Week 6 - Infections of the Genital Tract Flashcards
What is the most likely infective organism in a 19 year old female with no symptoms, mucopurulent discharge and cervical motion tenderness noted on speculum examination?
Chlamydia trachomatis - infections usually asymptomatic
Which infective organism causes a painless chancre in the early stages of infection?
Treponema pallidum
Describe the nature of the discharge produced by Trichomonas vaginalis infection.
- Foul-smelling
- Yellow-green vaginal discharge
What is the most likely infective organism in a patient presenting with vaginitis and a thin, grey vaginal discharge with a fishy, amine odour?
Gardnarella vaginalis
What is the nature of discharge produced by Candida albicans infection?
- Thick
- White
- Cottage-cheese like
What is the most likely infective organism for a male who is sexually active with symptoms of urethritis and whose urine sample showed the presence of gram-negative diplococci?
Chlamydia trachomatis
Which 2 organisms are the most common sexually transmitted organisms?
- Neisseria gonorrhoeae
2. Chlamydia trachomatis
Describe the structural features of Chlamydia trachomatis.
- Small
- Round/ovoid bacterium
- Rigid cell wall that resembles a gram negative envelope
- The morphology of the organism changes dependent on the stage in the life cycle
What is the normal vaginal pH range?
3.5-4.5
What is the dominant organism in normal vaginal flora?
Lactobacillus sp
Which microorganism is the pathogen that can cause bacterial vaginosis?
Gardnarella vaginalis
Which microorganism is the pathogen that can cause conjunctivitis in newborns?
Chlamydia trachomatis
State the causes of genital ulcers.
- Herpes simplex virus - HSV
- Syphilis
- Chanchroid - Haemophilus ducreyi
What can vesicles of Bullae be caused by?
HSV
State the causes of genital papules.
- Transient manifestations of STIs
- Condylomata acuminata - anogenital warts
- Umbilicated lesions of Molluscum contagiosum virus
State the important features of genital ulcers.
- Number
- Size
- Tenderness
- Base
- Edge
State the causative agents for non-gonococcal urethritis.
- Chlamydia trachomatis
- Mycoplasma
- Ureaplasma
- Trichomonas HSV
State the types of urethritis.
- Gonococcal urethritis
- Non-gonococcal urethritis
- Post-gonococcal urethritis
State the causes of vulvo-vaginitis.
- Candidiasis
- Trichomoniasis
- Staphylococcal
- Foreign body
- HSV
State the causes of cervicitis.
- C. trachomatis
- N. gonorrhoeae
- HSV
- HPV
State the causes of bartholinitis.
- Polymicrobial infections with endogenous flora
2. Rarely STIs
What features does a laboratory diagnosis of bacterial vaginosis consist of?
- Pungent odour with the KOH whiff test
- Vaginal pH of greater than 4.5
- Presence of clue cells on a wet mount lacking many PNMs
How is bacterial vaginosis thought to occur?
From a synergistic infection involving the overgrowth of normal bacterial flora including Gardnerella vaginalis
State the symptoms of bacterial vaginosis.
- Vaginal discharge
- Odour
- Itch
- Dyspareunia
- Soreness
State the differential diagnoses you would consider for a 19 year old male presenting with pain on passing urine, a creamy urethral discharge, slight reddening of the surrounding glans penis, no fever and no previous history of genital urinary problems.
- Chlamydial urethritis
- Gonococcal urethritis
- Non-specific urethritis
What antibiotics would you consider for treatment of gonorrhoea?
- Ciprofloxacin not currently recommended because of widespread resistance worldwide
- Ceftriaxone 500 mg Im + Azithromycin 1 g PO given
- Also consider treatment for chlamydia in the regime
Why do you think mixed infections with Chlamydia and Gonorrhoea are common?
- Common at-risk behaviours and associated factors
- Long-term asymptomatic infection
- Identical mode of transmission
- High prevalence rates of Chlamydia trachomatis infection
Outline treatment for Human papillomaviruses.
- None - spontaneous resolution: 1 year - 70%, 2 years - 90%
- Topical podophyllin, cryotherapy, intralesional interferon, imiquimod, surgery
Outline the methods of screening for HPV.
- Cervical pap smear cytology
- Colposcopy + acetowhite test
- Cervical swab - HPV hybrid capture - 40% of 20-24 year olds positive
Outline the techniques used for diagnosis of HPV.
- Clinical
- Biopsy + genome analysis
- Hybrid capture
Outline the 2 types of vaccine used for HPV.
- Cervarix - for HPV 16 and 18 - initially used in UK
2. Gardasil - for HPV 6, 11, 16 and 18 - used from 2011
Who is the HPV vaccine offered to?
Girls aged 12-13 year old (2 doses)
What infections can Chlamydia trachomatis cause in neonates?
- Inclusion conjunctivitis
2. Pneumonia
State the techniques used for diagnosis of Chlamydia trachomatis.
- Endocervical and cervical swabs - NAAT (IF, EIA, culture)
- First void urine - NAAT
- Neonatal infection - conjunctival swab (NAAT)
Outline the treatment for Chlamydia trachomatis infections.
- Doxycycline/azithromycin
2. Erythromycin in children
Who does the chlamydia screening programme target?
Sexually active under 25s
State the symptoms of primary genital herpes.
- Extensive painful genital ulceration
- Dysuria
- Inguinal lymphadenopathy
- Fever
State how you can diagnose herpes simples virus.
PCR of vesicle fluid and/or ulcer base
Which type of herpes simplex virus is associated with genital herpes?
HSV2
What is herpes simplex virus 1 usually associated with?
Cold sores
What is the treatment for herpes simplex virus?
Aciclovir - primary and severe disease
What types of infection can Neisseria gonorrhoeae cause in females?
- Asymptomatic
- Endocervicitis
- Urethritis
- PID which may lead to infertility
What effects can disseminated gonococcal infections have?
- Bacteraemia
2. Skin and joint lesions
Outline the techniques used to screen for human papillomavirus infection.
- Cervical pap smear cytology
- Colposcopy + acetowhite test
- Cervical swab - HPV hybrid capture (40% of 20-24 year olds positive)
