Repro: STI and PID Flashcards
Which factors affect transmission of genital infections?
- Age
- Ehtnicity
- Socioeconomic status
- Age at first sexual intercourse
- Number of partners
- Sexual orientation
- Condom use
- Menstrual cycle
What are the general considerations made during diagnosis of STI?
- Could be symptomatic or asymptomatic
- Sexual history and physical examinations are essential
- Diagnostic samples need to be collected from the correct sites
- Every effort should be made to isolate/diagnose the offending organism
- Prompt treatment and partner notification
- Advice, counselling and education of the patient and contacts
What are the general principles of STI treatment?
- Treatment (antibiotics, antiviral, topical creams)
- Co-infections are common so screen for other STIs
- Contact tracing
- STI prevention
What causes chlamydia and what are the microbial features of it?
- Chlamydia trachomatis
- Obligate intra-cellular bacterium
What are the symptoms of chlamydia in males?
- Urethritis
- Dysuria
- Epididymitis
- Proctitis
- Prostatitis
What are the symptoms of chlamydia in females?
- Mostly asymptomatic
- Increased discharge
- Post coital and intermenstrual bleeds
- Dyspareunia
Apart from the genital tract, which regions can chlamydia trachomatis affect?
- Ocular inoculation that manifest as conjunctivitis
- Pharyngeal infection which is usually asymptomatic
What test are used to diagnose chlamydia in men?
- First catch urine NAAT
- Urethral swabs (less acceptable)
- Rectal and pharyngeal NAAT for extragenial sampling
What is used to treat chlamydia?
- Doxycycline or Azithromycin 1st line
- Erythromycin or Ofloxacin 2nd line
What is the cause of gonorrhoea and what are the microbiological features of it?
Neisseria Gonorrhoeae
-Gram negative intracellular diploccus
What are the primary sites of infection for neisseria Gonorrhoeae?
-Urethra, Endocervix, Rectum, Pharynx, and Conjunctiva
What are the main symptoms of Gonorrhoea in men?
- Urethral discharge
- Dysuria
- Anal discharge
What are the main symptoms of gonorhea in women?
- Asymptomatic in women in most cases
- Altered discharge
- Lower abdominal pain
Which investigations are undertaken in the diagnosis of Gonorhea?
- Microscopy of gram stained genital specimen in men more than women
- NAATS
- Cultures for confirmatory identification and antimicrobial testing
What is used in the treatment of gonorrhoea?
- Intramuscular Ceftriaxone plus oral azithromycin
- Spectinomycin as alternative in penicillin allergy
- Test of cure
- Partner Notification
Why is azithromycin used in combination with ceftriaxone?
- Shown to boost action of ceftriaxone
- Decreases chances of developing resistance to ceftriaxone
- People how have an STI have an increased change of co-infections. Azithromycin covers clamydia as a co-infection
What is the cause of herpes?
Herpes Simplex Virus
HSV 1 - oral-labial herpes
HSV 2 - primary, non-primary or recurrent infection
What are the symptoms of Herpes?
- Painful ulceration
- Dysuria
- Vaginal discharge
- Can be asymptomatic
What are the systemic features of Herpes?
- Fever
- Myalgia
What is used to diagnose HSV?
- Virus detection of vesicle fluid or ulcer base
- Type specific Serology
What is the treatment for Herpes?
- General advice
- Aciclovir
- Suppresive treatment for recurrent HSV
What is the recommendation give to patient with primary herpes in pregnancy?
-Caesarian section recommended
What is the organism that causes syphilis and what are its microbial features?
- Treponema pallium
- Spirochete bacterium
What is the pathophysiology of syphilis?
1 - Painless ulcer
2 - Rash, mucosal lesion, multi system involvement
Latent- symptom-free for years
3 - Up to 40 years after initial infection (neurosyphillis, parenchymous, cardiovascular syphillis, Gummas)
What is trichomanas vaginalis?
Infection but flagellated Protozoa
Treated with metranidazole
Scabies can spread sexually. True/False
True. It can affect the genitalia and spread. Treatment is permethrin
What are anogenital warts?
- Benign lesion caused by the HPV virus
- More than 100 HPV types
Which HPV types commonly cause genital warts?
Types 6 or 11
What are the features of anogenital warts?
-Benign, painless, epithelial or mucosal outgrowths
Found at Penis, Vulva, Vagina, Urethra, Cervix, Perianal skin
Which strains of HPV are high risk oncogenic?
HPV 16
HPV 18
What is used in the diagnosis of Anogenital warts?
-Biopsy in atypical lesion or non-response treatment
What are the treatment measures for anogenital warts?
- No treatment
- Topical application
- Physical ablation
- HPV vaccination
What is bacterial vaginosis?
Common cause of abnormal (fishy) discharge in women of childbearing age.
- Gardnerella vaginalis
- Treated with metronidazole
What is vulvovaginal candidiasis?
- Caused by Candida albicans or non albicans candida species
- Vaginal discharge typically curdy and non offensive, Vulval itch, Soreness, Dyspareunia
Treatment: Topical and oral azoles
What is pelvic inflammatory disease?
- Result of infection ascending the endocervix
- Causes endometriosis, salpingitis, parametrises, oophoritis, tubo-ovarian abscess and/or pelvic peritonitis.
What is the pathophysiology of pelvic inflammatory disease?
- Ascending infection from endocervix and vagina
- Infecgtion causes inflammation
- Inflammationc causes damage which lead to damaged tubal epithelium and adhesion can then form
- Some recovery of the tubal epithelium does occur
What is endometritis?
Inflammation of the endometrial lining
What is salpingitis?
- Inflammation of the Fallopian tube
- Neutrophils and macrophages invade and this form and inflammatory exudate
- The tubes become filled with pus
- Formation of adhesions and fibrin blocks the tubes
What are complications of salpingitis?
-Abscess can form which can spread around the ovaries or within the tube
What is the aetiology of pelvic inflammatory disease?
-Sexually transmitted disease
Example organisms
- Chlamydia trachomatis
- Neisseria Gonorrhoea
What are the clinical symptoms of Pelvic inflammatory diseases?
- Pyrexia
- Pain
- Lower abdominal pain
- Deep dyspareunia
- Abnormal vaginal/ cervical discharge
- Abnormal vaginal bleeding
- Sexual history
- STI
- Contraceptive history
What is found on examination in patient with pelvic inflammatory diseases?
-Fever
-Lower abdominal tenderness (usually bilateral)
-Bimanual examination
of adnexal tenderness with or without a mass
-Cervical motion tenderness
-Speculum examination
-Lower genital infection
-Purulent cervical discharges
-Cervicitis
What are investigations undertaken in patients suspected with pelvic inflammatory diseases?
- Diagnostic laparoscopy is gold standard (Can also perform adhesiolysis and drain abscesses)
- Urinary and/or serum pregnancy test
- Endocervical and High vaginal swabs (absence of Clamydia trachomatis and Neisseria Gonorrhea doesnt exclude diagnosis)
- Blood tests: WBC and CRP
- Screening for other STIs including HIV
What are drugs used to treat PIDs?
- Ceftriaxone
- Docycline
- Metranidazole
How are PIDs managed?
- Low threshold for empirical treatment
- Symptomatic management with analgesia and rest
- Management of sepsis
- Severe disease requires IV antibiotics and admission for observation and possible surgical intervention
- Contact tracing for partners and full screening for women
What are complications of PIDs?
- Ectopic pregnancy
- Infertility
- Chronic pelvic pain
- Fits-Hugh-Curtis syndrome
- Reiter syndrome (disseminated chlamydial infection)
