Reproductive System - Level 2.1 Flashcards
Epidemiology of chlamydia?
- Commonest STI in the UK.
- Most important cause of tubal infertility
- 75% cases in under 25s
Causative organism of chlamydia?
• Chlamydia Trichomatis = obligate intracellular Gram-negative bacteria
• Initial sites of infection:
- Columnar and transitional epithelial cells of the urethra, cervix, rectum, pharynx and conjunctiva, depending on mode of exposure.
Risk factors of chlamydia?
- Age <25
- Sexual partner positive for chlamydia
- Two or more sexual partner in preceding year
- Recent change in partner
- Lack of barrier use
- Infection with another STI
- Poor socio-economic status
How many people asymptomatic in chlamydia?
Asymptomatic in 50% of men and 70% of women
- Found on screening, contact tracing and complications
Symptoms in females of chlamydia?
o Increased vaginal discharge secondary to cervicitis.
o Dysuria
o Urethritis
o Post coital and inter-menstrual bleeding
o Deep pain during sex (dyspareunia), lower abdomen
o Fever
Signs in females of chlamydia?
o Friable, inflamed cervix (cobblestone appearance) with contact bleeding
o Mucopurulent endocervical discharge
o Abdominal tenderness
Symptoms in males of chlamydia?
o Dysuria o Discharge – white, cloudy or water. o Unilateral testicular pain o Scrotal pain/swelling o Fever
Signs in males of chlamydia?
o Epididymal tenderness
o Mucoid or mucopurulent discharge
o Perineal fullness due to prostatitis
Symptoms in neonates with chlamydia?
- Neonatal conjunctivitis (30% within the first two weeks)
- Neonatal pneumonia (15% within the first four months)
- Otitis media
- Can develop vaginal infection
Complications in pregnancy of chlamydia?
- Infection can spread from the cervix into the uterine cavity causing chorioamnionitis.
- Can cause PROM, preterm delivery, low birth weight and post-partum infection
Who to test for chlamydia?
o Men or women with symptoms indicating infection
o Sexual partners of suspected/proven chlamydia
o All sexually active <25 people, annually or if changed partners
o People <25 treated for chlamydia in past 3 months
o People concerned about sexual exposure
o Two or more sexual partners in past year
o All presenting with TOP and to GUM clinic
o Mothers of infants with chlamydial infection
o Fitted with IUCD or IUS who are at risk of STI
Females investigations of chlamydia?
• Vulvovaginal swab (NAAT)
o 1st line for women, can use endocervical swab or urine sample
Window period 2 weeks – repeat test if indicated
Males investigations of chlamydia?
o Urine for NAAT PCR (men)
First catch, should not have passed urine for at least 1 hour
o GUM - Microscopy of urethral or rectal swab, NAAT
What screening programme is available for chlamydia?
- National screening programme for <25 year olds (urine test)
- Tests can be done at home, postal service
Management of chlamydia - general advice?
- Avoid sexual intercourse for a week after single-dose therapy or finishing longer regimen
- Do not resume sex with partner until they have completed treatment or received negative test
- Safe sex, contraception advice
- Full STI screen
Management of chlamydia - contact tracing?
o Four weeks prior to developing symptoms where a male has urethral symptoms and all contacts since
o All contacts in last six months of asymptomatic individuals and symptomatic women and men other than urethral
o Inform of risk and offer treatment, tracing and STI testing
Management of chlamydia - antibiotic management?
- Doxycycline 100mg BD for 7 days (CI in pregnancy) OR Azithromycin 1g single dose (4 tablets taken at once, >90% affective)
o Alternatives: Erythromycin, oflaxacin - In pregnancy – azithromycin 1g stat then 500mg for 2 days OR erythromycin 500mg QDS for 7 or BD for 14 days
o Test 3 weeks later
Management of chlamydia - test of cure?
- Performed on pregnant patient, persistent symptoms, non-compliance or re-exposed
- 3 weeks later
- In screening programme, <25 should repeat at 3 months
Complications of chlamydia?
- PID
- Ectopic pregnancy
- Reactive arthritis
- Reiter’s syndrome (triad of urethritis, arthritis and conjunctivitis)
- Tubal infertility, perihepatitis (Fitz-Hugh-Curtis syndrome) (women)
- Proctitis, epididymitis and epididymo-orchitis (men)
Epidemiology of genital herpes?
- Second most common STI in the UK.
- Seroprevalence of HS2 = ~20% of women.
- Most common in ages 15-24
Types of genital herpes?
- Herpes Simplex type 2 (genital) and type 1 (oral).
- HSV type 2 is responsible for ~70% of genital lesions.
- Both can affect mouth and/or genitals, due to oral sex or auto-inoculation
Incubation period of genital herpes?
- ~5-14 days
Transmission of genital herpes?
- Contact with infectious secretions on oral/genital/anal mucosa, or other anatomical sites (eyes, skin, herpetic whitlow)
Pathology of genital herpes?
- Enters the distal axonal processes of the sensory neuron and travels to the sensory (dorsal root) ganglion where it remains in a latent state
- Periodically reactivates, travelling down the axon and into the basal skin layers
- Some of these episodes will result in symptoms and signs while others will be asymptomatic