Infections of the Genital Tract Flashcards
(152 cards)
1
Q
What does the term sexually transmitted infections include?
A
Both symptomatic and asymptomatic cases, where sexual activity is the principle mode of transmission
2
Q
What does the term sexually transmitted disease include?
A
Symptomatic cases only
3
Q
Give two examples of infections where sexual activity is a possible mode of transmission, but also have other routes of transmission?
A
- BBV
- Sexual transmission of intestinal pathogens
4
Q
What intestinal pathogens can be transmitted sexually?
A
- Salmonella
- Shigella
- Giardia
- Entamoeba
5
Q
What groups are at risk of sexually transmitted infections?
A
- Young people
- Certain ethnic groups
- Low socio-economic status groups
6
Q
Why are young people at an increased risk of STIs?
A
Because they are more sexually active
7
Q
What do the groups at risk of STIs relate to?
A
Specific aspects of sexual behaviour
8
Q
What specific aspects of sexual behaviour can cause an increased risk of STIs?
A
- Age at first sexual intercourse
- Number of partners
- Sexual orientation
- Unsafe sexual activity
9
Q
What is happening to the incidence of STIs?
A
It is increasing
10
Q
Why may the incidence of STIs be increasing?
A
- Increased transmission
- Increased GUM attendence
- Improved diagnostic methods, including screening programmes
11
Q
Why may there be an increased transmission of STIs?
A
- Changing sexual and social behaviour
- Increased density and mobility of populations
12
Q
Why may increased GUM attendance give the impression that the incidence of STIs is increasing?
A
Leads to more diagnoses being made
13
Q
Why is GUM attendance increasing?
A
- Decreased stigma
- Greater public, medical, and national awareness
14
Q
How have diagnostic methods improved regarding STIs?
A
Better equipment makes it easier to detect organisms
15
Q
What factors contribute to the burden of STIs?
A
- Can be both acute and chronic/replapsing infections
- Stigma
- May be consequent pathologies
- Disseminated infectins
- Transmission to fetus/neonate
16
Q
What does stigma regarding STIs have an impact on?
A
- Diagnosis
- Tracing
17
Q
What consequent pathologies can arise from STIs?
A
- Pelvic inflammatory disease and infertility
- Reproductive tract cancers
18
Q
Which STI in particular can cause reproductive tract cancers?
A
Papilloma viruses
19
Q
What do disseminated STIs involve?
A
Multiple organ systems, over years and decades
20
Q
How can STIs be diagnosed?
A
- Patients present with genital lesions/problems to GP or GUM clinic
- Clinician notes non-genital clinical features suggestive of STI
- Asymptomatic cases may be detected with contact tracing or screening
21
Q
What genital problems may a patient present to a GP or GUM clinic with?
A
- Ulcers
- Vesicles
- Warts
- Urethral discharge or pain
- Vaginal discharge
22
Q
When may a clinical note non-genital clinical features that are suggestive of STI?
A
If there are clues from the history
23
Q
What may non-genital clinical features of an STI suggest?
A
Disseminated disease
24
Q
What does contact tracing and screening for STIs look for?
A
High risk people
25
What is the purpose of identifying asymptomatic cases by contact tracing and screening?
Reduce risk of complications and transmission
26
How are STIs managed?
* Treatment with antibiotics
* Contact tracing
* Education
27
What is preferable when giving antibiotics in STIs?
* Single dose or short course
* Delivered at time of diagnosis
* Oral drug
28
Are co-infections common with STIs?
Yes
29
What is it important to do due to the fact that co-infection with STIs are common?
* Screen
* Consider empiric treatment for other STIs
30
What happens to treatment for some STIs?
It changes over time
31
Why does the treatment for some STIs change over time?
* Drug availability
* New formulations
* Resistance
32
What is the purpose of contact tracing?
Patient and public health management
33
What education should be delivered regarding STIs?
* Sexual health education
* Advice on contraception
* Detailed instruction on practice and need for safer sex
34
How many types of human papillomaviruses are there?
