Flashcards in 6.1 Infections Deck (37):
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
Give at rid groups of STIs
Minority ethnic groups
Poverty and social exclusion
Low socio-economic status groups
Poor educational opportunities
Individuals born to teenage mother
What morbidity is associated with STIs?
Risk of infection with BBVs HBV/HIV
Congenital infection of neonate
Differential diagnosis for genital skin and mucous membrane lesions.
• Genital ulcers
o Herpes Simplex Virus (HSV)
• Vesicles or bullae
• Genital papules
o Transient manifestations of STIs
• Anogenital warts
o Number, size, tenderness, base, edge
Differential diagnosis and symptoms of urethritis.
Discharge, dysuria and frequency
• Gonococcal urethritis
• Chlamydial urethritis
• Non-specific urethritis
• Post-gonococcal urethritis
• Non-infectious urethritis
Differential diagnosis of vulvo-vaginitis
o Candidiasis, trichomoniasis, staphylococcal, foreign body, HSV
Differential diagnosis of cervicitis
o C. trachomatis, N. gonorrhoeae, HSV, HPV
Differential diagnoses of pelvis infections
o Post-partum endometriosis
• Pelvic Inflammatory Disease (PID)
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:
Acceptability of GUM services
Greater public awareness
Development in diagnostic methods.
What is the clinical presentation of chlamydia in females?
Endometriosis (ectopic uterine growth)
Clinical presentation of chlamydia in males? Complications?
Urethritis, conjunctivitis, arthritis
What is the most common infection in neonates? How does this progress?
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
How is chlamydia diagnosed?
What is the treatment for chlamydia?
Clincal presentation of gonorrhoea in males and females?
F Acute cervicitis with vaginal discharge, urethral syndrome, asymptomatic
How is gonorrhoea diagnosed?
M - urethral/rectal/pharyngeal swab
F - endocervical/urethral/rectal/pharyngeal swab
Gram stain - gram negative diplococci
What is the treatment for gonorrhoea?
+ azithromycin for chlamydia to prevent emergence of resistance to cephalosporins
Mixed infections common.
What is the clinical presentation of primary and recurrent genital herpes? Where can herpes lie dormant?
• Extensive, painful genital ulceration, dysuria, inguinal lymphadenopathy, fever
• Asymptomatic → Moderate
• Latent infection in dorsal root ganglia
How is genital herpes diagnosed?
Smear and swab of vesicle fluid
Treatment for herpes?
Prophylaxis for frequent recurrences
Which HPVs have highest risk?
16 and 18
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
How is HPV diagnosed?
• Clinical, biopsy and genome analysis, hybrid capture
How is HPV treated?
There is no treatment - frequent spontaneous resolution.
• Topical podophyllin, cryotherapy, intralesional interferon for prevention
How is HPV screened?
Cervical Pap smea cytology
What causes syphilis?
Treponema pallidum - spirochaete bateria
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
How is syphilis diagnosed?
Dark field microscopy
How is syphylis treated?
Classify trichomonad vaginalis.
What is the clinical presentation of trichomonasis
Thin, frothy, offensive discharge
Irritation, dysuria, vaginal inflammation
Diagnosis of trichomonas vaginitis. Treatment.
What causes vulvovaginal candidiasis?
Candida albicans and other candida yeast fungi
Risk factors for vulvovaginal candidiasis?
Antibiotics, oral contraceptives, pregnancy, obestiy, steroids, diabetes.
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