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Reproduction SOH > Microbiology - STIs etc > Flashcards

Microbiology - STIs etc Flashcards

1
Q

Which species predominates in the healthy vagina?

A

Lactobacillus species

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2
Q

What does lactobacillus species produce?

A

Lactic acid +/- hydrogen peroxide

- which suppresses the growth of other bacteria

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3
Q

Name 3 Non-STIs

A

Candida
Bacterial vaginosis
Prostatitis

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4
Q

Candida infection - definition

A

Vaginal thrush

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5
Q

Candida is a fungal infection. True or false?

A

False

- yeast infection

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6
Q

Candida infection - Most likely causative organism

A

Candida albicans

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7
Q

Candida infection - predisposing factors (name 4)

A

Recent antibiotic therapy
High oestrogen levels
Poorly controlled diabetes
Immunocompromised patients

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8
Q

More likely to get a candida infection if you are pregnant. True or false?

A

True

- due to high levels of oestrogen

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9
Q

Candida infection -clinical features

A

Intensely itchy

Thick, white vaginal discharge

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10
Q

Candida infection - investigations

A

Clinical diagnosis

High vaginal swab for culture

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11
Q

Candida infection - management

A

Topical clotrimazole
- either pessary or cream
Oral fluconazole

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12
Q

The presence of candida always indicates infection and should be treated. true or false?

A

False

- don’t treat if asymptomatic as some people always have low levels of candida app

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13
Q

Candida balanitis - definition

A

Candida of the male penis

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14
Q

Oropharyngeal candida gives risk of HIV. True or false?

A

true

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15
Q

Bacterial vaginosis - definition

A

Imbalance of bacteria in the vagina. unable to see the healthy organisms (lactobacilli)

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16
Q

Bacterial vaginosis is an STI. True or false?

A

False

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17
Q

Bacterial vaginosis is most common in sexually active people. True or false?

A

True

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18
Q

Bacterial vaginosis - clinical features

A

Fishy smell

Thin, watery, creamy coloured discharge

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19
Q

Bacterial vaginosis - investigations

A

Clinical diagnosis
High vaginal swab
- look for clue cells

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20
Q

Bacterial vaginosis - if you add potassium hydroxide to the discharge what happens?

A

Fishy odour, yielding a positive whiff test

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21
Q

High vaginal swab for bacterial vaginosis findings

A

Absence of bacilli and replacement with clumps of coccobacilli
Few polymorphonuclear leukocytes

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22
Q

Bacterial vaginosis - acidic/alkaline pH?

A

alkaline

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23
Q

Bacterial vaginosis - management

A

Oral metronidazole, 7 days

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24
Q

Bacterial vaginosis infection leads to increased rate of upper genital tract infections. True or false?

A

True

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25
Q

Prostatitis - clinical features

A 
Symptoms of UTI 
Also 
- lower abdominal pain
- back pain
- perineal pain
- penile pain
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26
Q

Prostatitis - investigations

A

MSSU for C+S

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27
Q

Prostatitis - management

A

Ciprofloxacin for 28 days

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28
Q

Prostatitis - management in patients at high risk of C diff

A

Trimethoprim

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29
Q

Syphilis is a bacterial/viral/parasitic STI

A

Bacterial

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30
Q

Name 3 bacterial STIs

A

Chlamydia
Gonorrhoea
Syphilis

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31
Q

Name 4 viral STIs

A

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

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32
Q

Name 2 parasitic STIs

A

Pubic lice

Trichomonas vaginalis

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33
Q

STI re-infection is common/uncommon

A

Common

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34
Q

With STIs it is common to have a co-infection. True or false?

A

True

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35
Q

What is the commonest bacterial STI in the UK?

A

Chlamydia

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36
Q

Chlamydia - highest incidence in which age group?

A

20-24

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37
Q

Chlamydia - transmission

A

Vaginal
Anal
Oral

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38
Q

Chlamydia - which sites does it infect?

