Urethritis and Cervicitis MR

Question 1

Causes of vaginal discharge (5)

Answer 1

1. physiological
2. cervicitis
3. genital candidiasis
4. bacterial vaginosis
5. other ie vaginitis and foreign body (tampon)

Question 2

Chlamydia

Answer 2

1. intracellular bacteria

2. biphasic lifecycle about 24-48 hours

Question 3

Life cycle

Answer 3

1. attachment and entry of elementary body into cell (6 hrs)
2. Formation of reticulate body (8 hrs)
3. Binary fission of reticulate body (24 hrs)
4. reorganization of reticulate bodies into elementary bodies (30 hrs)
5. release of elementary bodies (48 hrs)

Question 4

Types of diagnosis

Answer 4

1. NAAT (nucleic acid amplification testing)

2. CT diagnosis

Question 5

Specimen collection

Answer 5

Males: FVU
Females:
1. vulvovaginal swab for NAAT
2. speculum examination

Question 6

Treatment

Answer 6

1. Azithromycin 1gm stat
2. Doxycycline 100mg bid 7 days

(pregnant woman)

1. Azithromycin 1g stat
2. Amoxycillin 500mg tid for 7 days

Question 7

Neisseria gonorrhoea

Answer 7

1. gram negative diplococcus
2. humans are the only natural host
3. infect non-cornified epithelium via intracellular replication
4. oxidase positive
5. fastidious growth
6. chromosomal or plasmid mediated antibiotic resistance

Question 8

Pathogenic and defence mechanisms (5)

Answer 8

1. Pilin for adherence and resistance to neutrophils
2. Opa proteins for adherence
3. lipooligosaccharide (LOS)
4. Serum resistance
5. IgA protease

Question 9

Gonorrhea treatment

Answer 9

(uncomplicated)
If sensitivities unknown,
1. ceftriaxone 500mg IMI stat
2. Azithromycin 1g po stat

If sensitives known,

1. Ciprofloxacin
2. Azithromycin

Question 10

PID treatment

Answer 10

1. ceftriaxone 500mg IMI stat

2. doxycycline 100mg bid 14 day +/- metronidazole 400mg bid 14 day