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

15) Sexual & Reproductive Health - Sexually transmitted infections Flashcards

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
Q

Type of antibiotic azithromycin

A

Macrolide

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26
Q

Type of antibiotic doxycycline

A

Tetracycline

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27
Q

Type of antibiotic moxifloxacin

A

Fluoroquinolone

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28
Q

Serotypes of chlamydia responsible for urogenital infection

A

D-K

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29
Q

Serotypes of chlamydia responsible for LGV

A

L1-L3

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30
Q

Features of chlamydia trachomatis

A

Obligate intracellular bacteria

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31
Q

Most common curable bacterial STI in UK

A

Chlamydia

32
Q

Highest prevalence age for chlamydia

A

15-25

33
Q

Prevalence of chlamydia

A

5%

34
Q

Concordance rates for chlamydia

A

75%

35
Q

Rate of spontaneous resolution of chlamydia

A

50% within 12 months

36
Q

What percentage of women with chlamydia (untreated) will develop PID?

A

16%

37
Q

Re-infection rates of chlamydia

A

10-30%

38
Q

Diagnosis of chlamydia

A

NAAT

Vulvovaginal swabs from women, first pass urine from men

39
Q

Treatment of uncomplicated chlamydia infection

A

(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
Q

Treatment of chlamydia whilst pregnant/breast feeding

A

(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
Q

Test of cure for chlamydia?

A

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
Q

Clinical features of neonatal chlamydia and treatment

A
  • Ophthalmia neonatorum (5-12d PN)
  • Pneumonia (1-3m PN)
  • Treat with oral erythromycin for 14d
43
Q

Partner notification for chlamydia

A

Male index case with symptoms: All contacts since symptoms and in the 4 weeks preceding

All other index cases: 6m partner history

44
Q

Type of organism trichomonas

A

Flagellated protozoon

45
Q

What percentage of women affected by trichomonas have urethral infection?

A

90% (but only sole site of infection in 5%)

46
Q

Symptoms in trichomonas

A

10-15% asymptomatic
70% vaginal discharge (frothy yellow discharge 10-30%)
2% strawberry cervix

47
Q

Complications of trichomonas

A

PTB
IUGR
Maternal postpartum sepsis
Enhanced HIV transmission

48
Q

Diagnosis of trichomonas

A

NAAT is gold standard.
Culture is next best option.

Vaginal swab in women and urethral swab/first pass urine in men.

49
Q

Spontaneous cure rate of trichomonas

A

20-25%

50
Q

Management of trichomonas

A

(1) Metronidazole 2 gram PO STAT
(2) Metronidazole 400-500mg BD 5-7d
(3) Tinidazole 2 gram PO STAT

51
Q

Management of trichomonas in pregnancy/breast feeding

A

Avoid high dose metronidazole

Avoid tinidazole first trimester (and unsure if safe rest of time)

52
Q

Advice with metronidazole

A

Avoid alcohol for 48 hours following treatment (72h with tinidazole)

53
Q

Treatment failure options for trichomonas

A

(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
Q

Which partners to contact following gonorrhoea infection?

A

2w of symptomatic male partner.

3m for all others.

55
Q

Test of cure for gonorrhoea?

A

Yes, ideally 14d post completing of therapy (at least 72h)

56
Q

Which cases of gonorrhoea should be reported to public health england?

A

Ceftriaxone treatment failure

57
Q

Proportion of women with PID who have tubal infertility

A

1-20%

58
Q

Incidence of neonatal chlamydia

A

25%

59
Q

Treatment of neonatal chlamydia

A

Oral erythromycin 14 days

60
Q

Rate of co-existent mycoplasma and chlamydia

A

3-15%

61
Q

Description of bacterial vaginosis

A
  • Commonest cause of abnormal vaginal discharge

- Vaginal flora dominated by anaerobic bacteria (e.g. gardnerella)instead of lactobacilli

62
Q

Prevalence of bacterial vaginosis

A

At least 10%

63
Q

Risk factors for BV

A 
Vaginal douching
New sexual partner or multiple sexual partners
Other STIs
Receptive oral intercourse
Smoking
64
Q

Clinical features of BV

A

50% asymptomatic
Thin white discharge with fishy odour
No soreness/itching/irritation

65
Q

Diagnosis of BV

A

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
Q

Treatment for BV

A

Metronidazole (oral or intravaginal) or intravaginal clindamycin.

67
Q

When to treat BV?

A
  • Symptomatic
  • Risk factors for PTB
  • Prior to surgical procedure e.g. TOP
68
Q

Complications of BV

A

Non-obstetric: Increased risk of HIV acquisition

Obstetric: Late miscarriage, PTB, PPROM, postpartum endometritis

69
Q

Precautions with BV treatment

A
  • Use intravaginal if breast feeding
  • Avoid alcohol with metronidazole and for 48 hours
  • Avoid latex condoms with intravaginal clindamycin
70
Q

Definition of recurrent VVC

A

At least 4 episodes per 12 months with at least 2 confirmed by microscopy/culture (at least 1 by culture)

71
Q

Organism involved in VVC

A

80-90% candida albicans

72
Q

Risk factors for recurrent VVC

A
  • Persistence of candida
  • Immunosuppression
  • Poorly controlled diabetes
  • Extra oestrogen
  • Recent antibiotics
73
Q

Microscopy findings with VVC

A

Blastospores, pseudohyphae and neutrophils

Absence of neutrophils suggestive of colonisation rather than infection

74
Q

Role of culture in VVC

A

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
Q

Treatments for VVC

A
  • Fluconazole 150mg PO STAT
  • Clotrimazole 500mg pessary (if oral treatment contraindicated)

If severe: repeat treatment day 4

76
Q

Treatment for recurrent VVC

A
  • 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
Q

Precautions with treatment of VVC

A
  • Avoid orals in breastfeeding/pregnancy

- Topical treatments can damage latex condoms/diaphragms

Laura MRCOG Part 2 (56 decks)

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