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3a > WH: Genitourinary Medicine > Flashcards

WH: Genitourinary Medicine Flashcards

1
Q

What is bacterial Vaginosis ? what type of bacteria

A

over growth of bacteria in the vagina, specifically anaerobic bacteria
- Not an STI

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2
Q

what causes BV (pathophys) ?

A

caused by loss of lactobacilli (friendly bacteria)
- usually produce lactic acid => low pH => prevent other bacteria overgrowing
- low lactobacilli => high pH => anaerobic bacterial growth

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3
Q

what is normal vaginal pH ? what is it in BV ?

A

normal 3.5-4.5
BV > 4.5

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4
Q

is BV an STI ?

A

no but it can increase STI risk

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5
Q

What is the most common causative organs of BV ?

A

gardurella vaginalis (anaerobic bacteria)

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6
Q

BV RF ? (3)

A
  • multiple sexual parterns
  • excessive vaginal cleaning
  • recent Abx
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7
Q

BV presentation ?

A

fishing smelling white or grey vaginal discharge

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8
Q

BV Ix ?

A
  • vaginal pH >4.5
  • charcoal swab
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9
Q

vaginal swab shows clue cells found on microscopy - what condition ?

A

bacterial vaginosis

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10
Q

BV management ?

A
  • asymtopatttic: does not usually require treatment
  • metronidazole (works against anaerobic bacteria), need to avoid alcohol with this one (B V careful)
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11
Q

BV complications ? and in pregnancy ?

A
  • increase STI risk
  • preterm delevery
  • Prematur ROM
  • low birth weight
  • post partum endometritis
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12
Q

what is candidiasis ? and what is it also known as ?

A

thrush
- vaginal infection wiht a yeast of the candida family

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13
Q

what is the most common causative organism of thrush ?

A

Candida albicans

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14
Q

when might candida colonisation progress to infection ? (2)

A

candida may colonise vagina without symptoms => progress to infection when right environment occurs
- during pregnancy
- after broad spectrum Abx

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15
Q

thrush RF ? (4)

A
  • pregnancy
  • poorly controlled DM
  • Immunosuprresion
  • Broad spectrum Abx
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16
Q

candidiasis presentation ?

A
  • thick white discharge (doesn’t typically smell)
  • vaginal + vulval itching + discomfort
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17
Q

candidiasis Ix ? diagnostic ?

A

vaginal pH
charchoic swab with microscopy (diagnostic)

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18
Q

what would pH>4.5 indicate ? below 4.5 ?

A

pH>4.5 => BV or trichomonas
pH<4.5 => candidiasis or normal

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19
Q

What pathogen causes chlamydia? name and type of pathogen?

A

STI caused by bacterium chlamydia trachomatis

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20
Q

what kind of gram staining is chlamydia ? what is unique about this bacterium? how spread?

A

gram -ve bacteriarod shaped
- obligate, intracellular organism (enter + replicate within cells => rupture cell => spread to others)

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21
Q

Describe chlamydia transmission (2)

A
  • via unprotected vaginal/anal or oral sex
  • Can be skin-to-skin: infected semen/vaginal fluid enters eye => chlamydial conjunctivitis
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22
Q

What is the most common STI in UK

A

Chlamydia: significant cause of infertility

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23
Q

What can charcoal swabs be used for? (3) what makes them special/useful?

A

Used for microscopy, culture + sensitivities
- Contains amines transport medium + chemical solution to keep microorganisms alive during transport

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24
Q

How does NAAT test work? what does it stand for? for which infections are they useful ?

