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MRCOG Part one > Microbiology: Infections in O&G > Flashcards

Microbiology: Infections in O&G Flashcards

1
Q

How does the pH of the vaginal throughout a woman life & why does this occur?

A

At puberty under the influence of oestrogen the vagina changes from simple cuboidal to squamous epithelium and lactobacilli become the predominant organism, this drops pH to 3.5-4.5. After menopause changes back and pH rises to 7.0

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2
Q

What % of vaginal candidiasis are due to C.albicans?

A

80-90%

remaining C glabrata, C krusei C tropicalis

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3
Q

How many woman are colonised with candida (mostly asymptomatic)?
How does this change in pregnancy

A

20%

40%

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4
Q

How does the Tx of candida change in pregnancy?

A

Do not use oral azoles

Creams or pessaries

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5
Q

How can genuine recurrent infection with candida be Tx

A

6 month weekly fluconazole

Boric acid intravaginally

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6
Q

Does candida effect pregnancy?

A

no

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7
Q

What is the comment of cause of abnormal discharge? Prevelance in UK?

A

BV 12%

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8
Q

What is the pathophysiology BV

A

Anaerobic organism normally in low concentration increase, taking over the predominant lactobacilli. pH rises from 4.5 tp 7.0

gardnerlla vaginalis, bacteroides,..

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9
Q

What is the Amsel criteria to Dx BV?

A

vaginal pH >4,5
fish smell on addition of alkali
characterise discharge on examination
clue cells on microscopy

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10
Q

Tx of BV

A

Metronidazole tablets or cream

Clindamycin cream

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11
Q

Complications of BV in pregnancy

A

2nd trimester miscarriage, preterm delivery

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12
Q

Transmission of Trichomonas

A

Sexually transmitted, asymptomatic for many months

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13
Q

Clinical features of trichomonad

A

vulvovaginitis
green/yellow discharge +/- offensive smell
punctuate haemorrhage on cervix ‘strawberry’

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14
Q

Trichomoniasis is detected on what swab?

A

NAAT

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15
Q

Tx of trichomoniasis>

A

metronidazole

partner should also be Tx

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16
Q

Complications of trichomoniasis in pregnancy

A

increased risk of preterm birth but asymptomatic tx not shown to improve outcome

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17
Q

Tx for pubic lice and scabies

A

Topical malathion or permethrin

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18
Q

Tubal factor infertility is how common after PID (1 episode, 3 episodes)

A

Tubal infertility rate following 1 episode PID 12%

Tubal infertility rate following 3 episodes PID 50%

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19
Q

How common is chronic pelvis pain after PID

A

15%

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20
Q

Chlamydia and gonorrhoea account for what % of PID

A

25-50%

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21
Q

What % of women of childbearing age are infected with chlamydia

A

10% most common STI

highest <25

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22
Q

What % of people infected with chlamydia are asymptomatic?

A

50% & 80%

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23
Q

What form of chlamydia can cause severe proctitis?

A

Lymphogranuloa Venereum (LGV)

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24
Q

What type of bacteria is chlamydia?

A

Obligate intracellular bacteria

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25
Q

What abx are effective in uncomplicated chlamydia?

A

Azithromycin
Doxycycline
Ofloxacin
erythromycin

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26
Q

What % of women of child baring age are infected with gonorrhoea?

A

1%

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27
Q

What % of people infected with gonorrhoea are asymptotic?

A

women 50%

men 10%

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28
Q

What is the appearance of gonorrhoea on microscopy?

A

Gram -ve intracellular diplococci

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29
Q

reccommeneded Tx fo gonorrhoea?

A

Single dose azithryomycin 1g PO (or doxycycline)

Ceftriaxone 500mg IM

30
Q

How does cervicitis present?

A

Post coital bleeding

purulent vaginal discharge

31
Q

Chronic cervicitis can lead to what?

A

nabothian follicles (cysts) and scarring

32
Q

What clinical features indicate PID

A
  • hx pelvic pain and deep dyspareunia
  • cervical motion tenderness
  • lower UTI
  • pyrexia
  • adnexal ass (20%)

clinical dx 70-80% accurate

33
Q

Gold standard Ix for diagnosis for PID

A

laproscopy

34
Q

Complications of PID

A

Tubal factor infertility
Abscess
Adhesions - chronic pelvic pIN
pelvic peritonitis

35
Q

Standard Abx for PID

A

IM ceftriaxone 500mg
Doxycycline 200mg BD - 14days
Metronidazole 400mg BD - 14days

36
Q

What condition caused by chlamydia/gonnorea present with fever & RUQ pain

A

Fitz-high-curtis syndrome - requires 3 weeks abx

37
Q

Name of disseminated chlamydia that presents with asymmetrical oligoarthritis affecting large joints of lower limb, uveitis and a rash (similar to psoriasis)

A

Reiter syndrome

Associated with HLA B27

38
Q

How does disseminated gonorrhoea present?

