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Flashcards in 6.1 Infections Deck (37):
1

Give 2 sources of epidemiological data for genital infections and STIs

Genitourinary medicine clinica
(Underestimation as patients may present via other settings)

Communicable disease surveillance centres

2

Give at rid groups of STIs

Young people
Minority ethnic groups
Poverty and social exclusion
Low socio-economic status groups
Poor educational opportunities
Unemployed people
Individuals born to teenage mother

3

What morbidity is associated with STIs?

PID
Impaired fertility
Repro cancers
Risk of infection with BBVs HBV/HIV
Congenital infection of neonate

4

Differential diagnosis for genital skin and mucous membrane lesions.

• Genital ulcers
o Herpes Simplex Virus (HSV)
o Syphilis
o Chanchroid
• Vesicles or bullae
o HSV
• Genital papules
o Transient manifestations of STIs
• Anogenital warts
o Number, size, tenderness, base, edge

5

Differential diagnosis and symptoms of urethritis.

Discharge, dysuria and frequency

• Gonococcal urethritis
• Chlamydial urethritis
• Non-specific urethritis
• Post-gonococcal urethritis
• Non-infectious urethritis

6

Differential diagnosis of vulvo-vaginitis

o Candidiasis, trichomoniasis, staphylococcal, foreign body, HSV

7

Differential diagnosis of cervicitis

o C. trachomatis, N. gonorrhoeae, HSV, HPV

8

Differential diagnoses of pelvis infections

• Pregnancy-related
o Post-partum endometriosis
• Pelvic Inflammatory Disease (PID)

9

Describe recent trends in incidence of STIs. Explain

Plateau before 1995 reflecting changes in sexual behaviour in response to HIV epidemic
Gradual and sustained increase in no of diagnosed STIs since 1995 due to:

Increased transmission
Acceptability of GUM services
Greater public awareness
Development in diagnostic methods.

10

What is the clinical presentation of chlamydia in females?

Commonly asymptomatic
Endometriosis (ectopic uterine growth)
Salpingitis
Cervicitis
Urethritis
Dysuria
Frequency

11

Clinical presentation of chlamydia in males? Complications?

Urethritis

Acute epididymitis
Reiters syndrome:
Urethritis, conjunctivitis, arthritis

12

What is the most common infection in neonates? How does this progress?

Chlamydia trachomatis
Neonatal conjunctivits
Pneumonia

13

How are specimens collected in males, females and neonates to diagnose chlamydia?

M - Urethral swag or first catch urine
F - endocervical swab
N - Eye swab

14

How is chlamydia diagnosed?

Antigen detection:
Immunofluoresnce
Enzyme immunoassay
PCR

15

What is the treatment for chlamydia?

Macrolides (azithromycin)
Tetracycline (doxycycline)

16

Clincal presentation of gonorrhoea in males and females?

M Urethritis
F Acute cervicitis with vaginal discharge, urethral syndrome, asymptomatic

17

How is gonorrhoea diagnosed?

M - urethral/rectal/pharyngeal swab
F - endocervical/urethral/rectal/pharyngeal swab

Gram stain - gram negative diplococci
Culture

18

What is the treatment for gonorrhoea?

Ceftriaxone

+ azithromycin for chlamydia to prevent emergence of resistance to cephalosporins
Mixed infections common.

19

What is the clinical presentation of primary and recurrent genital herpes? Where can herpes lie dormant?

Primary:
• Extensive, painful genital ulceration, dysuria, inguinal lymphadenopathy, fever

Recurrent:
• Asymptomatic → Moderate
• Latent infection in dorsal root ganglia

20

How is genital herpes diagnosed?

Smear and swab of vesicle fluid
PCR

21

Treatment for herpes?

Aciclovir
Prophylaxis for frequent recurrences
Barrier contraception

22

Which HPVs have highest risk?

16 and 18

23

What is the clinical presentation of HPV?

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

24

How is HPV diagnosed?

• Clinical, biopsy and genome analysis, hybrid capture

25

How is HPV treated?

There is no treatment - frequent spontaneous resolution.
• Topical podophyllin, cryotherapy, intralesional interferon for prevention

26

How is HPV screened?

Cervical Pap smea cytology
Colposcopy
Cervical swab

27

What causes syphilis?

Treponema pallidum - spirochaete bateria

28

Describe the presentation stages of syphilis

Primary: indurated, painless ulcer (chancre)
Secondary: 6-8 weeks later - fever, rash, lymphadenopathy, mucosal lesions.
Latent: symptom free years
Chronic granulomatous lesions
CVS and CNS pathology

29

How is syphilis diagnosed?

Dark field microscopy
Serology

30

How is syphylis treated?

Penicilin

31

Classify trichomonad vaginalis.

Flagellated protozoan

32

What is the clinical presentation of trichomonasis

Thin, frothy, offensive discharge
Irritation, dysuria, vaginal inflammation

33

Diagnosis of trichomonas vaginitis. Treatment.

Culture
Metronidazole

34

What causes vulvovaginal candidiasis?

Candida albicans and other candida yeast fungi

35

Risk factors for vulvovaginal candidiasis?

Antibiotics, oral contraceptives, pregnancy, obestiy, steroids, diabetes.

36

Vulvovaginal candidasis clinical presenttion, diagnosis and treatment?

Profuse white curd like discharge
Vaginal itch, discomfort and erythema

High vaginal smear and culture

Topical azoles or oral fluconazole

37

What causes bacterial vaginosis? Clinical presentation? Diagnosis? Treatment?

Unsettled normal flora (anaerombes, enteric gram neg bacteroides)

Scanty but offensive, fishy discharge

pH > 5
KOH whiff test
Hgih vaginal smear - reduced lactobacilli

Metronidazole