Session 9 - Genital Tract Infections Flashcards
What are the factors affecting STI transmission?
Age (15-24 yrs highest incidence) Ethnicity Socioeconomic class (poorer populations) Age at first sexual intercourse Number of partners Sexual orientation (MSM) Lack of condom use
Give some examples of common STI and the organisms that cause them.
Chlamydia - chlamydia trachomatis Gonorrhoea - neisseria gonorrhoea Syphilis - treponema pallidum Genital warts - human papilloma virus Herpes - herpes simplex 1 and 2 Candidiasis - candida species Scabies - sarcoptes scabei (not always transmitted sexually)
Give some possible differentials for urethritis, cervicitis and abnormal discharge.
Chlamydia
Gonorrhoea
Bacterial vaginosis
Vulvovagina candidiasis
Give some possible differentials for skin manifestions (of genital infections).
Anogenital warts
Scabies and pubic lice
Give some possible differentials for genital ulceration.
Herpes
Syphilis
Give some possible differentials for systemic presentations/complications of genital tract infections.
Pelvic inflammatory disease (PID)
Prostatitis
Sexually acquired reactive arthritis (SARA)
What is dysuria?
Painful or difficult urination
How does chlamydia present in males?
Mild urethritis Dysuria Epididymitis Proctitis Prostatitis
How does chlamydia present in females?
Asymptomatic
Increased discharge
Post coital bleeds
Dyspareunia
How does ocular inoculation of chlamydia present?
Manifests as conjunctivitis
How does pharyngeal chlamydia present?
Asymptomatic
How is chlamydia diagnosed in males?
Urine nucleic acid amplifications tests (NAAT)
Urethral swabs
Rectal and pharyngeal NAATs
How is chlamydia diagnosed in females?
Vulvulovaginal swabs for NAAT
Urine, rectal and pharyngeal NAATs
What treatment is given for chlamydia?
Doxycycline
How does gonorrhoea present in males?
Urethral discharge
Dysuria
Anal discharge
How does gonorrhoea present in females?
Asymptomatic
Altered discharge
Lower abdominal pain
What is a possible complication of gonorrhoea?
Pelvic inflammatory disease
How is gonorrhoea diagnosed?
Cultures
Microscopy of gram stain
Neisseria gonorrhoea is a gram negative diplococcus
How is gonorrhoea managed?
IM ceftriaxone
Oral azithromycin
Combination presents resistance, co-infections and boosts the action of ceftriaxone
How does genital herpes present?
Asymptomatic Painful ulceration Dysuria Vaginal discharge Fever and myalgia
How is genital herpes diagnosed?
Virus detection of vesicle fluid
Serology
What is serology?
Blood test looking for antibodies in serum.
What treatment is given for genital herpes?
Acyclovir
How does genital warts present?
Wart like lesions
How is genital warts diagnosed?
Clinical (visual)
Biopsy of atypical lesions
How is genital warts managed?
No treatment
Topical applications
Physical ablation
Give some examples of non-sexually transmitted genital tract infections.
Scabies
Vulvovaginal candidiasis
Bacterial vaginosis
How does scabies present?
Itchy external vagina
Itchy external genitalia
How is scabies diagnosed?
Visual
How is scabies treated?
Permethprim
How does vulvovaginal candidiasis present?
Vaginal discharge
Vulval itch
Dyspareunia
How is vulvovaginal candidiasis diagnosed?
Vaginal smear
Culture
How is vulvovaginal candidiasis treated?
Topical or oral Azores
How does bacterial vaginosis present?
Abnormal discharge
Fishy smell with no itch or soreness
How is bacterial vaginosis diagnosed?
Vaginal smear and gram stain
How is bacterial vaginosis treated?
Metronidazole
