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Urogenital Y2 > L11 - Genital Infections > Flashcards

L11 - Genital Infections Flashcards

1. Describe the mechanisms of infection of the genital tract in relation to the immune / inflammation response seen and relate this to the pathology. 2. Describe the abnormalities in the composition and regulation of the normal microbiological flora of the genital tract lead to clinical symptoms and how this can pre-dispose to genital infections 3. Describe and recognise the main microbiological features of the common genital infections (gram negative, gram positive) 4. To understand what a f

1
Q

State examples of sexually transmitted infections caused by bacteria?

A
  • Neisseria Gonorrhoeae
  • Chlamydia Trachomatis
  • Trichomonas Vaginalis
  • Syphilis (Treponema Pallidum)
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2
Q

State examples of sexually transmitted infections caused by viruses?

A
  • Human Papilloma virus (HPV)
  • Herpes simplex virus (HSV)
  • Human immunodeficiency virus (HIV)
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3
Q

Examples of sexually transmitted viruses caused by mites?

A

Pediculosis pubis

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4
Q

State examples of non-sexually transmitted infections caused by bacteria?

A

Bacterial Vaginosis

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5
Q

Non-sexually transmitted infection caused by a fungus?

A

Candidiasis

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6
Q

Non-sexually transmitted infection caused by a virus?

rhymes with pollosum bontagiosum

A

Molluscum contagiosum

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7
Q

Briefly describe host defences against genital infection?

A

Innate

  • internal: phagocytes, macrophages, inflammation
  • external: skin, mucous membranes, healthy flora

Adaptive
- humoral (immunoglobulin), B-cells, T-cells

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8
Q

Examples of normal vaginal flora and their two categories?

A

Faecal flora

  • lactobacilli
  • group B streptococci
  • Coliforms (E-coli)
  • anaerobes
  • enterococci

Skin flora

  • coagulase negative staphylococci
  • diphtheroids
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9
Q

What is the normal pH range for the vagina?

A

Between 4 -5

Slightly acidic

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10
Q

Describe how the pH in the vagina is maintained?

A
  • Oestrogen / progesterone leads to release of glycogen.
  • Lactobacilli break this down into lactic acid.
  • Creates acidic environment
  • Facilitates growth of lactobacilli
  • Inhibits the growth of harmful bacteria
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11
Q

Describe host defences in males?

A 
Mechanical barrier (epithelial mucous membrane) 
- length of urethra and urinary flushes protect against most infective organisms.

Innate: phagocytes, complement
Adaptive: Ig, B-cell, T-cell

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12
Q

Case-study

Patient, Female, 25 y/o, discharge with abnormal odour (fishy smell)

A

Bacterial Vaginosis
- thin, white, homogenous discharge coating walls of vagina and vestibule
Many women are asymptomatic

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13
Q

Describe the Hay/Ison criteria of bacterial vaginosis?

A 
Grade 1 : normal
- Lactobacillus morphocytes predominate
Grade 2 : intermediate 
- mixed flora with some lactobacilli present 
- some Gardnerella or Mobiluncus morphocytes present
Grade 3 
- mainly Gardnerella / Mobiluncus 
- few lactobacilli
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14
Q

What is the Ansel critera for Bacterial vaginosis?

A
  1. Thin, white, homogenous discharge
  2. Clue cells on microscopy of wet mount
  3. pH of vaginal fluid >4.5
  4. Fishy odour
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15
Q

Common risk factors for bacterial vaginosis?

A

Overwashing
Recent change of sexual partner.
Smoking.
Presence of an STI

  • not sexually transmitted
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16
Q

Case study:

Female patient, thick white discharge, itchy

A

Vulvovaginal candidiasis (thrush)

17
Q

What is the most common bacteria causing thrush?

A

Candida Albicans >90%

also: Candida galbrata, candida tropicalis, candida krusei, candida parapsilosis

18
Q

What are some symptoms of vulvovaginal candidiasis?

A
  • vulval itching
  • vulval soreness
  • vaginal discharge
  • superficial dyspareunia
  • external dysuria
19
Q

Dysuria

A

painful or difficult urination

20
Q

Dyspareunia

A

Difficult or painful sexual intercourse

21
Q

Patient, female, 25 y/o, profuse discharge

A

Trichomonas Vaginalis

  • Vulval itching
  • Dysuria
  • Strawberry cervix
  • can cause preterm delivery and low birth rate
22
Q

What is Pelvic inflammatory disease?

A

Clinical syndrome associated with ascending spread of microorganisms from endocervix to endometrium, fallopian tubes etc

23
Q

What may cause Pelvic inflammatory disease?

A

Sexually transmitted infections:

  • Chlamydia trachomatis (most common)
  • Neisseria gonorrhea
  • mycoplasma genitalium
24
Q

Dysmenorrhea

A

Menstrual cramps

25
Q

What bacteria caused Gonorrhoea?

A

Gram-negative coccus Neisseria Gonorrhoeae

26
Q

Describe what happens with Neisseria Gonorrhoeae enters a host?

A
  • Invades non-ciliated epithelial cells which internalise the bacteria.
  • bacteria multiply within intracellular vacuoles so protected from phagocytes and anti-bodies
  • vacuoles fuse with basement membrane and discharge bacterial contents
27
Q

Describe Trichomonas infection?

A
  • Trichomonas vaginalis is a protozoan parasite

- and causes vaginitis with lots of discharge.

28
Q

Why is it difficult to identify chlamydia trachomatis?

A

Can’t gram stain chlamydia

  • intracellular parasite
  • lacks peptidoglycan wall
  • can’t retain the colour
29
Q

State some symptoms of Pelvic inflammatory disease?

A
  • Lower abdominal pain, typically bilateral
  • Deep dyspareunia
  • abnormal vaginal bleeding
  • abnormal discharge
30
Q

What is the incubation period of Neisseria gonorrhoeae?

A

2 - 5 days

31
Q

What are the stages of syphilis?

A

1.Primary

  1. Secondary
    - latent (early / late)
  2. Tertiary
    - neurosyphilis
    - cardiovascular syphilis
    - gumma
32
Q

Gumma

A

Soft, non-cancerous growth resulting from the tertiary stage of syphilis.

33
Q

Describe a syphilis sore?

A

aka chancre (primary)

  • sore where the syphilis infection entered your body,
  • firm, round and usually painless.
34
Q

What may be a symptom of a patient with secondary syphilis?

A

Macula papilla rash

35
Q

Tertiary syphilis?

treated with

affects where

A
  • Treated with penicillin.
  • Lots of neurological symptoms.
  • Affects liver, brain and eyes.
36
Q

What asymptomatic infections are screened for in a sexual health clinic?

A
  • Chlamydia trachomatis
  • Neisseria gonorrhoeae
  • HIV
  • Syphilis

Urogenital Y2 (16 decks)

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