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Reproductive System > Infections Of The Reproductive Tract > Flashcards

Infections Of The Reproductive Tract Flashcards

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1
Q

Risk factors for developing an STI

A
  • multiple sexual partners
  • not using physical contraception
  • early age first intercourse
  • sex workers
  • men who have sex with men
  • lack of immunisation
  • low socio-economic status
  • black Caribbean/African
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2
Q

List STIs

A

Chlamydia
Gonorrhoea
Genital herpes
Genital warts
HIV
Syphilis
Trichomoniasis

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3
Q

Describe physiological discharge in women

A

White or clear no offensive discharge that changes with the menstrual cycle

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4
Q

Describe changes in discharge in the phases of the menstrual cycle

A
  • follicular + luteal phase: small amount of cervix mucus
  • ovulation: abundant + elastic cervical mucus
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5
Q

Symptoms of vaginal thrush

A
  • vulval itching
  • vulval soreness + irritation
  • vaginal discharge (cheese like, no odour)
  • superficial dyspareunia
  • dysuria
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6
Q

what causes vaginal thrush?

A

candida albicans

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7
Q

risk factors of vaginal thrush

A
  • increased oestrogen (e.g. pregnancy*
  • poorly controlled diabetes
  • immunosuppression
  • broad spectrum abx
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8
Q

management of vaginal thrush

A
  • single dose clotrimazole cream or pessary at night
  • or 3 doses of lower dose pessary at night
  • single dose oral antifunal tablets e.g. fluconazole
  • canesten duo - OCP containing single fluconazole tablet + clotrimazole cream
  • advise alterantive contraception needed for 5 days after cream or pessary use - damage latex condoms + prevent spermicides working
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9
Q

What is dyspareunia?

A

Painful sexual intercourse

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10
Q

What is bacterial vaginosis?

A

Overgrowth of predominantly anaerobic organisms
e.g. gardnerella vaginalis

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11
Q

Risk factor for bacterial vaginosis

A
  • receiving oral sex
  • vaginal washes/douching
  • smoking
  • higher in sexually active women
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12
Q

What is the normal organism that causes bacterial vaginosis?

A

gardnerella vaginalis

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13
Q

Risk factors of bacterial vaginosis

A
  • multiple sexual partners
  • excessive vaginal cleaning - douching, vaginal washes
  • recent abx
  • smoking
  • copper coil
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14
Q

Investigation of bacterial vaginalis

A

Vaginal pH >4.5
Whiff test
Gram stain: clue cells
High vaginal swab + microscopy > clue cells

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15
Q

Finding of bacterial vaginosis on microscopy

A

Clue cells

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16
Q

Symptoms of bacterial vaginosis

A

thin, grey/white fishy smelling discharge
WITHOUT itching

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17
Q

Treatment of bacterial vaginosis

A

oral metronidazole
Clindamycin gel

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18
Q

What should be avoided whilst on metronidazole + why?

A

alcohol
cause a ‘disulfiram like reaction’ > N+V, flushing

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19
Q

complications of bacterial vaginosis

A
  • increases risk of STIS
  • severe complications in pregnancy: miscarriage, preterm delivery, premature membrane rupture, low birth weight, PP endometritis
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20
Q

Symptoms of chlamydia in women

A
  • asymptomatic in 70%
  • increased vaginal discharge
  • post-coital or intermenstrual bleeding
  • deep dyspareunia
  • pelvic pain
  • dysuria
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21
Q

Symptoms of chlamydia in men

A
  • asymptomatic 50%
  • urethral discharge
  • dysuria
  • epididymitis
  • reactive arthritis
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22
Q

What organism causes chlamydia?

A

chlamydia trachomatis

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23
Q

examination findings of chlamydia

A
  • pelvic or abdominal tenderness
  • cervical motion tenderness
  • inflamed cervix
  • purulent discharge
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24
Q

