WH: Genitourinary Medicine Flashcards
What is bacterial Vaginosis ? what type of bacteria
over growth of bacteria in the vagina, specifically anaerobic bacteria
- Not an STI
what causes BV (pathophys) ?
caused by loss of lactobacilli (friendly bacteria)
- usually produce lactic acid => low pH => prevent other bacteria overgrowing
- low lactobacilli => high pH => anaerobic bacterial growth
what is normal vaginal pH ? what is it in BV ?
normal 3.5-4.5
BV > 4.5
is BV an STI ?
no but it can increase STI risk
What is the most common causative organs of BV ?
gardurella vaginalis (anaerobic bacteria)
BV RF ? (3)
- multiple sexual parterns
- excessive vaginal cleaning
- recent Abx
BV presentation ?
fishing smelling white or grey vaginal discharge
BV Ix ?
- vaginal pH >4.5
- charcoal swab
vaginal swab shows clue cells found on microscopy - what condition ?
bacterial vaginosis
BV management ?
- asymtopatttic: does not usually require treatment
- metronidazole (works against anaerobic bacteria), need to avoid alcohol with this one (B V careful)
BV complications ? and in pregnancy ?
- increase STI risk
- preterm delevery
- Prematur ROM
- low birth weight
- post partum endometritis
what is candidiasis ? and what is it also known as ?
thrush
- vaginal infection wiht a yeast of the candida family
what is the most common causative organism of thrush ?
Candida albicans
when might candida colonisation progress to infection ? (2)
candida may colonise vagina without symptoms => progress to infection when right environment occurs
- during pregnancy
- after broad spectrum Abx
thrush RF ? (4)
- pregnancy
- poorly controlled DM
- Immunosuprresion
- Broad spectrum Abx
candidiasis presentation ?
- thick white discharge (doesn’t typically smell)
- vaginal + vulval itching + discomfort
candidiasis Ix ? diagnostic ?
vaginal pH
charchoic swab with microscopy (diagnostic)
what would pH>4.5 indicate ? below 4.5 ?
pH>4.5 => BV or trichomonas
pH<4.5 => candidiasis or normal
What pathogen causes chlamydia? name and type of pathogen?
STI caused by bacterium chlamydia trachomatis
what kind of gram staining is chlamydia ? what is unique about this bacterium? how spread?
gram -ve bacteriarod shaped
- obligate, intracellular organism (enter + replicate within cells => rupture cell => spread to others)
Describe chlamydia transmission (2)
- via unprotected vaginal/anal or oral sex
- Can be skin-to-skin: infected semen/vaginal fluid enters eye => chlamydial conjunctivitis
What is the most common STI in UK
Chlamydia: significant cause of infertility
What can charcoal swabs be used for? (3) what makes them special/useful?
Used for microscopy, culture + sensitivities
- Contains amines transport medium + chemical solution to keep microorganisms alive during transport
How does NAAT test work? what does it stand for? for which infections are they useful ?
Nucleic acid amplification tests (NAAT)
- check directly for DNA or RNA
- only used in chlamydia + gonorrhoea
Describe chlamydia presentation? men, women
asymptomatic ! (50% men, 75% women)
(when sexually active)
- Women: abnormal vaginal discharge, pelvic pain, AVB, dyspareunia, dysuria
- Men: urethral discharge or discomfort, dysuria, epididimo-orchitis
What would be found on examination of female patient with chlamydia ? (4)
might find nothing
- Pelvic/abdo tenderness
- Cervical motion tenderness
- Inflamed cervix
- Prurulent discharge
How is chlamydia diagnosed? first choice? (men, women)
- Women: NAAT (vulvovaginal- first choice)
- Men: first catch urine sample
Describe chlamydia management (4)
- Doxycycline 100mg BD for 7 days
- Abstain from sex for 7 days of treatments
- Refer to GUM for contact tracing
- Test + treat for other STIs
Describe the complications of chlamydia (8)
most common STI in UK
- PID, chronic pelvic pain, infertility, ectopic pregnancy, epididymo-orchitis, conjunctivitis, reactive arthritis,
- Infertility
- lymphongranuloma venerium
How can chlamydia affect pregnancy? (5)
- preterm labour
- Premature ROM
- Low birthweight
- post partum endometritis
- neonatal infection
What type of neonatal infection can chlamydia cause ? (2)
- conjunctivits
- Pneumonia
What chlamydia complication is associated with MSM ? briefly what is it ?