A

Nucleic acid amplification tests (NAAT)
- check directly for DNA or RNA
- only used in chlamydia + gonorrhoea

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25
Q

Describe chlamydia presentation? men, women

A

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

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26
Q

What would be found on examination of female patient with chlamydia ? (4)

A

might find nothing
- Pelvic/abdo tenderness
- Cervical motion tenderness
- Inflamed cervix
- Prurulent discharge

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27
Q

How is chlamydia diagnosed? first choice? (men, women)

A
  • Women: NAAT (vulvovaginal- first choice)
  • Men: first catch urine sample
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28
Q

Describe chlamydia management (4)

A
  • 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
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29
Q

Describe the complications of chlamydia (8)

A

most common STI in UK
- PID, chronic pelvic pain, infertility, ectopic pregnancy, epididymo-orchitis, conjunctivitis, reactive arthritis,
- Infertility
- lymphongranuloma venerium

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30
Q

How can chlamydia affect pregnancy? (5)

A
  • preterm labour
  • Premature ROM
  • Low birthweight
  • post partum endometritis
  • neonatal infection
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31
Q

What type of neonatal infection can chlamydia cause ? (2)

A
  • conjunctivits
  • Pneumonia
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32
Q

What chlamydia complication is associated with MSM ? briefly what is it ?

A

lymphogranuloma venerium (genital ulcer disease)

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33
Q

what abs are used in chlamydia treatment during pregnancy ?

A

azithromycin and erythromycin
(doxycycline is contraindicated)

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34
Q

how is the neonate managed if neonatal chlamydial conjunctivas is suspected ?

A
  • swabs taken from the eyelid (or nasopahrnx if indicated)
  • oral erythromycin
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35
Q

What is gonorrhoea ? what is it caused by ? describe the causative organism

A

curable STI caused by gram -ve diplococcus bacteria (Neisseria Gonorrhoea)

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36
Q

Where cell type does gonorrhoea infect - give example? explain this

A

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

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37
Q

How is gonorrhoea spread?

A

spreads via contact with mucus secretions from infected areas 9unprotected vaginal/oral/anal sex, vertical transmission (mother => child))

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38
Q

gonorrhoea Epi ? how common ? most common among who ?

A

sendon most common STI in UK (after chlamydia)
- Predominantly MSM

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39
Q

gonorrhoea RF ?

A
  • age<25
  • MSM
  • Multiple sexual partners
  • Non-barrier sex
  • prev gonorrhoea Hx
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40
Q

gonorrhoea presentation? men + women

A

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)

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41
Q

How is gonorrhoea diagnosed?be specific - for men ? women ?

A

NAAT (endocervical, first catch urine sample)

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42
Q

How is gonorrhoea managed? (5)

A

(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

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43
Q

gonorrhoea complications ? M + F

A

lots of em
- PID
- Chronic pelvic pain
- Inferitility
- epididymis-orchitis(M)
- prostatic (M)
- Disseminated gonococcal infeciton
- neonatal compicaltions
- Pregnancy complications

44
Q

What pregnancy associated gonococcal complications are there ? (3)

A

perinatal mortality
spontaneous abortion
early ROM

45
Q

what neonatal complications are there associated with gonorrhoea ?

A

gonococcal conjunctivitis (ophthalmica neonartum)

46
Q

what is ophthalmica neonartum ? can lead to what ?

A

complications of gonorrhoea during pregnancy (spread by vertical transmission)
- medical emergency
- can lead to perforation of eye, sepsis, blindness

47
Q

what is disseminated gonococcal infection ? caused by what ?

A

complication of untreated gonococcal infection (concerning complication)
- bacteria spread to skin + joints

48
Q

disseminated gonococcal infection presentation ? (3)

A
  • skin lesions
  • polyarthralgia
  • systemic symptoms
49
Q

What is trichomanoiasis ? what is the causative organism ?

A

trichomonas vaginalis is a parasite spread through sexual intercourse

50
Q

describe the pathogen in trichomoniasis ?

A

protozoan (single celled organism) with flagellum
- parasite

51
Q

where does trichomanas vaginaliss live ?

A

lives in urethra (M+F) + vagina

52
Q

complications of Trichomoniasis ? (5)

A
  • increase risk of HIV, BV, crevice cancer, PID
  • Greg complicaitons
53
Q

what pregnancy associated complications are there with Trichomoniasis ? (3)

A
  • preterm delivery
  • low birth weight
  • post partum sepsis
54
Q

Trichomoniasis presentation ?