\>100, *but small number of particular concern*
35
What kind of virus is HPV?
DNA virus
36
What % of young adults will experience HPV in their life?
˜4%
37
What are the most common types of HPV causing STIs?
HPV 6 and 11
38
What do HPV 6 and 11 cause?
* Cutaneous, mucosal, and anogenital warts
* Benign, painles, verrucous epithelial or mucosal outgrowths that can be on;
* Penis
* Vulva
* Vagina
* Urethra
* Cervix
* Perianal skin
39
What are the high risk type of HPV?
16 and 18
40
What are HPV 16 and 18 associated with?
Cervical (\<70%) and anogenital cancer
41
Why is cervical cancer a major public health concern?
* 2500 cases of cervical cancer in 2012
* Most common cancer in women 15-34
* Large % of cases are potentially preventable
42
What % of cervical cancers are associated with HPV 16 or 18?
\<70%
43
How is a diagnosis of HPV infection made?
* People likely to come forward with warts
* Clinical diagnosis
* Biopsy and genome analysis
* Hybrid capture
44
What is the purpose of biopsy and genome capture in HPV viruses?
Gives specific nucleic viral section, so can tell if warts are caused by papilloma
45
How is HPV treated?
* *No treatment*
* Topical podophyllin
* Cryotherapy
* Intralesional interferon
* Imiquimoid
* Surgery
46
Why is HPV often given no treatment?
Spontaneous resolution in 70% of cases in 1 year, and 90% in 2 years
47
How is HPV screened for?
* Cervical Pap smear cytology
* Colposcopy and acetowhite test
* Cervical swab
48
What does a cervical Pap smear cytology check for?
Early evidence of cervical cancer
49
What happens in a cervical swab for HPV?
HPV hybrid capture
50
What % of 20-24 year olds are positive for HPV hybrid capture?
40%
51
What are the types of HPV vaccine?
* Cervarix
* Gardisil
52
What does Cervarix protect against?
HPV 16 and 18
53
Why is cervarix no longer used in the UK?
There was a large backlash against decision to just protect against 2 HPV types when could protect against more
54
What does Gardasil protect against?
HPV 6, 11, 16, and 18
55
When was Gardasil introduced in the UK?
2011
56
Who is the Gardasil vaccine offered to?
Girls 12-13
57
How many doses of Gardasil are given?
2
58
How effective is Gardasil?
99% effective in preventing HPV 16 and 18 related cervical abnormaltiies in those not already infected
59
What is the most commonly detected STI?
Chlamydia Trichomatis
60
What kind of pathogen is C. Trachomatis?
An obligate intracellular bacterium
61
What is the diagnostic result of C. Trachomatis being an obligate intracellular bacterium?
* Can't grow on gram stains
* Can't grow on agar media
62
What serotypes of C. Trachomatis cause non-specific genital chlamydial infections?
D-K
63
What are different serotypes of C. Trachomatis associated with?
Different conditions
64
What does C. Trachomatis infection cause in males?
* Urethritis
* Epididymitis
* Prostatitis
* Proctitis
65
What does C. Trachomatis infection cause in females?
* Urethritis
* Cervicitis
* Salpingitis
* Perihepatitis
66
What is salpingitis?
Inflammation of the fallopian tubes
67
What are the symptoms of salpingitis?
Abdominal pain and referred shoulder pain from the liver
68
What does ocular inoculation of C. Trachomatis cause?
Conjunctivitis
69
What does neonatal infection of C. Trachomatis cause?
* Inclusion conjunctivitis
* Pneumonia
70
How is a C. Trachomatis infection diagnosed?
* Endocervical and urethral swabs
* 1st void urine
71
What is performed on samples taken for investigation of C. Trachomatis infection?
Nucleic acid amplification tests
72
How is a neonatal infection if C. Trachomatis detected?
Conjunctival swab, followed by nucleic acid amplification tests
73
How is a C. Trachomatis infection treated?
