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Semester 4 - Reproductive System > Session 6 - Genitalfections > Flashcards

Session 6 - Genitalfections Flashcards

1
Q

Name two sources of epidemiological date for assesing rates of infection of the genital tract

A

Genitourinary medicine clinics

Communicable disease surveillance centres

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2
Q

What is the issue with data from a GUM clinic?

A

Data is an underestimate, as does not take into account people presenting through their GPs

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3
Q

Give five groups at particular risk of STI

A

o Young people
o Minority ethnic groups
o Those affected by poverty and social exclusion
o Low socio-economic status groups
o Those with poor educational opportunities
o Unemployed people
o Individuals born to teenage mothers

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4
Q

What five conditions are associated with STI?

A

o Pelvic Inflammatory Disease (PID)
o Impaired fertility
o Reproductive tract cancers
o Risk of infection with blood-borne viruses – HBV, HIV
o Risk of congenital or peripartum infection of neonate

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5
Q

Give four differential diagnosis for genital skin and mucous membane lesions

A

o Genital ulcers
o Vesicles or bullae
o Genital papules
o Anogenital warts

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6
Q

Give five differential diagnosis for urethritis

A 
o	Gonococcal urethritis
o	Chlamydial urethritis
o	Non-specific urethritis
o	Post-gonococcal urethritis
o	Non-infectious urethritis
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7
Q

Give one main differential for vulvo-vaginitis

A

o Bartholinitis

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8
Q 
How much has the following increased since '95?
o	Uncomplicated Gonorrhoea 
o	Genital Chlamydia – 
o	Infectious Syphilis – 
o	GUM clinic workload
A

o Uncomplicated Gonorrhoea – 102% Increase
o Genital Chlamydia – 107% Increase
o Infectious Syphilis – 57% Increase
o GUM clinic workload – 34% Increase

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9
Q

What organism causes chalmydia?

A

Chlamydia trachomatis

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10
Q

Describe chlamydia trachomatis

A

Gram -‘ve obligate intracellular bacterium

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11
Q

How does chalmydia present in males?

A

o Urethritis, epididymitis, prostatitis, proctitis

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12
Q

How does chlamydia present in females?

A

o Urethritis, cervicitis, salpingitis, perihepatitis

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13
Q

How is chlamydia diagnosed?

A

o Doxycycline or Azithromycin

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14
Q

What causes gonorrhoeae?

A

Neisseria Gonorrhoeae is a Gram –‘ve intracellular diplococcus

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15
Q

What is the clinical presentation of gonnorohoea in men?

A

o Urethritis, epididymitis, prostatitis, proctitis, pharyngitis

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16
Q

What is the clinical presentation of gonnorohoea in women?

A

o Asymptomatic, endocervicitis, urethritis, PID

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17
Q

What does disseminated gonococcal infection present as?

A

o Bacteraemia, skin and joint lesions

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18
Q

How is gonnorohoea diagnosed?

A

o Smear and culture

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19
Q

What is the treatment of gonorrhoeae?

A

Ceftriaxone

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20
Q

What causes herpes?

A

Herpes Simplex Virus, an encapsulated, double stranded DNA virus.

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21
Q

What is the clinical presentation of primary genital herpes

A

o Extensive, painful genital ulceration, dysuria, inguinal lymphadenopathy, fever

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22
Q

What is the clinical presentation of recurrent genital herpes?

A

o Asymptomatic  Moderate

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23
Q

How is genital herpes diagnosed?

A

o Smear and swab of vesicle fluid and/or ulcer base

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24
Q

How is genital herpes treated?

A

Aciclovir

25
Q

What causes genital warts?

A

HPV

26
Q

What HPV strains cause the highest risk?

A

16 and 18

27
Q

What is the clinical presentation of HPV?

A

o Cutaneous, mucosal and anogenital (anus and genital) warts
o Benign, painless, verrucous epithelial or mucosal outgrowths
o Penis, vulva, vagina, urethra, cervix, perianal skin

28
Q

How is HPV diagnosed?

A

Clinical, biopsy and genome analysis, hybrid capture

29
Q

How is HPV treated?

A

o None – frequent spontaneous resolution

o Topical podophyllin, cryotherapy, intralesional interferon

30
Q

What causes syphilis?

A

Treponema pallidum

31
Q

What are the four stages of syphillis?

A
  1. Indurated, painless ulcer (chancre)
  2. 6 – 8 weeks later
     Fever, rash, lymphadenopathy, mucosal lesions
    Latent – Symptom free years
  3. Chronic Granulomatous lesions
  4. Cardiovascular and CNS pathology
32
Q

How is syphilis diagnosed?

A

Dark field microscopy, serology

33
Q

How is syphilis treated?

A

Penicillin and test of cure follow up

34
Q

What is trichomonas vaginitis caused by?

