Semester 2: STIs, UTIs, Obstetric/Perinatal Infections

Question 1

What are the anatomical barriers of the reproductive tract?

Answer 1

Skin

Access to mucosal sites/primary sites of infection

Question 2

What are the mucosal barriers of the reproductive tract?

Answer 2

pH does not favour growth of pathogens
Flushing action of fluids
Circulating immune cells

Question 3

What factors influence susceptibility to STIs?

Answer 3

Age (child bearing age for women)
Immune status
Gender (anatomical, transmission, in men circumcision, hormonal)
Concominant STIs
Social behaviour: sexual education, unprotected sex
Asymptomatic infections

Question 4

What are the sources of STIs

Answer 4

Mucosal
Breaches in skin - oral, anal
Shared blood/blood products

Question 5

Where do STIs most commonly effect?

Answer 5

Most STIs affect reproductive tract, oral, anal cavities

Question 6

What are bacterial sources of STIs

Answer 6

Neisseria gonorrhea
Chlamydia trachomatis
Treponema pallidum
Mycoplasma sp
Ureaplasma sp

Question 7

What are the viral sources of STIs

Answer 7

Herpes simplex virus (HSV)
Human papillomavirus (HPV)
Hep B
Hep C (low risk)
HIV

Question 8

What are the fungal sources of STIs

Answer 8

Candida albicans

Trichomonas vaginalis

Question 9

What are the ectoparasite sources of STIs?

Answer 9

Phthirus pubis - pubic lice

Sarcoptes scabiei - scabies

Question 10

What are some complications of STIs?

Answer 10

Pelvic Inflammatory Disease
Bacterial Vaginosis
Cancer
Neurological events (HIV, syphilis)
Sterility (chronic/untreated infections)

Question 11

What are some signs and symptoms of PID?

Answer 11

Range, many asymptomatic
Lower abdominal pain, fever, cervical motion tenderness, cervical inflammation
Inflammation of uterus, fallopian tubes, ovaries

Question 12

What are some complications of untreated PID?

Answer 12

May lead to infertility, ectopic pregnancy

Question 13

What is PID a common sequelae of?

Answer 13

Gonorrhea and chlamydia infection in women

Question 14

What are the causes of bacterial vaginosis?

Answer 14

Unknown but linked to STI, antibiotic usage, douching, imbalance in flora composiiton

Question 15

What are some signs and symptoms of bacterial vaginosis?

Answer 15

Abnormal vaginal discharge, foul-smelling, white or grey in colour
Burning sensations while urnating, vaginal itching

Question 16

What are some complications of bacterial vaginosis?

Answer 16

Increased risk of PID and associated complications, preterm labour and low birth weight. Increased risk of STI transmission

Question 17

What cancers are complications of STIs?

Answer 17

HPV cervical cancer

HIV Kaposi’s sarcoma

Question 18

What are anatomical factors influencing susceptibility to UTI?

Answer 18

Length of urethra
Disruption of urine flow, bladder voiding
Congential
Surgery/catheterization
Disease-related (neurological, mechanical)

Question 19

What are some factors in men influencing susceptibility to UTIs?

Answer 19

Circumcision

Enlarged prostate

Question 20

What are some factors in women influencing susceptibility to UTIs?

Answer 20

Sexual intercourse

pH changes, hormonal changes, pregnancy

Question 21

What are some pathogenic sources of UTIs?

Answer 21

E. coli (80%)
Coagulase negative staphylococci (10%)
S. aureus, enterococcus faecalis, pseudomonas aeruginosa, Klebsiella sp, Enterobacter sp.
C. albicans
Viral causes rare (CMV, adenovirus, mumps, rubella); associated with hemorrhagic cystitis
“SEEK PP”

Question 22

What are some sources of UTIs?

Answer 22

Colonization of the urinary tract (sexual intercourse, hygiene, ascending infection)
Hematogenous spread of another infection (kidneys, descending infection)
Device related (urinary catheter)

Question 23

What are the clinical features of UTIs

Answer 23

Urethritis - blood in urine, painful urination/ejaculation, vaginal d/c
Cystitis - cloudy/bloody urine, abdominal pain, fever
Pyelonephritis - fever, vomiting, abdominal pain, long term kd dysfunction, kd failure, high BP
Prostatitis - fever, chills, urinary dysfunction
Epididymitis - low grade fever/chills, testicular inflammation and pain

Question 24

How are UTIs diagnosed?

Answer 24

Urinalysis - culture, microscopy, dipstick test, nitrite test for enterobacteriaceae
Ultrasound - obstruction, kidney stones
X-ray - structural

Question 25

What are the complications of UTIs?

Answer 25

Long term pyelonephritis may lead to kd dysfunction/failure
Sepsis
In men - epididymitis may lead to sterlitiy

Question 26

What is the treatment for UTIs?

Answer 26

Antimicrobial sparing strategies important due to emerging antibiotic resistance (20-30% self-resolving) but untreated can lead to renal complications

Question 27

What infections may be reactivated during pregnancy?

Answer 27

CMV, EBV, HSV

Question 28

What infections may cause serious effects during pregnancy?

Answer 28

Malaria
UTI, Candidiasis
Influenza
Viral hepatitis

Question 29

What infections may cross the placental barrier?

Answer 29

Torch
Toxoplasmosis, Treponema
Other (Parvo, varicella, TB)
Rubella
CMV
HSV, HIV

Question 30

What are the potential fetal complications with toxoplasmosis?

Answer 30

fetal malformation

Question 31

What are the potential fetal complications with Treponema?

Answer 31

musocal, skin lesions, lymphadenopathy, hepatosplenomegaly

Question 32

What are potential fetal complications of CMV?

Answer 32

Deafness, mental retardation

Question 33

What are potential fetal complications of HSV?

Answer 33

Disseminated neonatal infection

Question 34

What infections may be passed on to the newborn during childbirth?

Answer 34

N. gonorrheae: neonatal conjunctivitis 
C. trachomatis: neonatal conjunctivits/pneumonia
HSV: infection skin/eye/mouth
Genital HPV: laryngeal warts
GBS: septicemia, death
C. albicans: neonatal oral thrush
HIV: childhood AIDS

Question 35

What infections may be passed to newborns via breast milk?

Answer 35

HIV
HTLV
CMV
Rubella