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Reproductive systems > Infections of the reproductive tract > Flashcards

Infections of the reproductive tract Flashcards

1
Q

Give some examples of STIs

A
  • Chlamydia
  • Gonorrhoea
  • Genital herpes
  • Genital warts
  • HIV
  • Syphilis
  • Trichomoniasis
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2
Q

Give some examples of non STI infections affecting the reproductive tract

A
  • Thrush
  • Bacterial vaginosis
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3
Q

What are the sexual behaviours that are risk factors for developing an STI?

A
  • Multiple sexual partners
  • Not using barrier contraception
  • Early age first intercourse
  • Certain sexual practices
  • Men who have sex with men
  • Sex workers
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4
Q

What are the other risk factors for developing an STI (non-sexual behaviour related)?

A
  • Low socio-economic status
  • Race/ethnicity (black Caribbean/African)
  • Lack of immunisation (Hep B, HPV)
  • Younger age 15-24
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5
Q

Which infections cause discharge in males?

A
  • Discharge comes from urethra
  • Chlamydia
  • Gonorrhoea
  • Non-gonococcal urethritis
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6
Q

Outline Chlamydia trachomatis

A
  • Most common STI in the UK
  • Unique cell wall; inhibits phagolysosome fusion (virulence factor)
  • Typically asymptomatic in men
  • Can cause testicular pain, dysuria
  • May have discharge
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7
Q

Outline Neisseria gonorrhoeae

A
  • Gonococcus
  • Gram negative
  • Diplococci
  • Unencapsulated, pilated
  • Most men are symptomatic
  • Only 50% of women are symptomatic
  • Causes thick, yellow discharge +/- dysuria
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8
Q

Outline non-gonococcal urethritis

A
  • Inflammation of urethra with associated discharge
  • Not caused by gonorrhoea
  • Can be sexually transmitted (chlamydia trichomatis, mycoplasma genitalium, trichomonas vaginalis)
  • Can be pathogen negative (less common, older men)
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9
Q

What investigations are done to find out why a man has urethral discharge?

A
  • Gonorrhoea: microscopy and culture, NAATs
  • Chlamydia: NAATs (most sensitive and specific)
  • Urethritis: NAATs
  • Excludes UTI as a cause of dysuria
  • Remember to screen for other STIs
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10
Q

Outline physiological discharge

A
  • Progesterone in secretory phase (post-ovulation)
  • Thicker cervical mucus
  • Cyclical
  • No other associations
  • Clear
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11
Q

How does N. gonorrhoeae affect women?

A
  • 50% asymptomatic
  • Dysuria
  • Increased or altered vaginal discharge
  • Lower abdominal pain
  • Intermenstrual bleeding or menorrhagia
  • Dyspareunia
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12
Q

How does C. trachomatis affect women?

A
  • Asymptomatic in 70%
  • Increased or purulent vaginal discharge
  • Post-coital or intermenstrual bleeding
  • Deep dyspareunia
  • Dysuria
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13
Q

Outline trichomoniasis infection (trichomonas vaginalis)

A
  • Protozoa (flagellates)
  • Presence of flagella allows mobility
  • Optimal growth ~pH 6.0 (vaginal pH ~4.0)
  • Increased alkalinity of vagina favours acquisition of disease
  • Causes copious, yellow, odorous discharge
  • Discharge is frothy
  • Vulval itching/soreness or ulceration
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14
Q

What is the treatment for trichomoniasis infection (trichomonas vaginalis)?

A
  • Metronidazole
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15
Q

Outline candidiasis (candida albicans)

A
  • Yeast: normal vaginal flora
  • Activated in immunocompromised states, diabetes or post antibiotics
  • Favours high oestrogen
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16
Q

Outline the symptoms of candidiasis

A
  • Vulval or vaginal itching
  • Vulval or vaginal soreness and irritation
  • Vaginal discharge (usually white, cheese-like and non-malodorous)
  • Superficial dyspareunia
  • Dysuria
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17
Q

Outline bacterial vaginosis (Gardnerella)

A
  • Characterised by an overgrowth of predominantly anaerobic organisms
  • E.g. Gardnerella vaginalis, prevotella species, mycoplasma hominis
  • Vagina loses its normal acidity and vaginal pH increases to greater than 4.5
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18
Q

What are the risk factors for bacterial vaginosis?

A
  • Not an STI; however prevalence is higher amongst sexually active women and in those with a new partner
  • Receiving oral sex
  • Vaginal washes/douching
  • Smoking
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19
Q

What are the symptoms of bacterial vaginosis?

A
  • Fishy-smelling, thin, grey/white homogeneous discharge
  • Not associated with itching or soreness
20
Q

How are STIs investigated in women?

A
  • Chlamydia: vulvo-vaginal swabs (VVS), endocervical swab
  • Gonorrhoea: VVS, endocervical swab
  • Trichomoniasis: high vaginal swab (HVS) in posterior fornix
  • BV: HVS, vaginal pH >4.5, whiff test
  • Candida: HVS; microscopy > culture
21
Q

Define physiological vaginal discharge

A
  • Thickened cervical mucus in latter stage of menstrual cycle
22
Q

What are the causes of infective vaginal discharge?

