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Infections fo the genital tract Flashcards

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1
Q

Who gets affected by STI’s commonly?

A

-black african/carribean

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2
Q

What age groups get STI’s mostly?

A

15-24 yrs

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3
Q

What are the factors affecting genital tract infections?

A
  • lower age of first intercourse
  • not using barrier contraception
  • multiple sexual partners
  • homosexulatilty
  • anal sex
  • low socio-economic status (linked to poor education)
  • Lack of immunisation (HPV, Hep B)
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4
Q

What STI is the most common in the UK?

A

Chlamydia Trachomatis

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5
Q

What is chlamydia trachomatis and what is the mechanism of action?

A
  • obligate intracellular bacteria
  • lets itself get taken up by phagocytosis
  • inhibits formation of phagolysosome so prevents itself getting expelled (virulence factor)
  • unique cell wall
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6
Q

What are the symptoms of chlamydia in men?

A
  • typically asymptomatic in men
  • mild urethritis
  • dysuria
  • inflammation of other structures (epididymis/prostatis)
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7
Q

What are the symptoms of chlmydia in women?

A
  • typically asymptomatic in women
  • can present as vaginal discharge
  • dyspareunia
  • post-coital bleeding
  • on speculum examination a muco-purulent discharge and cervical motion tenderness will be seen
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8
Q

How is chylymdia investigated?

A

using NAAT

-VVS (vulvo vaginal swab) or endocervical swab

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9
Q

What is the first line treatment from chlymidai?

A

doxycycline

-IN PREGNANCY USE ERYTHROMYCIN

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10
Q

What is the most common cause of urethral discharge in males?

A

Neisseria gonnorhoeae

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11
Q

What is neisseria gonnorghoeae?

A
  • diploccocus

- has pili to help adhere to mucosal membranes

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12
Q

What are the symptoms of gonnorhaea in males?

A
  • thick yellow dischagre

- may have dysuria

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13
Q

What are the symptoms of gonnorhea in females?

A

typically asymptmatic but can cause vaginal discharge and lower abdominal pain

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14
Q

What are the complications of gonnorheae?

A
  • reactive arthritis (painful joints)
  • epidydimo-orchitis in men
  • PID
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15
Q

What is the first line treatment for gonorrhoea?

A

combined antibiotic therapy

-ceftriaxone and azithromycin to boost the effect of this antibiotic and reduce resistance risk

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16
Q

What is a common co-infection of gonnorhoea?

A

chlamydia

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17
Q

What other investigations can you do for gonnorhoea?

A

microscopy and cultures and NAATS

  • urethral swab
  • VVS or endocervical
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18
Q

What is important to exclude?

A

UTI’s - do a first catch urine sample

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19
Q

Is discharge in women pathological?

A

could be physiological - progesterone in the secretory phase causes thicker cervical mucus - usually clear and has no associated symptoms

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20
Q

What could a fetus get if a mother has chlmydia?

A

neo-natal conjunctivitis

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21
Q

What is trichomoniasis caused by?

A

Trichomoniasis vaginalis

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22
Q

What is Trichomoniasis vaginalis mode of action?

A
  • protazoa

- has flagella to aid motility in the female reproductive tract

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23
Q

What is its optimal growth?

A

is pH 6.0 (female is 4.0) so more alkaline environments are more at risk of it

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24
Q

What is the symptom of trichonomiasis in men?

A

often asymptomatic (can cause dysuria or discharge)