lymphogranuloma venerium (genital ulcer disease)
what abs are used in chlamydia treatment during pregnancy ?
azithromycin and erythromycin
(doxycycline is contraindicated)
how is the neonate managed if neonatal chlamydial conjunctivas is suspected ?
- swabs taken from the eyelid (or nasopahrnx if indicated)
- oral erythromycin
What is gonorrhoea ? what is it caused by ? describe the causative organism
curable STI caused by gram -ve diplococcus bacteria (Neisseria Gonorrhoea)
Where cell type does gonorrhoea infect - give example? explain this
Spreads via contact with mucus membranes with columnar epithelium (endocervix, urethra, rectum, conjunctiva + pharynx)
- adheres to mucus membrane => invade host cell => acute inflam
- N. gon has surface proteins that bind to receptors of immune cells => prevent immune response
How is gonorrhoea spread?
spreads via contact with mucus secretions from infected areas 9unprotected vaginal/oral/anal sex, vertical transmission (mother => child))
gonorrhoea Epi ? how common ? most common among who ?
sendon most common STI in UK (after chlamydia)
- Predominantly MSM
gonorrhoea RF ?
- age<25
- MSM
- Multiple sexual partners
- Non-barrier sex
- prev gonorrhoea Hx
gonorrhoea presentation? men + women
usually symptomatic and depends site of infection
- Female: odourless prurient discharge (green/yellow), dysuria, pelvic pain
- Male: odourless prurulent discharge (green/yellow), dysuria, testicular pain or swelling (epididymo-orchitis)
How is gonorrhoea diagnosed?be specific - for men ? women ?
NAAT (endocervical, first catch urine sample)
How is gonorrhoea managed? (5)
(high level of Abx resistance)
- Abx (often broad spectrum as high level of Abx resistance)
- Follow up test-of-cure
- Abstain from sex (7 days)
- Test for other STIs
- Contact tracing
gonorrhoea complications ? M + F
lots of em
- PID
- Chronic pelvic pain
- Inferitility
- epididymis-orchitis(M)
- prostatic (M)
- Disseminated gonococcal infeciton
- neonatal compicaltions
- Pregnancy complications
What pregnancy associated gonococcal complications are there ? (3)
perinatal mortality
spontaneous abortion
early ROM
what neonatal complications are there associated with gonorrhoea ?
gonococcal conjunctivitis (ophthalmica neonartum)
what is ophthalmica neonartum ? can lead to what ?
complications of gonorrhoea during pregnancy (spread by vertical transmission)
- medical emergency
- can lead to perforation of eye, sepsis, blindness
what is disseminated gonococcal infection ? caused by what ?
complication of untreated gonococcal infection (concerning complication)
- bacteria spread to skin + joints
disseminated gonococcal infection presentation ? (3)
- skin lesions
- polyarthralgia
- systemic symptoms
What is trichomanoiasis ? what is the causative organism ?
trichomonas vaginalis is a parasite spread through sexual intercourse
describe the pathogen in trichomoniasis ?
protozoan (single celled organism) with flagellum
- parasite
where does trichomanas vaginaliss live ?
lives in urethra (M+F) + vagina
complications of Trichomoniasis ? (5)
- increase risk of HIV, BV, crevice cancer, PID
- Greg complicaitons
what pregnancy associated complications are there with Trichomoniasis ? (3)
- preterm delivery
- low birth weight
- post partum sepsis
Trichomoniasis presentation ?
