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imed3003 > Urethritis, Vaginal Discharges, PID, Prostatitis, Inguinal and Scrotal Swellings > Flashcards

Urethritis, Vaginal Discharges, PID, Prostatitis, Inguinal and Scrotal Swellings Flashcards

1
Q

What organism causes gonorrhea?

A

Neisseria gonorrhoeae

Gram negative intracellular diplococcus (intracellular in polymorps)

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2
Q

What is the infectivity rate of gonorrhea?

A

From men to women = 50% infectivity

20% from female to male

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3
Q

What percentage of males and females are asymptomatic with gonorrhea?

A

80% of females

10% of males

Many have signs though

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4
Q

How long is incubation period of gonorrhea?

A

2 - 5 days

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5
Q

What are the signs/symptoms of uncomplicated gonorrhea in males?

A

Urethritis

Epididymitis

Proctitis

Pharyngitis

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6
Q

What are the signs/symptoms of uncomplicated gonorrhea in females?

A

Cervicitis

Pelvic Inflammatory Disease

Disseminated disease

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7
Q

How is gonorrhea infection related to HIV risk?

A

Local inflammation results in 5 fold increase in HIV risk.

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8
Q

What are associated conditions with gonorrhea?

A

Associated rectal infection in 30% of women

Pharyngitis sole site in only 5%

Complications such as epididymitis and strictures in males are very rare

In females some complications can include infertility and adhesions

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9
Q

What factors affect likelihood of gonorrhea to spread?

A

Some types of GC more likely to spread

More common in women than in men

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10
Q

What symptoms are different in disseminated gonorrhea than the normal disease?

A

Less likely to cause urogenital symptoms

More likely sensitive to antibiotics in culture medium therefore negative cultures more common

Arthritis/dermatitis in 0.5 - 3% of untreated patients.

20% positive blood cultures

Tenosynovitis also commonly associated

Skin lesions (Typically necrotic on extremities but often atypical)

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11
Q

Which joints are affected most often by disseminated gonorrhea?

A

Wrist

MCP

Ankle

Knee

Often multiple

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12
Q

How is gonorrhea diagnosed?

A

Culture (80 - 95% sensitive and gives antibiotic sensitivity)

Slide is used for gram stain. (intracellular for diagnosis)

Nucleic acid detection can be done via PCR duplex testing for GC and CT.

Urine is very effective in men only (Almost as effective as urethral swabs)

In women urine must be combined with SOLVS

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13
Q

How sensitive is gonorrhea?

A

90% sensitive in urethritis

70% in cervicitis

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14
Q

What gonorrhea types can’t be tested for with nucleic acid tests?

A

Not validated for throat and rectum due to false positives like N cinerea and N subflava

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15
Q

What is SOLVS?

A

Self Obtained Low Vaginal Swab

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16
Q

What urine must be used for analysis in men for gonorrhea?

A

First 20ml

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17
Q

How is gonorrhea treated?

A

Ceftriaxone 500 mg IMI or IVI + Azithromycin 1g

In non-metro areas can be treated with amoxycillin 3g and probenecid 1g in north west

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18
Q

What must be a feature of antibiotics used to treat chlamydia?

A

It must have high cell penetrance.

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19
Q

What serovars cause trachoma and what serovars of chlamydia cause genital disease?

A

A - C trachoma

D - K Genital disease

L 1 - 3 Lymphogranuloma Venereum (LGV)

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20
Q

What kind of bacteria is chlamydia?

A

Obligate Intracellular Organism (intracellular reproductive phase and extracellular infective phase)

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21
Q

What are the sequelae of chlamydia infection?

A

Same as gonorrhea:

Males: Urethritis, epididymitis, infertility, etc)

Females: Infertility, Pelvic pain, Adhesions.

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22
Q

Who clears gonorrhea more quickly males or females?

A

Males clear it within 6 months

Females often need up to 4 years

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23
Q

How is chlamydia tested?

A

No culture so Nucleic Acid testing (PCR) [often tested for at the same time as gonorrhea]

24
Q

How is chlamydia treated?

A

Azithromycin and doxycycline are both very effective with >95% clearance at 2 - 4 weeks

Resistance is rare.

25
Q

How should doxycycline be administered for chlamydia?

A

Ideally rectal doxy is better for urethritis

26
Q

When should retesting be done to prove that chlamydia has left the body after treatment?

A

Proof Of Cure at 4 weeks

27
Q

What are mycoplasmas?

A

Very small bacteria with no cell wall.

28
Q

What mycoplasma species are commonly associated with infection/

A

Mycoplasma hominis

M genitalium

Ureaplasma urealyticum

29
Q

How is mycoplasma genitalium symptoms different to chlamydia?

