Infections Of The Genital Tract

Question 0

Which is the most common STI?

Answer 0

Chlamydia trachomatis - 209,000 cases

Accounts for nearly half of all cases of STIs

Question 1

How many cases of STIs in the UK?

Answer 1

450,000

Question 2

What are the at-risk groups for STIs?

Answer 2

Young people
Some ethnic groups
Age at first sexual intercourse
Number of partners
Sexual orientation
Unsafe sexual activity

Question 3

Why is there an increased incidence of STIs over recent years?

Answer 3

Increased transmission - changing sexual and social behaviour
Increasing density and mobility of population
Increased genitourinary medicine (GUM) clinic attendance
Greater public, medical and national awareness
Improved diagnostic methods including screening

Question 4

What are the problems of STIs?

Answer 4

Stigma - impact of tracing contacts and diagnosis
Consequent pathology - pelvic inflammatory disease and infertility, repro tract cancers
Disseminated infections
Transmission to fetus/neonate

Question 5

What are some differential diagnoses for genital skin and mucous membrane lesions?

Answer 5

Genital ulcers
Vesicles/bullae
Genital papules
Anogenital warts

Question 6

What are the symptoms of urethritis?

Answer 6

Discharge, dysuria, frequency

Question 7

What are some differential diagnoses of urethritis?

Answer 7

Gonococcal urethritis
Chlamydial urethritis
Non-specific urethritis
Post-gonococcal urethritis
Non-infectious urethritis

Question 8

What are some differential diagnoses for the cause of vulvo-vaginitis and cervicitis which are not caused by STIs?

Answer 8

Bacterial vaginosis

Bartholinitis

Question 9

Give the characteristics of Chlamydia trachomatis

Answer 9

Gram negative
Obligate
Intracellular bacterium

Question 10

Presentation of a Chlamydia trachomatis infection?

Answer 10

Males

• urethritis
• epididymitis
• prostatitis
• proctitis

Females

• urethritis
• cervicitis
• salpingitis
• perihepatitis

Most cases asymptomatic

Question 11

Presentation if there is ocular inoculation or neonatal infection with Chlamydia trachomatis?

Answer 11

Ocular inoculation - conjunctivitis

Neonatal infection - inclusion conjunctivitis, pneumonia

Question 12

How to diagnose Chlamydia trachomatis?

Answer 12

Endocervical and urethral swabs

First void urine - NAAT (nucleic acid amplification test)

Question 13

How to treat Chlamydia trachomatis?

Answer 13

Doxycycline or azithromycin

Erythromycin in children

Question 14

What is the screening method for chamydia?

Answer 14

Nucleic acid amplification test

Question 15

Features of the human papilloma virus?

Answer 15

DNA virus - over 100 types

Question 16

Presentation of HPV virus?

Answer 16

Cutaneous, mucosal and anogenital warts

-benign, painless verrucous epithelial/mucosal outgrowth on penis, vulva, vagina, urethra, cervix, perianal skin

Question 17

Which are the two high risk types of HYP which are oncogenic?

Answer 17

HPV 16 and 18

Question 18

Which cancers is HPV associated with?

Answer 18

Cervical - more than 70% of cancer patients have evidence of HPV
Anogenital

Question 19

How to diagnose HPV?

Answer 19

Clinical
Biopsy and genome analysis
Hybrid cancer

Question 20

Treatment of HPV?

Answer 20

Spontaneous resolution
Topical podophyllin
Cryotherapy
Intralesional interferon 
Inquimod 
Surgery

Question 21

How is HPV screened?

Answer 21

Cervical Pap smear cytology

Cervical swab, HPV capture is positive in 40% of 20-24 year olds

Question 22

What does the herpes simplex virus cause?

Answer 22

Primary genital herpes - extensive painful genital ulceration, dysuria, inguinal lymphadenopathy, fever

Question 23

Which virus is primary genital herpes associated with?

Answer 23

HSV 2

HSV 1 causes cold sores

Question 24

How is the HSV recurrent?

Answer 24

Lies latent in the dorsal root ganglia

Question 25

How to diagnose herpes simplex virus?

