Repro Session 6 Flashcards
Nongonococcal causes of urethritis?
chlamydia trachomatis
ureaplasma
mycoplasma
trichomonas HSV
causes of genital ulcers?
HSV
syphilis
chanchroid
pregnancy related infections of pelvis?
post-partum endometriosis episiotomy infections chorioamnionitis puerperal ovarian vein thrombophlebitis- vein inflammation due to blood clot osteomyelitis pubis
viral causes of orchitis?
mumps
coxsackie B
*coxsackie virus is resitant to gastric acid, along with polio, Hep A, and M.TB
what must be considered in difficulty determining method of diagnosis for chlamydia?
obligate IC bacteria so do not grow on routine lab media
infective form of chlamydia?
elementary body
what is salpingitis?
fallopian tube inflammation
most important causes of pelvic inflammatory disease in western world?
chlamydia trachomatis
major PID complication?
tubal damage, leading to infertility and ectopic pregnancy
most common neonatal infection due to cervical infection in pregnant women being source of chlamydia trachomatis?
neonatal conjuntivitis
what is pelvic inflammatory disease?
result of infection ascending from endocervix, causing endometritis, salpingitis, parmetritis, oophortis, tubo-ovarian abscess and/or pelvic peritonitis
2 organisms causative of PID?
chlamydia trachomatis
neisseria gonorrhoea
pathophysiology of PID?
infection ascends from endocervix and vagina into uterus, inflammation causes adhesions of mucosa to form ,and damage to tubal epithelium
behavioural RFs for PID?
sexual behaviour: multiple partners, unsafe sex
type of contraception used: intrauterine contraceptive device increases risk in 1st few wks of insertion
alcohol/drug use- more likely to have unsafe sex
cigarette smoking- immunocompro?*
contraception thought to be protective against symptomatic PID?
combined OCP
clinical features of PID?
pyrexia pain: bilateral lower abdominal tenderness adnexal tenderness cervical excitation deep dyspareunia abnormal vaginal/cervical discharge abnormal vaginal bleeding
gyanecological causes of pelvic pain other than PID?
ectopic pregnancy- would do a preg test
endometriosis- history will be of cyclical pain- before periods, continuous pain in PID
complications of an ovarian cyst- tends to be unilateral ovarian involvement so unilateral pain
GI causes of pelvic pain?
acute appendicitis
irritable bowel syndrome
renal causes of pelvic pain?
UTI
length of time antobiotics continued for in PID?
14 days
antibiotics used in PID?
ceftriaxone
doxycycline
metronidazole
tment of trichomonas vaginalis?
metronidazole
tment for chlamydia trachomatis?
doxycycline or azithromycin
features of history of patient with PID?
lower abdom pain
abnormal vaginal bleeding/discharge
deep dyspareunia
history of STIs in past
features of examination of patient with PID?
pyrexia >38 C lower abdom tenderness- bilateral adnexal tenderness cervical excitation discharge- vaginal or cervical, on speculum exam.
investigations in PID?
endocervical swab: gonorrhoea, chlamydia
high vaginal swab: bacterial vaginosis, trichomonas vaginalis, candida- picked up, but not causative of PID
+ve swabs support diagnosis but -ve don’t exclude it
general medical management of PID?
analgesia- paracetemol- fever and pain
antibiotics- oral for mild to mod, IV if severe
when to admit PID patient to hospital?
surgical emergency cannot be excluded, causing acute abdomen
clinically severe disease
tubo-ovarian abscess
PID in pregancy (v.rare as foetus in way for ascending infection)
lack or response/intolerance to oral therapy
when might laparoscopy/laparotomy be considered for PID?
if no response to therapy
clinically severe disease
presence of a tubo-ovarian abscess
an US-guided aspiration of pelvic fluid collections would be less invasive
possible SEs of metronidazole?
vomiting, this would be made worse if alcohol taken
what is a patient with PID at risk of in the future?
ectopic pregnancy as pelvic scars and adhesions
infetility as tubal adhesions
chronic pelvic pain- may need counselling
Fitz Hugh Curtis syndrome- adhesions by liver
what is fitz hugh curtis syndrome?
perihepatitis presenting with R upper quadrant pain- acute in onset and sharp, due to transabdominal spread of infection from PID e.g. chlamydia trachomatis.
