S9) Infections of the Reproductive Tract Flashcards
What are the main public health messages required to limit STI’s?
- Practice safe sexual behaviour
- Reduce total number of partners
- Seek better sexual health education
- Seek early treatment for suspected STI
- Avoid alcohol/illicit drug abuse
Identify 6 factors which affect the transmission of genital tract infections
- Age
- Condom use
- Sexual orientation
- Socioeconomic status
- Number of partners
- Ethnicity
Identify 5 of the most commonly occuring STI’s
- Chlamydia
- Gonorrhea
- Genital herpes
- Genital warts
- Syphillis
What is the causative organism in chlamydia?
Chlamydia trachomatis
- typically asymptomatic
What is the causative organism in gonorrhea?
Neisseria gonorrhea
- gram negative diplococci
- yellow discharge
- intermenstrural bleeding
What is the causative organism in genital warts?
Human papilloma virus
- DNA virus
What is the causative organism in genital herpes?
Herpes simplex virus (1&2)
- lifelong infection
- ulcers and blisters
- mouth-anus
- antivirals
Briefly, describe the incidence of different STI diagnoses in men
Briefly, describe the incidence of different STI diagnoses in women
Briefly, describe the incidence of different STI diagnoses in men by ethnic group
Briefly, describe the incidence of different STI diagnoses in women by ethnic group
How does chlamydia present in males?
- Urethritis
- Dysuria
- Epididymitis
- Prostatitis
- Conjunctivitis
- Asymptomatic pharyngeal infection
How does chlamydia present in females?
- Increased discharge
- Dyspareunia (painful sex)
- Post coital bleeds
- Intermenstrual bleeds
- Conjunctivitis
- Asymptomatic pharyngeal infection
How is chlamydia diagnosed in men?
- First catch urine NAAT (nucleic acid amplification testing)
- Rectal NAAT
- Pharyngeal NAAT
How is chlamydia diagnosed in women?
- Vulvovaginal & endocervical swabs for NAAT
- Rectal NAAT
- Pharyngeal NAAT
Describe the treatment of chlamydia in men and women
- Doxycycline / Azithromycin (1st line)
- Erythromycin / Ofloxacin (2nd line)
How does gonorrhea present in men?
- Urethral discharge
- Dysuria
- Anal discharge
- Asymptomatic pharyngeal infection
How does gonorrhea present in women?
- Altered discharge
- Lower abdominal pain
- Asymptomatic pharyngeal infection
- Asymptomatic rectal infection
How is gonorrhea diagnosed?
- Microscopy of gram stained genital specimen
- NAATs
- Cultures / swabs
Describe the treatment of gonorrhea
- Ceftriaxone & azithromycin
- Spectinomycin (alternative for penicillin allergy)
Why are both azithromycin and ceftriaxone given as treatment for gonorrhea?
Azithromycin prevents antibiotic resistance to ceftriaxone and also treats the possible co-infection of chlamydia
How does genital herpes present?
- Painful ulceration
- Dysuria
- Vagina discharge
- Fever
- Myalgia
How is genital herpes diagnosed?
- Type specific serology
- Virus detection of vesical fluid/ulcer base
Describe the treatment of HSV
- General advice
- Suppressive treatment for recurrent HSV
- Aciclovir, valciclovir/famciclovir
How do anogenital warts present?
Benign, painless outgrowths on penis / vulva, vagina, urethra and cervix
How are genital warts diagnosed?
Biopsy in atypical lesions
Describe the treatment of anogenital warts
- No treatment (spontaneous resolution)
- Topical application (podophyllotoxin)
- Physical ablation (excision, cryotherapy, electrosurgery)
What is a preventative measure for anogenital warts?
HPV vaccination
What is the causative organism in syphilus?
Treponema pallidum
- direct contant - vertical transmission (mother to child)
How does syphilis present?
- 1o – painless ulcer
- 2o – rash, mucosal lesions, multi-system involvement
- Latent – symptom-free years
- 3o – neurosyphilis, CV syphilis, parenchymous (40 years later)
What is the causative organism in trichomoniasis?
Trichomonas vaginalis (flagellated protozoa)
How does trichomoniasis present?
- Urethral discharge
- Dysuria
What is scabies?
