STIs and PID

Question 1

For which demographics are chlamydia and gonorrhea highest?

Answer 1

Younger women

Question 2

What are common tests for STIs? (2) Which diseases do we use each for?

Answer 2

NAAT: Chlamydia, gonorrhea, herpes, trichomonas, HPV

Serological test: syphilis, HepB, HepC

Question 3

Gonorrhea Structure and Growth requirements

Answer 3

Gram (-) diplococci

Grows in Thayer-martin or chocolate media with humid/CO2 atmosphere

Question 4

What is major resevoir for gonorrhea? Describe transmission rates for men and women

Answer 4

The major reservoir is asymptomatic carriers.

Women have 50% acquisition after single exposure to infected man. Men have 20% acquisition after single exposure

Question 5

Describe laboratory diagnosis methods (3) for Gonorrhea and their effectiveness

Answer 5

NAAT– combination assay

Gram stain of urethral drainage– 98% sensitive for symptomatic males but

Question 6

Describe structure of chlamydia and infectious route

Answer 6

Gram (-) bacilli

Intracellular parasite

Question 7

Describe pathogenesis of chalmydia…does prior infection provide immunity?

Answer 7

Cellular destruction–>Host immune response–>re-infection with tissue loss

There is no immunity

Question 8

What are symptoms of gonorrhea in men? In women? In neonates?

Answer 8

Men: Urethritis, epididymitis
Women: Cervicitis, endometritis, salpingitis, infertility
Neonates at risk for conjunctivitis

Question 9

How is chlamydia diagnosed? (2)

Answer 9

NAAT (cotest)

Antigen detection via ELISA

Question 10

What are some predominant vaginal flora? (3)

Answer 10

Lactobacilli (acidic pH)
Staph
Strep
Klebsiella

Question 11

Where does gonorrhea typically infect in cervix? Where does chlamydia?

Answer 11

Gonorrhea: Prefers lower O2 of cervical canal
Chlamydia: Infects glandular cells

Question 12

What are signs/symptoms of pelvic inflammatory disease? (6)

Answer 12

Lower abdominal pain, adnexal tenderness, cervical motion tenderness, fever, mucoprurulent cervicitis, inflammation (elevated WBC)

Question 13

What are some complications of PID? (4)

Answer 13

Infertility–due to tubal scarring, pyosalpinx, hydrosalpinx, distal tubal occlusion
Chronic pelvic pain
Tubal-ovarian abscess
Ectopic Pregnancy

Question 14

What is treatment for upper genital tract infection?

Answer 14

Broad spectrum antibiotics

Question 15

Prevention of PID consists of _____ (3)

Answer 15

Screening
Treatment of asymptomatic carriers
Condom use

Question 16

Epidemiology of salpingitis: who is most affected? What are predisposing factors? (3)

Answer 16

70% of infective salpingitis is seen in sexually active women under 25.

Predisposing factors: Lack of barrier protection, induced abortion, instrumentation of cervix

Question 17

What is route of spread for infective salpingitis?

Answer 17

Ascending/canalicular: through cervical canal and endometrial cavity

Question 18

What is gross appearance of acute infectious salpingitis? (4)

Answer 18

Tube swollen, adematous, congested, hyperemic

Question 19

What is histological appearance of acute infective salpingitis? (2)

Answer 19

Pus in cervical canal

Neutrophilic infiltrate

Question 20

What are courses of infective salpingitis? (3)

What are correspond sequellae? (4)

Answer 20

Fimbrial end stays patent–>chronic interstitial (follicular) salpingitis
Spread to ovary: tubo-ovarian abscess
Occlusion of fimbriated end: pyosalpinx/hydrosalpinx

Question 21

Describe histological appearance of follicular salpingitis: (2)

Answer 21

Pilcae of follicle fused together

Cystic/glandular structures

Question 22

Describe gross appearance of tuba-ovarian abscess

Answer 22

Inflamed fallopian tube and ovary is big pus-filled sac

Healing with fibrosis can form tuba-ovarian mass

Question 23

What are consequences of occluded fimbriated end?

Answer 23

Hydrosalpinx

Question 24

What is general course of PID?

Answer 24

Difficult to eliminate– consists of remissions/exacerbations

Question 25

What is the relationship between PID and IUD?

Answer 25

Old IUDs were associated with increased rate of PID. This is no longer the case. Actinomyces is associated with use of an IUD for longer than 3 years– this can cause tuba-ovarian abscess, but is not associated with PID.

Question 26

What are locations of ectopic pregnancy? (3)

Answer 26

Tube
Ovary
Abdominal cavity

Question 27

What are complications of tubal pregnancy? (3)

Answer 27

Tubal abortion: expelled from fimbriated end
Tubal hemorrhage: Decidual change cannot buffer trophoblastic invasion
Tubal rupture: In 50% pregnancies, due to inability to handle trophoblastic invasion

Question 28

What is clinical onset of tubal rupture?

Answer 28

Intra-abdominal hemorrhage–> Acute abdomen