50% asymptomattic
- non specific: vaginal discharge (yellow/green i think) n, itching, dysuria, dyspareunia
what would be seen on examination inf Trichomoniasis? (2)
- frothy hello/green discharge (with a fishy smell)
- strawberry cervix (due to tiny haemorrhage)
how is Trichomoniasis diagnosed ?
charcoal swab + microscopy
what would the vaginl pH be in Trichomoniasis ?
> 4.5
Trichomoniasis management ?
metronidazole + contract tracing
What is mycoplasma agenitalium ?
bacterial STI that causes non-gonococcal urethritis
mycoplasma genitalium presentation ? key feature?
mostly asympttmttic
- urethritis (key features)
- epididymitis
- cervicitis
- PID
mycoplasma genitalium Ix ?
- NAAT: vaginal swab (F), first uric sample (M)
mycoplasma genitalium Mx?
doxycycline followed by azithromycin
mycoplasma genitalium Mx in pregnancy ?
azithromycin alone (doxycycline is contraindicated in pregnancy)
What is syphilis ? name the causative organism ?
STI caused by Treponema Pallidum (spirochete)
Where does the syphilis pathogen enter ?
natter enters by skin or mucus membrane
syphilis transmission (4) ?
- sexual (oral, vaginal, anal - any involving direct contact with infected area)
- vertical transmission (during pregnancy)
- IV drug use
- Blood trasfusions (rare due to screening)
What are the 4 stages of syphilis ?
- primary
- secondary
- latent
- tertiary
describe the sx in primary syphilis ? how long does this last ?
- painless ulcer (chacre) - usually on genitals
- lymphadenopathy
(last 3-8 weeks)
describe the sx in secondary syphilis ? (4) how long does this last ?
systemic sx (3 - 12 weeks)
- maculo-papular rash (hands and feet)
- wart like lesions round genitals
- low grade fever
- alopecia
describe the sx in latent syphilis ? how long does this last ?
sx disappear + patient is asymptotic despite being infected
describe the sx in tertiary syphilis ? how long does this last ?
can occur many yrs after + affects many organs of body
- gumatous lesions
- aortic aneuysms
- neurosyphilis
describe the sx in neurosyphilis ?
neurosyphilis is if tertiary syphilis affects CNS (=> neuro symptoms)
- headache, altered behaviour, dementia, ocular syphilis, paralysis
Syphilis Ix ? diagnostic ?
- antibody testing for T.Palidum bacteria (screening)
- Diagnostic: sample form infection site (PCR)
syphilis Mx ?
GUM, Sti screening, avoid sexual intercourse, contract tracing
- Deep IM bensathine bensylpenecillin
what is done to prevent syphilis in pregnancy ?
screening at first antenatal appointment
syphilis pregnancy complications ?
- misscarriage
- still birth
- preterm labour
- congenital syphilis
congenital syphilis presentation ?
sever + debilitating (I think risk of death)
What is PID ? what structures affected ?
pelvic inflammatory disease
- inflammation + infection of organs of the pelvis (upper genital tract - uterus, Fallopian tubes + ovaries)
PID important complications ? (2)
- significant cause of tubular inferility
- chronic pelvic pain
PID causes ? (5)
- STI: gonorrhoea, chlamydia, mycoplasma genitalium
- non-STI: garderella vaginalis (BV), E.COli
PID RF ? (6)
same as other STI
- multiple patterns
- non-barrier sex
- existing STI
- PID HX
- IUD
- 15-24
PID presentation ? (6)
- pelvic of lower bod pain
- abnormal vaginal discharge
- abnormal bleeding
- dyspareunia
- fever
- dysuria
PID OE ?
- pelvic tenderness
- cervical motion tenderness
- inflamed cervix
- prurulent discharge
- sings of sepsis (fever + tachy)
PID Ix ? which test for which thing ?
test for causative organisms
- NAAT (for gonorrhoea, chlamydia, mycoplasma)
- HIV test
- Syphilis test
- preg test
- TVUS
PID Mx ? when admission ?
