomatic infection. Rare cases may cause an exudative pharyngitis with cervical lymphadenopathy.
47
Q

Why is it so important to treat pharyngeal gonococcal infection?

A

They may exchange genetic material with other bacteria to lead to gonococcal resistance.

48
Q

How would you treat gonorrhoea?

A

IM Cephalosporin plus azithromycin (used for resistant gonococcal infection and to treat chlamydia).

49
Q

What antibiotics are gonorrcoccus resistant too?

A

Penicillins, tetracyclines, quinolones and most oral cephalosporins.

50
Q

What is proctitis?

A

Inflammation of the lining of the rectum.

51
Q

How would you diagnose rectal gonorrhoeal infection?

A

NAAT.

52
Q

What is the differential diagnosis of rectal gonorrhoeal infection?

A

Other traditional STI’s, Ulcerative colitis, Crohns, anal fissure, rectal lacerations and proctocolitis.

53
Q

What organism causes syphilis?

A

Treponema pallidum

54
Q

Does syphillis gram stain? Can it be cultured? Which tests are used for diagnosis?

A

NOPE and nope

PCR is used.

55
Q

Describe the first stage of syphillis infection?

A

Primary lesion- chancre (painless ulcer). Organism multiplies at inoculation site, and enters the bloodstream. Chancre will heal with treatment.

56
Q

Describe the second stage of syphillis infection?

A

Large numbers of bacteria circulate in the bloodstream. with multiple manifestations at different sites (snail-track, mouth ulcers, generalised rash, flu-like symptoms)

57
Q

Describe the third stage of syphillis infection?

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 stages.

58
Q

What happens if the syphillis is left untreated?

A

Some patients will self cure.

Others will go on to develop neurological and cardiovascular complications.

59
Q

How would you diagnose syphillis?

A

Dark ground microscopy to look for spirochaetes in exudate from primary and secondary lesions.
Swab lesions for PCR
Blood tests- serology- tests for specific and non-specific antibodies to T palladium in the blood.

60
Q

What do non-specific tests in syphillis tell you?

A

The disease activity. Useful to monitor response to treatment.

61
Q

What non specific tests into syphillis are there?

A

VDRL- venereal diseases research laboratory
RPR-rapid plasma reagin

NOTE- they may be falsely positive e.g. in SLE, malaria and pregnancy.

62
Q

What specific serological tests can be used to diagnosis syphillis?

A

TPPA- T. Pallidum agglutination assay
TPHA- T. Pallidum haemaglutination assay
IgM and IgG Elisa- screening test.

63
Q

Which serological test in syphillis is not specific but remains positive for life?

A

TPHA- T. Pallidum haemaglutination assay

64
Q

If you test positive for IgM and IgG Elisa, what happens next?

A

Go on to have further tests performed on the blood
-VDRL test
TPPA test.

65
Q

What is the treatment for syphillis?

A

Injectable long acting penicillin.

66
Q

What causes genital herpes?

A

HSV type 1 (also causes cold sores) and type 2.

67
Q

How can you contract genital herpes?

A

Close contact with someone with herpes.

68
Q

Describe the pathogenesis of genital herpes?

A

Primary infection may be asymptomatic.
Virus replicates in dermis and epidermis.
Gets into nerve endings of sensory and autonomic nerves
Inflammation at nerve endings- very painful, multiple small vesicles which are easily deroofed.
Virus migrates to sacral root ganglion and hides from the immune system there.
Virus can reactivate from there causing recurrent genital herpes attacks.

69
Q

How would you diagnose genital herpes?

A

Swab in virus transport medium of the deroofed blisters for PCR.

70
Q

How would you treat genital herpes?

A

Aciclovir and pain relief.

71
Q

What is trichomonas vaginalis?

A

A single celled protozoal parasite.

72
Q

How is trichomonas vaginalis transmitted?

A

Sexual contact.

73
Q

What symptoms does trichomonas vaginalis cause?

A

Vaginal discharge and irritation in females.

Urethritis in men

74
Q

How would you treat trichomonas vaginalis?

A

Oral metronidazole

75
Q

What is pthirus pubis?

A

Pubic lice

76
Q

How can pubic lice be acquired?

What do the lice do?

A

Close genital skin contact.

The lice bite the skin and feed on blood causing itching in the pubic area.

77
Q

How would you treat pubic lice?

A

Malathion lotion.

Reproduction (34 decks)

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