* Doxycycline or azithromycin, *can be given as a single large dose*
* Erythromycin in children
74
Is C. Trachomatis ever asymptomatic?
Yes, many cases are, especially in women
75
What does the fact that many causes of C. Trachomatis are asymptomatic have implications for?
Transmission
76
How many cases of C. Trachomatis are diagnosed each year?
\>200,000, *nearly half of all STIs*
77
What % of C. Trachomatis cases are diagnosed at GUM clinics?
50%
78
What % of C. Trachomatis cases are diagnosed from the chlamydia screening programme?
50%
79
Who does the chlamydia screening programme target?
Sexually active under 25's
80
How is the chlamydia screening programme carried out?
Urine (M&F) or swab (F), followed by nucleic acid amplification test
81
What is chlamydia sometimes screened for in conjunction with?
N. gonorrhoea
82
What are the symptoms of primary genital herpes?
* Extensive and painful genital ulceration
* Dysuria
* Inguinal lymphadenopathy
* Fever
83
What is the inguinal lymphadenopathy caused by in primary genital herpes?
Local inflammation
84
What is primary genital herpes usually associated with?
HSV2
85
What does HSV1 usually cause?
Cold sores
86
How severe is recurrent genital herpes?
Can be asymptomatic to moderate
87
What allows recurrent genital herpes to occur?
Due to latent infection in dorsal root ganglia
88
How is a diagnosis of genital herpes made?
PCT of vesicle fluid and/or ulcer base
89
How is genital herpes treated?
Aciclovir
90
When is aciclovir prophylaxis given?
When a patient has frequent recurrences, to try and reduce frequency and severity
91
What reduces the risk of transmission of genital herpes?
Barrier contraception
92
What kind of pathogen is Neisseria gonorrheae?
Gram negative intracellular diplococcus
93
What does N. gonorrhoae cause in males?
* Urethritis and painful discharge
* Epididymitis
* Prostatitis
Proctitis
* Pharyngitis
* May have referred pain to testes or prostate (felt in perineum)
94
In whom does N. gonorrhoae cause proctitis and pharyngitis?
In MSM
95
What does N. gonorrhoeae cause in women?
* *Asymptomatic*
* Endocervicitis
* Urethritis
* PID
96
What does PID lead to?
Inflammation of the fallopian tubes, which causes them to block and may lead to infertility
97
What can disseminated gonococcal infection lead to?
* Bacteriaemia
* Skin and joint lesions
98
How is a gonorrhoea diagnosis made?
* Swab from urethra, cervix, throat, or rectum, or urine sample
* Gram stain of pus or normally sterile site
99
What is the diagnostic difficulty with N. gonorrheae?
Fastidious organism requiring special media
100
How is gonorrhoea treated?
Intramuscular ceftrixone
101
Why must gonorrhoea be treated with IM ceftrixone?
Due to increasing resistance to many other agents
102
What is the increasing antibiotic resistance of N. gonorrhoae partially due to?
Movement of strains between different parts of the world, particularly the Middle East
103
What happens to all patients with gonorrhoea?
They are treated (and tested) for chlamydia with azithromycin
104
What is the addition benefit of treating gonorrhoea patients with azithromycin for chlamydia?
May prevent emergence of resistance to cephalosporins
105
What is the aetiological agent of syphilis?
Treponema pallidum
106
Who are most cases of sphilis found in?
MSM
107
What is the first stage of a syphilis infection?
Indurated, painless ulcer called chancre
108
What happens to the chancre?
It gradually heals
109
When does the second stage of a syphilis infection occur?
6 to 8 weeks later
110
What happens in the second stage of a syphilis infection?
* Fever
* Rash
* Lymphadenopathy
* Mucosal lesions
111
Describe the rash in stage 2 syphilis?
Can develop anywhere, in any shape/form
112
Where is the lymphadenopathy in stage 2 syphilis?
Local area around the groin
113
What is the third stage of syphilis?
Latent, with disease three years
114
What may syphilis develop into in its final stage?
