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Z MD1 Reproductive Block > STIs and congenitally acquired infection > Flashcards

STIs and congenitally acquired infection Flashcards

1
Q

what are the routes of transmission for STIs

A
  • oral-genital
  • vaginal intercourse
  • anal intercourse
  • anilingus
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2
Q

4 ways we can diagnose STIs

A
  • microscopy
  • culture
  • serology
  • nucleic acid aggregation (PCR)
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3
Q

typical presentation of neisseria gonorrhoeae when symptomatic

A
  • urethral discharge (thick and creamy)

- throat (pharyngitis with lymphadenopathy)

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4
Q

what kind of bacteria of Gonorrhoea

A

gram negative diplococci

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5
Q

where does gonorrhoea adhere to and what is the incubation period

A

columnar epithelial cells

2-7 days

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6
Q

explain who and what proportion of people with gonorrhoea are asymptomatic

A

females - 80%

males - 10%

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7
Q

what do you see under microscopy for gonorrhoea

A

neutrophils showing phagocytosed diplococci

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8
Q

what symptoms do you get with disseminated gonorrhoea

A
  • arthritis
  • maculopapular rash
  • meningitis
  • endocarditis
  • epididymitis
  • peri-hepatitis (Fitz-Hugh-Curtis Syndrome)
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9
Q

what are the symptoms of pelvic inflammatory disease

A

fever, pelvic tenderness, discharge, manual palpation of cervix can induce pain

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10
Q

when can gonorrhoea pass to the foetus/baby

A

during delivery as the baby touches the cervix/vagina

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11
Q

what is the presentation of neonatal gonorrhoea and what can it lead to

A

gross purulent conjunctivitis –> can lead to perforation and blindness

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12
Q

what is the treatment of neonatal gonococcal opthalmia

A
  • cefotaxime 50mg/kg IV, 8 hourly, for 7 days
  • irrigation regularly
  • treat mother and sexual contacts
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13
Q

what kind of diagnostic specimens do you need to take for gonorrhoea

A
  • cervical swab
  • male urethral swabs
  • first pass void
  • from other body fluids
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14
Q

what technique do you use to diagnose gonorrhea

A
  • culture

- Nucleic acid amplification tests

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15
Q

treatment of gonorrhoea

A

cefriaxone 550mg IM/IV and azithromycin Ig oral

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16
Q

what kind of organisms are gonorrhoea and chlamydia

A

gonorrhoea - bacteria

chlamydia - obligate intracellular parasite

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17
Q

which serovars of chlamydia are associated with genital infection

A

D-K

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18
Q

which serovars of chlamydia are associated with LGV

A

L1-3

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19
Q

which serovars of chlamydia are associated with ocular infection (trachoma)

A

A-C

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20
Q

what are the two Life stages of chlamydia and what are their properties

A
  • elementary bodies - infectious, non-replicating, hardy

- reticulate bodies - metabolically active, replicate

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21
Q

which sex is usually asymptomatic for chlamydia

A

females

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22
Q

what are the clinical findings of chlamydia in men

A
  • dysuria
  • meatal erythema
  • clear urethral discharge
  • testicular pain
  • prostatis
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23
Q

what are the clinical findings of chlamydia in women

A
  • cervicitis, endometritis, vaginal discharge
  • urethritis/dysuria
  • irregular bleeding
  • pelvic pain and dyspareunia
  • PID
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24
Q

what is lymphogranuloma venereum

A

invasive lymphatic infection by a chlamydia sp

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25
Q

what are the signs of chlamydia - LGV

A
  • ulcerative genital lesion

- procto-colitis with strictures

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26
Q

what is the transmission rate from mum to bub with chlamydia

A

50%

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27
Q

what are the signs of neonatal chlamydia

A
  • conjunctivitis (more haemorrhage) - (25%)

- pneumonia (10%)

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28
Q

what lab investigations do you do for chlamydia

A
  • cervical/urethral/anal swab
  • first pass void
  • PCR
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29
Q

which STIs require test of cure

A

chlamydia

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30
Q

treatment of chlamydia

A

azithromycin or doxycycline

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31
Q

what kind of organism is trichomonas vaginalis

A

flagellated protozoon

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32
Q

what kind of vaginal discharge is associated with trichomonas vaginalis

A

frothy, green-yellow, smelly, discharge

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33
Q

what signs and symptoms do you have with trichomonas vaginalis if the patient is symptomatic

A
  • vaginal discharge
  • cervical erythema and friability
  • pruritis, dysuria, abdominal pain
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34
Q

what lab investigations do you do for trichomonas vaginalis

A
  • high vaginal swab –> wet prep microscopy or culture

- urine –> PCR

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35
Q

treatment of trichomonas vaginalis

A

metronidazole or tinidazole

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36
Q

what is the proper organism name for syphilis

A

treponema pallidum

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37
Q

what is the primary infection of syphilis

A

chancres on the genitals (1-2cm, painless) occurs 2-3 weeks after exposure –> heals