A

Flagellatd protozoan, trichomonas vaginalis

35
Q

What are the key features of trichomonas vaginalis?

A

o Thin, frothy, offensive discharge

o Irritation, dysuria, vaginal inflammation

36
Q

What is the treatment of trichomonas vaginitis?

A

Metronidazole

37
Q

What are two types of parasites which cause genital infection?

A

Scabies mite

Pubic louse

38
Q

Give two infections which occur post partum

A

Vulvovaginal Candidiasis

Bacterial Vaginosis

39
Q

What causes vulvovaginal candidiasis?

A

Candida albicans

40
Q

Give six risk factors for vulvovaginal candidiasis

A

 Antibiotics, oral contraceptives, pregnancy, obesity, steroids, diabetes

41
Q

Give symptoms vulvovaginal candidiasis

A

o Profuse, white, curd-like discharge

o Vaginal itch, discomfort and erythema

42
Q

How is vulvovaginal candidiasis diagnosed?

A

High vaginal smear and culture

43
Q

How is vulvovaginal candidiasis treated?

A

Topic azoles or oral fluconazole

44
Q

What distinguished bacterial vaginosis from vaginitis?

A

No inflammation of vaginal wall

- Caused by unsetlled normal flora

45
Q

What is the main symptom of bacterial vaginosis?

A

Offensive fishy discharge

46
Q

How does one diagnose bacterial vagnosis

A

 pH > 5, KOH whiff test

 High Vaginal Smear – Gram variable coccobacilli, reduced numbers of lactobacilli

47
Q

How does one treat bacterial vaginosis

A

Metronidazole

48
Q

Give five types of pelvic inflammatory disease

A 
o	Endometritis
o	Salpingitis
o	Oophoritis
o	Pelvic peritonitis
o	+/- tubo ovarian abscess
49
Q

Give five PID risk factors

A

o Young age at first intercourse
o Multiple sexual partners (polygyny)
o High frequency of sexual intercourse
o High rate of acquiring new partners within pervious 30 days
o Alcohol/Drug use
o Cigarette smoking (2x increased risk)
o IUDs increase risk at point of insertion/removal for a few weeks

50
Q

Give 5 bacteria that can cause PID

A 
o	Nesseria Gonorrhoea
	Gram –‘ve intracellular diplococci
o	Chlamydia Trachomatis
	Gram –‘ve extracellular (infective) organism
o	Bacterial Vaginosis
	Anareobes, Enteric Gram –‘ve Bacteroides 
o	Streptococci
o	Haemophillis Influenzae
o	Cytomegalovirus
o	Mycobacterium Tuberculosis
51
Q

Give two immediate sequelae of PDI

A

 Tubo-ovarian abscess

 Pyo-salpinx

52
Q

Give five long term sequlae of PID

A

 Ectopic Pregnancy (1 episode of PID  7x increased risk)
 Infertility (1 episode of PID  12% increase, 2  25%, 3+  50-75%)
 Dyspareunia (Painful sexual intercourse)
 Chronic PID / Chronic pelvic pain
 Pelvic adhesions

53
Q

What is the pathogenesis of PID

A

Infection of the cervix (endocervicitis) spreads, either directly or via lymphatics to the endometrium, uterine tubes and the pelvic peritoneum

54
Q

Give four factors associated with the ascent of bacteria in PID

A

o Instrumentation
 Cervical dilation, coil insertion
o Hormonal changes associated with menstruation
 Lowers bacteriostatic effect of cervical secretion
o Retrograde menstruation
 Infection more common after a period
o Virulence of the organisms in acute chlamydial and gonococcal PID

55
Q

Give four laboratory tests for PID

A

Pregnancy test
Triple and urethral swabs
Midstream urine
C-reactive protein

56
Q

What is a triple swab?

A

 High vaginal swab – Bacteria vaginosis organisms
 Endocervical swab – Neisseria gonorrhoea
 Endocervical swab - Chlamydia trachomatis

57
Q

Give six differential diagnoses for PID

A

o Ectopic pregnancy
o Acute appendicitis
o Irritable Bowel Syndrome (IBS)
o Ovarian cyst accidents (torsion, rupture, haemorrhage)
o Urinary Tract Infection (UTI)
o Functional pelvic pain of unknown origin

58
Q

What is chronic pelvic inflammatory disease?

A 
Symptoms >6 months duration 
o	Pelvic pain
o	Secondary dysmenorrhoea
o	Deep dyspareunia
o	Menstrual disturbance
o	Recurrent acute painful exacerbations
59
Q

Give five clinical sequalae of chronic pelvic inflammatory disease

A 
o	Infertility
o	Ectopic pregnancy
o	Chronic pelvic pain
o	Pelvic adhesions/tubo-ovarian complex
o	Abnormal / painful periods

Semester 4 - Reproductive System (30 decks)

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