A

50% asymptomattic
- non specific: vaginal discharge (yellow/green i think) n, itching, dysuria, dyspareunia

55
Q

what would be seen on examination inf Trichomoniasis? (2)

A
  • frothy hello/green discharge (with a fishy smell)
  • strawberry cervix (due to tiny haemorrhage)
56
Q

how is Trichomoniasis diagnosed ?

A

charcoal swab + microscopy

57
Q

what would the vaginl pH be in Trichomoniasis ?

A

> 4.5

58
Q

Trichomoniasis management ?

A

metronidazole + contract tracing

59
Q

What is mycoplasma agenitalium ?

A

bacterial STI that causes non-gonococcal urethritis

60
Q

mycoplasma genitalium presentation ? key feature?

A

mostly asympttmttic
- urethritis (key features)
- epididymitis
- cervicitis
- PID

61
Q

mycoplasma genitalium Ix ?

A
  • NAAT: vaginal swab (F), first uric sample (M)
62
Q

mycoplasma genitalium Mx?

A

doxycycline followed by azithromycin

63
Q

mycoplasma genitalium Mx in pregnancy ?

A

azithromycin alone (doxycycline is contraindicated in pregnancy)

64
Q

What is syphilis ? name the causative organism ?

A

STI caused by Treponema Pallidum (spirochete)

65
Q

Where does the syphilis pathogen enter ?

A

natter enters by skin or mucus membrane

66
Q

syphilis transmission (4) ?

A
  • sexual (oral, vaginal, anal - any involving direct contact with infected area)
  • vertical transmission (during pregnancy)
  • IV drug use
  • Blood trasfusions (rare due to screening)
67
Q

What are the 4 stages of syphilis ?

A
  • primary
  • secondary
  • latent
  • tertiary
68
Q

describe the sx in primary syphilis ? how long does this last ?

A
  • painless ulcer (chacre) - usually on genitals
  • lymphadenopathy
    (last 3-8 weeks)
69
Q

describe the sx in secondary syphilis ? (4) how long does this last ?

A

systemic sx (3 - 12 weeks)
- maculo-papular rash (hands and feet)
- wart like lesions round genitals
- low grade fever
- alopecia

70
Q

describe the sx in latent syphilis ? how long does this last ?

A

sx disappear + patient is asymptotic despite being infected

71
Q

describe the sx in tertiary syphilis ? how long does this last ?

A

can occur many yrs after + affects many organs of body
- gumatous lesions
- aortic aneuysms
- neurosyphilis

72
Q

describe the sx in neurosyphilis ?

A

neurosyphilis is if tertiary syphilis affects CNS (=> neuro symptoms)
- headache, altered behaviour, dementia, ocular syphilis, paralysis

73
Q

Syphilis Ix ? diagnostic ?

A
  • antibody testing for T.Palidum bacteria (screening)
  • Diagnostic: sample form infection site (PCR)
74
Q

syphilis Mx ?

A

GUM, Sti screening, avoid sexual intercourse, contract tracing
- Deep IM bensathine bensylpenecillin

75
Q

what is done to prevent syphilis in pregnancy ?

A

screening at first antenatal appointment

76
Q

syphilis pregnancy complications ?

A
  • misscarriage
  • still birth
  • preterm labour
  • congenital syphilis
77
Q

congenital syphilis presentation ?

A

sever + debilitating (I think risk of death)

78
Q

What is PID ? what structures affected ?

A

pelvic inflammatory disease
- inflammation + infection of organs of the pelvis (upper genital tract - uterus, Fallopian tubes + ovaries)

79
Q

PID important complications ? (2)

A
  • significant cause of tubular inferility
  • chronic pelvic pain
80
Q

PID causes ? (5)

A
  • STI: gonorrhoea, chlamydia, mycoplasma genitalium
  • non-STI: garderella vaginalis (BV), E.COli
81
Q

PID RF ? (6)

A

same as other STI
- multiple patterns
- non-barrier sex
- existing STI
- PID HX
- IUD
- 15-24

82
Q

PID presentation ? (6)

A
  • pelvic of lower bod pain
  • abnormal vaginal discharge
  • abnormal bleeding
  • dyspareunia
  • fever
  • dysuria
83
Q

PID OE ?