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38
Q

what is the secondary infection of syphilis

A

rash (particularly on the palms and soles), lymphadenopathy, alopecia –> goes away to a phase of latency

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39
Q

explain the early and late phases of latency of syphilis

A 
early = asymptomatic but lots of organisms and very infectious
late = less infectious but more difficult to treat
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40
Q

explain the tertiary infection of syphilis

A

gummers

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41
Q

what is the laboratory detection of syphilis

A
  • microscopy

- serology (more common) - non treponemal and treponemal tests

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42
Q

what does the non-treponemal tests for syphilis test for

A

antibodies to cellular lipids and lecithin

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43
Q

what is the sensitivity of non-treponemal serology testing

A

70% within 2 weeks of chancre

100% for secondary and latent syphilis

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44
Q

when does the non-treponemal serology testing become positive

A

between 4-8 weeks post infection

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45
Q

what are the non-treponemal tests for syphilis also useful for

A

screening and monitoring therapy

titrate to detect response to treatment

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46
Q

what are the benefits of treponemal tests for syphilis

A

positive slightly earlier

positive for life

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47
Q

how do we diagnose mycoplasma genitalium

A

PCR

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48
Q

symptoms of mycoplasma genitalium

A
  • urethritis in men
  • cervicitis in women
  • acute endometritis
49
Q

treatment of mycoplasma genitalium

A

azithromycin or moxifloxacin (if azithromycin fails)

50
Q

what are the differences between prenatal, perinatal and postnatal

A

prenatal - during foetal development
perinatal - around the time of delivery
postnatal - after delivery

51
Q

what is vertical and horizontal disease transmission to baby

A 
vertical = mum to foetus/baby
horizontal = one person to another
52
Q

what is ascending infection

A

vaginal organisms producing foetal infection

53
Q

describe the structure of VZV

A

icosahedral, dsDNA, eveloped

54
Q

VZV is part of which family of viruses

A

herpes viridae

55
Q

what is the incubation period of chickenpox

A

10-21 days

56
Q

route of transmission of VZV

A

respiratory and direct contact with vesicles

57
Q

signs and symptoms of chickenpox

A

fever, lethargy, pruritic vesicular rash (starts face and trunk and then spreads outwards)

58
Q

explain the time course of the vesicles of chicken pox

A

clear vesicle –> cloudy –> ruptures –> ulceration

59
Q

what are the 3 major complications of chickenpox

A
  • secondary bacterial infection (commonly by Strep pyogenes or Staph aureus) –> purpura fulminans
  • pneumonitis
  • acute cerebellar ataxia
60
Q

death from maternal varicella is most common in which trimester

A

3rd (when your IS is the most compromised)

61
Q

what things can happen to foetus with a first trimester primary infection of varicella

A
  • limb hypoplasia
  • cicatricial scarring (dermatomal)
  • microcephay
  • cataracts
  • mental retardation
  • GI and GI abnormalities
62
Q

when does mum have to get varicella for the baby to get perinatal varicella

A

-7 to +2 days from delivery

63
Q

what is the transmission rate of perinatal varicella

A

17-30%

64
Q

what is the outcome of perinatal varicella

A

disseminated infection –> mortality in 25-30%

65
Q

who can you give prophylactic VCIG to

A
  • susceptible pregnant women
  • infants whose mothers develop varicella <7 days prior to delivery and in first month of life
  • IC people
  • premature babies
66
Q

treatment of acute varicella

A

acyclovir

  • oral if no systemic symptoms
  • IV is systemic symptoms
67
Q

when is the varicella vaccine given

A

18 months

2 doses when >14

68
Q

which viral family does cytomegalovirus below to

A

herpesviridae

69
Q

explain the structure of cytomegalovirus

A

icosahedral capsid, dsDNA, spherical lipid envelope

70
Q

where does cytomegalovirus live when latent

A

within WBCs

71
Q

what is the transmission of CMV

A

body fluids

72
Q

what are the routes of infection of CMV for foetus/babies

A
  • transplacental (haematogenous)
  • perinatal (genital secretions, breast milk, saliva)
  • toddlers in day care
73
Q

what are the symptoms of congenital cytomegalovirus

A

sepsis like syndrome

  • hepatomegaly
  • respiratory distress
  • atypical lymphocytosis
74
Q

what percentage of congenital CMV show symptoms at birth

A

10%

75
Q

what is the difference in getting congenital CMV during a primary maternal CMV infection and a reactivation of CMV

A

primary - 20-50% foetal infection

reactivation - 1-3% foetal infection

76
Q

what is the most common long term sequelae of CMV

A

unilateral sensoryneural deafness

77
Q

can asymptomatic congenital CMV babies have long term sequelae?

