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Infection Flashcards

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1
Q

What kind of organisms can cause infections?

A

Bacteria
Viral
Fungal
Parasites

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2
Q

What fungal infection can affect the reproductive system?

A

Candida

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3
Q

Is candida sexually transmitted?

A

Not really

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4
Q

What does candida cause in females?

A

Candidiasis

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5
Q

What is candidiasis normally called?

A

Vaginal thrush

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6
Q

What organism causes candida?

A

Candida Albicans

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7
Q

What can you see on microscopy of candida?

A

Buds

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8
Q

Is candida always pathogenic?

A

No- can be commensal

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9
Q

What are some risk factors for developing candidiasis?

A

Antibiotic treatment
High oestrogen levels- pregnancy/contraception
Poorly controlled diabetes
Immunocompromised

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10
Q

What are some symptoms of candidiasis?

A

Intense vulvar itch- Erethema and swelling

White vaginal discharge

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11
Q

How many episodes of candidiasis are needed in a year for it to be classed as recurrent?

A

4+

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12
Q

How is candidiasis diagnosed?

A

Clinically
High vaginal swab for culture
Microscope of swab for spores and mycelia
Rule out Trichomonas and bacterial for itch and discharge

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13
Q

How do you treat candidiasis first line?

A

Topical clotrimazole 500mg single dose

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14
Q

How do you treat recurrent candidiasis?

A

Fluconazole 100 mg weekly for 6 months

Clotrimazole pessary 500 mg weekly for 6 months

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15
Q

What is candida infection called in males?

A

Balanitis

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16
Q

What is balanitis?

A

Infection of the glans

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17
Q

What are some symptoms of balanitis?

A

Balanoposthitis
Self-limiting burning penile irritation immediately after sex with infected partner
Spotty rash on glans

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18
Q

What must you exclude before diagnosis balanitis?

A

Exclude diabetes

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19
Q

Name some bacterial causes of reproductive tract infection?

A 
Bacterial vaginosis
Prostatitis
Gonorrhoea
Chlamydia
Lymphogranuloma venereum (LGV)
Urethritis
Syphilis
Mycoplasma Genitalium
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20
Q

Is bacterial vaginosis sexually transmitted?

A

No

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21
Q

What causes bacterial vaginosis?

A

Change in vaginal flora

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22
Q

What are the bacterial changes in bacterial vaginosis?

A

Gardnerella vaginalis, anaerobes including Bacteroides, Mobiluncus spp. and Mycoplasma hominis replaces the normal lactobacilli

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23
Q

What does lactobacilli do in the vagina?

A

produce acid to keep vaginal pH at 4-4.5

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24
Q

What is the normal pH of the vagina?

