STI II Flashcards
Cervicitis
Characterised by mucopurulent discharge from the endocaervical canal plus inflamed, edematous, friable ectropian.
Commonly associated with coexisting urethral infection, and with a history of dysuria.
Cervicitis caustive organisms
- Chlamydia trachomatis D-K serovars* (most common)
- Gonococcalinfection
- HSV
- Trichomonas vaginalis
- Anaerobes
Specimen collection for cervicitis
- High vaginal swab
- Endocervical swab (+/- urethral swab)
- Collect first pass urine for PCR
Urethritis
Characterised by urethral discharge and meatal inflammation
Urethritis causative organisms
– Gonococcus – Chlamydia trachomatis – And others • Ureaplasma urealyticum • Mycoplasmahominis • Trichomonas vaginalis • HSV
Urethritis specimen collection
- Urethral; +/- pharyngeal; and anorectal swabs
* First pass urine (for PCR)
PID definition
Inflammation and infection of the upper genital tract in women, typically involving the endometrium, fallopian tubes, ovaries and surrounding structures.
PID aetiology
- Ascending spread of micro-organisms from the vagina or cervix to the upper genital tract
- Common causative agents: C. trachomatis (+/- N. gonorrhoeae); hence, often polymicrobial flora*
Causes of non surgically-acquired PID
Increase susceptibility to endogenous vaginal flora following mechanical disruption of the cervical barrier by:
Pregnancy termination; delivery; surgical procedures, or following insertion of IUCD (intra uterine contraceptive device)
PID clinical symptoms
– Lower abdo pain/ discomfort – Vaginal discharge – Abnormal vaginal bleeding – Dyspareunia (pain on intercourse) – Nausea (severe disease)
PID complications
– 20% infertility
– 20% chronic pelvic pain
– 10% ectopic pregnancy
PID clinical signs
– Lower abdo tenderness/ guarding/rebound
– Adnexal tenderness
– Cervical motion tenderness
– Raised temperature
Neisseria spp.
Gram negative, aerobic, cocci (diplococci)
Neisseria gonorrhoea epidemiology and transmission
• Occurs naturally only in humans
• Infection rates: males = females
• Peak incidence of infection: 15 to 24 years of age
• Asymptomatic carriers are a major reservoir
– Half of infected women are symptomatic
– Most infected men are symptomatic
• Carrier state also dependent on site of infection:
– Rectal and pharyngeal infections are more likely to be asymptomatic
Risk factors associated with Neisseria gonorrhoea infection
- Low socio-economic status
- Urban residence
- Unmarried status
- Race/Ethnicity
- Men who have sex with men (MSM)
- Prostitution
- History of STDs
- Hormonal contraception
- Unprotected intercourse - Male: 20% single exposure 80% multiple exposures. Female: >80% single exposure
- High risk partners
- Drug use
Presentation Neisseria gonorrhoea in males
After 2-7 days (range 1-14 days) incubation, symptoms and signs include:
– Urethritis (+ discharge 90-95%)
– Dysuria
– Asymptomatic (5%)
– Ascending infection* (10%; see next slide)
Presentation Neisseria gonorrhoea in women
After ~ 8-10 days incubation, symptoms and signs include:
– Cervicitis (+ thin, purulent, unpleasant smelling discharge 20-75%)
– Urethritis (70-90%)
– Bartholin’s gland infection (30%)
– Abdominal/pelvic pain
– Abnormal intra-menstrual bleeds
– Ascending infection* (10-20%; see next slide )
– NOTE: symptoms and signs can mimic thrush/cystitis
Complications of Neisseria gonorrhoea in men
Ascending infection: – Epididymitis – Prostatitis – Urethral stricture – Periurethral abscess
Complications of Neisseria gonorrhoea in women
Ascending infection often results in PID (pelvic inflammatory disease) associated with: – Salpingitis – Endometritis – Tubo-ovarian abscess (ectopic pregnancy)
Gonococcemia
Complication of Neisseria gonorrhoea (septicaemia). It causes disseminated infections of the skin and joints (1-3% of infected women, and much lower percentage of infected
men)
Symptoms and signs include:
– Fever
– Migratory arthalgias
– Suppurative arthritis in the wrists, knees, and ankles
– Pustular rash on an erythmatous base over the extremeties but not on head and trunk
ophthalmia neonatorum
Complication of Neisseria Gonorrhoea. Purulent conjunctivitis in newborns infected during vaginal delivery
Anorectal gonorrhoea
Complication of gonorrhoea. Commonly MSWM.