The spread of disease from the pelvis to the liver may be due to circulation of fluid along the paracolic gutter- infracolic compartment of greater sac, it may be due to lymphatic drainage or it may be via the bloodstream.
How can risk of PID be reduced in patients who have had it previously?
use of barrier contraception
clinical presentation of primary genital herpes?
extensive, painful genital ulceration
dysuria
inguinal lyphadenopathy
fever
if recurrent genital herpes, may be asymptomatic to moderate
diagnosis of genital herpes?
smear (IF) and swab (viral culture) of vesical fluid and/or base of ulcer, and send for viral PCRs
How can risk of HSV transmission be reduced?
barrier contraception
tment of primary genital herpes and severe disease?
aciclovir- only activated within virally-infected cells as molecule produced by virus necessary for drug activation, so therefore minimses damage to cells not infected by the virus
what management can be given for frequent recurrences of genital herpes?
aciclovir prophylaxis
clinical presentation of genital warts?
cutaneous, mucosal and anogenital warts caused by HPV. Benign, painless, verrucous epithelial or mucosal outgrowths- penis, vulva, vagina, urethra, cervix, perianal skin
diagnosis of genital warts?
clinical, biopsy + genome analysis, hybrid capture- detect viral DNA
tment of genital warts?
frequent spontaneous resolution topical podophyllin cryotherapy intralesional interferon imiquimod- immune response modifier surgery
what infections might N.gonorrhoea cause in men?
epididymitis, prostatitis, proctitis- inflammation of lining of rectum, urethritis, pharyngitis
what infections might N.gonorrhoea cause in women?
PID, endocervicitis, urethritis
may be asymptomatic with N.gonorrhoea
tment of N gonorrhoea infection?
ceftriaxone (IM)-cephalosporin also used to treat N.meningitidis
ciprofloxacin (oral) used till very recently but has been superseded by resistance*
features of disseminated gonococcal infection?
bacteraemia, skin and joint lesions
diagnosis of gonorrhoea?
smear and culture
clinical presentation of chlamydial infections in females?
urethritis, cervicitis, salpingitis, perihepatitis
clinical presentation of chlamydial infections in males?
urethritis, epididymitis, prostatitis, proctitis
diagnosis of chlamydial infections?
endocervical and urethral swabs
1st void urine
what is trichomonas vaginalis?
flagellated protozoan
causes trichomonas vaginitis: thin, frothy, offensive discharge
irritation, dysuria, vaginal inflammation
diagnosis of trichomonas vaginalis?
vaginal wet preparation +/- culture enhancement
causative agent of syphilis?
treponema pallidum
tment of syphilis?
penicillin and ‘test of cure’ follow-up
tment of bacterial vaginosis?
metronidazole
causes of bacterial vaginosis?
perturbed normal flora- gardnerella, anaerobes, mycoplasmas
RFs for vulvovaginal candidiasis?
antibiotics, oral contraceptives*, pregnancy, obesity, steroids, diabetes
tment of vulvovaginal candidiasis?
oral fluconazole
topical azoles or nystatin
specific at risk groups for STIs?
young people
minority ethnic groups
those affected by poverty and social exclusion
low SE status
poor education opps
unemployed
individuals born to teenage mothers- unprotected sex
stages of syphilis disease?
primary= indurated, painless ulcer
secondary- 6 to 8wks later- fever, rash, lymphadenopathy, mucosal lesions
tertiary- chronic granulomatous lesions
quaternary- CVS and CNS pathology
diagnosis of syphilis?
dark field microscopy, serology
tment of trichomonas vaginalis infection?
metronidazole
bacteria, viruses, protozoa, and fungi can cause STIs? which arthropods can cause STIs?
scabies mite
pubic louse
why is bacterial vaginosis different from vaginitis?
bacterial vaginosis from perturbed normal flora, no inflammation
diagnosis of bacterial vaginosis?
clinical and laboratory
clinical= vaginal pH>5, KOH whiff test
laboratory= higher vaginal smear- clue cells- epithelial cells with gram -ve coccobacilli
redcuced nos lactobacilli
