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REPRODUCTION & GYNAECOLOGY > Microbiology of the GU Tract > Flashcards

Microbiology of the GU Tract Flashcards

1
Q

What are the most common bacterial, sexually transmitted infections?

A

Chlamydia (Chlamydia trachomatis)
Gonorrhoea (Neisseria gonorrhoeae)
Syphilis (Treponema pallidum)

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2
Q

Name 3 common viral STIs?

A

Human papilloma virus (genital warts)
Herpes simplex (genital herpes)
Hepatitis and HIV (not covered in this lecture)

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3
Q

What parasitic STIs are the most common?

A

Trichomonas vaginalis
Phthirus pubis (pubic lice or “crabs”)
Scabies

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4
Q

Why is pubic lice becoming less common?

A

shaving pubic hair is more common in today’s society

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5
Q

Describe how gonorrhoea and chlamydia can infect the same tissue but cause different symptoms

A

Gonococci in male urethra produce intense neutrophil response => pus discharge and dysuria

chlamydia in male urethra = produce a mild, watery discharge or no symptoms at all.

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6
Q

Immunity does not occur in the GU tract. TRUE/FALSE?

A

TRUE
- reinfection is very common
=> vaccine development is very difficult

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7
Q

What species predominates in normal vaginal flora?

A

Lactobacillus spp. predominate in the “healthy” vagina

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8
Q

What do the lactobacilli in the normal vaginal flora produce?

A

Lactic acid
+/- hydrogen peroxide
these suppress growth of pathogenic bacteria

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9
Q

What microbes can be found colonising the vagina in small traces?

A

Candida (just colonising - not causing symptoms)
Strep viridans
Group B Beta Haemolytic Strep

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10
Q

In what group of patients should you treat Group B Beta - haemolytic strep colonisation in the vagina?

A

Pregnant women (as this can cause complications when child is born)

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11
Q

Describe the discharge found in bacterial vaginosis

A
  • may contain bubbles

- sometimes has a “fish-like” odour

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12
Q

How does a bacterial vaginosis appear on microscopy and what other test an be done?

A
  • “clue cells”- coccobacilli osbcuring edge of vaginal epithelium
  • large no.s of leukocytes may indicate coincident infection
  • Positive “whiff” test - Add 10% potassium hydroxide to discharge to elicit a fishy odour
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13
Q

What does bacterial vaginosis put women at a higher risk of developing?

A
  • increased rate of upper urinary tract infection (endometritis, salpingitis)
  • premature rupture of the membranes and preterm delivery
  • increased HIV risk
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14
Q

What STI is the most common in the UK?

A

Chlamydia

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15
Q

Where can chlamydia affect?

A

urethra, rectum, throat and eyes (♂ + ♀)

endocervix (♀)

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16
Q

Is chlamydia a gram positive or negative organism?

A

NEITHER

there is no peptidoglycan in its cell wall => it does not take up Gm stain well

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17
Q

What are the 3 serovar groups of chlamydia and what does each cause?

A

Serovars A-C = Trachoma - eye infection
Serovars D-K = Genital infection
Serovars L1-L3 = Lymphogranuloma venereum (LGV)

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18
Q

What investigation is used to diagnose gonorrhoea or chlamydia?

A
  • Nucleic Acid Amplification Tests (NAATs) OR PCR
  • Male patients – first pass urine sample
  • Female patients – High/ vulvo-vaginal swab (can be self-taken by patient)
  • Rectal/ throat/ eye swabs can also be self taken if req’d
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19
Q

What are the advantages of NAATs over culture?

A
  • more sensitive (especially if organism has died on way to lab)
  • can test urine specimens/self-obtained swabs
  • faster (hours VS days)
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20
Q

What are the disadvantages of NAATs over culture?

A
  • more expensive
  • may be false positives for gonorrhoea
  • doesn’t give antibiotic sensitivity for organism
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21
Q

What types of antibiotic are any strains of gonorrhoea now resistant to in the UK?

A
  • penicillins
  • tetracyclines
  • quinolones (ciprofloxacin/ofloxacin)
  • most oral cephalosporins
22
Q

Guidance on how to treat gonorrhoea changes very frequently. How is it currently being treated in the UK (2019)?

A

IM Cetriaxone

23
Q

What are the 4 stages of Syphilis infection?