A 
Urethra
Rectum
Throat
Eyes
Endocervix
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39
Q

Chlamydia - causative organism

A

Chlamydia trachomatis

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40
Q

Does chlamydia trachoma’s stain with gram stain?

A

No, there is no peptidoglycan in the cell wall

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41
Q

Chlamydia - which serovars are most common to cause genital infection?

A

Serovars D-K

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42
Q

Chlamydia - clinical features (female)

A

Post coital or intermenstrual bleeding
Lower abdo pain
Dyspareunia
Mucopurulent cervicitis

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43
Q

Chlamydia - clinical features (male)

A 
Milky urethral discharge
Dysuria
Urethritis 
Epididymo-orchitis 
Proctitis
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44
Q

Chlamydia is often asymptomatic. true or false?

A

True

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45
Q

Chlamydia discharge

A

Milky, watery

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46
Q

Which STI is associated with pelvic inflammatory disease?

A

Chlamydia

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47
Q

Investigate for chlamydia ___ days after sexual exposure?

A

14 days

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48
Q

Chlamydia investigations are combined with what other STI ?

A

Gonorrhoea

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49
Q

Combined chlamydia and gonorrhoea investigations

A

NAATs

PCR

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50
Q

Combined chlamydia and gonorrhoea investigations - females

A

Vulvovaginal swab or

high vaginal swab

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51
Q

Combined chlamydia and gonorrhoea investigations - males

A

First void urine

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52
Q

Advantages of NAATs and PCR over culture ?

A

Faster

Increased sensitivity

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53
Q

Disadvantages of NAATs and PCR

A

Tell you genetic material of chlamydia when there is not particularly an active infection as it can detect dead organisms

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54
Q

Should you do a test of cure for chlamydia and gonorrhoea patients ?

A

Yes

- 5 weeks after diagnosis

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55
Q

Chlamydia - management

A

Doxycycline 100mg bd x 7 days

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56
Q

Why is azithromycin no longer used for management of chlamydia?

A

Rate of resistance has increased

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57
Q

Clinical features of chlamydia transmission to neonate?

A

Conjunctivitis

Pneumonia

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58
Q

Gonorrhoea - transmission

A

Sex

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59
Q

Higher risk of transmitting gonorrhoea if spreading from woman -> man. True or false?

A

False

- Man -> woman

60
Q

Gonorrhoea - incubation period

A

2-5 days

61
Q

Gonorrhoea - what sites does it infect?

A 
Urethra
Rectum
Throat
Eyes
Endocervix
62
Q

Gonorrhoea - causative organism

A

Neisseria gonorrhoeae

63
Q

Neisseria gonorrhoea microbiology

A

Gram -ve diplococcus

64
Q

Microscopy of which organism looks like 2 kidney beans facing each other?

A

Neisseria gonorrhoea

65
Q

Gonorrhoea - clinical features (males )

A

Purulent dischage
Urethritis
Dysuria

66
Q

Gonorrhoea - clinical features (female)

A

Altered/increased vaginal discharge
Dysuria
Pelvic pain

67
Q

Gonorrhoea - more likely to be asymptomatic in males/females?

A

Females

68
Q

Gonorrhoea - which other STI do you co-test for?

A

Chlamydia

69
Q

Combined gonorrhoea and chlamydia testing

A

NAATs

PCR

70
Q

Gonorrhoea - investigations

A

NAATS
PCR
Microscopy of urethral/endocervical swabs
Culture

71
Q

If doing a culture for gonorrhoea, which agar should be used?

A

Non selective chocolate agar

72
Q

Gonorrhoea - management

A

IM ceftriaxone 500mg

73
Q

Gonorrhoea - Why must patients be managed in hospital?

A

Route of ceftriaxone is IM

74
Q

Gonorrhoea - when should you do a test of cure?

A

2 weeks after

75
Q

Gonorrhoea - why should you do a test of cure?

A

Untreatable gonorrhoea has been described in many parts of the world

76
Q

Humans are the only hosts of syphilis. True or false?