A

Septic oligoarthritis effecting hands and wrists + scanty papular rash

39
Q

How does infection with chlamydia/gonorrhoea effect pregnancy/newborn?

A

Pregnancy: chorioamnitis and 2-3 high risk of preterm birth
Infant: Opthalmia neonatorum (may lead to corneal scarring and blindness), in chlamydia may develop pneumonitis

40
Q

What are the symptoms of genital tuberculosis?

A

In most cases, the disease is asymptomatic, infertility is the most common.

Other symptoms reported are menstrual irregularities and abnormal vaginal discharge.

41
Q

Pelvic actinomycosis is associated with what iatrogenic cause?

A

IUCD

42
Q

Syphilis is caused by which bacteria?

A

Treponema Pallidum

43
Q

How & when does primary syphilis present?

A

Painless chancre and lymphadenopathy 3-90 days (women do no always see the chancre as often on cervix)

44
Q

How & when does secondary syphilis present?

A

Widespread rash typically affecting hands and soles of feet.
Wart lesions (condyloma latum) of mucus membranes
within 6 months

45
Q

What occurs after secondary syphilis?

A

Latent phase

No symptoms, +be serological testing, can transmit

46
Q

How & when does tertiary syphilis present

A

Gummas OR
Neurosyphilis OR
Cardiovascular syphilis

3+ year after primary infection

47
Q

Main Abx to Tx syphilis?

A

Penicillins

48
Q

By what gestation must syphilis be treated to prevent late congenital symphilis?

A

20 weeks

49
Q

How can syphilis effect the fetus

A

Fetal death
long term
- 8th nerve deafness, insteitial keratitis, abnormal teeth

50
Q

Infectious causes of genital ulcer diease

A 
Herpes simplex
Primary syphilis 
Lymphogranuloma venereum
chancroid 
donovanosis 
HIV
51
Q

What is chancroid

A

Chancroid is a bacterial sexually transmitted disease (STD) caused by infection with Haemophilus ducreyi. It is characterized by painful necrotizing genital ulcers that may be accompanied by inguinal lymphadenopathy.

52
Q

What is granuloma inguinale (donovanosis)

A

Granuloma inguinale is a rare sexually transmitted disease caused by the bacteria Klebsiella granulomatis. It leads to chronic inflammation and scarring of the genitals. Granuloma inguinale typically causes a painless, red lump on or near the genitals, which slowly enlarges, then breaks down to form a sore.

53
Q

What are the common low risk HPV strains responsible for 90% genital warts?

A

HPV 6 & 11

54
Q

What are the common high risk HPV stains found in 70% of cervical cancer cases?

A

HPV 16&18

55
Q

Lifetime risk of infection with HPV?

A

80%

56
Q

Lifetime risk of cancer if infected with HPV 16 or 18

A

5% in unscreened

1-2% in screened women

57
Q

Gardasil vaccinate against which strains

A

6,11,16,18

58
Q

Tx of genital warts

A

Physical methods - weekly cryotherapy
podophyllotoxin applied BD for 3 days
imiqimod TDS

59
Q

On average if untreated how long does HIV take to develop into AIDS

A

10 years

60
Q

How is HIV diagnosed, the monitored

A

Antibody to gp120 or p24 antigen
Monitored by measuring CD4 lymphocytes
Conc of Viral RNA

61
Q

Treatment of HIV

A

1) Antiretrovirals → NRTI + NNRTI or protease inhibitor

2) Prophylaxis against opportunistic infections

62
Q

How often does vertical transmission happen in pregnancy of HIC if no interventions take place?

A

25-40%

With antiretrovirals 1.2%

63
Q

How often does transmission throughou the breastmilk occur?

A

15%

Breastfeeding should be avoided regardless of viral load

64
Q

Can women with HIV give birth vaginally?

A

Depend on 36 week viral load
<50: Yes
50-400: consider other risk factors
>400: ELCS or if taking zidovudine mono therapy

65
Q

When is infant Antiretroviral therapy(ART) given?

A

Depends on which risk group
Very low risk: 2 weeks zidovudine
Low risk: 4 week zidovudine
high risk: PEP

66
Q

How often should women with HIV have cervical cytology?

A

Yearly - HPV flourishes and higher risk cervical cancer

67
Q

What contraception can be offered to women taking antiretrovirals?

A

Depot infection

IUCD

68
Q

What can be offered to women how experience frequency UTI after sexual intercourse?

A

3-6 months of low dose abx either every night or after intercourse (trimethoprim 100mg on)

69
Q

Which bacteria can cause a more severe puerperal fever?

A

Group A strep

70
Q

How many women a year die from puerperal sepsis?

A

10

MRCOG Part one (28 decks)

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