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Reproduction > 6) Infections of the genital tract > Flashcards

6) Infections of the genital tract Flashcards

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1
Q

What are the epidemiological data sources for STIs?

A 
GUM clinics (Genitourinary medicine)
Communicable disease surveillance centres
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2
Q

Why is data on STIs an underestimation?

A

Patients present via other settings
e.g. GPs
STI may be asymptomatic

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3
Q

Which groups are at risk of STIs?

A

Young people
Minority ethnic groups
Those affected by Poverty & social exclusion
Low socio-economic status groups
Those with poor educational opportunities
Unemployed
Individuals born to teenage mothers

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4
Q

What morbidities are associated with STIs?

A 
PID
Impaired fertility
Repro tract cancers
Risk of infection with BBV - HBV, HIV
Risk of congenital or peripartum infection of neonate
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5
Q

What are the most common STIs and their infecting agents?

A 
HPV - Human Papillomaviruses
Herpes - Herpes simplex virus Types 1&2
Chlamydia - Chlamydia Trachomatis
Gonorrhoea - Neisseria gonorrhoeae
Syphilis - Treponema pallidum
Trichomoniasis - Trichomonas vaginalis
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6
Q

What possible differential diagnoses could there be for the clinical sign of genital skin & mucous membrane lesions?

A

Genital ulcers
Vesicles or bullae
Genital papules
Anogenital warts

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7
Q

What possible differential diagnoses could there be for the clinical sign of urethritis - discharge, dysuria, frequency?

A 
Gonococcal urethritis
Chlamydial urethritis
Non-specific urethritis
Post-gonococcal urethritis
Non-infectious urethritis
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8
Q

What possible differential diagnoses could there be for the clinical sign of vulvo-vaginitis & cervicitis?

A

Vulvo-vaginitis
Cervicitis
Bacterial vaginosis
Bartholinitis

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9
Q

What possible differential diagnoses could there be for the clinical sign of infections of the female pelvis?

A

Pregnancy-related

Pelvic Inflammatory Diease (PID)

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10
Q

What type of bacterium is Chlamydia trachomatis?

A

Gram -ve

Obligate intracellular bacterium

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11
Q

What is the clinical presentation of Chlamydia trachomatis in males & females?

A

Males - Urethritis, epididymitis, prostatitis, proctitis

Females - Urethritis, cervicitis, salpingitis, perihepatitis

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12
Q

How is Chlamydia trachomatis diagnosed & treated?

A

Endocervical & urethral swabs

Doxycycline or Azithromycin

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13
Q

What is the clinical presentation of Neisseria gonorrhoeae in males & females?

A

Males - Urethritis, epididymitis, prostatitis, proctitis, pharyngitis
Females - Asymptomatic, endocervicitis, urethritis, PID

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14
Q

What symptoms could you get with a disseminated gonococcal infection?

A

Bacteraemia

Skin & joint lesions

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15
Q

How is Neisseria gonorrhoeae diagnosed & treated?

A

Smear & culture

Ceftriaxone (intramuscular injection)

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16
Q

What type of bacterium is Neisseria gonorrhoeae?

A

Gram -ve

Intracellular diplococcus

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17
Q

What type of virus is the herpes simplex virus?

A

double stranded DNA virus

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18
Q

What is the clinical presentation of primary genital herpes?

A

Extensive, painful genital ulceration, dysuria, inguinal lymphadenopathy, fever

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19
Q

What is the clinical presentation of recurrent genital herpes?

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A

Asymptomatic > Moderate

20
Q

How is genital herpes diagnosed & treated?

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A

Smear & swab of vesicle fluid and/or ulcer base

Aciclovir

21
Q

What type of virus is the human papilloma virus?

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A

Small, double stranded DNA virus
Over 100 types
Highest risk are types HPV 16 & 18

22
Q

What is the clinical presentation of HPV?

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A

Cutaneous, mucosal & anogenital (anus & genital) warts
Benign, painless, verrucous epithelial or mucosal outgrowths
Penis, vulva, vagina, urethra, cervix, perianal skin

23
Q

How is HPV diagnosed & treated?

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A

Clinical biopsy & genome analysis, hybrid capture
No treatment - frequent spontaneous resolution
Topical podophyllin, cryotherapy, intralesional interferon

24
Q

What is the clinical presentation of Syphilis?