A

4-4.5

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25
What are some symptoms of bacterial vaginosis?
Can be asymptomatic Thin, watery, fish-smelling vaginal discharge (pH>5) No inflammation
26
What do you not get in bacterial vaginosis?
No inflammation
27
What can bacterial vaginosis cause in pregnancy?
Can cause premature birth
28
How do you diagnosis bacterial vaginosis?
Clinically
29
What things can be used to clinically diagnose bacterial vaginosis?
Vaginal discharge Amine test Fishy odor on mixing a drop of discharge with 10% potassium hydroxide Clue cells
30
What is the amine test?
Raised vaginal pH using narrow-range indicator paper (>4.7)
31
What are clue cells?
Squamous epithelial cells from the vagina, which have bacteria adherent to their surface, giving a granular appearance to the cell. A Gram stain gives a typical reaction of partial stain uptake.
32
How do you treat bacterial vaginosis?
Oral Metronidazole 400mg 2x daily for 5-7 days | Topical 2% clindamycin cream 5 g intravaginally once daily for 7 days
33
Should you treat asymptomatic bacterial vaginosis?
No
34
What are the two types of prostatitis?
Acute | Chronic
35
What are the symptoms of acute prostatitis?
Lower back, perineum, or genital pain Tender prostate on examination UTI symptoms- Pain, Frequency, Hesitance, Blood Generally unwell
36
What are the UTI symptoms?
Pain, Frequency, Hesitance, Blood
37
How do you diagnose acute prostatitis?
Clinical | Bacteria in blood or urine
38
How do you treat acute prostatitis?
4-6w Ciprofloxacin
39
How long do you need to have had symptoms for to have chronic prostatitis?
3 months
40
What are the symptoms of chronic prostatitis?
``` Lower back, perineum, or genital pain Tender prostate on examination UTI symptoms- Pain, Frequency, Hesitance, Blood Erectile dysfunction Pain when ejaculating ```
41
How do you diagnose chronic prostatitis?
Urine culture
42
How do you treat chronic prostatitis?
4-8w Ciprofloxacin
43
What causes gonorrhoea?
Neisseria gonorrhoeae
44
Describe Neisseria gonorrhoeae
Gram-negative intracellular diplococcus | Looks like kidney beans facing each other
45
What does Neisseria gonorrhoeae look like under the microscope?
Looks like kidney beans facing each other
46
What is the only host of Neisseria gonorrhoeae?
Humans
47
What tissue does Neisseria gonorrhoeae infect?
Infects epithelium of urogenital tract, rectum, pharynx and conjunctiva.
48
What does Fastidious mean?
Doesn't survive well outside of the body
49
How does gonorrhoea spread?
Intimate contact
50
Is it more likely for gonorrhoea to be spread from male to female or female to male?
Male to female
51
What is the incubation period for gonorrhoea?
2-14 days
52
What percentage of sufferers with gonorrhoea are asymptomatic?
50% women | 10% men
53
Give some symptoms of gonorrhoea in males?
Urethritis- Dysuria Urethral discharge Rectal pain, discharge and itch
54
What is a complication of gonorrhoea in males?
Ascending infection- Epididymis, Prostate
55
What are some symptoms of gonorrhoea in females?
``` Increased or altered vaginal discharge Pelvic pain Dysuria Intermenstrual bleeding Rectal and pharyngeal usually asymptomatic ```
56
What are some complications of gonorrhoea in females?
Bartholin’s abscesses Infertility Conjunctiva infection in neonates
57
What are some general symptoms of gonorrhoea?
Arthritis Papular or pustular rash with an erythematous base Fever/malase
58
How can you diagnose gonorrhoea?
``` Culture from affected area Microscopy of swab Nucleic acid amplification tests (NAATs) Blood cultures Synovial fluid examination ```
59
What areas can you take a swab from to culture gonorrhoea?
Endocervical, rectal and throat swabs | Not high vaginal
60
What sample is required for Nucleic acid amplification tests (NAATs)?
First void urine sample
61
What is a benefit of NAAT?
Very sensitive Doesn't matter if organism is dead Quick- hours not days
62
What are some drawbacks to NAAT?
Can give false positives Not good for antibiotic resistance Will pick up organisms upto five weeks after treatment
63
When do you treat gonorrhoea?
Confirmed diagnosis | Sex with confirmed diagnosis
64
How do you treat gonorrhoea?
Single does Ceftriaxone i.m. (1g)
65
How many sexual partners should you test from someone with gonorrhoea?
All from past three months
66
What causes chlamydia?
Chlamydia trachomatis Serovars D-K
67
Describe Chlamydia trachomatis
