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Case 2 > Sexually Transmitted Infections and Urinary Tract Infections > Flashcards

Sexually Transmitted Infections and Urinary Tract Infections Flashcards

1
Q

What is chlamydia

A

An obligate intracellular bacterial pathogen. Full name- chlamydia trachomatis

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2
Q

What are the three different biovars (forms) of chlamydia

A
  1. Causes trachoma infection of the eyelids (leading cause of blindness worldwide). 2. Causes STI. 3. Causes Lymphogranuloma veneruem (infection of the lymph nodes and the lymphatic system, rare in the western world)
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3
Q

What is gonorrhoeae

A

Gram negative diplococcus. Full name- neisseria gonorrhoeae

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4
Q

What is syphillis

A

A bacterial infection causes by treponema pallidum

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5
Q

How is syphillis spread

A

By skin and mucous membranes following direct contact

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6
Q

What is genital herpes caused by

A

Herpes simplex virus

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7
Q

Describe Type 1 herpes

A

Classic cause of oral cold sore

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8
Q

Describe Type 2 herpes

A

Historically more associated with STI

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9
Q

Where does genital herpes remain laten

A

In sensory root ganglia

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10
Q

What can herpes be

A

Primary or recurrent

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11
Q

What is genital warts caused by

A

Human papilloma virus (HPV)

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12
Q

What are the symptoms of chlamydia

A

Urethritis, epididymitis, cervicitis, proctitis . Commonly asymptomatic (80%)

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13
Q

What are the symptoms of gonorrhoea

A

Urethritis, proctitis and discharge (vaginal, anal and urethral). Pharangitis and eye infections. May be asymptomatic (10%) particularly in men

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14
Q

What are the 3 stages of syphilis

A

Primary syphilis, secondary syphilis and tertiary syphilis

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15
Q

Describe primary syphilis

A

Painless but highly infectious sore (chancre) lasts 2-6 weeks

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16
Q

Describe secondary syphilis

A

Skin rash (affects palms of the hands and soles of the feet), fever and sore throat- few weeks

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17
Q

Describe tertiary syphilis

A

33% of untreated patients develop tertiary syphilis. Gummatous (15%)- soft inflammatory masses involving bone, skin and liver. Cardiovascular (6%)- aorititis and aneurysm. Neurological (10%)- dementia, psychosis, paresis (tabes dorsalis, general paralysis of the insane)

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18
Q

What are the symptoms of genital herpes

A

Can by symptomatic or non-symptomatic: intermittent viral shedding occurs in both. Painful genital vesicles and ulcers

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19
Q

What are the symptoms of genital warts

A

Could take 1-2 months to develop or 9 months or incubate depending on the speed of cellular replication or the quantity of the virus. May not be visible. Will cause a visible, painless soft fleshy growth in or around the genitalia. Does not always cause visible signs and symptoms

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20
Q

What are the consequences of chlamydia

A

Pelvic inflammatory disease (15%), ectopic pregnancy (1 in 10), tubal infertility (1 in 5), chronic pain (1 in 5), increased HIV transmission 3-5 fold, Reiter’s syndrome, transmission to baby during birth- conjunctivitis and neonatal pneumonia

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21
Q

What are the consequences of gonorrhoea

A

PID, may spread to blood stream and cause bone and soft tissue infections, neonatal infection (conjunctivitis), global resistance to antibiotics emerging

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22
Q

Describe early congenital syphilis

A

Rash, snuffles, perostitis, hepatosplenomegaly, generalised lymphadenopathy, neurological or occular movement

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23
Q

Describe late congenital syphilis

A

Stigmata- Clutton’s joints, Hutchinson’s incisors, mulberry molars. Facial deformities- high palatal arch, frontal bossing, short maxilla, protuberance of mandible, saddlenose (due to collapsed cartilage). Neurological or gummatous involvement

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24
Q

What are the consequences of genital herpes

A

Recurrent disease more likely with HSV type 2. Can affect newborns- if primary infection is acquired late in pregnancy, baby is premature

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25
Q

What are the consequences of genital warts

A

First infects the DNA of the skin a mucous membranes. Then replicates and causes a cellular abnormality that is spread through the area. If the correct variation of HPV is contracted a genital wart abnormality will develop from these infected epithelial tissues

