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Laura MRCOG Part 2 > 15) Sexual & Reproductive Health - Sexually transmitted infections > Flashcards

15) Sexual & Reproductive Health - Sexually transmitted infections Flashcards

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1
Q

Type of organism Neisseria gonorrhoea

A

Gram negative diplococcus

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2
Q

Clinical features of gonorrhoea in women

A

50% altered/increased discharge

25% lower abdominal pain

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3
Q

What percentage of women with urogenital gonorrhoea also have rectal gonorrhoea?

A

1/3

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4
Q

What percentage of women with gonorrhoea get PID?

A

14%

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5
Q

What percentage of patients with gonorrhoea have concurrent chlamydia?

A

19%

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6
Q

Diagnostic options for gonorrhoea

A

(1) Microscopy - only suitable for men with penile discharge or rectal symptoms.
(2) NAAT- First pass urine for men, vulvovaginal swab for women
(3) Culture - for antimicrobial sensitivity

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7
Q

Who should have rectal/pharyngeal gonorrhoea testing?

A
  • All MSM
  • Women who are contacts of gonorrhoea
  • Based on risk assessment

Pharyngeal swabs if confirmed genital gonorrhoea and:

  • susceptibility unknown but may have been acquired in Asia/Pacific
  • confirmed resistant strain
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8
Q

When should testing be done after exposure to ensure adequate?

A

> 14 days

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9
Q

How long to abstain for after positive gonorrhoea diagnosis?

A

7 days from completion of treatment for patient and partner

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10
Q

Treatment options for uncomplicated gonorrhoea

A
  1. Ceftriaxone 1 gram IM STAT
  2. If known to be sensitive - ciprofloxacin 500mg PO STAT

Alternatives if required:

  • Cefixime 400mg PO and azithromycin 2 gram PO
  • Gentamicin 240mg IM and azithromycin 2 gram PO
  • Spectinomycin 2g IM and azithromycin 2 gram PO
  • Azithromycin 2 gram PO
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11
Q

Rates of ciprofloxacin resistance of gonorrhoea in UK

A

35%

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12
Q

Rates of azithromycin resistance of gonorrhoea in UK

A

9%

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13
Q

Treatment of disseminated gonococcal infection

A
  • Ceftriaxone 1 gram IM/IV every 24 hours OR cefotaxime 1 gram every 8 hours or ciprofloxacin 500mg IV BD or spectinomycin 2g IM BD

After 24-48h can convert to:

  • Cefixime 400mg BD
  • CIprofloxacin 500mg BD
  • Ofloxacin 400mg BD
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14
Q

Treatment of gonorrhoea whilst pregnant/breast feeding

A
  1. Ceftriaxone
  2. Spectinomycin
  3. Azithromycin (only if no other options)
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15
Q

Features of mycoplasma genitalium

A
  • Mollicutes class
  • Smallest self replicating bacteria
  • Fastidious. Weeks to culture.
  • “tip like” projection which allows epithelial cell adherence and invasion
  • No cell wall therefore can’t gram stain
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16
Q

Prevalence of myocoplasma genitalium in general population

A

1-2%

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17
Q

Clinical features mycoplasma genitalium

A

> 90% asymptomatic

  • 10-20% of NGU
  • 10-13% of PID
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18
Q

How to test for mycoplasma?

A

NAAT (culture is no use - too slow)
Men - first void urine, women - HVS + endocervical swab
Test all for macrolide resistance (azithromycin)

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19
Q

Rate of macrolide resistance in mycoplasma genitalium

A

40%

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20
Q

Treatment of uncomplicated mycoplasma genitalium

A

(1) Doxycycline 100mg BD for 7 days THEN azithromycin 1 gram STAT THEN azithromycin 500mg OD for 2 days
(2) Moxifloxacin 400mg OD 10 days if macrolide resistant

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21
Q

Treatment of complicated mycoplasma genitalium

A

Moxifloxacin 400mg OD 14 days

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22
Q

Who to do partner notification for in mycoplasma?

A

Current partners

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23
Q

Treatment of mycoplasma in pregnancy/breast feeding

A

3d azithromycin but not moxi/doxy

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24
Q

Test of cure in mycoplasma?

