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Repro > Infections of the repro tract > Flashcards

Infections of the repro tract Flashcards

1
Q

What are the two ways infections of reproductive tract are classified?

A

Sexually transmitted vs non-sexually transmitted

Based on presenting symptom

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2
Q

STI’s

A

Chlamydia
Gonorrhoea
Genital herpes
Genital warts
HIV
Syphilis
Trichomoniasis

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3
Q

Non STI’s

A

Thrush (candida albicans)
Bacterial vaginosis

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4
Q

Who are STIs most prevalent in?

A

Age 20-24 year olds

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5
Q

Most common STI

A

Chlamydia (then gonorrhoea)

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6
Q

Ethnic group most commonly affected by STI’s

A

Black caribbean
Black African
Mixed race

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7
Q

Area where STIs are prevelant

A

London

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8
Q

Risk factors for STI

A

Sexual behaviours:
Multiple partners
Not using barrier contraception
Early age first intercourse
Certain sexual practives
Men who have sex with men
Sex workers

Other:
Low socio-economic staus
Race - black caribbean or black african
Lack of immunisation (hep B and HPV)
Younger age 15-24

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9
Q

Differentials for male urethral discharge

A

Chlamydia
Gonorrhoea
Non-gonococcal urethritis

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10
Q

What is chlamydia caused by and gram stain?

A

Chlamydia trachomatis - obligate intracellular bacterium
Gram -ve
(acts like a virus)

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11
Q

What is a virulence factor of chlamydia trachomatis?

A

Has unique cell wall - inhibits phagolysosome fusion
= can’t be destroyed

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12
Q

Presentation of chlamydia in men

A

Asymptomatic typically or:
Testicular pain
Dysuria
+/- Discharge

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13
Q

What causes gonorrhoea and gram stain?

A

Neisseria gonorrhoea - Gonococcus
Gram -ve diplococci, unencapsulated, pilated

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14
Q

Presentation of gonorrhoea men vs women

A

90% symptomatic men, only 50% women symptomatic

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15
Q

Symptoms of gonorrhoea in male

A

Thick, yellow discharge +/- dysuria

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16
Q

What is non-gonococcal urethritis?

A

Inflammation of the urethra with associated discharge that is not caused by gonorrhoea

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17
Q

What can cause non-gonococcal urethritis?

A

can be STI:
Chlamydia trachomatis
Mycoplasma genitalium
Trichomonas vaginalis

or can be pathogen negative - less common, more often older men

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18
Q

2 investigations for male presenting with discharge

A

Urine sample:
for gonorrhoea (MC&S)
Chlamydia (NAATs is most sensitive and specific - Nucleic acid amplification tests
Urethritis
AND it excludes a UTI

Urethral swab:
for gonorrhoea

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19
Q

What should you do if someone is presenting with 1 STI symptom?

A

Screen for other STI’s - HIV, syphilis, hepatitis

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20
Q

Differentials for women presenting with vaginal discharge

A

Physiological
Neisseria gonorrhoeae
Chlamydia trachomatis
Trichomoniasis - trichomonas vaginalis
Candidiasis - candida albicans
Bacterial vaginosis - Gardnerella

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21
Q

Physiological discharge explained

A

In secretory phase (within luteal phase), progesterone causes thick cervical mucus to form

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22
Q

Features of physiological discharge

A

Cyclical
No other associated symptoms
Clear

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23
Q

STI’s that can cause unusual discharge in women

A

Neisseria gonorrhoeae
Chlamydia trachomatis

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24
Q

Presentation of neisseria gonorrhoeae in women

A

50% asymptomatic or:
Dysuria
Increased/altered vaginal discharge
Lower abdominal pain
Intermenstrual bleeding or menorrhagia
Dyspareunia

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25
Q

Presentation of chlamydia trachomatis female

A

Asymptomatic 70% or:
Increased or purulent discharge
Post coital or intermenstrual bleeding
Deep dyspareunia
Dysuria

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26
Q

What causes trichomoniasis?

A

Trichomonas vaginalis - protozoa with flagella for mobility

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27
Q

Optimal growth for trichomonas vaginalis

A

pH 6 (less acidic than normal vagina)

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28
Q

Symptoms in trichomonas vaginalis women

A

Frothy, yellow and green dishcharge
Vulval itching/soreness or ulceration

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29
Q

Treatment for trichomonas vaginalis

A

Metronidazole - cannot have alcohol with as inhibits aldehyde dehydrogenase

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30
Q

Trichomoniasis vs BV

A

BV - fishy odour with no vulval itch
Trich - vulval itching, no fishy odour

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31
Q

Non sexually transmitted infections causing discharge in women

A

Candidiasis - candida albicans
Bacterial vaginosis - Gardnerella

32
Q

How does candidiasis occur?

A

Candida albicans is part of normal vaginal flora
Overgrowth causes symptoms

33
Q

Who is likely to get candidiasis?

A

Immunocompromised
Diabetes
Post antibiotics - wipes out normal flora removing competition
High oestrogen - combined oral contraceptive pill

34
Q

Symptoms of candidiasis

A

Vulval/vaginal itching defining symptom)
Vulval/vaginal soreness and irritation
Vaginal discharge - cheese like, white, no odour
Superficial dyspareunia
Dysuria

35
Q

treatment for candidiasis

A

Clotrimazole pessary or tablet

36
Q

Usual bacteria causing bacterial vaginosis

A

Gardnerella vaginalis - becomes dominant over lactobacillus
Overgrowth of anaerobic organisms (esp GV)
Loss of lactobacilli

37
Q

Problem with losing lactobacilli

A

Vagina loses usual acidity
Vaginal pH goes >4.5

38
Q

Risk factors for bacterial vaginosis

A

Not an STI but being sexually active has higher prevalence

Receiving oral sex

Vaginal washes/douches

Smoking

39
Q

Symptoms of BV

A

Fishy smelling, thin, grey/white homogenous (watery, milk like) discharge]
NO ITCHING/SORENESS

40
Q

Investigations for women presenting with unusual vaginal discharge

A

Vaginal swabs

41
Q

Which organisms are detected using vulvo-vaginal swabs and endocervical swabs?