A

yes - about 10-15% of them

78
Q

how can you test for CMV infection

A

IgG (seroconversion)
IgM - acute phase antibody tell
IgG avidity (stronger avidity = longer time after infection)
PCR

79
Q

in practice, how do you test for maternal CMV

A

IgG seroconversion (from the past)
IgG avidity
look for the virus in the amniotic fluid

80
Q

how do you confirm foetal CMV infection

A

amniotic fluid PCR

foetal cord blood IgM sensitivity or PCR

81
Q

action taken if baby with congenital CMV is asymptomatic at birth

A

serial audiometry
serial visual assessment
psychomotor assessment
watch for pneumonitis

82
Q

which virus family is rubella

A

togavirus

83
Q

explain the structure of rubella virus

A

eveloed, ssRNA

84
Q

incubation period of rubella

A

14-21 days

85
Q

transmission of rubella

A

nasopharyngeal secretions

86
Q

what proportion of rubella patients are symptomatic

A

25-50%

87
Q

what are the signs and symptoms of rubella if the patient is symptomatic

A
  • low grade fever
  • lymphadenopathy (particularly occipital nodes)
  • exanthem (maculopapular - face–>trunk–>limbs)
  • polyathralgia/arthritis
88
Q

during what time of gestation is the greatest risk of passing rubella to foetus

A

<4 weeks

89
Q

if baby gets congenital rubella syndrome >12 weeks gestation, what will the symptoms be

A

retinopathy and deafness only

90
Q

what is the classical triad for congenital rubella syndrome (gained it <12 weeks gestatino)

A

Opthalmological - cataracts, glaucoma, retinopathy
Cardiac - PDA, PA stenosis
Auditory - sensorineural deafness

91
Q

how do you diagnose rubella

A

IgG seroconversion or rising titre
IgM
amniotic fluid/cord blood PCR

92
Q

why can you give rubella vaccine during pregnancy

A

live vaccine

93
Q

explain the structure of parvovirus

A

ssDNA

94
Q

what does parvovirus cause

A

shortens the lifespan of RBC progenitors –> erythema infectiosum (fever, rash and generalised maculopapular rash)

  • can also cause arthralgia in adults
  • can also cause acute aplastic crisis through chronic haemolytic anaemia if patient has abnormal RBC already
95
Q

outcome of congenital parvovirus infection

A 
hydrops foetalis (anaemia)
foetal loss in small percentage
96
Q

parvovirus diagnosis

A
  • IgG past infection (immunity)
  • IgM present at time of rash
  • PCR
97
Q

HSV infection during pregnancy can lead to

A

abortion
IUGR
preterm labour

98
Q

3 patterns of disease seen with HSV infection near delivery

A
  • skin-eye-mouth
  • encephalitis
  • disseminated
99
Q

treatment of primary HSV infection during pregnancy

A
  • acyclovir treatment and suppression until deliver

- C section

100
Q

treatment of recurrent HSV disease during pregnancy

A
  • acyclovir suppression
  • avoid instrumentation
  • careful clinical examination for lesions
  • investigations of baby for ‘colonization’
101
Q

explain the differences in the transmission of syphilis to a foetus at different times of gestation

A 
primary - 90%
secondary - 60-90%
early latent - 40%
late latent - <10%
tertiary rare
102
Q

outcomes of congenital syphilis

A 
stillbirth
premature delivery
early and late onset disease
hepatosplenomegaly
snuffles
osteochondritis syphilitica
Hutchinson's teeth
hereditary gumma
103
Q

what is the rate of transmission of congenital chlamydia

A

50%

104
Q

symptoms of congenital chlamydia

A

haemorrhagic conjunctivitis

pneumonitis

105
Q

what proportion of babies with congenital toxoplasma gondii are asymptomatic

A

70-90%

106
Q

explain structure of Hep B virus

A

dsDNA, glycolipid envelope

107
Q

incubation period of Hep B

A

45-180 days

108
Q

what proportion of people are chronic carriers

A

0.2% of women
12% of adults following infection
90% of congenitally infected babies

109
Q

outcome of chronic Hep B

A

cirrhosis

can develop hepatocellular carcinoma

110
Q

explain the Hep B vaccination schedule

A

birth, 2 4, 6 and 12 months

111
Q

explain the treatment of baby born with congenital Hep B

A

give hepatitis B immunoglobulin within 12 hours of delivery

112
Q

explain infection of baby with group B strep

A

infection by ascending infection or colonized at birth

113
Q

what proportion of babies with mothers who have strep B in bowel/vagina are colonised

A

40-70%

114
Q

symptoms/signs of group B strep in babies

A

pneumonia and sepsis - common for early onset infection

meningitis - common for late onset infection

115
Q

what are the maternal risk factors for passing strep B strep to baby

A
  • preterm delivery
  • prolonged ruptured membranes
  • intrapartum fever
  • chorioaminonitis
  • previous baby with group B strep
116
Q

treatment of group B strep

A

penicillin + gentamicin

117
Q

what is the recommended screening of pregnant mothers

A 
rubella
syphilis
HBV
HCV
HIV
118
Q

what are the extra tests that may be considered for screening of pregnant mothers

A

VZV
CMV
toxoplasma gondii

Z MD1 Reproductive Block (12 decks)

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