A
  • Primary lesion - (chancre)
  • Secondary stage - (large nos. bacteria circulating in blood causing manifestations at different sites)
  • Latent stage – (no symptoms, but low-level multiplication of spirochaete in small blood vessels)
  • Late stage syphilis – cardiovascular or neurovascular complications
24
Q

What non-specific serological tests can be used in diagnosing syphilis?

A

VDRL(Venereal Diseases Research Laboratory)
RPR (Rapid Plasma Reagin)
TPPA

25
Q

What else are the non-specific serological syphilis tests used for?

A
  • monitoring response to therapy
26
Q

When may non-specific serologial testing for syphilis be falsely positive?

A
  • The tests indicate tissue inflammation

=> may be falsely positive if pt has lupus, malaria, pregnant etc

27
Q

What virus causes Genital Herpes?

A

Herpes simplex virus type 1

28
Q

How is genital herpes spread?

A

Transmitted by close contact with someone shedding the virus
=> genital/genital contact
=> oropharyngeal/genital contact

29
Q

Explain the appearance of an acute phase of genital herpes

A

painful multiple small vesicles

which are easily deroofed

30
Q

What does it mean that the herpes simplx virus causing genital warts is “latent”?

A

Virus can reactivate from sacral root ganglion

=> causing recurrent genital herpes attacks

31
Q

What type of sample and diagnostic test is completed for suspected genital HSV?

A

Viral swab of deroofed blister for PCR

32
Q

What anti-viral treatment an be given for Genital Herpes?

A

Aciclovir

+/- Pain relief

33
Q

What symptoms does the parasite trichomonas vaginalis cause in males and females?

A
  • vaginal discharge and irritation in females

- urethritis in males

34
Q

What test is used to diagnose Trichomonas Vaginalis?

A

High vaginal swab for microscopy
(PCR test also available NOT in Tayside)
=> so no good test for males!

35
Q

How is trichomonas vaginalis treated?

A

Oral metronidazole

36
Q

How is pubic lice transmitted?

A
  • close genital skin contact
37
Q

Describe the symptoms of pubic lice

A

Lice bite skin and feed on blood
=> causes itching in pubic area
Female louse lays eggs on hair next to skin => replication

38
Q

What treatment is used for pubic lice

A

malathion lotion

39
Q

What pH is the normal vaginal flora?

A

4-4.5 (acidic)

40
Q

How does candida albicans appear on microscopy?

A
  • “budding” Yeasts and hyphae
41
Q

What are the predisposing factors to candida infection?

A
  • Recent antibiotic therapy
  • High oestrogen levels (pregnancy, certain contraceptives)
  • Poorly controlled diabetes
  • Immunocompromised patients
42
Q

A girl being treated for a candida infection should prompt her partner to also get treated. TRUE/FALSE?

A
  • NOT an STI

=> partner doesnt need treatment unless they also have candida infection

43
Q

Describe the appearance of a candida infection on a female’s speculum examination

A

“cottage cheese” appearance

44
Q

What treatments may NOT be as effective for Non-albicans Candida species?

A

More likely to be -azole resistant (clotrimazole/fluconazole)

45
Q

How does a candida infection appear in males?

A

Typical “spotty”rash

  • Candida Balanitis
  • LESS COMMON
46
Q

Describe how neisseria gonorrhoea appears with gram stain?

A

Gram Negative intracellular diplococci

Looks like 2 kidney beans facing each other

47
Q

Why is gonorrhoea only cultured if patients present to the sexual health clinic rather than the GP?

A

Organism would die in transit to the lab

AND need specific agar to culture

48
Q

Why do you have to wait before testing patients for cured gonorrhoea infection?

A

NAAT test can still pick up dead organisms up to 5 weeks after

49
Q

WHat is the treatment for chlamydia?

A

NEW GUIDANCE 2019 = Doxycycline 100mg bd x 7 days

Previously was Azithromycin (1g single oral dose) for uncomplicated chlamydia

50
Q

What shape is the syphilis organism and what tests are used for diagnosis?

A
  • Spirochaete
  • Does NOT stain with gram stain and cant be cultured
    => PCR test or serological (blood) tests to detect antibodies
51
Q

The presence of what antibody indicates an acute syphilis infection?

A

IgM

52
Q

What is the best treatment for syphilis?

A
  • Injectable long-acting penicillin

- provided patient is not penicillin hypersensitive)

REPRODUCTION & GYNAECOLOGY (58 decks)

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