A

True

77
Q

Name the 4 stages of syphilis

A

Primary lesion
Secondary stage
Latent stage
Late stage

78
Q

Syphilis - what is the primary lesion called?

A

Chancre

79
Q

Syphilis - what is a chancre?

A

Painless ulcer at the site of contact with the vulva (inoculation site)

80
Q

Syphilis - a chancre must be treated?

A

False, will heal without treatment

81
Q

Syphilis - incubation period

A

21 days

82
Q

Syphilis - secondary stage clinical features

A

Snail track mouth ulcers
Generalised rash on palms and soles of feet
Flu like symptoms
Patchy alopecia
Condylomata lata (genital wart like lesions which ooze fluid)

83
Q

Syphilis - latent stage clinical features

A

None

84
Q

Syphilis - late stage clinical features

A

Cardiovascular or neurovascular complications occur many years later

85
Q

Syphilis - causative organism

A

Treponema Pallidum

86
Q

Treponema pallidum - which kind of organism is it ?

A

Spirochete - cork screw appearance

87
Q

Treponema pallidum stains with gram stain. True or false?

A

False

88
Q

Syphilis - transmission

A

Sexual contact
Vertical
Blood transfusions
Non-sexual contact (healthcare workers and needles)

89
Q

Syphilis - clinical features

A 
Painless ulcer (chancre) 
Snail track mouth ulcers 
Generalised rash on palms and soles 
Non tender local lymphadenopathy
Flu like symptoms
90
Q

Syphilis - investigations of chancre

A

Swab for PCR

91
Q

Syphilis - investigations to demonstrate organism

A

Dark field microscopy or PCR

- demonstrates treponema pallidum

92
Q

Syphilis - serological testing (non specific)

A 
Used to monitor response to treatment and measure disease activity 
IgG
IgM - active infection
VDRL - indicates tissue inflammation 
RPR - indicates tissue inflammation
93
Q

Which 2 non specific serological tests are useful to monitor response to therapy?

A

VDRL
RPR
- they usually become negative after treatment

94
Q

Specific serological tests for syphilis

A 
Confirm the diagnosis but levels often remain positive for life 
EIA - screening test 
TPHA
TPPA
CLIA
FAT
95
Q

Syphilis - it is possible to self cure. True or false?

A

True

96
Q

Syphilis - management

A

Long acting IM penicillin

- penicillin has to hang around for a long time enough for the bug to die

97
Q

Syphilis - management in penicilin allergic patients

A

Desensitisation. Give the patient very small doses and gradually build up whilst being closely monitored

98
Q

Syphilis - follow up

A

RPR should fall and be negative

- titres should decrease by 3-6 months in early syphilis

99
Q

Name a new emerging STI

A

Mycoplasma genitallium

100
Q

Mycoplasma genitalium - clinical features

A

Persistent urethritis

101
Q

What is the most common viral STI in the UK ?

A

Genital warts

102
Q

Genital warts - cause

A

HPV

- most common types that cause genital warts: type 6,11

103
Q

Genital warts - Transmission

A

Likely to have acquired it from an asymptomatic partner (80% of population are already exposed to HPV but only 10% have detectable infection)

104
Q

Genital warts - clinical features

A

Painless warts
Present around sites of friction
Cauliflower appearance
- rough surface

105
Q

Genital warts - investigations

A

Clinical diagnosis only

106
Q

Genital warts - management

A

Podophyllotoxin cream/lotion
Imiquimod
Cryotherapy

107
Q

Genital warts are cured after treatment. true or false?

A

False

- commonly recur

108
Q

HPV vaccination - which age group is this given to

A

11-13 year old females

109
Q

What does HPV vaccination immunise against?

A

Type 6,11,16,18

110
Q

Who gets HPV vaccination?

A

Females 11-13

MSM up to and including those age 45

111
Q

Genital herpes - organism

A

Herpes simplex virus type 1 or 2

112
Q

Genital herpes is most commonly HSV type 1 or 2 ?

