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Reproduction - Lian > Reproduction 4 - STIs > Flashcards

Reproduction 4 - STIs Flashcards

0
Q

List high risk groups

A

o Young people
o Minority ethnic groups
o Those affected by poverty and social exclusion
o Low socio-economic status groups
o Those with poor educational opportunities
o Unemployed people
o Individuals born to teenage mothers

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1
Q

What data sources are there for information on STIs etc?

A

o Genitourinary Medicine (GUM) Clinics
▪ Open access clinics that offer free, confidential sexual health services including diagnosis and treatment of STIs.
▪ Data from GUM clinics is underestimated, as many patients present via other settings, e.g. GP

o Communicable disease surveillance centres
▪ Notified of aggregate data via regular returns from GUM clinics and receive data on gonorrhoea, genital chlamydia, genital herpes and syphilis through voluntary or statutory reporting.

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2
Q

What morbidities are STIs associated with?

A

o Pelvic Inflammatory Disease (PID)
o Impaired fertility
o Reproductive tract cancers
o Risk of infection with blood-borne viruses – HBV, HIV
o Risk of congenital or peripartum infection of neonate

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3
Q

Identify the infecting organism for genital warts and what kind of virus is it?

A

Human Papillomaviruses - Small double stranded DNA virus

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4
Q

Describe the organism responsible for genital herpes

A

Herpes Simplex Virus is an encapsulated, double stranded DNA virus.

Genitial herpes usually associated with HSV2 (HSV usually cold sores)

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5
Q

Organism responsible for chlamydia

A

Chlamydia Trachomatis: Gram –‘ve obligate intracellular bacterium.

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6
Q

Organism causing gonorrhoea

A

Neisseria Gonorrhoeae: Gram –‘ve intracellular diplococcus.

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7
Q

Organism for syphilis

A

Treponema Pallidum - spirochaete - dark field microscopy

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8
Q

Differential diagnosis for genital skin and membrane lesions

A

o Genital ulcers
o Vesicles or bullae
o Genital papules
o Anogenital warts

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9
Q

Differential diagnosis for urethritis

A 
o Gonococcal urethritis
o Chlamydial urethritis
o Non-specific urethritis
o Post-gonococcal urethritis
o Non-infectious urethritis
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10
Q

Differential diagnosis for vulvo-vaginitis & cervicitis

A

o Vulvo-vaginitis
o Cervicitis
o Bacterial vaginosis
o Bartholinitis

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11
Q

Infections of the female pelvis

A

o Pregnancy-related

o Pelvic Inflammatory Disease (PID)

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12
Q

Discuss recent trends in the incidence of STIs

A

OVERALL INCREASE

• Increased transmission
– changing sexual and social behaviour
– increasing density and mobility of populations

• Increased GUM attendance

• Greater public, medical and national
awareness (e.g. with campaigns)

• Improved diagnostic methods including screening programs

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13
Q

Presentation, diagnosis and treatment of chlamydia

A

Clinical Presentation in Males
o Urethritis, epididymitis, prostatitis, proctitis

Clinical Presentation in Females
o Urethritis, cervicitis, salpingitis, perihepatitis

Diagnosis
o Endocervical and urethral swabs

Treatment
o Doxycycline or Azithromycin

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14
Q

Presentation, diagnosis and management of gonorrhoea

A

Clinical Presentation in Males
o Urethritis, epididymitis, prostatitis, proctitis, pharyngitis

Clinical Presentation in Females
o Asymptomatic, endocervicitis, urethritis, PID

Disseminated Gonococcal infection
o Bacteraemia, skin and joint lesions

Diagnosis: Swab from urethra, cervis (throat, rectum) or urine (NAAT) & culture

Treatment
o Ceftriaxone (Intramuscular Injection) & azithromycin
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15
Q

Presentation, diagnosis and treatment of herpes

A

Clinical Presentation of Primary Genital Herpes
o Extensive, painful genital ulceration, dysuria, inguinal lymphadenopathy, fever

Clinical Presentation of Recurrent Genital Herpes
o Asymptomatic to Moderate

Diagnosis: Smear and swab (then PCR) of vesicle fluid and/or ulcer base

Treatment
o Aciclovir

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16
Q

Presentation, management & treatment of genital warts

A

Clinical Presentation
o Cutaneous, mucosal and anogenital (anus and genital) warts
o Benign, painless, verrucous epithelial or mucosal outgrowths
o Penis, vulva, vagina, urethra, cervix, perianal skin

Diagnosis
o Clinical, biopsy and genome analysis, hybrid capture
Treatment

o None – frequent spontaneous resolution

o Topical podophyllin, cryotherapy, intralesional interferon

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17
Q

Three common causes for vaginal discharge

A

Candidiasis, Bacterial vaginosis, trichomonas vaginalis

18
Q

Name two arthropods transmitted through sexual contact

A

o Scabies mite

o Pubic louse

19
Q

What organism is responsible for Vulvovaginal Candidiasis?

A

o Candida Albicans and other candida species

▪ Normal GI and genital tract flora

20
Q

What are the risk factors associated with candida albicans?

A

▪ Antibiotics, oral contraceptives, pregnancy, obesity, steroids, diabetes

21
Q

Symptoms and diagnosis of candidiasis?

