Repro 4 Flashcards
Outline the types, diagnosis, treatment, screening and vaccines when discussing the Human Papilloma viruses (HPV)
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
- high risk - implicated in >70% of cervical cancer
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
Describe the Herpes Simplex Virus (HSV), diagnosis and treatment
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
Describe the specimen collection from males, females and neonates in regards to Chlamydia trochamatis
Males
- urethral swab
- first catch urine
Females
- endocervical swab (not too acceptable by the patient)
Neonates
- eye swab - invert eyelid and take swab
Why is Chlamydia trochamatis harder to diagnose than other STIs ?
It is an obligate intracellular bacteria and it doesn’t grow in labs as well. Therefore it is harder to diagnose.
What is peri-hepatitis? Name two infections that can cause peri-hepatitis. Name one presenting symptom of peri-hepatitis
This is the inflammation of the liver capsule.
Chlamydia trochamatis and neisseria gonorrhoea can cause this.
Often presents with shoulder tip pain, referred pain.
Describe the infection of Chlamydia trochamatis is females and neonates.
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
Describe Chlamydia trochamatis infection in men
Presents as urethritis, prostatitis, epididymitis.
What triad of symptoms constitutes ‘acute epididymitis’
Arthritis, urethritis and conjunctivitis.
Outline the diagnosis of Chlamydia trochamatis
- 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.
Outline the treatment, and reason for dual treatment, of neisseria gonorrhoea
IM ceftriaxone with azithromycin
- azithromycin given to prevent the emergence of resistance to the cephs.
Outline the diagnosis of neisseria gonorrhoea infection
females
- endocervical, urethral and pharyngeal
Males
- urethral and laryngeal swabs
NAAT testing dual with chlamydia.
Outline the problems neisseria gonorrhoea infection can cause in males and females
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.
What type of bacteria is neisseria gonorrhoea and how is it grown?
Gram negative diplococci
Grown on enriched agar, such as chocolate agar.
How is BV diagnosed and treated?
Vaginal pH > 5
KOH whiff test
Treated with metronidazole.
Describe the abnormality in vulvovaginal candidiasis
- 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.
Which are the ‘at risk’ groups of getting STIs ?
- Young people
- lower socioeconomic groups
- ethnic groups
- specific sexual behaviours
- age of first intercourse
- number of sexual partners
- sexual orientation
- especially homosexuals
What is pelvic inflammatory disease?
The result of ascending inflammation from the endocervix, which can cause salpingitis, oophoritis, tubule-ovarian abscess, endometritis, parametritis and/or pelvic peritonitis.
How does inflammation occur, in regards to PID? How are adhesions formed?
Inflammation occurs as a result of infection.
Adhesions occur when the tubular epithelium gets damaged, forming adhesions.
Define the following:
- Endometritis
- Salpingitis
- Tubo-ovarian abscess
- Inflammation of the endometrium - the lining of the uterus
- Inflammation of the Fallopian tubes
- A pocket of pus that forms during an infection of Fallopian tubes and ovaries.
What are the complications of PID?
Fitz-Hugh-Curtis Syndrome
- RUQ pain and Peri hepatitis - chlamydia infections
Ectopic pregnancy
Infertility
Chronic pelvic painWhat are the two most common causative agents of PID? Besides these, name some others.
- Chlamydia and gonorrhoea
- most common
- get get dual testing kits
- others include:
- gardenerella vaginalis
- anaerobes
- mycoplasma
Name some risk factors for PID
- 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
Pain is a clinical feature of PID. Explain this in slightly more depth.
- bilateral lower abdo pain
- Adnexal tenderness
- Adnexal structures are those that are accessory
- eg Fallopian tubes, ligaments and ovaries
- Adnexal structures are those that are accessory
- deep dyspareunia
- pain after coitus
- cervical excitation
Besides pain, what other 3 symptoms would you expect in a woman who you suspect is suffering from PID?
- pyrexia
- abnormal vaginal bleeding
- abnormal vaginal discharges or cervical discharge.
What is cervical excitation?
Pain on moving the uterus around
Chandeliers sign is the colloquial name for which symptom of PID?
Cervical excitation.
What are investigations you would like to conduct in a case of suspected PID
- 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
What is the treatment regimen for an inpatient PID patient?
IV ceftriaxone 500mg stat
IV/PO doxycycline 100mg BD
IV metronidazole 400mg BD
What is the treatment for PID for an outpatient
IV ceftriaxone 500mg stat
PO Doxy 100mg BD + PO metronidazole 400mg BD.
In what situation would a laparoscopy or laparotomy be indicated?
Presence of tubo-ovarian abscess
No luck with pharmacological treatment
Clinically severe disease.
Why is contact tracing vital?
To treat sexual partners.