A

Type 2

113
Q

Genital herpes - primary infection

A

Asymptomatic in many

114
Q

Genital herpes - pathogenesis

A

Virus replicates in dermis and epidermis
Virus gets into the nerve endings or sensory and autonomic nerves
Inflammation at nerve endings
Virus migrates to sacral root ganglion and hides from immune system
Reactivation of virus

115
Q

Genital herpes - transmission

A

Close contact with someone shedding the virus

Spread by either genital/genital or genital/orpharyngeal contact

116
Q

Genital herpes - clinical features

A

Recurrent
VERY painful ulcers
Blistering and ulceration of external genitalia
Vaginal or urethral discharge
Local lymphadenopathy
Recurrent vesicular rash on thigh or buttocks

117
Q

Genital herpes - investigations

A

Swab for PCR

- must derive blisters when taking swab

118
Q

Genital herpes - management

A

Oral aciclovir 400mg TDS 5 days

Topical relief - lignocaine

119
Q

Genital herpes and pregnancy

A

May need caesarean section

120
Q

Trichomonas vaginalis - organism

A

Single celled protozoa parasite which divides by binary fission

121
Q

Trichomonas vaginalis - transmission

A

Sexual contact

122
Q

Trichomonas vaginalis - clinical features

A

Yellow vaginal discharge
Irritation in females
Urethritis in males

123
Q

Trichomonas vaginalis - investigations

A

Microscopy

  • high vaginal swab
  • organism will be seen moving about
124
Q

Trichomonas vaginalis - management

A

Metronidazole

125
Q

Pubic lice - organism

A

Phthirus pubis

126
Q

Pubic lice - how is it acquired

A

By close genital skin contact

127
Q

Pubic lice - clinical features

A

Intense itch

128
Q

Pubic lice - otherwise known as

A

Crabs

129
Q

Pubic lice - management

A

Malathion lotion

130
Q

First pass urine or MSU for chlamydia/gonorrhoea?

A

First pass urine

131
Q

Treatment of prostatitis

A

Ciprofloxacin 28 days

132
Q

Ophthalmia neonatorum

A

Chlamydia passed on through birth from mother to child resulting in conjunctivitis in the neonate

133
Q

Testing for chlamydia in asymptomatic male who has sex with woman

A

first pass urine for NAATS

134
Q

Testing for chlamydia in SYMPTOMATIC male who has sex with woman

A

microscopy - during clinical examination take urethral swab and will get result in 5 mins
+
first pass urine for NAATS

135
Q

Testing for chlamydia in MSM

A

First-catch urine (or urethral swab) and

pharyngeal and rectal swabs (all NAAT)

136
Q

Test of cure is required for chlamydia. True or false?

A

False

- only required if patient is pregnant or if treatment compliance is in question

137
Q

First line investigation for ?sypphilis

A

PCR test

138
Q

Which test is specific for syphilis but not useful for monitoring?

A

TPPA

139
Q

What is the ELISA test and what is it used for?

A

Tests for IgG and IgM antibodies for syphilis

140
Q

EILSA test done and comes back negative. What do you do?

A

Nothing, patient is negative

141
Q

EILSA test done and comes back positive. What do you do`?

A

Further tests

  • TPPA
  • IgM EILSA
142
Q

What is the treatment of Primary/Secondary and early latent

infection

A

2.4MU benzathenepenicillin IM.

143
Q

Herpes simplex virus is a single/double stranded DNA/RNA

A

Double stranded DNA

144
Q

Common causative organism for prostatitis?

A

E coli

145
Q

Patients at risk of having acquired a BBV should be tested for?

A

Hep B
HIV
Hep C
Syphilis

146
Q

Partner notification is required for HSV. True or false?

A

False

- progresses differently in different patients

147
Q

If a young person (under 16) meets the criteria for the X guidelines they are said to have ______ _______

A

Fraser guidelines

Gillick competence

Reproduction SOH (50 decks)

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