A

o Profuse, white, curd-like discharge, Vaginal itch, discomfort and erythema
o Diagnosis: High vaginal smear and culture

22
Q

Treatment of candidiasis

A

Topic azoles or oral fluconazole, nyastatin

23
Q

What is bacterial vaginosis and what are the symptoms?

A

o Not vaginitis (no inflammation of vaginal wall)
o Unsettled normal flora (Anareobes, Enteric Gram –‘ve Bacteroides
o Scanty but offensive, fishy discharge

24
Q

How would you diagnose and treat bacterial vaginosis?

A 
o Diagnosis
▪ pH > 5, KOH whiff test
▪ High Vaginal Smear – Gram variable coccobacilli, reduced numbers of lactobacilli
o Treatment
▪ Metronidazole
25
Q

Define pelvic inflammatory disease

A 
Pelvic Inflammatory Disease (PID) is an ascending infection from the endocervix causing:
o Endometritis
o Salpingitis
o Oophoritis
o Pelvic peritonitis
o +/- tubo ovarian abscess
26
Q

What are risk factors associated with PID?

A

o Young age at first intercourse
o Multiple sexual partners (polygyny)
o High frequency of sexual intercourse
o High rate of acquiring new partners within pervious 30 days
o Alcohol/Drug use
o Cigarette smoking (2x increased risk)
o IUDs increase risk at point of insertion/removal for a few weeks

27
Q

List some causative organisms of PID

A 
o Nesseria Gonorrhoea
▪ Gram –‘ve intracellular diplococci
o Chlamydia Trachomatis
▪ Gram –‘ve extracellular (infective) organism
o Bacterial Vaginosis
▪ Anareobes, Enteric Gram –‘ve Bacteroides
o Streptococci
o Haemophillis Influenzae
o Cytomegalovirus
o Mycobacterium Tuberculosis
28
Q

Name two immediate sequelae of PID

A

▪ Tubo-ovarian abscess

▪ Pyo-salpinx

29
Q

List 5 long-term sequelae of PID

A

▪ Ectopic Pregnancy (1 episode of PID –> 7x increased risk)
▪ Infertility (1 episode of PID –>12% increase, 2 –> 25%, 3+ –> 50-75%)
▪ Dyspareunia (Painful sexual intercourse)
▪ Chronic PID / Chronic pelvic pain
▪ Pelvic adhesions

30
Q

What instrumental factors are associated with the ascent of the bacteria in PID?

A

Cervical dilation, coil insertion

31
Q

Other than instrumental causes, what other factors are associated with ascent of bacteria in PID?

A

o Hormonal changes associated with menstruation
▪ Lowers bacteriostatic effect of cervical secretion
o Retrograde menstruation
▪ Infection more common after a period
o Virulence of the organisms in acute chlamydial and gonococcal PID

32
Q

How does infection of the cervix (endocervicitis) spread? (Routes)

A

Either directly or via lymphatics to the endometrium, uterine tubes and the pelvic peritoneum

33
Q

List some investigations for diagnosing/treating PID

A

o Pregnancy test
o Triple and urethral swabs
▪ High vaginal swab – Bacteria vaginosis organisms
▪ Endocervical swab – Neisseria gonorrhoea
▪ Endocervical swab - Chlamydia trachomatis
▪ Urethral swab – Chlamydia trachomatis (males only)
o Midstream Urine
▪ Leucocytes and nitrates
o C-Reactive Protein
▪ Marker for acute infection / inflammation

34
Q

What other diagnoses may present similar to PID?

A

o Ectopic pregnancy
o Acute appendicitis
o Irritable Bowel Syndrome (IBS)
o Ovarian cyst accidents (torsion, rupture, haemorrhage)
o Urinary Tract Infection (UTI)
o Functional pelvic pain of unknown origin

35
Q

List some symptoms associated with chronic PID

A 
o Pelvic pain
o Secondary dysmenorrhoea
o Deep dyspareunia
o Menstrual disturbance
o Recurrent acute painful exacerbations
36
Q

Sequelae of chronic PID

A 
o Infertility
o Ectopic pregnancy
o Chronic pelvic pain
o Pelvic adhesions/tubo-ovarian complex
o Abnormal / painful periods
37
Q

What organism is responsible for trichomonas vaginalis?

A

Trichomonas vaginalis - an anaerobic, flagellated protozoan parasite

38
Q

Symptoms of trichomoniasis?

A

Thin, frothy, offensive discharge

- Irritation, dysuria, vaginal inflammation

39
Q

How would you diagnose & treat trichomonas vaginitis?

A
  • vaginal wet preparation & culture

- metronidiazole

40
Q

Symptoms and diagnosis of bacterial vaginosis

A

Scanty but offensive fishy discharge & vaginal pH >5, KOH whiff test

41
Q

Treatment of bacterial vaginosis

A

metronidazole

42
Q

Symptoms, diagnosis, treatment & screening of HPV

A

Symptoms: Cutaneous, mucosal and anogenital (anus and genital) warts, Benign, painless, verrucous, epithelial or mucosal outgrowths effecting Penis, vulva, vagina, urethra, cervix, perianal skin

Diagnosis: Clinical, biopsy and genome analysis, hybrid capture

Treatment None – frequent spontaneous resolution o Topical podophyllin, cryotherapy, intralesional interferon

Screening: Cervical Pap smear cytology (HPV vaccine)

Reproduction - Lian (9 decks)

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