Neisseria gonorrhoea laboratory diagnosis
For culture: specimens collected by swabbing the cervix, urethra, rectum, and throat
Important : use Dacron or rayon swabs NOT calcium alginate (toxins) or cotton
Transport medium is usually chocolate agar with swift delivery to the lab
Do NOT refrigerate
First pass urine for PCR
Chlamydia trachomatis
Infections restricted to humans
Chlamydia trachomatis clinical manifestations
- Trachoma (chronic keratoconjunctivitis)
- Adult inclusion conjunctivitis
- Neonatal conjunctivitis
- Infant pneumonia
- Urogenital infections (females)
- Urogenital infection (men)
- Lymphogranuloma venereum (LGV)
Chronic keratoconjunctivitis (trachoma)
C. trachomatis
Leading cause of blindness in endemic areas,
including North and sub-saharan Africa; Middle-
east; Southern Asia; and South America
Predominantly affects young children Transmitted via: • Eye to eye by droplets • Contaminated hands, clothing • Flies • Respiratory droplets and faeces
Adult inclusion conjunctivitis
C. trachomatis
• Occurs in people ~ 18- 30 years old
• Genital infection usually precedes eye involvement
• Transmission is thought to occur via auto- inoculation
Characterised by mucopurulent discharge; keratitis, and corneal scarring over time.
Neonatal conjunctivitis
C. trachomatis
Acquired during passage of the infant through infected birth canal After 5 to 12 days of incubation: – Eyelids swell – Hyperemia – Copious purulent discharge
Infant pneumonia
C. trachomatis
- Onset usually 2 to 3 weeks after birth, characterised by:
- Rhinitis
- Staccato cough
- Afebrile throughout illness
- Radiographic signs of infection can persist for months
Urogenital infections with C. trachomatis clinical symptoms in women
80% infected women are asymptomatic; when symptomatic: – Bartholinitis – Cervicitis – Endometritis – Perihepatitis – Proctitis – Salpingitis – Urethritis (can occur with or without concurrent cervical infection often associated with mucopurulent discharge)
Urogenital infections with C. trachomatis clinical symptoms in men
- Most often symptomatic
- Urethritis with purulent discharge
- Proctitis
- Reiter’s syndrome (urethritis;; conjunctivitis;; polyarthritis; and mucocutaneous lesions)
Lymphogranuloma venereum (LGV)
1st Stage (1 to 4 weeks after infection) characterised by: • Painless lesion (papule or ulcer) at site of infection (penis; urethra; scrotum; vaginal wall; endocervix, and vulva)
2nd Stage (1 to 4 weeks after infection) characterised by:
• Swelling and inflammation of lymph nodes
• Infected lymph nodes can be painful giving rise to fluctuant buboes that can enlarge and rupture
Systemic symptoms characterised by:
• Fever
• Chills
• Headache, myalgias, arthralgias
C. trachomatis laboratory diagnosis
- Specimens: collected from site of infection (urethra; endocervix; rectum; oropharynx, and conjunctiva)
- PCR- amplification of specific sequence of the 16S ribosomal RNA
Non-gonococcal urethritis (NGU)
Mycoplasma and ureplasma
Genital mycoplasma epidemiology
Ureaplasma spp/ M. hominis/ M. genitalium
• Colonise the vagina and cervix of adult women
– 40-80% (Ureaplasma spp)
– 21-58% (M. hominis)
– ≤ 1% (M. genitalium)
• Colonisation in males is much lower than in females
• Frequency of colonization increases after puberty
Genital mycoplasma clinical manifestations
Ureaplasma spp/ M. hominis
• Simple colonisation of the vagina and cervix of adult pregnant women is not usually associated with disease
• But presence of Ureaplasma spp and to a lesser extent M. hominis in placental membrane or amniotic fluid associated with: Chorioamnionitis, Preterm birth, Neonatal disorders (perinatal pneumonia and sepsis in preterm infants)
• Both Ureaplasma spp/ M. hominis associated with postpartum fever
M. hominis • Pelvic inflammatory disease (PID) • Pyelonephritis • Bacterial vaginosis • NGU (25% of cases)
M. genitalium • Cervicitis • Endometritis • PID • Tubal infertility
Laboratory diagnosis genital mycoplasma
Ureaplasma/M. hominis/M. genitalium:
• Specimens: collected from site of infection (urethra, vagina,endocervix, urine, abscess material, prostatic secretions, and semen, for example)
• Culture?
• PCR
