6: Microbiology of genital tract infections

Question 1

Gonorrhoea produces a ___ discharge.

Chlamydia produces a ___ discharge.

Answer 1

gonorrhoea - purulent

chlamydia - watery

Question 2

The normal vaginal pH is (acidic / basic).

Answer 2

acidic

Question 3

Which commensal bacteria is most commonly found in the vagina?

Answer 3

Lactobacillus

Question 4

Apart from Lactobacillus, what other organisms are found naturally found in the vagina?

Answer 4

Group B Strep

Candida

Strep viridans

Question 5

Which fungal infection commonly affects the female genital tract?

Answer 5

Candida albicans

Question 6

Non-albicans Candida infections are more common in ____ patients.

Answer 6

immunosuppressed

Question 7

Poorly controlled ___ is a risk factor for Candida infection.

Answer 7

diabetes

Question 8

What is the presentation of Candida infection?

Answer 8

White vaginal discharge

Itch

Question 9

How is candida infection investigated?

Answer 9

Vaginal swab for culture

Question 10

Which antifungal is used for Candida infection?

Answer 10

Clotrimazole

Question 11

What causes bacterial vaginosis?

Answer 11

?Lack of balance

Question 12

What is the presentation of bacterial vaginosis?

Answer 12

Intensely smelly, frothy vaginal discharge

Question 13

In bacterial vaginalis, the normal vaginal bacteria are replaced with which bacteria?

Answer 13

Gardnerella vaginalis

and anaerobes

Question 14

What happens to the vaginal pH in bacterial vaginosis?

Answer 14

Becomes alkaline

i.e the pH increases

Question 15

Bacterial vaginosis is an imbalance of bacteria, not an infection.

Why is it treated regardless?

Answer 15

Risk of genital tract infection

Question 16

Which antibiotic, effective against anaerobes, is effective for treating bacterial vaginosis?

Answer 16

Metronidazole

Question 17

STIs tend to ___.

Answer 17

co-exist

so you test for all of them

Question 18

What is the most common STI in the UK?

Answer 18

Chlamydia trachomatis

Question 19

Chlamydia trachomatis can be split into subtypes depending on its ___.

Answer 19

serology

what it produces

Question 20

How does Chlamydia appear on a Gram stain?

Answer 20

Doesn’t stain

Question 21

Which serovars of chlamydia trachomatis cause genital tract infections?

Answer 21

D-K

Question 22

The guidance for antibiotic treatment of chlamydia trachomatis has just changed.

What is the empirical treatment?

Answer 22

Doxycycline 100mg BD for 7 days

Question 23

Before it became doxycycline 100mg, what was the antibiotic treatment for chlamydia?

Answer 23

Azithromycin 1g

Question 24

What are the investigations for genital chlamydia and gonorrhoea in

a) males
b) females?

Answer 24

a) First pass urine sample

b) Vulvo-vaginal swab

Question 25

What other investigations, apart from genital ones, exist for **chlamydia and gonorrhoea?**

Answer 25

**Rectal swab** **Throat swab** **Eye swab**

Question 26

What is the appearance of **gonorrhoea** on a Gram stain?

Answer 26

**Gram -ve intracellular diplococcus**

Question 27

What does **neisseria gonorrhoeae** look like on microscopy?

Answer 27

**Gram negative diplococcus** "Two kidney beans facing one another"

Question 28

What type of media is used to culture **neisseria gonorrhoeae**?

Answer 28

**Selective media** kills competitors

Question 29

The samples obtained from **first pass urine samples** or **vulvovaginal swabs** are sent for which type of testing?

Answer 29

**Nucleic acid amplification tests (NAATs)** More sensitive for diagnosing chlamydia/gonorrhoea than culture

Question 30

Which antibiotic is given for gonorrhoea infection?

Answer 30

**Ceftriaxone**

Question 31

**Neisseria gonorrhoea** has recently become ___ in some places.

Answer 31

**untreatable** resistant to all antibiotics

Question 32

**Treated** **gonorrhoea infection** is subjected to a ___ \_\_\_ ___ before discharging the patient.

Answer 32

**test of cure**

Question 33

What is **lymphogranuloma venerum**? What is the causal organism?

Answer 33

**Infection of the lymph nodes**, usually presenting as **prostatitis** in MSM **Chlamydia trachomatis** (serovars L1 - L3)

Question 34

How is **bacterial prostatitis** treated empirically?

Answer 34

**Ciprofloxacin** One month course

Question 35

Which antibiotic is used to treat **acute bacterial prostatitis?**

Answer 35

**Ciprofloxacin**

Question 36

Which organism causes **syphilis**?

Answer 36

**Treponema pallidum**

Question 37

What is the appearance of **Treponema pallidum** on microscopy?

Answer 37

**Spirochaete**

Question 38

**Does Treponema pallidum appear on Gram film?**

Answer 38

**No**

Question 39

How is **Treponema pallidum** detected?

Answer 39

**PCR**

Question 40

Can **treponema pallidum** be grown in culture?

Answer 40

**No** PCR

Question 41

What is the **primary lesion** of syphilis called?

Answer 41

**Chancre**

Question 42

What does a **chancre** look like?

Answer 42

**Ulcer**

Question 43

Are **chancres** painful?

Answer 43

**Painless**

Question 44

What is the **baseline blood test** for suspected syphilis?

Answer 44

**Syphilis IgM & IgG test**

Question 45

What antibiotic is used to treat syphilis?

Answer 45

**Injectable, long-acting penicillin** i.e **benzylpenicillin**

Question 46

Which **virus** can cause genital infection?

Answer 46

**Herpes simplex 1 & 2**

Question 47

What structures does **HSV** infiltrate?

Answer 47

**Nerves**

Question 48

What is the **investigation** for **genital herpes**?

Answer 48

**Genital swab \> PCR**

Question 49

What is the **treatment** for genital herpes?

Answer 49

**Aciclovir** **Analgesia**

Question 50

***Trichomonas vaginalis*** is a protozoan parasite which causes **vaginal discharge** and **irritation**. How is it **investigated** and **managed?**

Answer 50

**Ix: High vaginal swab for MICROSCOPY** **Rx: ORAL METRONIDAZOLE**

Question 51

What is the **treatment** for **genital lice**?

Answer 51

**Malathion lotion**