STDs and Infertility

Question 1

What is the bacteria that causes Chlamydia infection?

Answer 1

Chlamydia trachomatis.

Question 2

Clinical presentation & symptoms of Chlamydia

Answer 2

Asymptomatic in about 60% of women and 25% of men.

Symptoms may include:
- Urethral discharge
- Testicular or scrotal pain
- Vaginal discharge
- Abnormal bleeding due to cervicitis.
- Pysuria
- Proctitis

Question 3

Diagnosis of Chlamydia

Answer 3

Chlamydia infection is diagnosed by detecting Chlamydia trachomatis in appropriate specimens.

The preferred tests are nucleic acid amplification tests (NAAT)

Specimens are obtained via;
- Urethral swab
- Vaginal swab
- FV urine
- Endocervical swab
- If the patient has had receptive oral sex and no oral symptoms, take a throat swab for NAAT

Question 4

Complications of Chlamydia

Answer 4

• Peri-hepatitis (abdominal pain, fever, tender liver)
• Conjunctivitis in adults or newborns
• Pneumonia of newborns
• Reactive arthritis (Reiter’s Syndrome)
• Abdominal pain and fever due to PID
• Contributes to infertility

Question 5

Treatment of Chlamydia

Answer 5

Adults

Doxycycline 100 mg orally, 12-hourly for 7 days

OR

Azithromycin 1 g orally, as a single dose -Where there is any concern that the patient will not be compliant with doxycycline, azithromycin may be more suitable.

Question 6

Explain Ophthalmia Neonatorum

Answer 6

Conjunctivitis of the newborn (neonatal complication of chlamydia)

• risk of infection to neonate is between 20-50%
• usually presents approximately one week after birth as a red sticky eye
• usually bilateral.
• eyes should be swabbed to diagnose
• treat with tetracycline eye ointment and a course of erythromycin to prevent pneumonitis
• may also cause otitis media (an infection of the middle ear)

Question 7

Describe Chlamydia Pneumonitis

Answer 7

Chlamydia Pneumonia in Infancy

• risk of infection to neonate is between 10-20%, babies can die from this
• diagnosed through physical assessment, chest x-ray and septic screen
• treat with systemic antibiotics.

Question 8

What is the bacteria that causes Gonorrhoea?

Answer 8

Neisseria Gonorrhoeae

Question 9

Clinical presentation & symptoms of Gonorrhoea

Answer 9

Gonorrhoea is asymptomatic in 80% of women and 10% to 15% of men

• Urethral discharge (urethritis) and/or burning sensation (dysuria)
• Cervical discharge (cervicitis) and/or intermenstrual or post-coital bleeding
• Anorectal infection (proctitis) with discharge, painful defecation, disturbed bowel function or irritation
• Pharyngeal infection
• Pelvic inflammatory disease (PID) and associated dyspareunia (pain during vaginal intercourse)
• Prostatitis (very rarely)
• Epididymitis
• Conjunctivitis
• Skin lesions
• Disseminated disease is uncommon but serious; it can present as septic arthritis, meningitis, endocarditis, sepsis, and macular rash that may include necrotic pustules.

Question 10

Diagnosis of Gonorrhoea

Answer 10

Diagnosis is established by detecting N. gonorrhoeae in a clinical specimen by culture or by NAAT

Question 11

Complications of Gonorrhoea

Answer 11

• Infertility
• PID
• prostatitis and epididymitis
• conjunctivitis
• skin lesions
• arthritis
• meningitis or endocarditis
• Disseminated Gonococcal Infection

Question 12

Treatment of Gonorrhoea

Answer 12

Dual antibiotic treatment
* Ceftriaxone 500 mg in 2 mL 1%, given by IM injection
AND
* Azithromycin 1 g (orally), given together as a single treatment