Small obligate intracellular bacteria that doesn't gram stain
68
How can chlamydia be transmitted?
Vaginal, anal and oral transmission
69
How many males with chlamydia are asymptomatic?
50%
70
What are some symptoms of chlamydia in males?
Urethritis with dysuria and discharge Epididymitis Rectal infection leading to proctitis
71
What percentage of females with chlamydia are asymptomatic?
80%
72
What are some symptoms of chlamydia in females?
``` Vaginal discharge Postcoital or intermenstrual bleeding lower abdominal pain Infection and inflammation of the fallopian tubes Reactive arthritis/Reiter's syndrome Pelvic inflammatory disease ```
73
What can pelvic inflammatory disease cause?
infertility and and ectopic pregnancy
74
What can chlamydia cause in neonates?
Conjunctivitis | Pneumonia
75
How do you diagnose chlamydia?
Nucleic acid amplification test (NAAT)/PCR | Cell culture
76
What samples should be used for chlamydia NAAT?
Male- first pass urine/rectal swab/throat swab/eye swab | Female- High vaginal swab/vulvo-vaginal swab/endocervical swab/rectal swab/throat swab/eye swab
77
What is an benefit of cell culture for chlamydia diagnosis chlamydia?
100% accurate
78
WHat is a disadvantage of cell culture for chlamydia diagnosis?
Expensive and difficult
79
Where is the best place to swab for chlamydia in women?
Endocervical swab
80
What is the standard treatment for chlamydia?
Doxycycline 100 mg 12-hourly for 7 days | Azithromycin 1 g as a single dose
81
How many partners should you notify about chlamydia?
All from last 6 months
82
What causes Lymphogranuloma venereum (LGV)?
Chlamydia trachomatis types LGV 1, 2 and 3
83
Where is Lymphogranuloma venereum (LGV) endemic to?
Tropics
84
What are the stages of Lymphogranuloma venereum (LGV)?
Primary lesion Regional lymphadenopathy Nodes may become fluctuant (buboes) and can rupture
85
What can chronic Lymphogranuloma venereum (LGV) cause?
Extensive scarring and abscess and sinus formation
86
Describe the primary lesion in LGV
Painless ulcerating papule on the genitalia occurring 7–21 days following exposure
87
How long after the primary lesion in LGV does regional lymphadenopathy start?
Days to weeks after it heals
88
Describe the regional lymphadenopathy in LGV
lymph nodes are painful and fixed and the overlying skin develops a dusky erythematous appearance
89
What can LGV mimic?
Anorectal Crohn's- present as presents as proctitis with perirectal abscesses
90
How do you diagnose LGV?
Clinical NAAT Isolation of C. trachomatis from clinical lesions
91
What is the differential for LGV?
Syphilis and genital herpes
92
How do you treat LGV?
Doxycycline (100 mg twice daily for 21 days) | Erythromycin (500 mg four times daily for 21 days)
93
How long do you follow up LGV for?
Follow-up should continue until signs and symptoms have resolved
94
How many partners should you inform about LGV?
Past month
95
What is Urethritis?
Not STI as such but inflammation secondary to it.
96
What are the three categories of urethritis?
``` Gonococcal Urethritis (GU) Non- gonococcal urethritis (NGU) Postgonococcal urethritis (PGU) ```
97
What can cause Non- gonococcal urethritis (NGU)
``` Chlamydia urethritis Trichomonas vaginalis Mycoplasma genitilium HSV Syphilitic chancres Warts within the urethra UTI Prostitis Foreign body ```
98
What are some symptoms of urethritis?
Urethral discharge- Mucoid, Worse in the morning Crusting at meatus- Stains on underwear Discomfort/itch in penis Dysurea Reactive arthritis causing conjunctivitis with arthritis occurs, particularly in HLA B27-positive individuals
99
How do you diagnose urethritis?
Look for chlamydia or gonorrhoea If negative Smear when haven't passed urine for 4h for microscopy Five or more polymorphonuclear leucocytes is diagnostic
100
How do you treat urethritis?
NGU- Azithromycin 1 g oral single does Doxycycline 100 mg 12-hourly for 7 days Avoid sexual intercourse
101
How many partners should you notify for urethritis?
last month
102
What is syphilis often coinfected with?
HIV
103
What causes syphilis?
Treponema pallidum
104
Describe Treponema pallidum?
Motile spirochete | Does not gram stain
105
How does Treponema pallidum enter the human body?
Breaches in epithelium
106
Can Treponema pallidum be cultured?
No
107
How can syphilis be spread?
Sexual contact Across placenta Blood transfusion
108
What are the four stages of syphilis?
