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Microbiology > Repro: Genital Tract/ STIs > Flashcards

Repro: Genital Tract/ STIs Flashcards

1
Q

What is the main organism found in normal vaginal flora?

A

Lactobacillis sp

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2
Q

What does lactobacillis sp produce?

A

Lactic acid

Hydrogen peroxide

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3
Q

Why does lactobacillis produce 2 acids?

A

To lower pH of vagina

Suppress growth of any other bacteria

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4
Q

What are 3 other organisms found in normal vaginal flora?

A

Strep viridans
Group B beta-haemolytic streptococcus
Candida sp

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5
Q

What percentage of women have a candida infection but no symptoms?

A

30%

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6
Q

Name 4 predisposing factors to a candida infection

A

Recent antibiotic therapy (broad spectrum)
High oestrogen levels (pregnancy, contraceptives)
Poorly controlled diabetes
Immunocompromised patients

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7
Q

What is the common presentation of candida infection?

A

Intensely itchy white discharge

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8
Q

How is candida infection diagnosed?

A

Clinical diagnosis

High vaginal swab for culture

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9
Q

What is the most common type of candida to cause infection?

A

Candida albicans

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10
Q

What is the treatment of candida infection?

A

Topical clotrimazole pessary/ cream

Oral fluconazole

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11
Q

What causes bacterial vaginosis?

A

Imbalance of bacteria (rather than infection)

Overgrowth of bacteria like gardnerella vaginalis and monbiluncus sp

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12
Q

What are the symptoms of bacterial vaginosis?

A

Thin, watery, fishy-smelling vaginal discharge

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13
Q

How is bacterial vaginosis diagnosed?

A

Clinical diagnosis

pH > 4.5

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14
Q

What investigations can be done for bacterial vaginosis?

A

Microscopy to look for Clue cells

Use the Hay-Ison scoring system to estimate proportions of clue cells to epithelial cells and lactobacilli

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15
Q

What is the treatment for bacterial vaginosis?

A

Oral Methronidazole (because it is an anaerobic infection)

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16
Q

What are the symptoms of acute bacterial prostatitis?

A

Like a UTI but may also have lower abdo pain/ back / perineal/ penile pain and tender prostate on examination

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17
Q

What organisms usually cause acute bacterial prostatitis?

A

E. coli

Enterococcus sp

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18
Q

Are E coli gram negative or positive?

A

Negative rods

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19
Q

Are enterococcus gram negative or positive

A

Positive cocci

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20
Q

How is a diagnosis of acute bacterial prostatitis made?

A

Clinical signs

Midstream uring sample for culture and stain

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21
Q

What is the treatment of acute bacterial prostatitis?

A

Quinolone e.g. ciprofloxacin for 28 days

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22
Q

What is the treatment for acute bacterial prostatitis if there is a risk of C. diff?

A

Trimethoprim 28 days

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23
Q

What percentage of bacterial prostatitis is chronic?

A

<5%

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24
Q

What is the commonest bacterial STI in UK?

A

Chlamydia Tachomatis

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25
Q

What does chlamydia infect?

A

Urethra, rectum, throat, eyes and endocervix

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26
Q

Describe the type of bacteria that chlamydia is

A

Obligate intracellular bacteria with biphasic life cycle

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27
Q

Will chlamydia grow on its own outside cell?

A

No - ‘energy parasite’

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28
Q

Why is Chlamydia never cultured or gram stained?

A

No peptidoglycan in cell wall - won’t stain

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29
Q

What serovars (variation) of chlamydia causes trachoma (eye infection)?

A

Serovars A - C

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30
Q

What serovars of chlamydia causes genital infection?

A

D - K

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31
Q

What serovars of chlamydia causes lymphogranuloma venereum?

A

L1 - L3

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32
Q

What symptoms does lymphogranuloma venereum cause if in penis or vagina?

A

Abscesses in inguional region (where draining lymph nodes are)

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33
Q

What symptoms does lymphogranuloma venereum cause if in rectum?

A

Proctocolitis symptoms - fistulation

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34
Q

What is the treatment of uncomplicated chlamydia?

A

Azithromycin (1g oral)

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35
Q

What is the treatment of lymphogranuloma venereum?

A

Doxycycline 100mg BD for 7 days

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36
Q

What type of bacteria is Neisseria Gonorrhoeae?

A

Gram negative diplococcus

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37
Q

Why do samples of gonorrhoea need to be analysed quickly?

A

Doesn’t grow well outside body

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38
Q

What is a sign that clearly indicates gonorrhoea?

A

‘Dripping tap’ of purulent discharge

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39
Q

How is gonorrhoea diagnoses?

A

Combined nucleic acid amplification tests (NAATs)

Polymerase chain reaction (PCR)

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40
Q

What sample is needed for a NAATs and a PCR on a male?

A

First pass urine

Rectal and throat (depending on type of sex)

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41
Q

What sample is needed for a NAATs and a PCR on a female?

A

High vaginal or vulvo-vaginal swab

Rectal and throat

42
Q

What sample is needed for a NAATs and a PCR on a newborn?

43
Q

Why are two samples taken for STI test?

A

One for culture

One for NAATs or PCR

44
Q

Why do you need to be certain of the strain of gonorrhoea before starting antibiotics?

A

Targeted antibiotic therapy

Some strains are becoming resistant

45
Q

Apart from NAATs and PCR, what are other STI tests for chlamydia and gonorrhoea?