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A 
Multistage disease
1 - Indurated, painless ulcer (chancre)
2 - 6-8wks later Fever, rash, lymphadenopathy, mucosal lesions
Latent symptom free years
3 - Chronic granulomatous lesions
4 - Cardiovascular & CNS pathology
25
What causes syphilis?
Treponema Pallidum - spirochaete | May be contracted congenitally
26
How is syphilis diagnosed & treated?
Dark field microscopy, serology | Penicillin & 'test of cure' follow-up
27
What is Trichomonas vaginalis?
Flagellated protozoan
28
What is the clinical presentation of Trichomonas vaginalis?
Thin, frothy, offensive discharge | Irritation, dysuria, vaginal inflammation
29
How is Trichomonas vaginalis diagnosed and treated?
Culture | Metronidazole
30
Name some STIs caused by arthropods
Scabies mite | Pubic louse
31
Where is Candida albicans usually found in the body?
Normal GI & genital tract flora
32
What are the risk factors for a genital tract infection caused by Candida albicans?
``` Antibiotics Oral contraceptives Pregnancy Obesity Steroids Diabetes ```
33
What are the symptoms of a Candida albicans infection?
Profuse, white curd-like discharge | Vaginal itch, discomfort & erythema
34
How is a Candida albicans infection diagnosed and treated?
High vaginal smear & culture | Topic azoles or oral Fluconazole
35
What is bacterial vaginosis?
``` Unsettled normal flora (anaerobes, enteric gram -ve bacteroides) Not vaginitis (no inflammation of vaginal wall) ```
36
What are the symptoms of a bacterial vaginosis infection?
Scanty but offensive, fishy discharge
37
How is bacterial vaginosis diagnosed & treated?
pH>5, KOH whiff test High vaginal smear - Gram variable coccobacilli, reduced lactobacilli Metronidazole
38
What is Pelvic Inflammatory Disease (PID)?
An ascending infection from the endocervix causing - Endometritis - Salpingitis - Oophoritis - Pelvic peritonitis - +/- tubo ovarian abscess
39
What are the risk factors for PID?
Young age at 1st intercourse Multiple sexual partners (polygyny) High frequency of sexual intercourse High rate of acquiring new partners within previous 30 days Alcohol/drug use Cigarette smoking (2x increased risk) IUDs increase risk at point of insertion/removal for a few weeks
40
What are the causative organisms of PID?
``` Neisseria gonorrhoea Chlamydia trachomatis Bacterial vaginosis Streptococci Haemophilis Influenzae Cytomegalovirus Mycobacterium tuberculosis ```
41
What are the sequelae of PID?
Immediate - Tubo-ovarian abscess, Pyo-salpinx | Long term - Ectopic pregnancy, Infertility, Dyspareunia (painful sex), Chronic PID/Chronic pelvic pain, Pelvic adhesions
42
Describe the pathogenesis of PID
Infection of cervix (endocervicitis) spreads to endometrium, uterine tubes &pelvic peritoneum Directly/lymphatic spread
43
What factors are associated with the ascent of bacteria in PID?
Instrumentation - coil insertion, cervical dilation Hormonal changes associated with menstruation - Lowers bacteriostatic effect of cervical secretion Retrograde menstruation - Infection more common after a period Virulence of organisms in acute chlamydial & gonococcal PID
44
Which lab investigations take place to help diagnose PID?
Pregnancy test Triple & urethral swabs - High vaginal swab (bacteria vaginosis organisms) - Endocervical swab (Neiss. gon, Chlam. trich) - Urethral swab (Chlam. trich males only) Midstream urine (leucocytes & nitrates) C-reactive protein (acute infection/inflammation marker)
45
What could be differential diagnoses for PID?
``` Ectopic pregnancy Acute appendicitis Irritable Bowel Syndrome (IBS) Ovarian cyst accidents (torsion, rupture, haemorrhage) UTI Functional pelvic pain of unknown origin ```
46
What are the symptoms of Chronic PID?
``` Symptoms >6months duration Pelvic pain Secondary dysmenorrhoea Deep dyspareunia Menstrual disturbance Recurrent acute painful exacerbations ```
47
What are the sequelae of Chronic PID?
``` Infertility Ectopic pregnancy Chronic pelvic pain Pelvic adhesions/tubo-ovarian complex Abnormal/painful periods ```

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