A

More men are symptomatic (75 vs 50%) and same for women.

Treatment failures reported with single-dose azithromycin

30
Q

When is M genitalium tested for?

A

First line testing in NSUrethritis and PID.

31
Q

What is the treatment for M genitalium?

A

Moxifloxacin is recommended but expensive

Pristinomycin

Azithromycin (administered differently to chlamydia)

32
Q

What are the features of reactive arthritis?

A

Arthritis, Urethritis, and Conjunctivitis

Mucocutaneous lesions

Appears autoimmune and associated with HLA B27

Associated with many STIs (Gonorrhea and chlamydia, mycoplasmas, and shigella+salmonella+yersinia)

33
Q

Who most commonly gets reactive arthritis?

A

Males are seen in 90% of cases.

34
Q

What causes discharges in females?

A

Gonorrhea

Chlamydia

Non-specific cervicitis

Trichomoniasis (3)

Bacterial vaginosis (1)

Candidiasis (2)

Herpes cervicitis

Atrophic vaginitis

Neoplasia

Foreign bodies

Trauma

*Numbers refer to common ranking

35
Q

What is bacterial vaginosus?

A

Bacterial imbalance

No inflammation

Profuse malodorous discharge

36
Q

How is bacterial vaginosus diagnosed?

A

pH >4.5

Poor smell

Homogenous discharge

Clue cells

Gram stain of bacteria present

37
Q

What bacteria cause bacterial vaginosus?

A

Gardnerella

Mobiluncus

Bacteriodes

Prevotella

Mycoplasmas

Ureaplasmas

38
Q

What causes bacterial vaginosus?

A

pH rises - lactobacilli absent

Overgrowth or transmission

Semen (makes vagina more alkaline)

Vaginal sponges

39
Q

What are possible sequelae of bacterial vaginosus?

A

Preterm delivery

Post surgical endometritis

Ascending infection

HIV transmission

NGU in partners

40
Q

How is bacterial vaginosus treated?

A

Metronidazole or Tinidazole

Clindamycin cream or oral

Changing bacterial flora.

41
Q

How is candidiasis treated?

A

Topical imidazoles

Oral azoles

Partners, Bowel reservoir, Diet

42
Q

What causes trichomonas vaginalis?

A

Males are usually asymptomatic

43
Q

How is trichomonas infection diagnosed?

A

Pap smear

Culture

PCR

44
Q

How is trichomonas infection treated?

A

Metronidazole

Tinidazole

Always treat partner and think of gonorrhea

45
Q

What is Pelvic Inflammatory Disease?

A

A wide spectrum of diseases that are poorly defined and diagnosed.

They include endometritis, salpingitis, tubo-ovarian abscesses and peritonitis.

46
Q

What are the potential problems that arise from PID?

A

Important cause of tubal infertility, ectopic pregnancy and chronic pelvic pain.

Repeat infections result in worse outcomes.

10% of PID sufferers are infertile

40% increase in risk of ectopic pregnancy in those with >2 episodes of PID

47
Q

What are some predisposing causes of PID?

A

Sexually acquired

Post delivery

Post instrumentation

UTIs

48
Q

What organisms are causative of PID?

A

Gonorrhea (15 - 25% risk)

Chlamydia Trachomatis (10 - 15% risk) worse inflammation occurs with each infection.

Anaerobes (BV and UTI causing)

Myco and ureaplasma

Actinomyces

TB

49
Q

What are the symptoms of PID?

A

Many asymptomatic early

Bilateral pelvic pain

RUQ pain

Vaginal discharge

Low Back Pain

Irregular vaginal bleeding

Dysuria

Dyspareunia (pain during sex)

Toxic

50
Q

What are the signs of PID?

A

Abdominal tenderness

Cervicitis

Cervical excitation

Adnexal tenderness (bilateral)

Fever

Right Upper Quadrant tenderness (Fitzhugh Curtis Syndrome)

51
Q

What investigations should be done for PID?

A

High Vaginal Swab and Endocervical swab for culture

Urine and ECS for PCR

Pregnancy test

FBC (50% have normal WCC)

CRP

Ultrasound

Laparoscopy

52
Q

Who is PID commonly seen in?

A

PID is very likely in young women with abdominal pain

53
Q

How is PID treated?

A

Know the bugs then use appropriate drugs

54
Q

When should patients be admitted into hospital?

A

When diagnosis is uncertain

Surgical emergency

Abscess

Severe illness

Unable to tolerate oral medication

55
Q

How is PID managed?

A

Review at one week

Treat partner

Education (Condoms, and IUCD)

56
Q

What are the clinical features of epididymitis?

A

Pain and swelling in scrotum (Bilateral)

Sexually acquired <35

UTI >35

imed3003 (48 decks)

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