Repro 6 STIs and PID Flashcards
Why is the term STI instead of STD used?
STI - symptomatic and asymtomatic infection - still potential problems and potential to spread it
STD - symptomatic infection only
Where is the national data for STIs collected from?
GUM clinics - Gentio Urinary Medicine, which notify STDs centrally
Why is there a gradual and sustained increase in STI prevalence from 1995 to 99?
Increased transmission
Acceptability of GUM services
Greater public awareness
Development in diagnostic methods
Behavioural, socio-economic, healthcare provision and biological factors all contribute
What is the suspected reason for the fall in STI diagnosis prior to 95?
Thought to reflect changes in behaviour in response to the HIV epidemic
Why is data from GUM clinics an underestimation of the true incidence of STIs?
Patients may be seen in other settings e.g. GP or family planning clinics
Many infections are asymptomatic and only approx 10% of cases attend GUM
Who are the at risk groups in society of contracting STIs?
Young people Ethnic minority (stigma) Poverty/social exclusion Low socio-economic status Poorly educated Unemployed Teenage mothers (at risk behaviour)
What factors contribute to the risk of contracting STIs?
Age at first intercourse Total number of sexual partners Frequency of change of partners Concurrent partners Sexual orientation (with other factors) Practice of unsafe sex Lack of skills ad confidence to negotiate safe sex
What STIs might cause genital ulcers?
HSV (herpes simplex virus)
Syphilis
Chanchroid (Haemophilus ducreyi)
What STIs might cause vesicles of bullae?
HSV
When might an STI cause genital papules? Give some examples.
Transient manifestation of STIs - condylomata acuminata (anogenital warts), umbilicated lesions of Molluscum contagiosum virus
What should aspects of genital ulcers should be assessed?
Number Size Tenderness Base Edges
What are the various types of urethritis and what might cause them?
Gonococcal urethritis NGU (nongonococcal urethritis) - chlamidia trachomatis, ureaplasma, mycoplasma, trichomonas HSV Post-gonococcal urethritis Non-specific urethritis Non-infectious urethritis
What is vulvovaginitis and what might cause it?
Vaginal infection - candidias, trichomoniasis, staphylococcal, foreign body, HSV
What might cause cervicitis?
C. trachomatis, N. gonorrhoeae, HSV, HPV
What is bartholinitis and what might cause it?
Inflammation of one or both of the bartholin glands. Caused by polymicrobial infections with endogenous flora or rarely STIs
What are the symptoms of bacterial vaginosis?
Discharge Odour Itch Dyspareunia Soreness
How is bacterial vaginosis diagnosed?
Vaginal pH >4.5
Pungent odour with KOH (whiff test)
Presence of clue cells on a wet mount lacking many PNMs
What is the cause of bacterial vaginalis?
Thought to be the result of a synergistic infection involving the overgrowth of normal flora including gardnerella vaginalis
What are the potential pregnancy related causes of infections of the female pelvis?
Chorioamnionitis Post-partum Endometriosis Episiotomy infections Peurperal ovarian vein thrombophlebitis Osteomyelitis pubis
What are the different types of prostatitis?
Acute bacterial
Chronic bacterial
Chronic pelvic pain syndrome
What are the different types of epididymitis?
Non-specific bacterial
Sexually transmitted
What are the causes of orhchitis?
(inflammation of the testes)
Viral (mumps, coxsackie B)
Pyogenic bacterial
Why do chlamydia trachomatis not grow on routine lab media?
They are obligate intracellular bacteria
What is the infective form of chlamydia trachomatis?
Elementary body which develops within the host cell into the reticulate body
What does the reticulate body of chlamydia trachomatis do?
Replicates eventually reverting back to elementary bodies which leave the cell to infect other cells
Where in the female reproductive tract does chlamydia replicate?
Epithelium of the cervix and urethra
What are the consequences of an infection of C. trachomatis?
An ascending infection with involvement of the upper genital tract occurs and can result in clinical or subclinical PID presenting as endometritis or salpingitis. Perihepatitis is a rare complication (more likely from gonorrhoea)
What results from a cervical infection of C. trachomatis?
The majority of infections are symptomatic but it is an important cause of muopurulent cervicitis
What are the manifestations of a urethral infection of chlamydia?
Acute urethral syndrome - dysuria and frequency (most common in young sexually active women)
What are the common symptoms of chlamydia infection in males?
Urethritis
Prostatitis
Proctitis
What ar epotential complication of chlamydia infection in males?
Acute epididymitis
What is Reiters syndrome?
Urethritis, conjunctivitis, and arthritis are the classical triad f clinical manifestations
Predominantly occurs in male patients affected with chlamydia
Where other than the genital tract may there be a manifestation of chlamydia?
Eye - ocular infections
What is the cause of chlamydia in neonates?
Cervical infection in pregnant women
What are the manifestations and complications of chlamydia in neonates?
Neonatal conjunctivitis
Neonatal pneumonia
How are specimen collected from males to test for chlamydia?
Urethral swab or first catch urine
How are specimen collected from females to test for chlamydia?
Endocervical swab. It is important that any pus is first removed from the cervix and that good quality cellular material is obtained
What are the pros and cons for urine samples as a specimen collection for chlamydia testing?
Less sensitive than swabs
Patients may provide their own samples whereas swabs are time consuming and requires a trained member of staff to take the specimen and is less acceptable to the patient
How are specimens collected from neonates to test for chlamydia?
Eye swab - remove pus, invert eyelid and scrape conjunctiva surface to obtain cellular material
For pneumonia, serology is useful. A differential on a WCC may show eosinophilia
How are diagnoses of chlamydia made?
Used to employ tissue culture but this is expensive and requires highly specialised labs Antigen detection (immunofluorescence) Enzyme Immunoassays (EIA) Molecular methods (PCR) Nucleic acid amplification from first void urine
Describe the method of antigen detection in diagnosing chlamydia.
Specimens may be fixed to a slide and stained with a monoclonal antibody that is tagged with fluorescein
Slides are examined under a UV microscope
What are the drawbacks and advantages to antigen detection in diagnosing chlamydia?
Results are subject to observer error and the method is time consuming (only suitable for small number of specimens)
Quality of specimen can be assessed