Primary Secondary Latency Tertiary
109
What are the symptoms of primary syphilis?
Hard painless chancre at site of infection | Painless, regional lymphadenopathy
110
How long does primary syphilis last?
2-3 weeks
111
How long after primary syphilis heals does secondary syphilis start?
4-10 weeks
112
What are some symptoms of secondary syphilis?
Nephritis Hepatitis Mucous membranes- Mucous patches, ‘snail-track’ ulcers in oropharynx and on genitalia Skin- Painless, regional lymphadenopathy General- Fever, Malase, Arthralgia, Sore throat, Lymphadenopathy
113
What can secondary syphilis do to foetuses?
Infect them
114
How long does secondary syphilis last?
3-12 weeks
115
How long does the latency between secondary and tertiary syphilis last?
2 years
116
What are some symptoms of tertiary syphilis?
Benign- Gummas (Granuloms on bone and viscera) Cardio- Aortitis and aortic regurgitation Neurosyphilis- Meningovascular involvement, General paralysis of the insane (GPI), Tabes dorsalis
117
What is Tabes dorsalis?
Slow degeneration of lateral dorsal tracts
118
Describe congenital syphilis?
Apparent 2-6w after birth Nasal discharge Skin and mucous membrane lesions Failure to thrive
119
When does tertiary syphilis present in neonates?
2yo
120
What can syphilis cause in neonates?
‘stigmata’ relating to early damage of developing structures, particularly teeth and long bones
121
What is a complication of syphilis?
Jarisch–Herxheimer reaction
122
What is Jarisch–Herxheimer reaction?
Caused by endotoxins | 8h after first dose of treatment
123
What are some symptoms of Jarisch–Herxheimer reaction?
Mild fever Malase Headache Lasts several hours
124
How do you diagnose primary syphilis?
Dark- ground microscopy from chancres and Mucous lesions | PCR
125
How do you diagnose secondary and tertiary syphilis?
Serology: Treponemal specific- T. pallidum enzyme immunoassay Treponemal non-specific- Venereal Disease Research Laboratory (VDRL) or rapid plasma reagin (RPR)
126
What is Treponemal specific serology good for?
Good for diagnosis but remains for lifetime after infection
127
Give an example of Treponemal specific serology
T. pallidum enzyme immunoassay
128
What is Treponemal non-specific serology good for?
Indicates how active the disease is
129
Give an example of Treponemal non-specific serology
Venereal Disease Research Laboratory (VDRL) | rapid plasma reagin (RPR)
130
Describe Treponemal non-specific serology
non-specific, becoming positive within 3–4 weeks of the primary infection
131
How do you treat syphilis?
Long-acting penicillin Benzathine penicillin G single intramuscular dose Doxycycline 100 mg, taken orally twice daily for 14 days 1w longer in late stage
132
How long must antibiotic levels be maintained to treat syphilis?
7 days
133
How do you treat syphilis if the patient is penicillin allergic?
doxycycline 200 mg daily 2-4w | erythromycin 500mg four times daily 2-4w
134
What antibiotic should not be given in syphilis and why?
Azithromycin- resistance
135
How long should you follow up syphilis after treatment?
1 year
136
How many partners should you notify with syphilis?
Primary- 90 days Secondary- 2 years Other infections- 3 months before most recent negative test
137
What is Mycoplasma Genitalium associated with?
non-gonococcal urethritis
138
What are the symptoms of Mycoplasma Genitalium?
Asymptomatic
139
How do you diagnose Mycoplasma Genitalium?
NAAT
140
Where can herpes infect?
Mucous membranes in genital tracts, rectum, mouth and oropharynx
141
WHat causes herpes?
HSV Type 1- Mainly oral, less genital | HSV Type 2- Mainly genital
142
Which type of HSV normally infects the genitalia?
HSV Type 2
143
What is the peak age of contracting herpes?
16-24
144
How is HSV transmitted?
Close physical contact
145
How long is the incubation period for HSV?
3-6 days
146
What are the two stages of HSV infection?
Primary | Recurrence
147
What are some symptoms of primary herpes?
``` Multiple painful shallow ulcers develop which may coalesce- develop crusts and dry over 10-14 days Fever Myalgia Headache Tender inguinal lymphadenopathy Aseptic meningitis Urine retention Vaginal/urethral discharge ```
148
What causes urine retention in herpes?
Involvement of the sacral autonomic plexus
149
How long does primary herpes last?
2-3 weeks
150
How long does recurrent herpes last?
5-7 days
151
What are some symptoms of recurrent herpes?
Blisters | No systemic involvement