A

3-5 weeks after start of treatment

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25
Type of antibiotic azithromycin
Macrolide
26
Type of antibiotic doxycycline
Tetracycline
27
Type of antibiotic moxifloxacin
Fluoroquinolone
28
Serotypes of chlamydia responsible for urogenital infection
D-K
29
Serotypes of chlamydia responsible for LGV
L1-L3
30
Features of chlamydia trachomatis
Obligate intracellular bacteria
31
Most common curable bacterial STI in UK
Chlamydia
32
Highest prevalence age for chlamydia
15-25
33
Prevalence of chlamydia
5%
34
Concordance rates for chlamydia
75%
35
Rate of spontaneous resolution of chlamydia
50% within 12 months
36
What percentage of women with chlamydia (untreated) will develop PID?
16%
37
Re-infection rates of chlamydia
10-30%
38
Diagnosis of chlamydia
NAAT | Vulvovaginal swabs from women, first pass urine from men
39
Treatment of uncomplicated chlamydia infection
(1) Doxycycline 100mg BD 7 days (2) Azithromycin 1 gram STAT then 500mg OD 2/7 Alternatives: - Erythromycin 500mg BD 10-14d - Ofloxacin 200mg BD or 400mg OD 7d
40
Treatment of chlamydia whilst pregnant/breast feeding
(1) Azithromycin 1 gram then 500mg OD 2/7 (2) Erythromycin 500mg QDS for 7 days (3) Erythromycin 500mg BD for 14 days (4) Amoxicillin 500mg TDS for 7 days
41
Test of cure for chlamydia?
Not routinely recommended as non-viable DNA can remain up to 3-5 weeks. Recommended in pregnancy/suspected poor compliance or persistent symptoms (no earlier than 3 weeks after completing treatment)
42
Clinical features of neonatal chlamydia and treatment
- Ophthalmia neonatorum (5-12d PN) - Pneumonia (1-3m PN) - Treat with oral erythromycin for 14d
43
Partner notification for chlamydia
Male index case with symptoms: All contacts since symptoms and in the 4 weeks preceding All other index cases: 6m partner history
44
Type of organism trichomonas
Flagellated protozoon
45
What percentage of women affected by trichomonas have urethral infection?
90% (but only sole site of infection in 5%)
46
Symptoms in trichomonas
10-15% asymptomatic 70% vaginal discharge (frothy yellow discharge 10-30%) 2% strawberry cervix
47
Complications of trichomonas
PTB IUGR Maternal postpartum sepsis Enhanced HIV transmission
48
Diagnosis of trichomonas
NAAT is gold standard. Culture is next best option. Vaginal swab in women and urethral swab/first pass urine in men.
49
Spontaneous cure rate of trichomonas
20-25%
50
Management of trichomonas
(1) Metronidazole 2 gram PO STAT (2) Metronidazole 400-500mg BD 5-7d (3) Tinidazole 2 gram PO STAT
51
Management of trichomonas in pregnancy/breast feeding
Avoid high dose metronidazole | Avoid tinidazole first trimester (and unsure if safe rest of time)
52
Advice with metronidazole
Avoid alcohol for 48 hours following treatment (72h with tinidazole)
53
Treatment failure options for trichomonas
(1) Repeat 7d course metronidazole (40% respond) (2) High dose metronidazole (2gram OD 5-7d or 800mg TDS 7d) - 70% respond (3) Tinidazole 1gram BD/TDS for 14d +/- intravaginal tinidazole 500mg BD 14 days (AND do resistance testing)
54
Which partners to contact following gonorrhoea infection?
2w of symptomatic male partner. | 3m for all others.
55
Test of cure for gonorrhoea?
Yes, ideally 14d post completing of therapy (at least 72h)
56
Which cases of gonorrhoea should be reported to public health england?
Ceftriaxone treatment failure
57
Proportion of women with PID who have tubal infertility
1-20%
58
Incidence of neonatal chlamydia
25%
59
Treatment of neonatal chlamydia
Oral erythromycin 14 days
60
Rate of co-existent mycoplasma and chlamydia
3-15%
61
Description of bacterial vaginosis
- Commonest cause of abnormal vaginal discharge | - Vaginal flora dominated by anaerobic bacteria (e.g. gardnerella)instead of lactobacilli
62
Prevalence of bacterial vaginosis
At least 10%
63
Risk factors for BV
``` Vaginal douching New sexual partner or multiple sexual partners Other STIs Receptive oral intercourse Smoking ```
64
Clinical features of BV
50% asymptomatic Thin white discharge with fishy odour No soreness/itching/irritation
65
Diagnosis of BV
Either Hay/Ison criteria or Amsel criteria. Hay/Ison: - Look at gram stained vaginal smear and evaluate based on predominance of lactobacilli v gardnerella/mobiluncus. grade 1-3 with grade 3 being BV Amsel: 3/4 of: - White discharge - Fishy odour when adding alkali - ph >4.5 - Clue cells
66
Treatment for BV
Metronidazole (oral or intravaginal) or intravaginal clindamycin.
67
When to treat BV?
- Symptomatic - Risk factors for PTB - Prior to surgical procedure e.g. TOP
68
Complications of BV
Non-obstetric: Increased risk of HIV acquisition | Obstetric: Late miscarriage, PTB, PPROM, postpartum endometritis
69
Precautions with BV treatment
- Use intravaginal if breast feeding - Avoid alcohol with metronidazole and for 48 hours - Avoid latex condoms with intravaginal clindamycin
70
Definition of recurrent VVC
At least 4 episodes per 12 months with at least 2 confirmed by microscopy/culture (at least 1 by culture)
71
Organism involved in VVC
80-90% candida albicans
72
Risk factors for recurrent VVC
- Persistence of candida - Immunosuppression - Poorly controlled diabetes - Extra oestrogen - Recent antibiotics
73
Microscopy findings with VVC
Blastospores, pseudohyphae and neutrophils | Absence of neutrophils suggestive of colonisation rather than infection
74
Role of culture in VVC
No role in acute presentations but in recurrent it should be used to identify growth to a species level and test for fluconazole sensitivity.
75
Treatments for VVC
- Fluconazole 150mg PO STAT - Clotrimazole 500mg pessary (if oral treatment contraindicated) If severe: repeat treatment day 4
76
Treatment for recurrent VVC
- Fluconazole every 72 hours for 3 doses and then weekly for 6 months - Clotrimazole daily for 7-14d and then weekly If non-albicans or azole resistant: Nystatin pessaries.
77
Precautions with treatment of VVC
- Avoid orals in breastfeeding/pregnancy | - Topical treatments can damage latex condoms/diaphragms

Laura MRCOG Part 2 (56 decks)

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