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26
Q

How do you investigate/ diagnose chlamydia

A

Performed when symptomatic- urethritis, PID, Reiter’s syndrome. Early detection and treatment of asymptomatic infection requires screening. Microscopy, fluorescent antibody tests ELISA, all relatively insensitive- genital swabs. Nucleic acid amplification tests most sensitive and specific (NAAT testing). Genital swabs and/or urine specimens

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27
Q

How do you investigate/ diagnose gonorrhoea

A

Presence of gram negative diplococci in pus. Culture from swabs and pus speciemens- need to distinguish from other neisseria that man colonise mucous membranes N.menigitidis, N.lactamia (sugar fermentation and biochemical tests). NAAT testing

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28
Q

How do you investigate/ diagnose syphilis

A

Microscopy- dark ground illumination. Serology- specific tests detect T. pallidum IgG and/or IgM (enzyme immunoassay (EIA) T. pallidum haemagglutination assay (TPHA), T. pallidum particle, agglutination assay (TPPA), fluorescent treponemal antibody absorbed test (FTA)), cross react with other treponemal infections (Yaws, Pinta). Non treponemal tests- detect anticardiolipin antibodies (VDLR, Reagin test (RPR)). Can be quantified and becomes negative with successful treatment. Use one test to screen and another to confirm. Monitor response with VDRL/RPR

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29
Q

Describe how you investigate/ diagnose genital herpes

A

Diagnoses by immunofluorescence/ PCR on vesicular fluid

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30
Q

Describe how you investigate/ diagnose genital warts

A

May not be visible and therefore must be diagnosed through a colposcopic exam of the cervix or vagina because the genital warts may be located on the vaginal walls and the cervix

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31
Q

Describe the national chlamydia screening program

A

Targets 14-24 year olds including anal screening and when change of sexual partner. Also offered during pregnancy and TOP.

32
Q

Describe the use of NAAT in chlamydia

A

Fully automated extraction, amplification and detection systems (rapid and widely available), do not require viable organisms, swab (urethral, cervical, rectal) or urine all validated, can detect chlamydia and gonococcus in same sample

33
Q

What is the treatment for chlamydia

A

Easily treated, drugs readily available azithromycin (single dose) and doxycycline (a longer course, usually two capsules a day for two weeks), screen for other STIs, screen and treat contacts

34
Q

What is the treatment for gonorrhoea

A

Increasing resistance leads to treatment failures. Combination therapy now reccomended ceftriaxone 500mgx1 IM, plus azithromycin 1gx1 orally. Test of cure recommended, screen for other STIs and screen contacts

35
Q

Describe the use of mercury in the treatment of syphilis

A

Long used to cure all ailments, used widely in treatment of syphilis, very toxic- renal failure, skin ulcers, tooth loss and death

36
Q

Describe the use of arsenic in the treatment of syphilis

A

Antisyphilitic effects of arsenic discovered 1910, Salvarsan developed

37
Q

Describe the use of fever therapy in the treatment of syphilis

A

Giving patients malaria moderately effective after quinine discovered

38
Q

What is the treatment for early (primary or secondary) syphilis

A

Benzathine penicillin G 2.4 MU i.m. single dose and procaine penicillin 600,000 units i., o.d. for 10 days

39
Q

What is the treatment for latent, cardiovascular or gummatous syphilis

A

Benzathine oenicillin G 2.4 MU i.m. weekly for 3 doses and procaine penicillin 600,000 units i.m. o.d. 17 days

40
Q

What is the treatment for neurosyphilis

A

Procaine penicillin 1.8-2.4 MU i.m. o.d. plus probenecid 500mg po q.d.s for 17 days.

41
Q

Describe the treatment of genital herpes

A

Treated with aciclovar

42
Q

Describe the treatment options for genital warts

A

Surgery, freezing, chemical

43
Q

Describe surgery of genital warts

A

By surgical incision around the site or with laser surgery to cauterize and remove

44
Q

Describe freezing of genital warts

A

Small warts can be removed by freezing (liquid nitrogen)

45
Q

Describe chemical treatment of genital warts

A

Imiquimod a 5% cream that is an interferon inducer or a 25% podophyllin solution which is applied to the affected area and washed off after several hours