Answer 25

PCR of vesicle fluid or ulcer base

Question 26

Treatment of HSV?

Answer 26

Aciclovir for primary and severe disease | Aciclovir prophylaxis for frequent recurrences

Question 27

Give the features of Neisseria gonorrhoeae

Answer 27

Gram negative Intracellular Diplococcus

Question 28

How does Neisseria gonorrhoeae present?

Answer 28

Males - urethritis with discharge - epididymitis - prostatitis - pharyngitis Females - asymptomatic - endocervicitis - urethritis - PID

Question 29

Complication of Neisseria gonorrhoeae in females?

Answer 29

Infertility

Question 30

Complication of Neisseria gonorrhoeae for both sexes?

Answer 30

Disseminated gonoccocal infection | -bacteraemia, skin and joint lesions

Question 31

How to diagnose Neisseria gonorrhoeae?

Answer 31

Swab from the ureteha, cervix, throat, rectus, urine Gram stain It is a fastidious organ requiring special media

Question 32

Treatment of Neisseria gonorrhoeae?

Answer 32

IM ceftriaxone There is increasing resistance to many other agents including penicillin and ciprofloxacin Also treated for chlamydia as a co-infection -given azithromycin which may also prevent emergence of resistance to cephalosporins

Question 33

What is the aetiological agent of syphilis

Answer 33

Treponema pallidum

Question 34

Who is syphilis most common in?

Answer 34

MSM and men

Question 35

What are the stages of syphilis?

Answer 35

Primary - indurated painless ulcer (chancre) Secondary - 6-8 weeks later; fever, rash, lymphadenopathy, mucosal lesions Then have latent, symptom-free years Tertiary - neurosyphilis, CVS syphilis, gummas (destructive lesions of the skin)

Question 36

What is congenital syphillis?

Answer 36

When it has spread from mother to baby

Question 37

How is syphilis diagnosed?

Answer 37

Serologically using antibodies

Question 38

Treatment of syphilis?

Answer 38

Penicillin and test of cure follow up

Question 39

What infections can cause inguinal lymphadenopathy?

Answer 39

LGV - rapidly healing papule then inguinal bubo Chancroid - (Haemophilus ducreyi) - painful genitak ulcers Granuloma inguinale (Klebsiella granulomatis) - causes genital nodules leading to ulcers and lymphadenopathy

Question 40

What is a chancre?

Answer 40

Syphilitic lesion

Question 41

What type of microbe is Trichomonas vaginalis?

Answer 41

Flagellated protozoan

Question 42

Presentation of Trichomonas vaginitis?

Answer 42

Thin frothy offensive discharge Irritation Dysuria Vaginal inflammation

Question 43

How to diagnose Trachomonas vaginitis?

Answer 43

Vaginal wet preparation

Question 44

How to treat Trichomonas vaginitis?

Answer 44

Metronidazole

Question 45

What can vulvovaginal candidiasis be caused by?

Answer 45

Candida albicans and other candida species

Question 46

Risk factors for vulvovaginal candidiasis?

Answer 46

``` Antibiotics Oral contraceptives Pregnancy Obesity Steroids Diabetes ```

Question 47

Presentation of vulvovaginal candidiasis?

Answer 47

Profuse, white, itchy, curd-like discharge

Question 48

How to diagnose vulvovaginal candidiasis?

Answer 48

High vaginal smear

Question 49

Treatment of vulvovaginal candidiasis?

Answer 49

Topical azoles or nyastin or oral fluconazole

Question 50

Proper term for pubic lice and the crab louse?

Answer 50

Pubic lice - pediculosis pubis | Crab louse - phthirus pubis

Question 51

What can cause bacterial vaginosis?

Answer 51

Gardenerella Anaerobes Mycoplasmas

Question 52

Presentation of bacterial vaginosis?

Answer 52

Scanty but offensive fishy discharge

Question 53

How to diagnose bacterial vaginosis?

Answer 53

Vaginal pH > 5 KOH whiff test HVS Gram stain smear - clue cells - epithelial cells studded with Gram variable coccobacilli - reduced number of lactobacilli - absence of pus cells

Question 54

How to treat bacterial vaginosis?

Answer 54

Metronidazole