* Neurosyphilis
* Cardiovascular syphilis
* Gummas
115
What are gummas?
Local destruction
116
How is congenital syphilis prevented?
Screen pregnant women to ensure that they don't have undetected syphilis that could be passed on to child
117
What is the problem with diagnosis of syphilis?
Organism can't be grown, apart from in foot pads of various animals, and then must be looked at using dark-field microscopy
118
How is syphilis diagnosed?
Serology; initial screening with EIA antibody test, and then for people who test positive;
* Rapid Plasma Reagin (RPR) titre
* TP particle agglutination (TPPA)
119
What is done with the serology of a patient with suspected syphilis?
The serological pattern is interpreted, including false positives and response to treatment
120
How is syphilis treated?
Pencillin and 'test of cure' follow up to ensure serology is improving
121
How is syphilis screening conducted?
Detects possibility, then go on to do more specific test
122
What may inguinal lymphadenopathy be caused by?
* Lymphogranuloma venereum (LGV)
* Chancroid (Haemophilus ducreyi)
* Granuloma inguinale/donovanosis (Klebsiella granulomatis)
123
What causes LGV?
C. trachoma serotypes L1, L2, L3
124
What does LGV cause?
Rapidly healing papules (raised lumps) leading to inguinal bubo (abscess)
125
Where have there been recent clusters on LGV?
Europe, with MSM
126
What is Chancroid?
Painful genital ulcers
127
What happens in granuloma inguinale/donovanosis?
Genital nodules leading to ulcers
128
What kind of pathogen is trichomonas vaginalis?
Flagellated protozoan
129
How is tricomonas vaginalis spread?
Normally by sexual route
130
What is the relevance of males in trichomonas vaginalis?
They are involved in transmission, but not really affected by it
131
What does trichomonas vaginalis cause?
Trichomonas vaginitis
132
What are the symptoms of trichomonas vaginitis?
* Thin, frothy, offensive discharge
* Irritation
* Dysuria
* Vaginal inflammation
133
How is trichomonas vaginitis diagnosed?
Vaginal wet preperation, with or without culture enhancement
134
How is trichomonas vaginitis treated?
Oral metronidazole
135
What is vulvovaginal candidiasis caused by?
Candida albicans, or other candida species
136
Where may candida albicans, or other candida species, come from?
May be part of normal GI and genital tract flora, *commonly present in very small numbers*
137
What are the risk factors for vulvovaginal candidiasis?
* Antibiotics
* Oral contraceptives
* Pregnancy
* Obesity
* Steroids
* Diabetes
138
What does vuvlovaginal candidiasis cause?
Profuse, white, itchy, curd-like discharge
139
How is a diagnosis of vulvovaginal candidiasis made?
Usually made by looking at discharge, and based on symptoms, but can also be made by a high vaginal smear, with or without culture
140
How is vulvovaginal candidiasis treated?
* Topical azoles or nystatin
* Oral fluconazole
141
What can scabies affect?
Genitalia
142
How can scabies be spread?
Sexually
143
Are pubic lice distinct from other human (body) lice?
Yes
144
What causes bacterial vaginosis?
Pertubed normal flora
145
Disruption to what normal flora can cause bacterial vaginosis?
* Gardnerella
* Anaerobes
* Mycoplasmas
146
What is the disruption of normal flora in bacterial vaginosis usually due to?
Change in pH
147
What are the symptoms of bacterial vaginosis?
Scanty but offensive fishy discharge
148
How is a clinical diagnosis of bacterial vaginosis made?
* Vaginal pH \>5
* KOH whiff test
149
How is a laboratory diagnosis of bacterial vaginosis made?
HVS Gram stained smear
150
What features on a HVS gram stained smear are diagnostic of bacterial vaginosis?
* 'Clue cells'
* Reduced number of lactobacilli
* Absence of pus cells
151
What are clue cells?
Epithelial cells studded with gram variable coccobacilli
152
How is bacterial vaginosis treated?
Metronidazole