46
Q

Name lower UTIs

A

Urethritis and cystitis

47
Q

Name upper UTIs

A

Prostatitis, pyelonephritis, intrarenal and perinephric abscesses

48
Q

What is the leading cause of sepsis

A

UTIs

49
Q

Who are UTIs more common in

A

Females as have a shorter urethra

50
Q

What are the sources of a UTI

A

Bowel, heamatogenous spread, instrumentation

51
Q

What are the bowel sources of UTIs

A

E. coli, Proteus, Enterococci

52
Q

Describe the haematogenous spread of UTIs

A

Staphylococcal aureus, Streptococci

53
Q

Describe the instrumentation sources of UTIs

A

Catheterisation, cytoscopy= MRSA, Candida, Pseudomonas

54
Q

What is the commonest health care associated infection

A

Catheters becoming colonised, this is an indication for removal not necessary treatment

55
Q

What is pathogenicity

A

It takes two to make a pathogen- host response and microbial virulence

56
Q

What are host factors associated with UTIs

A

Flushing effect of voiding urine. Antibacterial effects of urine (low pH, high urea, high osmolality), secreted IgA, secretory bactericidial peptides, blood group (ABO blood group secretor status)- blood group related carbohydrate antigens reduce availability of urethral receptors

57
Q

What are predisposing factors of a UTI

A

Female sex, dehydration, obstruction- stone, urethral valve, enlarged prostate, pregnancy, sexual intercourse, inadequate bladder emptying- neurogenic bladder, enlarged prostate, hydronephrosis and reflux

58
Q

What are microbe factors of UTIs

A

Numbers- gut contains 10 to the 12 bacteria, many are motile, oissess fimbria (E.coli)- specific receptors on certain serotypes adhere to uroepithelim. Possess urease (proteus)- splits urea, alters pH leads to stone formation

59
Q

Describe symptoms of urethritis

A

Dysuria, smelly cloudy urine, urgency, frequency

60
Q

Describe symptoms of cystitis

A

Dysuria, smelly cloudy urine, urgency, frequency, subrapubic tenderness, haematuria

61
Q

Describe symptoms of an upper UTI

A

Dysuria, smelly cloudy urine, urgency, frequency, subrapubic tenderness, haematuria, loin pain, fever, chills

62
Q

What can an upper UTI progress to

A

Septicaemia, sepsis, septic shock, death

63
Q

Why do you need a midtream urine sample

A

Urine for microbial analysis should be free of external contaminant

64
Q

Describe the procedure for collecting a midstream urine sample

A

Collected aseptically, urethral meatus cleaned first, intitial and terminal portion of urine discarded, middle portion collected into sterile conatined (often heavily contaminated with perineal and bowel flora)

65
Q

What does interpretation of a midstream urine sample require

A

Microscopy for presence of pus cells (and absence of epithelial cells). Quantitative culture of bacteria, >100,000 CFU/ml indicative if infection (contamination is common), asymptomatic if bacteriuria exist (not indication for treatment in pregnancy)

66
Q

What does a urine dipstick test for

A

Nitrite and leucocyte esterase

67
Q

What does presence of nitrite indicate

A

Presence of bacteria

68
Q

What does presence of leucocyte esterase indicate

A

Presence of white blood cells

69
Q

What urine dipstick results should you treat

A

If both nitrite and leucocyte esterase are positive

70
Q

In what situations is a midstream urine sent to labatory

A

In pregnant women, children under 2, men, pylenonephritis, relapse/ failed antibiotic treatment, renal impairment

71
Q

When do you treat a UTI

A

If someone has 3 or more symptoms

72
Q

What is the empiricle treatment for UTIs

A

Encourage fluids (cranberry juice)

73
Q

What do you use to treat uncomplicated UTIs

A

Trimethprim

74
Q

What do you use to treat complicated UTIs

A

Amoxycillin +/- gentamicin

75
Q

What are complicated UTIs

A

Children under 5 years, men; pregnancy; pyelonephritis or urosepsis; relapseed, recurrent or refractory infection; renal tract abnormality, obstruction, recent instrumentation; renal impairement, immunocompromised

76
Q

When is furtehr investigation warrented

A

In children under 5 years or recurrent UTI

77
Q

What are common implications (complications) of UTI

A

Sepsis. Recurrent UTI lead to renal scarring- particularly in children less than 2 years, chronic renal failure (need for dialysis/ transplantation), stones. May require prophylactic antibiotic treatment. Antibiotic resistance an increasing problem

Case 2 (8 decks)

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