A

Microscopy

Culture on specifically-selective agar plates

46
Q

4 advantages of PCR/NAATs compared to culture?

A
  1. Less invasive
  2. More sensitive
  3. Positive even if organisms die in transit
  4. Quick - hours
47
Q

2 disadvantages of PCR/NAATs compared to culture?

A
  1. Cannot track sensitivities

2. Sensitive - tracks dead organisms

48
Q

How long does it take before you can do a test of cure for gonorrhoea/ chlamydia?

49
Q

What is the treatment for gonorrhoea?

A

IM ceftriaxone

Oral azithromycin

50
Q

What organism causes syphilis?

A

Treponema pallidum

51
Q

What type of organism is Treponema pallidum?

A

Spirochaete (spiral) bacterium

52
Q

Does Treponema pallidum stain with gram stain?

53
Q

What are the 4 stages of syphilis?

A

Primary lesion
Secondary stage
Early latent stage and Late latent stage
Late stage

54
Q

What is the primary lesion of syphilis?

A

Painless ulcer at point of contact (chancre)

55
Q

What is the secondary stage of syphillis?

A

Many bacteria circulating in blood

Multiple manifestations at many sites

56
Q

What are examples of symptoms of the secondary stage of syphillis?

A

Snail track mouth ulcers
Rash on palms and soles
Flu like symptoms

57
Q

What is the third early latent and late latent stage of syphilis?

A

Low level multiplication of spirochaeta in blood vessel intima

58
Q

Is the third stage of syphilis infectious?

59
Q

What is the fourth stage of syphilis?

A

Many years later
Aortia aneurysm
Neurovascular

60
Q

What is a neurovascular complication of syphilis?

A

Loss of proprioception - high stumping gait

61
Q

How is syphilis diagnosed?

A

Dark ground microscopy
Serology
PCR (for research - not clinical diagnosis)

62
Q

Why is diagnosis of syphilis not by culture?

A

Doesn’t stain with gram stain

Can’t be cultured

63
Q

What is looked for in dark ground microscopy of syphilis?

A

Spirochaetes in exudate from primary and secondary lesions

64
Q

What is tested for in serology of syphilis?

A

Specific and non-specific antibodies

65
Q

What are the non-specific serology tests for syphilis?

A

VDRL (veneral diseases research lab)

RPR (rapid plasma reagin)

66
Q

What do non-specific serology tests for syphilis indicate?

A

How active the disease is

67
Q

What are non-specific serology tests for syphilis used for?

A

Monitor response to treatment

68
Q

What might give a false positive non-specific serology tests for syphilis? and why?

A

SLE, malaria, pregnancy etc

Because it just indicates tissue inflammation

69
Q

What are the specific serology tests for syphilis?

A

TPPA (T. pallidium particle agglutination assay)
TPHA (T. pallidium haemagglutination assay)
IgM and IgG ELISA (screening test)

70
Q

What are non-specific serology tests for syphilis used for?

A

Confirm diagnosis

Often remain positive for life

71
Q

What is the treatment for syphilis?

A

PENICILLIN
PENICILLIN
PENICILLIN
injectable long acting

72
Q

What is the commonest viral STI?

A

Genital warts caused by HPV

73
Q

What type of virus is HPV?

A

Non-enveloped icosohedral virus containing double stranded DNA

74
Q

Can HPV be grown in culture?

75
Q

How many types of HPV are there?

76
Q

What types of HPV cause genital warts?

77
Q

What types of HPV are associated with an increased risk of cervical cancer?

78
Q

How are genital warts spread?

A

Via close genital skin contact

79
Q

How is a diagnosis of genital warts made?

80
Q

What is the treatment of genital warts?

A

Cryotherapy

Podophyllotoxin cream/ lotion

81
Q

What is the HPV vaccine and who is it offered to?

A

Against types 6, 11, 16 and 18

Girls age 11 - 13

82
Q

What strain of Herpes causes cold sores?

83
Q

What strain of Herpes causes genital herpes?

A

HSV 1 and 2

84
Q

What type of virus is HSV?

A

Enveloped virus containing double stranded DNA

85
Q

Where does the HSV virus replicate?

A

Within dermis and epidermis

86
Q

After reaching the dermis and epidermis, where does the HSV virus go?

A

Into nerve ending of sensory and autonomic nerves

87
Q

Why is herpes painful?

A

Virus causes inflammation at nerve ending

88
Q

Where does the HSV virus ‘hide’?

A

Sacral root ganglion

89
Q

How is HSV diagnosed?

A

Swab virus in transport medium of deroofed blister

PCR test

90
Q

What is the treatment for HSV?

A

Aciclovir if taken early

Pain relief

91
Q

What type of organism is Trichomonas vaginalis?

A

Single celled protozoal parasite

92
Q

How does Trichomonas vaginalis divide?

A

Binary fission

93
Q

What are symptoms of Trichomonas vaginalis?

A

Vaginal discharge and irritation

94
Q

How is Trichomonas vaginalis diagnosed?

A

High vaginal swab for microscopy

Strawberry cervix

95
Q

What is the treatment for Trichomonas vaginalis?

A

Oral metronidazole

96
Q

What organism causes pubic lice?

A

Phthirus pubis

97
Q

What causing the itching symptom of pubic lice?

A

Lice bite skin and feed on blood

98
Q

How long do male lice live?

99
Q

How long do female lice live?

100
Q

What is the treatment for pubic lice?

A

Malathion lotion

Microbiology (6 decks)

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