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Amars Semester Two cards > Repro 4 > Flashcards

Repro 4 Flashcards

1
Q

Outline the types, diagnosis, treatment, screening and vaccines when discussing the Human Papilloma viruses (HPV)

A

Types

  • HPV 6&11
    • benign & painless - outgrowths on the penis, vagina, perianal skin
    • cause anogenital warts
  • HPV 16&18
    • high risk - implicated in >70% of cervical cancer
      - can cause anogenital Cancer
      - cervical cancer is most common cancer 15-34 age range

Diagnosis
- biopsy, hybrid capture and genome analysis

Treatment

  • can be None - 70% resolve in 1year with 90% in 2 years
  • topical podophyllin, imiquimod, surgery

Screening

  • cervical papsmear - identifies precancerous cells - NOT cancer
  • colposcopy, cervical swab.

Vaccines

  • gardasil - protection vs HPV 6,11,16&18
  • Cervarix - protection vs 16&18
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2
Q

Describe the Herpes Simplex Virus (HSV), diagnosis and treatment

A

PC: extensive, painful genital ulceration +/- dysuria (painful urination)
- can present with painful inguinal lymphadenopathy

Types

  • HSV1 - cold sores
  • HSV2- genital herpes

Recurrent infections are possible as the virus can remain latent in the dorsal root ganglion

Diagnosis
- take a swab of the lesions/ulcers/blisters and do PCR

Treatment

  • aciclovir in first episode or severe disease
    - also given prophylactically in recurrent episodes
  • barrier contraception is a must
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3
Q

Describe the specimen collection from males, females and neonates in regards to Chlamydia trochamatis

A

Males

  • urethral swab
  • first catch urine

Females
- endocervical swab (not too acceptable by the patient)

Neonates
- eye swab - invert eyelid and take swab

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4
Q

Why is Chlamydia trochamatis harder to diagnose than other STIs ?

A

It is an obligate intracellular bacteria and it doesn’t grow in labs as well. Therefore it is harder to diagnose.

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5
Q

What is peri-hepatitis? Name two infections that can cause peri-hepatitis. Name one presenting symptom of peri-hepatitis

A

This is the inflammation of the liver capsule.
Chlamydia trochamatis and neisseria gonorrhoea can cause this.
Often presents with shoulder tip pain, referred pain.

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6
Q

Describe the infection of Chlamydia trochamatis is females and neonates.

A

Females

  • infection of the epithelium of the urethra or cervix
  • often can be asymptomatic
  • ascending infection involving the urinary genital tract can present as salpingitis or endometritis but is often PID
  • most common PID agent and routinely causes infertility or ectopic pregnancy due to the tubule damage.

Neonates

  • can lead to neonatal conjunctivitis
  • presents as conjunctivitis but it is a systemic infection not local
  • can cause neonatal pneumonia if untreated or only treated locally
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7
Q

Describe Chlamydia trochamatis infection in men

A

Presents as urethritis, prostatitis, epididymitis.

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8
Q

What triad of symptoms constitutes ‘acute epididymitis’

A

Arthritis, urethritis and conjunctivitis.

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9
Q

Outline the diagnosis of Chlamydia trochamatis

A
  • tissue culture but it is expensive as this is an obligate intrwllular bacteria and doesn’t grow easily in labs.
  • Nucleic Acid Amplification Test (NAATs)
    • high sensitivity
    • can dual test with Neisseria gonorrhoea.
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10
Q

Outline the treatment, and reason for dual treatment, of neisseria gonorrhoea

A

IM ceftriaxone with azithromycin

- azithromycin given to prevent the emergence of resistance to the cephs.

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11
Q

Outline the diagnosis of neisseria gonorrhoea infection

A

females
- endocervical, urethral and pharyngeal

Males
- urethral and laryngeal swabs

NAAT testing dual with chlamydia.

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12
Q

Outline the problems neisseria gonorrhoea infection can cause in males and females

A

Men
- gonacoccal urethritis.

Female

  • acute cervicitis
  • PID - tubo-ovarian abscess
  • Bartholin gland abscess - glands located near the base of vagina
    • can grow into the size of an egg.
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13
Q

What type of bacteria is neisseria gonorrhoea and how is it grown?