Question 13

Explain gonococcal ophthalmia neonatorum

Answer 13

Also known as Gonococcal conjunctivitis

• begins in the first few days of life and is manifested by a profuse purulent
• conjunctival discharge which is frequently bilateral
• can lead to corneal ulceration and scarring and less commonly blindness if left untreated
• occasionally the neonate may develop gonococcal infection elsewhere such as gonococcal arthritis
• eyes should be swabbed to culture gonorrhoea
• topical and systemic antibiotics should be given according to sensitivities. Usually ceftriaxone IM or IV plus local treatment with saline

Question 14

Explain Syphilis

Answer 14

Systemic disease caused by Treponema

Incubation period
* 9 to 90 days from exposure to primary syphilis
* 30 to 150 days from exposure to secondary stage
* usually 5 to 35 years from exposure to tertiary stage

Can be transmitted through sexual contact or blood

Question 15

Clinical Presentation of Syphilis

Answer 15

PRIMARY SYPHILIS
Genital ulcer that is usually a single indurated painless ulcer which occurs in the genital region or elsewhere on the body

SECONDARY SYPHILIS
Rash that is typically bilaterally symmetrical and non-itchy, ulcers of the mouth, nasal cavity or vulva, enlarged lymph nodes and condylomata lata. Hair loss involves scalp and eyebrows

LATENT SYPHILIS
Presence of Treponema Pallidum in the body without Signs/Symptoms

TERTIARY SYPHILIS
Progression to involve heart, nervous system, eye, ear or the development of gummata (granulomatous lesions)

Question 16

Presentation of Tertiary Syphilis

Answer 16

• aortic incompetence
• aneurysm of the ascending arch of the aorta
• dementia
• personality change
• multifocal neurological disorders
• nerve deafness
• pupillary abnormalities
• retinal disease or uveitis.

Question 17

Treatment of Syphilis

Answer 17

Penicillin is the drug of choice.

Benzathine penicillin
OR
Procaine penicillin

Doxycycline may be used if penicillin allergy.

Question 18

What causes Genital Warts?

Answer 18

Human Papilloma Virus (HPV)

Question 19

Clinical Presentation of Genital Warts/HPV

Answer 19

The majority of newly acquired HPV infections appear to be subclinical and asymptomatic.

Clinically visible manifestations of HPV include warts that may be condylomatous, papular, flat or keratotic in appearance.

Question 20

Diagnosis of Genital Warts/HPV

Answer 20

Clinical observation/Pap smear

Question 21

Treatment of Genital Warts/HPV

Answer 21

• Podophyllotoxin paint
• Cryotherapy
• Surgical ablative therapy
• Imiquimod cream

In pregnancy only cryotherapy or surgical ablative therapy is safe

Question 22

Explain Herpes Simplex/Genital Herpes

Answer 22

Two types
* Herpes simplex virus type 1
* Herpes simplex virus type 2

• Transmitted through contact with a person who is shedding the virus in a secretion or from a lesion or mucosal surface.
• Virus travels to the dorsal root ganglion where it persists for life.
• Virus remains latent until reactivated.

Question 23

Explain Human immunodeficiency virus (HIV)

Answer 23

• Causes AIDS
• Main modes of transmission are sexual contact, other exposures to infected blood or body fluids, mother to baby
• Infects and kills helper T cells causing immunodeficiency
• Three stages
• Ultimately fatal
• Controlled by antiretroviral medications.

Question 24

Explain Hepatitis

Answer 24

Inflammation/damage of the liver which affects its function

In Australia, the most common hepatitis viruses are hepatitis A, B & C

It is thought that HBV causes inflammation and progressive fibrosis in the infected liver by triggering the immune system to attack the hepatocytes.

Question 25

What causes Hepatitis

Answer 25

Hepatitis is often caused by a virus

other causes include;
* heavy alcohol use
* toxins
* some medications
* certain medical conditions

Question 26

Explain Hepatitis B virus

Answer 26

• Transmission: usually passed on through direct contact with infected blood and blood products, or other bodily fluids including semen and vaginal fluids.
• An infected mother can pass hepatitis B on to her baby during childbirth.
• Incubation period: Usually 45 to 180 days, with an average of 60 to 90 days.
• Infectious period: From weeks before to months after onset. Long-term carriers may be infectious for life.