A
  • pelvic tenderness
  • cervical motion tenderness
  • inflamed cervix
  • prurulent discharge
  • sings of sepsis (fever + tachy)
84
Q

PID Ix ? which test for which thing ?

A

test for causative organisms
- NAAT (for gonorrhoea, chlamydia, mycoplasma)
- HIV test
- Syphilis test
- preg test
- TVUS

85
Q

PID Mx ? when admission ?

A
  • 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
86
Q

PID complications ?

A
  • sepsis
  • Abscess
  • Infertility
  • Chronic pelvic pain
  • Ectopic pregnancy
  • Fitz-hugh-Curtis syndrome
87
Q

what is Fitz-hugh-Curtis syndrome ? associated with what ?

A

complication of PID
- inflammation + infection of liver capsule => adhesions between liver + peritoneum => RUQ pain

88
Q

What is HIV ? what is AIDS ?

A

HIV => when not treated => AIDS (immunocompromised + opportunistic infections + ADIS-defining illnesses)

89
Q

what type of pathogen is HIV ? most common strain ? targets what ?

A

RNA retrovirus (HIV 1 most common): virus enters + destroys CD4 T helper cells

90
Q

describe HIV disease Course ?

A
  • Initial seroconversion: flue like illness occurs within few weeks of infection
  • asymptomattic
  • immunodeficiency (destroyed enough CD4 cells => opportunist ADIS defining illnesses)
91
Q

Describe AIDS transmission ?

A
  • unprotected anal/vaginal/oral sex
  • vertical transmission (during birth, pregnancy, breast feeding)
  • mucous membranes, blood, open wound (needles, blood in eye)
92
Q

what are AIDS defining illnesses ? name some ? (5)

A

when CD4 count so low, allows for opportunistic infection + malignancies
- Kaposis sarcoma
- cytomegalovirus
- Candidiasis (oesophageal)
- lymphoma
- TB

93
Q

what screening tests for HIV ? (2)

A
  • check for antibodies to HIV
  • P24 antigen
94
Q

what do you monitor in HIV ?

A
  • CD4 count (low => increased risk of opportunistic infection)
  • HIV RNA per ml of blood (viral load)
95
Q

what is normal CD4 count ? undetectable viral load ?

A

CD4: 500-1200 cells/mm3 normal range, <200 => increase risk of opportunistic infection)
- HIV RNA per ml of blood: undetectable about <20

96
Q

HIV Tx ? (4)

A
  • Anitretroviral therapy (ART): + genotypic resistance testing to identify HIV strain)
  • prophylactic co-trimoxazole
  • avoid live vaccines
  • Correct use of condoms
97
Q

HIV prohpyslasi ?

A
  • Condons
  • PEP (reduce risk of transmission after exposure)
  • PrEP: emtricitabin/tenofovir
98
Q

what is HSV ? what strains ? disease course ?

A

HSV commonly responsible for coldsore + genital herpes
(HSV 1 + HSV 2)
- after initial infection, virus is latent in associated sensory nerve ganglia

99
Q

how is HSV spread ?

A

spread through direct contact with affected muscle memebraes (even when person is asymptomatic)

100
Q

HSV presentaiton ? (5)

A

initial ep most severe + recurrent eps are milder
- ulver/blistering lesions (of genital area)
- neuropathic pain
- flu like sx
- dysuria
- inguinal lymphadenopathy

101
Q

HSV Dx ?

A

can be made clinically
- viral PCR swab can confirm diagnosis

102
Q

HSV Mx ?

A
  • GUM referral
  • Aciclovir
103
Q

what can pregnancy and genital herpes lead to ?

A

not pre or congenital abnormalities but…
- neonatal herpes simplex infection (contracted during labour)
- high mortality and morbidity
(CNS hopers affects NS + brain => encephalitis)

104
Q

pregnancy + genital herpes Mx ? primary ? recurrent?

A
  • 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
105
Q

What are genital warts ? what strains ?

A

benign epithelial/mucosal out growths caused by the DNA HPV
- HPV 6 + 11 responsible for 90% cases

106
Q

genital warts Mx ?

A

treatment not always necessary as will resolve spontaneously overtime

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