A
  • Sexually transmitted e.g. N. Gonorrhoeae, C. trachomatis, T. vaginalis
  • Non-sexually transmitted e.g. bacterial vaginosis, candidiasis
23
Q

Outline HPV

A
  • DNA virus (non-enveloped)
  • Can cause genital or cutaneous warts
  • Many many different types
  • 6 and 11 cause 90% of genital infections
  • 16 and 18 have highest association with cervical cancer
  • Can do PCR to identify high risk types
  • Vaccination exists
24
Q

Outline herpes simplex virus

A
  • DNA virus (enveloped)
  • Lifelong infection
  • Initial then recurrent infection
  • Can be asymptomatic initially or present with painful ulcers/blisters
  • Can be accompanied by systemic symptoms
25
Q

Which areas need to be checked for evidence of herpes infection?

A
  • Genitals
  • Mouth
  • Anus
26
Q

How do we diagnose herpes?

A
  • PCR
  • NAATs
27
Q

How do we manage herpes?

A
  • Management: antivirals e.g. acyclovir
  • Cannot eradicate infection
  • Reduce severity and duration of current episode
  • Limited effect frequency/severity of repeated episodes
28
Q

Outline syphilis (treponema pallidum)

A
  • Transmitted by direct contact and vertical transmission
  • Not as common generally
  • 40% co-infected with HIV
29
Q

What are the symptoms of primary syphilis?

A
  • Typically painless ulcers
30
Q

What are the symptoms of secondary syphilis?

A
  • 4-10 weeks after initial infection
  • Multi-system
  • Can enter a latent phase
31
Q

What are the symptoms of tertiary syphilis?

A
  • 1-46 years after exposure
  • Neurological/cardiovascular/gummatous
32
Q

How do we diagnose syphilis?

A
  • Microscopy
  • PCR
  • Serology
33
Q

How do we manage syphilis?

A
  • Penicillin based antibiotics
34
Q

What is the general management of STIs?

A
  • Co-infections are common
  • Consider screening for others
  • Consider presenting complaint
  • Appropriate investigation and therapy
  • Contact tracing
35
Q

How are bacterial STIs treated?

A
  • Can give multiple antibiotics (co-infections)
  • E.g. azithromycin and ceftriaxone
  • Targets different organisms
  • One antibiotic can augment the effect of the other
36
Q

How can we educate patients about STIs?

A
  • Barrier contraception
  • Other ‘safe sex’ advice
  • Avoid sex until course of treatment is completed
37
Q

How do we treat non-sexually transmitted infections?

A
  • Use appropriate therapy for organism (Candida treated with antifungals and BV treated with antibiotics)
  • Try and remove precipitating features
  • Patient education (COCP and vaginal hygiene)
38
Q

Define PID

A
  • Pelvic inflammatory disease is a general term for infection of the upper genital tract
39
Q

What does PID result from?

A

Ascending infection from the endocervix causing one or more of the following:
- Endometriosis
- Salpingitis
- Parametritis
- Oophoritis
- Tubo-ovarian abscess
- Pelvic peritonitis

40
Q

What normally causes PID?

A
  • Chlamydia trachomatis
  • Neisseria gonorrhoeae
  • Mycoplasma genitalium
  • Organisms in normal vaginal flora
41
Q

What are the symptoms of PID?

A
  • Pelvic pain/lower abdominal pain
  • Discharge
  • Post coital/intermenstrual bleeding
  • Fever
  • Dyspareunia
  • Right upper quadrant pain due to peri-hepatitis (Fitz-Hugh-Curtis syndrome)
  • Secondary dysmenorrhoea
42
Q

What are the signs of PID?

A
  • Lower abdominal tenderness (usually bilateral)
  • Adnexal tenderness (with or without a palpable mass)
  • Cervical motion tenderness or uterine tenderness
  • Abnormal cervical or vaginal mucopurulent discharge
  • Fever greater than 38 0C
43
Q

What are the differentials for pelvic/lower abdominal pain?

A
  • Ectopic pregnancy
  • Appendicitis
  • Endometriosis
  • Ovarian cyst
  • UTI
44
Q

What are the early complications of PID?

A
  • Sepsis
  • Peritonitis
45
Q

What are the late complications of PID?

A
  • Chronic pelvic pain
  • Pelvic abscess
  • Can lead to subfertility (adhesions from chronic inflammation, increased risk of ectopic pregnancy, reduced likelihood of successful fertilisation)
  • Peritonitis Fitz-Hugh Curtis Syndrome
46
Q

How is PID managed?

A
  • Admit if unwell
  • Start empirical antibiotics as soon as a presumptive diagnosis of PID is made clinically
  • Screen for other STIs
  • Contact tracing
  • Advise re completing course, potential complications, barrier contraceptive

Reproductive systems (20 decks)

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