Session 6 : Reproduction Flashcards
What is the difference between an STI and an STD ?
STI - Sexually transmitted infection includes symptomatic and assymptomatic cases
STD - (disease) only includes the symptomatic cases.
What is the usual presentation of chlamydia in women ?
Usually assymptomatic
Vaginal discharge
Sterile pyuria and pain on urination can commonly occur in these infections.
What are the complications of chlaymidia in women ?
Cervictitis , urethritis, salpingitis, peri hepatitis ( violin strings can be seen on the capsule of the liver )
Right upper quadrant pain
Shoulder tip pain
(Abdominal pain)
What is the common presentation of chlaymidia in men?
Pain in the testis, perineum and prostate
Prostitis , epididymitis, urethritis, proctitis
Inflammation around the anus
What are the common complications of chlamydia in men and women?
Reiters syndrome : autoimmune reaction from inflammation from a past reaction. This can cause problems with vision (conjunctivitis),joint problems (Arthirits) & urethritis.
What are the complications of chlamydia for children ?
Inclusion conjunctivitis
Pneumonia in children
How do you Diagnose chlaymdia?
Endocervical swabs - which can then grow on media (culture)
First catch urine tests
NAAT & PCR this is key in the recognition of the disease.
What type of screening is available for chlamydia ?
Under 25 year olds can be screened (those who are sexually active)
What can of treatment is given to those who suffer from chlamydia?
Doxycycline / Azithromycin
Erythromycin
Bacteriostatic - inhibit protein synthesis (tetracycline or Macrolides)
These can be given as a large single dose.
What type of organism is chlamydia?
Obligate Intracellular bacteria.
Which serotypes can cause typical chlamydia?
D/ K serotypes.
What other problem can chlamydia (serotypes L1/L2/L3) cause ?
This can cause Lymphagranuloma venarum (a chronic disease)
This presents as inguinal lymphadenopathy (lump)
There can be a rapidly raised papule followed by an inguinal bubo (abscess)
Fever
Sometimes can cause acute heamorrhagic proctitis.
How does an infection with HPV present commonly as?
Cutaneous, mucosal & anogenital warts
–> with warts observe the size, shape, edges and number
These are often painless and benign.
Which strains of HPV are significant in terms of STI/STD ?
HPV 6/11 - Associated with warts
HPV 16/18- Associated with anogenital or cervical cancer
How do you diagnose HPV ?
Biopsy the warts with genome analysis (NAAT) & histological analysis.
What is the treatment of the HPV?
Usually requires no tx.
Topical podophyllitoxin, cryotherapy, interlesional inteferon,imiquod and surgery.
What kind of screening is available for the cervix?
Ages 25 + cervical screening every 3 years
Speculum
If HPV is confirmed than what should be offered to a female ?
Cervical screening
Coloposcoy - close examination of the vulva, cervix and vagina
Acetowhite test -> to test the ectocervix neoplasia : neoplastic regions remain white.
Which vaccines are offered for HPV?
Cervarix against HPV 16/18
Cardasil against HPV 6/11 16/18
What kind of organism is Nisseria Gonnorhoea ?
Gram negative diplococci
Intracellular obligate organism
–> organism attaches to the mucosal surface via pilli before becoming endocytosed
What is the common presentation of gonorrhoea in women and men?
Women : assymptomatic , vaginal discharge , pharyngitis, endocervictitis, bartholin abscess.
Men : urethritis , purulent discharge, pain in prostate and testis, discomfort in the perineum, epididymitis , prostatitis, proctitis and pharyngitis
What are the complications of Gonnhoreae?
Reiters syndrome
PID - pelvic inflammatory disease
How do you diagnose for Gonnhorea ?
Endocervical swab , urethral swab , pharyngeal and rectal swab.
Gram staining is the key for staining
Culturing the organism can help to identify better treatment plans (sensitivity & specificity)
What is the common treatment for gonorrhoea ?
Penicillin resistance has led to :
Azithromycin & intramuscular ceftriaxone (inhibit cell walll synthesis)
What is the common presentation of Herpes simplex virus ?
Initial presentation : fever , dysuria, ulceration of the skin , lymphadenopathy (lump in the inguinal region) , pain.
Onset of herpes is extremely painful and can often require hospitalisation
What are the common complications of herpes?
This can cause relapse and remitting infections.
This is as the organism can reside in the dorsal route ganglion and remit in the future.
Which Strains of herpes simplex virus can cause genital problems?
HSV1 - this will cause cold sores
HSV2 - this will cause genital problems
Herpes virus - ds DNA non-enveloped virus.
How do you diagnose this herpes simplex?
Vesicle fluid and ulcer base fluid
Test for PCR & NAAT
Urine sampling
How do you treat a herpes simplex virus infection?
Treat the systemic problems (analgaesia)
Aciclovir -> severe disease or in recurrent infection
When a person is infected with herpes simplex virus what information can should be given about intercourse ?
They should not have sex when blisters are present on the genetila.
What is the presentation of Syphillis ?
Syphillis presents differently over time
1º painless ulcer on penis or vagina, papules can also be seen on the skin (chancre)
2º 6-8 weeks later, lymphadenopathy in the groin/inguinal region, mucosal lesions in the mouth, fever & rash
Then can be latent for a while
3º cerebrospinal problems, cardiovascular symptoms, and gummas present on the skin (lesions which are nodules of granulmoatous tissue)
Wha effect will Syphillis have in children ?
