S9.1 Genital Tract Infecitons Flashcards
Identify risk factors for GTIs
Age 15-24 Low socio-economic groups Unprotected sex High number of partners Sexual orientation Ethnicity
List the common presentations of GTIs
Urethritis, cervicitis and abnormal discharges – chlamydia, gonorrhoea
Genital ulceration – herpes, syphilis
Skin manifestations – anogenital warts
Systemic presentation – PID
How can you diagnose STIs in men?
Urine analysis
Urethral sampling
Bloods
How can you diagnose STIs in women?
Vulvovagainal swab
Endocervical swab
Urine analysis
Bloods
What is the organism causing chlamydia?
Chlamydia trachomatis
What is the presentation of chlamydia in women?
Often asymptomatic
Increased discharge
Dyspareunia
What is the presentation of chlamydia in men?
Urethritis
Epididymitis, prostitis, proctitis
Epididymitis can lead onto Reiters syndrome: urethritis, conjunctivitis, arthritis
How do you diagnose chlamydia?
Females - vulvovaginal swab, first catch urine
Males - first catch urine NAAT
What is the management for chlamydia?
Doxycycline or azithromycin
NB erythromycin for pregnant women
What is the organism causing gonorrhoea?
Neisseria gonorrhoea. Gram-negative diplococcus. Primary sites – urethra, rectum, pharynx.
What is the presentation of gonorrhoea in women?
Often asymptomatic
Altered discharge
What is the presentation of gonorrhoea in men?
Urethral discharge
Dysuria
Very common in MSM
Can lead to prostitis or epididymo-orchitis
How do you diagnose gonorrhoea?
Females: endocervical swab
Males: urethral swab
Gram stain
Culture
What is the management for gonorrhoea?
IM ceftriaxone alongside azithromycin (as often occurs with chlamydia)
What organism causes genital herpes?
Herpes simplex virus, HSV 2
Describe how patients present with herpes
Primary herpes: painful genital ulceration, dysuria
Recurrent herpes: asymptomatic to moderate
How do you diagnose herpes?
PCR of vesicle fluid
What is the management for herpes?
Acyclovir
What organism causes genital warts?
Human papilloma virus, HPV 6 and 11
Describe the presentation of genital warts
Benign, painless, epithelial or mucosal outgrowths around the penis or vagina.
How do you diagnose genital warts?
Biopsy
What is the management for genital warts?
70% resolve completely after 1 year, can physically remove or freeze them e.g. cryotherapy.
What organism causes syphilis?
Treponema pallidum
Common in MSM
Describe the presentation of syphilis
Multi-stage disease;
Stage 1: indurated painless ulcer in genital tract
Stage 2: 4-10w later; rash, mucosal lesions
Latent - symptom free years
Stage 3: neuro-syphilis
How do you diagnose syphilis?
EIA antibody test
Lab diagnosis by PCR
What is the management for syphilis?
Penicillin
Dose depends on stage of disease
What type of organism is trichomonas vaginalis?
Flagellated protozoa
How do patients present with trichomonas vaginalis?
Men: up to 50% asymptomatic. Urethral discharge or dysuria
Women: frothy vaginal discharge
How do you diagnose trichomonas vaginalis?
Vaginal wet preparation and culture enhancement
What is the treatment for trichomonas vaginalis?
Metronidazole
Describe the features of bacterial vaginosis
A non-sexually transmitted GTI Caused by overgrowth of the normal flora including Gardnerella. Symptoms: fishy discharge Diagnosis: high vagina smear Management: metronidazole
Describe the features of vulvovaginal candidiasis
A non-sexually transmitted GTI
Caused by Candida albicans
Symptoms: white curd-like discharge
Management: topical and oral azoles such as fluconazole