Scabies is a skin condition caused by an infestation of the human itch mite called Sarcoptes scabiei
What are pubic lice?
Pubic lice are small parasites (crab louse – Phthirus pubis) affecting the genital area
What is bacterial vaginosis?
- Bacterial vaginosis is a female genital tract infection which is not sexually transmitted
- It is the most common cause of abnormal discharge, odour and irritation in women of childbearing age
What are the causative organisms in bacterial vaginosis?
- Gadnerella vaginalis
- Prevotella spp
- Mobiluncus spp
How is bacterial vaginosis diagnosed?
- High vagina gram stained smear
- Vaginal pH > 4.5
- Pungent odour with the KOH ‘whiff test’
- Presence of clue cells on a wet mount
How is bacterial vaginosis treated?
Metronidazole
What is vulvovaginal candidiasis? non STI
Vulvovaginal candidiasis is a genital tract infection referring to vaginal and vulval symptoms caused by a yeast
What are the causative organisms of vulvovaginal candidiasis?
- Candida albicans
- Other non-albicans candida species
How does vulvovaginal candidiasis present?
- Vaginal discharge
- Vulval itch
- Soreness
- Dyspareunia
State 5 risk factors for vulvovaginal candidiasis
- Pregnancy
- Antibiotics
- Oestrogen oral contraceptives
- Diabetes
- Immunosupression
How is vulvovaginal candidiasis diagnosed?
High vaginal smear (± culture)
Describe the treatment of vulvovaginal candidiasis
- Topical azoles
- Oral azoles
What is LGV?
Lymphogranuloma venereum is an STI caused by C. trachomatis serotypes L1-3 and presents with a rapidly healing papule then inguinal bubo
What is chancroid?
Chancroid is a bacterial STD presenting as painful genital ulcers which are caused by infection with Haemophilus ducreyi
What is Donovanosis?
Donovanosis is a tropical sexually transmitted infection presenting as genital nodules which progress to ulcers, caused by Klebsiella granulomatis
Provide a differential diagnosis for a patient presenting with genital skin and mucous membrane lesions
- Genital ulcers – HSV, syphilis, chanchroid
- Vesicles of Bullae – HSV
- Genital papules – anogenital warts
Provide a differential diagnosis for a patient presenting with urethritis
- Gonococcal urethritis
- Non-gonococcal urethritis – C.trachomatis, ureaplasma, mycoplasma, HSV
- Post-gonococcal urethritis
Provide a differential diagnosis for a female patient presenting with a pelvic infection
- Pregnancy related – chorioamnionitis, post-partum endometriosis
- Pelvic Inflammatory Disease
Provide a differential diagnosis for a patient presenting with vulvo-vaginitis and cervicitis
- Vulvovaginitis – candiasis, trichomoniasis, HSV
- Cervicitis – C. trachomatis, N. gonorrhea, HSV, HPV
- Bartholinitis
- Bacterial vaginosis
Provide a differential diagnosis for a patient presenting with prostatitis
- Acute bacterial prostatitis
- Chronic bacterial prostatitis
- Chronic pelvic pain syndrome
Provide a differential diagnosis for a patient presenting with epididymitis
- Non-specific bacterial epididymitis
- Sexually transmitted epididymitis
Provide a differential diagnosis for a patient presenting with orchitis
- Viral orchitis (mumps, coxsackie B)
- Pyogenic bacterial orchitis
What is the illness iceberg and how does this concept apply in the case of STI’s?
- The illness iceberg states that patients presenting to the GP are a small representative of a larger population of people with a specific condition
- In terms of an STI, most are asymptomatic so patients presenting to the GP are a small minority of those with STI’s as they have symptoms
what is non-gonococcal urethritis
- inflammation of the urethra associated with discharge
- can be sexually transmitted
- chlamiydia trichomatis
- mycoplasma genitalium
what is trichomonads vaginalis?
- protozoa
- increases alkaliity
- causes frothy green/yellow discharge
- vulval itching
bacterial vaginosis
non-sti
- via oral-sex
- smoking
- fishy smelling, thin, grey homogenous discharge
differences in discharge
what are the two common medications given
common antibiotics:
azithromycin
ceftriaxone