This can cause congenital Syphillis, miscarriage or stillbirths.
Which organism will cause Syphillis ?
This is Treponema pallidum
A type of spirochete which can be seen on darkfield microscopy.
How can you treat Syphillis ?
Penicillin
How do you diagnose Syphillis ?
Serology - > this is a specialised area .
Which other organisms can cause ulceration on the genitals?
Chancroid –> haemophilus ducreyi
Granuloma Inguinale/ Donovanosis —> klebsiella granulomatis
These can cause painless ulceration and genital nodules.
What kind of problem can Trichomonas vaginalis cause ?
An increase in itchy, offensive discharge, thin.
Irritation, dysuria, and vaginal inflammation
How can you diagnose a person with trichomonas vaginalis ?
High vaginal swab
Vaginal wet preparation : vaginal discharge +/- culture enhancement.
How do you treat Trichomonas vaginalis infection ?
Metronidazole
Treats anti-protozoan & anaerobic bacteria
What is vulvovaginal candidasis and what risk factors can cause it?
This is commonly due to a disruption in the normal flora of the vagina this will then cause an overgrowth of the candida
Risk factors : oral contraceptives, pregnancy, obesity, steroids and diabetes
What are the symptoms of vulvovaginal candidasis ?
Curd like discharge, white, which is profuse
This can be accompanied with itching.
How do you diagnose & treat candidasis infection ?
Diagnose : high vaginal swab with cultures
Treatment : nystatin/ anole creams or fluconazole Ab.
This can effect the integrity of the cell wall of the fungi.
Which organisms can cause bacterial vaginosis ?
This is due to perturbed flora in the tract :
Gardnella vaginosis
Anaerobes
Mycoplasma hominids
What are the symptoms of bacterial vaginosis ?
Scanty , offensive fishy discharge.
How do you diagnose bacterial vaginosis ?
High vaginal swab with culture
Koh test –> you can smell the fishy odour
Clue cells can be seen —> epithelial cells studded with coccobacilli
There are less lactobacilli in the region and an absence of pus cells?
How do you treat bacterial vaginosis ?
Tx : with metronidazole
What other organisms can cause problems in the repro tract?
Scabies –> skin mite which can cause itchiness and soreness
Pubic lice & crabs (phthirus pubis) –> itchiness and soreness.
What is pelvic inflammatory disease ?
This is due to ascending infections from the endocervix that can present as endometriosis, salpangitis, oophonitis, pelvic peritonitis, and tuburo-ovarian abscess
Which organisms can cause PID ?
Gonorrhoea Chlamydia T. Vaginalis Bacterial vaginosis --> gardnella, actinomycetes, mycoplasma hominids & anaerobes H. Influenzae ,streptococci and CMV
What is the Pathophysiolog of PID ?
Infection will cause inflammation of the tubal epithelium which can then cause adhesion formation and abscess formation.
What complications and problems can arise from PID?
Ectopic pregnancy and infertility (as a result of the adhesions)
Adherence to the pelvic side walls
Lymphadenopathy (increase in the number of germinal centres)
Abscess Rupture which can cause sepsis
Chronic pelvic pain
Reiters syndrome
Fitz-Hugh-Curtis syndrome (perihepatitis of the capsule surrounding the liver)
What are the risk factors associated with PID?
Unprotected sex Low socioeconomic calls Age (younger) Sexual habits Coil --> in placing in the coil and removing the coil an inherent risk is presented to the px. This often results in actinomycetes problems Hormonal changes following menses. Previous infections and STI
What are the clinical features associated with this disease?
Fever >38 Abdominal pain and deep dysparenuia Abnormal vaginal or cervical discharge (itchy,purulent , offensive smelling) Abnormal bleeding (post coital , in between menses)
What examinations are done to determine PID ?
Bimanual examination :
Adnexal tenderness
Cervical motion tenderness
Speculum examination :
Red and inflammed cervix
Purulent discharge.
How do you confirm diagnosis of PID ?
Urine sampling - dipstick, pregnancy,
Endocervical and high vaginal swab
Blood test to check for markers of inflammation (CRP & wbc)
Other STI screening
NAAT & PCR on samples
Surgical : laparoscope –> visualise and remove adhesions or abscess..
What differential diagnosis can be also present as PID?
Gynae: ectopic pregnancy (hcg test), endometriosis (presents with relapse remitting pain, ovarian cyst complication (shorter onset of pain which is more severe)
Urinaty : dysuria and frequency
GI tract : IBS & appendicitis (nausea and Vomititng)
Other functional pain (MSK)
How do you manage PID?
Ab, with severe disease (not responding to Ab, pregnancy, suspected ectopic pregnancy and HIV –> hospitalised)
Analgesic for pain
If px has sepsis –> treat for sepsis
What is the tx for PID ?
Broad spec antibiotics
Inpx : IM Ceftriaxone, orally : metronidazole & doxycycline
PutPx : IV Ceftriaxone , metronidazole and doxycycline
2 week tx
Follow up in 72 hrs then later in 4 weeks.
What are GUM clinics and what are they good at ?
Genitourinary medicine
- maintain anonymity
- technical know how
- provide info for safe sex
- good for contact tracing
- rapid and efficient tx.
What advice would be given to px with STI?
Wear loose Undrwear
Safe Sex With Barrier Contraception
Treat partner as well to limit re- infection
Avoid warm moist enviomrents
Which two are the most common causative organisms ?
N. Gonorrhoea
C. Trochamitis