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25
What are the symptoms of trichomoniasis in women?
-copous, yellow, odourous discharge
26
How is trichomoniasis treated?
metrondiazole | - need to do a high vaginal swab which includes looking at the posterior fornix
27
What are some complications of trichomoniasis?
in men - this Protozoa is a cause of non-gonococcal urethritis
28
What is non-gonococcal urethritis?
inflammation of the urethra with associated discharge that isn't caused by gonnorhea
29
What are the culprits of NGU?
- can be sexually transmitted - chlamydia trichomatis - mycoplasma genitalium - trichomoniasis vaginalis
30
When would NGU be non- pathogenic?
-older men but still is less common
31
What causes syphillis?
Treponema pallidum | -spirochete
32
What age group and gender is syphillis most common in?
men aged 25-33 | -those infected with HIV
33
What is primary syphillis?
- initially presents as a painless ulcer in the genitals - very infection - lesion will usually disappear
34
What is secondary syphilis?
- can develop weeks later as a rash or affect other body systems (liver) - symptoms will often disappear
35
What is tertiary syphilis?
- can remain latent and become reactivated later in life like pregnancy - can cause congenital syphilis
36
How is syphilis diagnosed?
- swabs taken and blood test to confirm the infection and monitor treatment - serology
37
What is the treatment for syphilis?
depends on the stage of infection | -penicillin-based antibiotics
38
What is mode of transmission of syphilis?
- direct contact | - vertical transmission
39
What is the most common viral STI?
Human papilloma virus | (HPV) strains 6 + 11
40
What is HPV?
non-enveloped DNA virus
41
How does HPV present?
-genital warts on the penis, vulva, viagina, cervis and perianal skin
42
What strains of HPV have the highest association with cervical and anal cancer?
HPV 16+18
43
How is HPV prevented?
there is a vaccine against strains now (for women) | -smear tests should also be carried out regularly
44
What is herpes?
cause by the herpes simplex virus (HSV)
45
What type of virus is HSV?
enveloped DNA virus | -there are 2 types HSV 1 and HSV 2
46
What does HSV 1 cause?
- oral and genital herpes | - associated with cold sores
47
What does HSV-2 cause?
genital herpes and often leads to recurrent infection | -associated with HIV
48
When is HSV 2 most dangerous?
in pregnancy as vagincal delivery means that the baby can develop complications of herpes
49
How does herpes present?
- painful ulcers - dysuria - dischagre - OR asymptomatic
50
How is herpes indenitified?
swabs and serology
51
How is herpes treated?
antivirals like acyclovir
52
What is "thrush"?
``` a yeast (fungus) infection causes by candida alicans -it is a normal vagincal flora and will present in people who have the risk factors ```
53
What are the risk factors for thrush?
- immunosuppression (pregnancy and HIV) - diabvtetes - antibiotics - COCP
54
What are the symptoms of thrush?
-white, non-offensive vaginal discharge with pruritus, pain and dyspareunia
55
How is thrush diagnosed?
high vaginal swabs | microscopy
56
How is thrush treated?
clotrimazole (vaginal pessary or cream)
57
What is the most common vaginal flora and what is its role?
lactobacillus- acts to decrease the pH in the vagina to help protect against bacteria proliferation
58
WHat happens in BV?
- bacterial vaginosis | - overgrowth of gardnerella vaginalis
59
How do you get a decrease in the lactobacillus?
-anything that disrupts the vagina floor e.g. washing the vagina with strong soaps or washing inside the vagina
60
If you have an altered flora what can this lead to?
-increased risk of contracting STI's
61
What does BV present with?
offensive vaginal discharge without pruritis or pain
62
How is BV diagnosed?
high vaginal swabs | gram staining and KOH test
63
What is BV treated with?
metronidazole
64
What is PID?
pelvic inflammatory disease | - ascending infection of the uterus, fallopian tubes and ovaries
65
What microorganisms can cause PID?
-c.trachomatis -N.gonnorhoeae -Gardenellla sp. -Mycoplasma genitalium (also inserting IUDs)
66
What is inflammation of the fallopian tubes called?
salpingitis
67
What are the clinical complications of salpingitis and PID?
- long term damage to the ciliated epithelium of the tubes - inflammaotry exudate can cause the tubes to fill with pus leading to adhesions and obstruction of the tube - tubo-ovarian abscess formation - can lead to sub fertility - Fitz-hugh Curtis syndrome
68
What are the risk factors of PID?
``` young age multiple sex partners lack of barrier contracteption low-socio economic status IUD ```
69
Who does PID most commonly affect?
sexually active women aged 20-30
70
What are the symptoms of PID?
- lower abdominal pain - dyspareunia - purulent discharge - AUB WOMEN MAY BE ASYMPTOMATIC AND ONLY PRESENT WITH CHRONIC PELVIC PAIN / PROBLEMS WITH FERTILITY
71
What are the signs of PID?
- pyrexia - pain on palpation (bimanual vaginal examination) - evidence of discharge on speculum
72
Why would a women have abnormal discharge or vaginal bleeding in PID?
due to endometriosis
73
Why else could the women have pain in the lower abdomen? (think differential diagnosis)
- constipation - ectopic pregnancy - appendicitis - IBD - UTI - endometriosis - ovarian cysts
74
Why does PID lead to sub-fertility?
- adhesions from chronic inflammation - increased risk of ectopic pregnancy - reduced likelihood of successful fertilisation
75
What is fitz-hugh curtis syndrome?
inflammation of the liver capsule causes peri-hepatitis and RUQ pain and scarring between liver and diaphragm
76
How is PID managed?
Prevention better than cure!!! - antibitotics (broad spectrum) for more than 14 days to ensure eradication - analgesia - screening to sexual partners
77
What is the next step if a women fails to respond to treatment?
-laproscopy! essentail to confirm the diagnosis or make an alternative diagnosis

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