152
How do you diagnose herpes?
Clinical | Genome detection analysis of lesion sample- Amp with PCR
153
What is herpes often mistaken for?
Candida
154
When are you infectious with herpes?
When asymptomatic and have lesions
155
How do you treat primary herpes?
``` 5 day course: Aciclovir 200 mg 5x daily Treat secondary bacterial infection IV aciclovir for meningitis/encephalopathy Analgesia- 5% topical lignocaine Antipyretics Salt water wash or warm bath to soothe Rest ```
156
How do you treat recurrent herpes?
Salt water bathing Psyche help Many reoccurrences give suppression therapy- Aciclovir 400 mg twice daily for 6–12 months significantly reduces the frequency of attacks
157
How can herpes infect a neonate?
Birth canal- most common | Placenta- Rare
158
How do you treat herpes in pregnant mothers?
Treat as normal in 1st/2nd trimester 3rd trimester- 400mg aciclovire 3x daily Primary at 3rd trimester- Deliver by CS Reoccurrence- Low chance to pass on unless active at time of birth
159
What causes genital warts?
HPV types 6 and 11
160
What strains of HPV cause cervical cancer?
Types 16 and 18
161
How id HPV transmitted?
Catch by sex with someone in sub/clinical infection | Infected birth canal
162
What is the incubation period of HPV?
2w-8m
163
What are the symptoms of genital warts?
Warts around genitalia Can get them on cervix too Penile shaft, subpreputial space, urethra, meatus Can involve rectum
164
What are genital warts associated with?
Cervical intraepithelial neoplasia
165
How do you diagnose genital warts?
Clinical | Biopsy if in doubt
166
What is a differential for genital warts?
Condylomata lata of secondary syphilis
167
What are the two main categories of treatment for genital warts and when should they be used?
Local- non-keratinised warts | Physical- keratinised warts
168
Give some examples of local treatments for genital warts
``` Podophyllin extract (15–25% solution, once or twice weekly) Podophyllotoxin (0.5% solution or 1.5% cream in cycles) Trichloroacetic acid ```
169
When should local agents not be used for genital warts?
Pregnancy | Keratinised lesions
170
What are some physical therapies used to treat genital warts?
Cryotherapy electrocautery Laser ablation
171
What is Imiquimod and what is it used for?
Immune response modifier- induces cytokine response | Genital warts
172
With regards to genital warts who should get regular cervical screening?
Females with warts | Female partners of males with warts
173
How can genital warts be prevented?
Use condom for 8m after treatment Vaccine: Old affective against- HPV 16 and 18 New affective against- HPV 6,11,16,18
174
What causes Trichomoniasis?
Trichomonas vaginalis
175
Describe Trichomonas vaginalis
Flagellated protozoon
176
How does Trichomonas vaginalis infect you
Sexually transmitted Mother to child Attaches to squamous epithelium Infects vagina and urethra
177
What are some symptoms of Trichomoniasis in women?
Offensive vaginal discharge- Frothy yellow Local irritation- erythematous vaginal walls Strawberry cervix- small haemorrhagic areas on cervix
178
What are some symptoms of trichomoniasis in men?
Often asymptomatic Urethral discharge Irritation Urinary frequency
179
What can trichomoniasis cause in pregnancy?
Preterm | Low birth weight
180
How do you diagnose trichomoniasis?
Phase-contrast, dark-ground microscopy of a drop of vaginal discharge shows TV swimming High vaginal swab for microscopy Many polymorphonuclear leucocytes Culture
181
How do you treat trichomoniasis?
Oral Metronidazole for 7 days Nimorazole if resistant Topical therapy- intravaginal tinidazole Treat asymptomatic partners
182
How many partners should you inform of trichomoniasis infection?
Last 4 weeks
183
What is Pediculosis pubis?
Pubic lice infestation
184
What causes pediculosis pubis?
Phthirus pubis
185
How is Phthirus pubis transmitted?
Close physical contact
186
What are some symptoms of a pubic lice infection?
Can be asymptomatic | Itch
187
How do you diagnose a pubic lice infection?
Clinical: Look for lice. Resemble small freckles but move | Blue macules may be seen at the feeding sites
188
How do you treat a pubic lice infection?
``` Lice and eggs must be killed: 0.5% Malathion 1% permethrin 0.5% carbaryl Apply to all areas of the body below the neck and wash off after 12h. May need further application after a week. ```

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