S9) Infections of the Reproductive Tract Flashcards
1
Q
What are the main public health messages required to limit STI’s?
A
- 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
2
Q
Identify 6 factors which affect the transmission of genital tract infections
A
- Age
- Condom use
- Sexual orientation
- Socioeconomic status
- Number of partners
- Ethnicity
3
Q
Identify 5 of the most commonly occuring STI’s
A
- Chlamydia
- Gonorrhea
- Genital herpes
- Genital warts
- Syphillis
4
Q
What is the causative organism in chlamydia?
A
Chlamydia trachomatis
5
Q
What is the causative organism in gonorrhea?
A
Neisseria gonorrhea
6
Q
What is the causative organism in genital warts?
A
Human papilloma virus
7
Q
What is the causative organism in genital herpes?
A
Herpes simplex virus (1&2)
8
Q
Briefly, describe the incidence of different STI diagnoses in men
A
9
Q
Briefly, describe the incidence of different STI diagnoses in women
A
10
Q
Briefly, describe the incidence of different STI diagnoses in men by ethnic group
A
11
Q
Briefly, describe the incidence of different STI diagnoses in women by ethnic group
A
12
Q
How does chlamydia present in males?
A
- Urethritis
- Dysuria
- Epididymitis
- Prostatitis
- Conjunctivitis
- Asymptomatic pharyngeal infection
13
Q
How does chlamydia present in females?
A
- Increased discharge
- Dyspareunia (painful sex)
- Post coital bleeds
- Intermenstrual bleeds
- Conjunctivitis
- Asymptomatic pharyngeal infection
14
Q
How is chlamydia diagnosed in men?
A
- First catch urine NAAT (nucleic acid amplification testing)
- Rectal NAAT
- Pharyngeal NAAT
15
Q
How is chlamydia diagnosed in women?
A
- Vulvovaginal & endocervical swabs for NAAT
- Rectal NAAT
- Pharyngeal NAAT
16
Q
Describe the treatment of chlamydia in men and women
A
- Doxycycline / Azithromycin (1st line)
- Erythromycin / Ofloxacin (2nd line)
17
Q
How does gonorrhea present in men?
A
- Urethral discharge
- Dysuria
- Anal discharge
- Asymptomatic pharyngeal infection
18
Q
How does gonorrhea present in women?
A
- Altered discharge
- Lower abdominal pain
- Asymptomatic pharyngeal infection
- Asymptomatic rectal infection
19
Q
How is gonorrhea diagnosed?
A
- Microscopy of gram stained genital specimen
- NAATs
- Cultures
20
Q
Describe the treatment of gonorrhea
A
- Ceftriaxone & azithromycin
- Spectinomycin (alternative for penicillin allergy)
21
Q
Why are both azithromycin and ceftriaxone given as treatment for gonorrhea?
A
Azithromycin prevents antibiotic resistance to ceftriaxone and also treats the possible co-infection of chlamydia
22
Q
How does genital herpes present?
A
- Painful ulceration
- Dysuria
- Vagina discharge
- Fever
- Myalgia
23
Q
How is genital herpes diagnosed?
A
- Type specific serology
- Virus detection of vesical fluid/ulcer base
24
Q
Describe the treatment of HSV
A
- General advice
- Suppressive treatment for recurrent HSV
- Aciclovir, valciclovir/famciclovir
25
How do anogenital warts present?
Benign, painless outgrowths on penis / vulva, vagina, urethra and cervix
26
How are genital warts diagnosed?
Biopsy in atypical lesions
27
Describe the treatment of anogenital warts
- No treatment (spontaneous resolution)
- Topical application (podophyllotoxin)
- Physical ablation (excision, cryotherapy, electrosurgery)
28
What is a preventative measure for anogenital warts?
HPV vaccination
29
What is the causative organism in syphilus?
Treponema pallidum
30
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)
31
What is the causative organism in trichomoniasis?
Trichomonas vaginalis (flagellated protozoa)
32
How does trichomoniasis present?
- Urethral discharge
- Dysuria
33
What is scabies?
**Scabies** is a skin condition caused by an infestation of the human itch mite called Sarcoptes scabiei
34
What are pubic lice?
**Pubic lice** are small parasites (crab louse – Phthirus pubis) affecting the genital area
35
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
36
What are the causative organisms in bacterial vaginosis?
- Gadnerella vaginalis
- Prevotella spp
- Mobiluncus spp
37
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
38
How is bacterial vaginosis treated?
Metronidazole
39
What is vulvovaginal candidiasis?
**Vulvovaginal candidiasis** is a genital tract infection referring to vaginal and vulval symptoms caused by a yeast
40
What are the causative organisms of vulvovaginal candidiasis?
- Candida albicans
- Other non-albicans candida species
41
How does vulvovaginal candidiasis present?
- Vaginal discharge
- Vulval itch
- Soreness
- Dyspareunia
42
State 5 risk factors for vulvovaginal candidiasis
- Pregnancy
- Antibiotics
- Oestrogen oral contraceptives
- Diabetes
- Immunosupression
43
How is vulvovaginal candidiasis diagnosed?
High vaginal smear (± culture)
44
Describe the treatment of vulvovaginal candidiasis
- Topical azoles
- Oral azoles
45
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
46
What is chancroid?
**Chancroid** is a bacterial STD presenting as painful genital ulcers which are caused by infection with Haemophilus ducreyi
47
What is Donovanosis?
**Donovanosis** is a tropical sexually transmitted infection presenting as genital nodules which progress to ulcers, caused by Klebsiella granulomatis
48
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
49
Provide a differential diagnosis for a patient presenting with urethritis
- **Gonococcal urethritis**
- **Non-gonococcal urethritis** – C.trachomatis, ureaplasma, mycoplasma, HSV
- **Post-gonococcal urethritis**
50
Provide a differential diagnosis for a female patient presenting with a pelvic infection
- **Pregnancy related** – chorioamnionitis, post-partum endometriosis
- **Pelvic Inflammatory Disease**
51
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**
52
Provide a differential diagnosis for a patient presenting with prostatitis
- Acute bacterial prostatitis
- Chronic bacterial prostatitis
- Chronic pelvic pain syndrome
53
Provide a differential diagnosis for a patient presenting with epididymitis
- Non-specific bacterial epididymitis
- Sexually transmitted epididymitis
54
Provide a differential diagnosis for a patient presenting with orchitis
- Viral orchitis (mumps, coxsackie B)
- Pyogenic bacterial orchitis
55
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