- empirical Abx (ceftrioxone) started before swab result (avoid complications)
- if sever/signs of sepsis/pregnant: admit + IV Abx
- contact tracing, no sexu til Abx finished
PID complications ?
- sepsis
- Abscess
- Infertility
- Chronic pelvic pain
- Ectopic pregnancy
- Fitz-hugh-Curtis syndrome
what is Fitz-hugh-Curtis syndrome ? associated with what ?
complication of PID
- inflammation + infection of liver capsule => adhesions between liver + peritoneum => RUQ pain
What is HIV ? what is AIDS ?
HIV => when not treated => AIDS (immunocompromised + opportunistic infections + ADIS-defining illnesses)
what type of pathogen is HIV ? most common strain ? targets what ?
RNA retrovirus (HIV 1 most common): virus enters + destroys CD4 T helper cells
describe HIV disease Course ?
- Initial seroconversion: flue like illness occurs within few weeks of infection
- asymptomattic
- immunodeficiency (destroyed enough CD4 cells => opportunist ADIS defining illnesses)
Describe AIDS transmission ?
- unprotected anal/vaginal/oral sex
- vertical transmission (during birth, pregnancy, breast feeding)
- mucous membranes, blood, open wound (needles, blood in eye)
what are AIDS defining illnesses ? name some ? (5)
when CD4 count so low, allows for opportunistic infection + malignancies
- Kaposis sarcoma
- cytomegalovirus
- Candidiasis (oesophageal)
- lymphoma
- TB
what screening tests for HIV ? (2)
- check for antibodies to HIV
- P24 antigen
what do you monitor in HIV ?
- CD4 count (low => increased risk of opportunistic infection)
- HIV RNA per ml of blood (viral load)
what is normal CD4 count ? undetectable viral load ?
CD4: 500-1200 cells/mm3 normal range, <200 => increase risk of opportunistic infection)
- HIV RNA per ml of blood: undetectable about <20
HIV Tx ? (4)
- Anitretroviral therapy (ART): + genotypic resistance testing to identify HIV strain)
- prophylactic co-trimoxazole
- avoid live vaccines
- Correct use of condoms
HIV prohpyslasi ?
- Condons
- PEP (reduce risk of transmission after exposure)
- PrEP: emtricitabin/tenofovir
what is HSV ? what strains ? disease course ?
HSV commonly responsible for coldsore + genital herpes
(HSV 1 + HSV 2)
- after initial infection, virus is latent in associated sensory nerve ganglia
how is HSV spread ?
spread through direct contact with affected muscle memebraes (even when person is asymptomatic)
HSV presentaiton ? (5)
initial ep most severe + recurrent eps are milder
- ulver/blistering lesions (of genital area)
- neuropathic pain
- flu like sx
- dysuria
- inguinal lymphadenopathy
HSV Dx ?
can be made clinically
- viral PCR swab can confirm diagnosis
HSV Mx ?
- GUM referral
- Aciclovir
what can pregnancy and genital herpes lead to ?
not pre or congenital abnormalities but…
- neonatal herpes simplex infection (contracted during labour)
- high mortality and morbidity
(CNS hopers affects NS + brain => encephalitis)
pregnancy + genital herpes Mx ? primary ? recurrent?
- primary genital herpes < 28 weeks: Aciclovir + prophylactic Aciclovir from 36 weeks
- primary genital herpes > 28 weeks: Aciclovir + immediate aciclor + CS recommended
- recurrent genital hepres (low risk of neonatal infection): consider acicloier from 36 weeks
What are genital warts ? what strains ?
benign epithelial/mucosal out growths caused by the DNA HPV
- HPV 6 + 11 responsible for 90% cases
genital warts Mx ?
treatment not always necessary as will resolve spontaneously overtime