A

Gram negative diplococci

Grown on enriched agar, such as chocolate agar.

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14
Q

How is BV diagnosed and treated?

A

Vaginal pH > 5
KOH whiff test

Treated with metronidazole.

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15
Q

Describe the abnormality in vulvovaginal candidiasis

A
  • infection via Candida albicans, which is part of normal flora.
  • can occur in diabetes, treatment with other Abx, obesity, steroids,OC
  • profuse white, itchy, curd like discharge
  • treated with topical or oral Azoles or nystatin.
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16
Q

Which are the ‘at risk’ groups of getting STIs ?

A
  • Young people
  • lower socioeconomic groups
  • ethnic groups
  • specific sexual behaviours
    • age of first intercourse
    • number of sexual partners
    • sexual orientation
      • especially homosexuals
17
Q

What is pelvic inflammatory disease?

A

The result of ascending inflammation from the endocervix, which can cause salpingitis, oophoritis, tubule-ovarian abscess, endometritis, parametritis and/or pelvic peritonitis.

18
Q

How does inflammation occur, in regards to PID? How are adhesions formed?

A

Inflammation occurs as a result of infection.

Adhesions occur when the tubular epithelium gets damaged, forming adhesions.

19
Q

Define the following:

  1. Endometritis
  2. Salpingitis
  3. Tubo-ovarian abscess
A
  1. Inflammation of the endometrium - the lining of the uterus
  2. Inflammation of the Fallopian tubes
  3. A pocket of pus that forms during an infection of Fallopian tubes and ovaries.
20
Q

What are the complications of PID?

A 
Fitz-Hugh-Curtis Syndrome
    - RUQ pain and Peri hepatitis - chlamydia infections
Ectopic pregnancy
Infertility
Chronic pelvic pain
21
Q

What are the two most common causative agents of PID? Besides these, name some others.

A
  • Chlamydia and gonorrhoea
    • most common
    • get get dual testing kits
  • others include:
    • gardenerella vaginalis
    • anaerobes
    • mycoplasma
22
Q

Name some risk factors for PID

A
  • sexual partners and behaviour
  • IUCD
    • increases risk in first week, but then eventually settles down
  • OCP is considered protective against symptomatic PID
  • alcohol, drug and cigarette use.
  • similar to STIs
    • low socioeconomic class
    • age of first sexual intercourse
    • lack of barrier contraception
23
Q

Pain is a clinical feature of PID. Explain this in slightly more depth.

A
  • bilateral lower abdo pain
  • Adnexal tenderness
    • Adnexal structures are those that are accessory
      • eg Fallopian tubes, ligaments and ovaries
  • deep dyspareunia
    • pain after coitus
  • cervical excitation
24
Q

Besides pain, what other 3 symptoms would you expect in a woman who you suspect is suffering from PID?

A
  • pyrexia
  • abnormal vaginal bleeding
  • abnormal vaginal discharges or cervical discharge.
25
Q

What is cervical excitation?

A

Pain on moving the uterus around

26
Q

Chandeliers sign is the colloquial name for which symptom of PID?

A

Cervical excitation.

27
Q

What are investigations you would like to conduct in a case of suspected PID

A
  • pregnancy test - rule this out asap
  • blood test - WBC / CrP
  • endocervical and high vaginal swabs
    • presence of NG or CT supports the PID diagnosis
    • absence of NG or CT does not exclude diagnosis of PID
28
Q

What is the treatment regimen for an inpatient PID patient?

A

IV ceftriaxone 500mg stat
IV/PO doxycycline 100mg BD
IV metronidazole 400mg BD

29
Q

What is the treatment for PID for an outpatient

A

IV ceftriaxone 500mg stat

PO Doxy 100mg BD + PO metronidazole 400mg BD.

30
Q

In what situation would a laparoscopy or laparotomy be indicated?

A

Presence of tubo-ovarian abscess
No luck with pharmacological treatment
Clinically severe disease.

31
Q

Why is contact tracing vital?

A

To treat sexual partners.

Amars Semester Two cards (37 decks)

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