A

Chlamydia trachomatis
Neisseria Gonorrhoeae

42
Q

Which organisms are detected using high vaginal swab (posterior fornix)

A

Trichomonas vaginalis
Bacterial vaginosis - Gardnerella
Candida albicans (for MC and S)

43
Q

Additonal findings on bacteria vaginosis swab test

A

Gram stain would contain clue cells
Vaginal pH >4.5 and positive whiff test (fishy odour after adding KOH to the sample)

44
Q

Why do we not use urine dip for women STI’s/non sti’s?

A

Not as effective at detecting in women - need SWABS

45
Q

Genital lesions in men and women

A

HPV - human papilloma virus
Herpes simplex virus
Syphilis

46
Q

What type of virus is HPV?

A

DNA virus (non-enveloped)
Can cause genital or cutaneous warts

47
Q

HPV number which causes genital and HPV number which is associated with cervical cancer

A

Genital warts - 6 and 11
Cervical cancer - 16 and 18

48
Q

How can we identify HPV high risk individuals?

A

PCR - from biopsy/swab

49
Q

Preventing HPV?

A

Vaccine -
Gardasil (6,11,16 and 18, protects against genital warts and cancers)

Cervarix (just 16 and 18, only protective against cervical cancer)

50
Q

What type of virus is herpes simplex virus?

A

DNA virus enveloped - LIFELONG, stays latent in sensory neurones
Can get recurrent infections

51
Q

Presentation of herpes simplex virus

A

Asymptomatic initially or with painful ulcers/blisters
Can have systemic symptoms - fever, body aches etc

52
Q

Types of HSV and what they are associated with

A

HSV 1 - cold sores
HSV 2 - more likely to become infected with HIV

53
Q

Where to check for herpes simplex virus?

A

Genitals
Mouth
Anus

(need to know what kind of sex they’re having)

54
Q

Testing for HSV

A

Swabs sent for PCR or nucleic acid amplification tests

55
Q

Management of HSV

A

Cannot eradicate but can reduce severity and duration of episode with antivirals eg ACICLOVIR

56
Q

What causes syphilis?

A

Treponema Pallidum - spirochete

57
Q

Transmission of syphilis

A

Direct contact with syphilitic sore
Vertical transmission (mother to baby)
40% coinfected with HIV

58
Q

Stages of syphilis

A

Primary - painless ulcers

Secondary - 4-10 weeks after infection, multisystem widespread rash, can enter latent phase

Tertiary syphilis - 1-46 years after exposure - neurological, CVS and gummatous (flesh destroyed)

59
Q

Diagnosing syphilis

A

Microscopy, PCR, serology

60
Q

Treatment for syphilis

A

Penicillin based antibiotics

61
Q

General management for STIs

A

Screen for others - coinfections common
Consider presenting complaint
Contact tracing
Appropriate investigation and therapy

62
Q

Bacterial STI management

A

Multiple antibiotics (co-infections common)
Azithromycin + Ceftriaxone

63
Q

Patient education management STI

A

Barrier contraception
Avoid sex until treatment complete

64
Q

Syphilis vs herpes ulcers

A

Syphilis - usually one ulcer
Herpes - several

65
Q

Herpes lesions look like

A

Fluid filled blisters

66
Q

Non STI management

A

Use therapy for target organism
Remove precipitating features (eg douching)
Educate patients on COCP and vaginal hygiene

67
Q

What is pelvic inflammatory disease?

A

Infection of the upper genital tract ascending from the endocervixus causing inflammation

68
Q

What can PID cause inflammation of?

A

Endometritis (endometrium)
Salpingitis (fallopian tubes)
Parametritis
Oophoritis (ovaries)
Tubo-ovarian abscess
Pelvic peritonitis

69
Q

Cause of PID

A

ALMOST ALWAYS STI - chlamydia trachomatis, mycoplasma genitalium, neisseria gonorrhoeae

Or can be normal vaginal flora

70
Q

PID symptoms

A

Pelvic pain, lower abdo pain
Discharge
Post coital/intermenstrual bleeding
fever
Dysparenuria
Right upper quadrant pain - due to peri hepatitis
Secondary dysmenorrhoea

71
Q

Signs of PID

A

Lower abdo tenderness
Internal exam shows: adnexal tenderness, cervical motion tenderness, uterine tenderness
Abnormal cervical or vaginal mucopurulent (pus) discharge
Fever >38

72
Q

Differentials for pelvic/lower abdo pain

A

Ectopic pregnancy
Appendicitis
Ovarian cyst
Endometriosis
UTI

73
Q

Early complications of PID

A

Sepsis
Peritonitis

74
Q

Late complications of PID

A

Chronic pelvic pain
Pelvic abscess
Subfertility (adhesions from chronic inflammation, increased ectopic risk, reduced chance successful fertilisation)
Peri hepatitis - peritonitis Fitz-Hugh Curtis syndrome

75
Q

management of PID

A

Admit if unwell - eg signs of peritonitis, fever etc
Start empirical abx ASAP eg oral Ofloxacin adn metronidazole
Screen for other STIs
Contact tracing
Advise on potential complications, barrier contraceptives

Repro (22 decks)

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