Question 27

Symptoms of Hepatitis B

Answer 27

• loss of appetite
• fatigue
• nausea and vomiting
• rashes
• pain in the right-hand side of the abdomen
• fever
• sore joints
• jaundice (yellow skin and eyes).

Question 28

Explain Hepatitis C virus

Answer 28

HCV is a non-cytopathic virus that enters the liver cell and undergoes replication simultaneously causing cell necrosis by several mechanisms including immune-mediated cytolysis in addition to various other phenomena such as hepatic steatosis, oxidative stress and insulin resistance

Hepatitis C is spread only through exposure to an infected person’s blood.

Question 29

Symptoms of Hepatitis C

Answer 29

• During the initial infection people often have mild or no symptoms.
• Occasionally a fever, dark urine, abdominal pain and jaundice occur.
• Acute infection progresses to chronic disease in up to 75% of cases.
• Chronic infection is usually asymptomatic. However, without treatment, around 20–30% of people with chronic HCV infection will develop cirrhosis, generally after 20–30 years of infection.
• In some cases, those with cirrhosis will develop complications such as portal hypertension, liver failure and liver cancer.

Question 30

List fertility treatments

Answer 30

• IVF
• Ovulation Tracking
• Ovulation Induction
• Artificial insemination
• Fertility Surgery
• Frozen Embryo Transfer
• ICSI Treatment (injection of single sperm into egg)

Question 31

Causes of female infertility

Answer 31

• Ovulation disorders, which affect the release of eggs from the ovaries. These include hormonal disorders such as polycystic ovary syndrome, hyperprolactinemia, hyperthyroidism & hypothyroidism - can affect the menstrual cycle or cause infertility. Other underlying causes may include too much exercise, eating disorders or tumours.
• Uterine or cervical abnormalities, e.g. polyps or shape of the uterus. Uterine fibroids may cause infertility by blocking the fallopian tubes or stopping a fertilized egg from implanting in the uterus.
• Fallopian tube damage or blockage, often caused by inflammation. This can result from PID, which is usually caused by a sexually transmitted infection, endometriosis or adhesions.
• Endometriosis, which occurs when endometrial tissue grows outside of the uterus, may affect the function of the ovaries, uterus and fallopian tubes.
• Primary ovarian insufficiency (early menopause)
• Pelvic adhesions, bands of scar tissue that bind organs that can form after pelvic infection, appendicitis, endometriosis or abdominal or pelvic surgery.
• Cancer and its treatment. Both radiation and chemotherapy may affect fertility.

Question 32

Causes of male infertility

Answer 32

• Abnormal sperm production or function due to undescended testicles, genetic defects, health problems such as diabetes, or infections such as chlamydia, gonorrhoea, mumps or HIV. Enlarged veins in the testes (varicocele) also can affect the quality of sperm.
• Problems with the delivery of sperm due to sexual problems, such as premature ejaculation; certain genetic diseases, such as cystic fibrosis; structural problems, such as a blockage in the testicle; or damage or injury to the reproductive organs.
• Overexposure to certain environmental factors, such as pesticides and other chemicals, and radiation. Cigarette smoking, alcohol, marijuana, anabolic steroids, and taking medications to treat bacterial infections, high blood pressure and depression also can affect fertility.
• Damage related to cancer and its treatment, including radiation or chemotherapy.

Question 33

Impaired fertility risk factors

Answer 33

• Age - fertility decreases from the age of 35
• Lifestyle
• Stress
• Alcohol
• Weight - being underweight can inhibit or stop the menstrual cycle - high levels of fat can disturb hormone production and cause irregular periods.
• Smoking
• Heat
• Use of prescription or recreational drugs
• Pollutants , Exposure to chemicals, heavy metals, pesticides, chemotherapy and x-ray therapy
• Lubricants, (such as K-Y Jelly, Surgilube and Apha Keri lotation) contain bacteriostatic agents which can affect sperm motility.