2.4 Genital Tract Infections Flashcards
(41 cards)
Physiological vaginal discharge is usually white/clear, non-offensive and varies cyclically:
• Contains _____________ (containing dead vaginal cells), ____________ (secreted by cervical glands), and _____________ (smaller amount)
• Lactobacilli in the vagina convert _______________ in the epithelium → acidifies the vaginal discharge (as transudate passes through) → pH 4 – 5 (inhibits multiplication of other microorganisms)
vaginal transudate;
cervical mucus;
endometrial gland secretions
glycogen to lactic acid
what is the clinical presentation of bacteria vaginosis?
60% of affected women are asymptomatic:
• Fishy-smelling, white/grey vaginal discharge (if symptomatic)
what are the complications of bacteria vaginosis?
- Obstetric: preterm birth, preterm rupture of membranes, post-abortal or postpartum infections
- Gynaecological: PID, acquisition of STIs, plasma-cell endometritis, post-hysterectomy vagina cuff cellulitis
What is the diagnostic criteria of bacteria vaginosis?
Fulfilling 3 out of 4 of the Amsel’s criteria:
- Greyish-white vaginal discharge
- Clue cells on saline wet mount involving > 20% of epithelial cells
- pH > 4.5
- Positive whiff test: 10% KOH applied to vaginal discharge sample on saline wet mount microscopy → fishy odour
What is the treatment of the bacteria vaginosis?
Metronidazole (anti-anaerobe spectrum of activity)
What is recurrent vulvovaginal candidasis?
≥ 4 episodes of symptomatic infection in 1 year
What is the clinical presentation of vulvovaginal candidasis?
Symptoms: vulvar pruritus (itching), vulva pain & irritation (may cause dysuria and dyspareunia)
Signs: curd-like discharge (on vaginal examination), erythematous vulva/vagina, vulva excoriation/fissure
What are the risk factors for vulvovaginal candiasis?
Diabetes mellitus, antibiotic use (wipes out bacterial flora → allows Candida to proliferate), increased oestrogen levels (e.g. OCP, pregnancy), immunosuppression (increased risk of fungal infections), sex
What is the diagnostic criteria of vulvovaginal candiasis?
- Presence of the characteristic clinical symptoms
2. Presence of Candida on microscopy (wet mount, Gram stain) or on vaginal culture
What is the treatment for uncomplicated infections (sporadic mild to moderate infections by C. albicans in normal hosts)
oral fluconazole (150mg x 1 dose), topical/vaginal antifungal agents (e.g. isoconazole, clotrimazole)
What is the treatment for complicated/recurrent infections (severe signs/symptoms, non-albicans species, immunocompromised state): multiple doses of oral antifungal agents for longer periods of time
3 doses of oral fluconazole 2 hours apart → followed by weekly maintenance doses
Group B Streptococcus (S. agalactiae) is a _____________ which frequently colonises the _______________.
Pathogenesis: Pregnant women: 20 – 40% maternal carriage (intermittently) → frequently affects the urinary system
• Causes ___________ (marker for heavy genital GBS colonisation; increased infection risk), cystitis, pyelonephritis
• Maternal infections (e.g. chorioamnionitis) associated with ____________ (e.g. endometritis)
Foetal: 80% maternal-to-foetal colonisation rate (0.5 in 1000 births with invasive neonatal disease)
• Most common onset of severe early onset infection in newborns
• Associated with _______________
Gram-positive coccus;
genital and gastrointestinal tracts
asymptomatic bacteriuria;
pregnancy loss, preterm delivery, postpartum infections;
generalised sepsis, pneumonia, meningitis
What is the investigation for Group B Streptococcus (S. agalactiae
GBS screening at 35 – 37 weeks of gestation or 3 – 5 weeks before the anticipated delivery date (for vaginal births)
What is the treatment for Group B Streptococcus (S. agalactiae
Prevent transmission to foetus: intrapartum antibiotic prophylaxis Treatment: IV benzylpenicillin or clindamycin (if penicillin allergy) until delivery
Actinomyces is a _____________ which is a part of the normal GI flora and often present in the vagina without symptoms/sequelae:
• Actinomyces-like organisms seen in 0.26% of Pap smears without IUCD (intrauterine contraceptive device) and 7% of Pap smears with IUCD
• If Actinomyces is seen on Pap smear, evaluate the patient for symptoms of PID and perform a _______________
Gram-positive anaerobic rod;
cervical culture for Actinomyces
what is the treatment for asymptomatic for PID + culture negative for actinomyces?
Leave IUCD in place (no further treatment)
what is the treatment for asymptomatic for PID + symptomatic for PID and/or Actinomyces on cervical culture?
Penicillin/tetracycline + empirical treatment Remove IUCD after initiation of antibiotics
Neisseria gonorrhoeae (gonococcus) is a Gram-negative diplococcus which infects the mucous membranes of the \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ • 40% of patients with gonorrhoea also have \_\_\_\_\_\_\_\_\_\_\_
endocervix, urethra, rectum, pharynx, and conjunctiva;
concurrent chlamydia
What are the presentations of cervicitis due to neisseria gonorrhoea?
- Typical: mucopurulent vaginal discharge, vaginal pruritus • Other symptoms: IMB, dyspareunia
- Gonococcal cervical infection is indistinguishable from acute cervicitis of other causes
what is the presentation of urethritis due to neisseria gonorrhoea?
Presents with dysuria, frequency and urgency
what is the presentation of PID due to neisseria gonorrhoea?
Presents with abdominal pain, abnormal vaginal discharge/bleeding, dyspareunia, perihepatitis (Fitz-Hugh-Curtis syndrome) → inflammation of peritoneal coating of the liver)
what is the extragenital presentation of neisseria gonorrhoea?
Conjunctivitis, pharyngitis, proctitis (inflammation of rectum and anus)
Disseminated gonococcal infection: purulent arthritis or triad of tenosynovitis (synovium surrounding tendon), dermatitis, polyarthralgias
what are the complications of neisseria gonorrhoea?
Obstetric: chorioamnionitis, preterm birth, low birth weight
Foetal transmission: gonococcal ophthalmia neonatorum (neonatal conjunctivitis), other localised infections (neonatal vaginitis, proctitis, urethritis), disseminated infections, scalp abscess
what are the investigations of neisseria gonorrhoea?
- Nucleic acid amplification test on urogenital/ extragenital specimens
- Gram stain and culture
- Check for co-infection with Chlamydia trachomatis