Diagnosis of chlamydia

A
  • nucleic acid amplification tests NAAT
  • vulvovaginal or endocervical swab
  • first catch urine sample
  • urethral swab in men
  • rectal swab or pharyngeal swab
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25
Management of chlamydia
- first line: **doxycylcine 100mg BD for 7 days** - if contraindicated: azithromycin or erythromycin - sexual abstinence for 7 days - refer to GUM for contact tracing - advise on prevention
26
contraindications of doxycycline
pregnancy breast feeding
27
What organism causes gonorrhoea?
*Neisseria gonorrhoeae*
28
Describe *Neisseria gonorrhoeae*
Gram negative (pink) diplocci Unencapulsated Pilated
29
Symptoms of gonorrhoea in men
- thick yellow discharge - dysuria
30
Symptoms of gonorrhoea in women
- 50% asymptomatic - dysuria - dyspareunia - increased or altered discharge - lower abdominal pain - intermenstrual bleeding or Menorrhagia - rare
31
What organism causes trichomoniasis?
*Trichomonas vaginalis*
32
Describe *trichomonas vaginalis*
Protozoa With flagella Causes trichomonasis
33
Symptoms of trichomoniasis in females
- lots of yellow, frothy discharge with odour - vulval itching/soreness
34
Treatment of trichomoniasis
Metronidazole
35
What is non-gonococcal urethritis in men? What often casues it?
Inflammation of urethra with associated discharge Caused by chlamydia trachomatis
36
Investigations of STIs in men
Urine sample Urethral swap
37
Investigation of STIs in females
High vaginal swab Endocervical swab Vulvovaginal swab (self swab)
38
What do you use a high vaginal swab to test for?
Trichomonasis Candida BV
39
What do you use an endocervial swab to test for?
Chlamydia Gonorrhoea
40
What do you use an vulvovaginal swab to test for?
Chlamydia Gonorrhoea
41
Describe human papilloma virus
DNA virus Non enveloped Causes genital warts
42
What organism causes genital warts?
*human papillomavirus* 6 + 11
43
Importance of HPV 6+11
Cause genital infections
44
Importance of HPV 16+18
Association with cervical cancer
45
Describe *herpes simplex virus*
DNA virus Enveloped
46
What organism causes cold sores?
herpes simplex 1
47
Management of herpes
Antivirals *e.g. acyclovir* - cannot eradicate infection (no cure) - reduce severity + duration of current episode
48
What organism causes syphilis?
*treponema pallidum*
49
Describe treponema pallidum
Bacteria Spirochete Causes syphilis
50
Describe primary syphilis
Painless ulcers
51
Treatment of syphilis
Penicillin But depends on stage Doxycycline or erythromycin if allergic
52
Management of bacterial STIs
Multiple antibiotics *e.g. azithromycin + Ceftriaxone*
53
Treatment of vaginal thrush
Nystatin Clotrimazole
54
What is pelvic inflammatory disease?
General term for infection of upper genital tract
55
What organism can cause PID?
*chlamydia trachomatis* *neisseria gonorrhoeae* *mycoplasma genitalium* Normal vaginal flora
56
What can PID cause?
**Endometritis** - uterus **Saplpingitis** - uterine tubes **Parametritis** - pelvic floor **Oophoritis** - ovaries **Turbo-ovarian abscess** **Pelvic peritonitis**
57
Symptoms of PID
- pelvic pain/lower abdominal pain - discharge - post-coital/intermenstrual bleeding - fever - dyspareunia - right upper quadrant pain due to peri-hepatitis - secondary dysmenorrhea
58
Signs of PID
- lower abdominal tenderness - abnormal cervical or vaginal discharge - pain on moving cervix or palpating uterus - adnexal tenderness - fever >38°
59
Early complications of PID
Sepsis Peritonitis
60
Late complications of PID
- chronic pelvic pain - pelvis abscess (tube-ovarian) - infertility - ectopic pregnancy - Fitz-Hugh Curtis Syndrome (peri-hepatitis)
61
Management of PID
- antibiotics *e.g. oral ofloxacin + oral metronidazole* - screen for STIs - contract tracing - advise
62
What antibiotics are given for PID?
*oral ofloxacin + metronidazole*
63
What STIs and non-STIs present with a change in discharge in women? What is the change in each?
- **vaginal thrush**: non odorous cottage cheese-like white discharge WITH itching - **bacterial vaginosis**: fishy white/grey vaginal discharge WITHOUT itching - **chlamydia**: increased vaginal discharge - **gonorrhoea**: increased discharge - **trichomoniasis**: lots of frothy, yellow/green, odorous discharge WITH itching
64
Treatment of chlamydia
*doxycycline* or *azithromycin* *erythromycin* in pregnancy/allergy
65
Investigation of chlamydia
NAAT Nucleic acid amplification tests Vaginal swabs
66
Treatment of gonorrhoea
- *cefriaxone* to treat - *azithromycin* to boost the effect
67
Why is *azithromycin* used along side *cefriaxone* to treat gonorrhoea?
*azithromycin*: - boosts the effects - reduces risk of resistance - treatment of chlamydia in case of co-infection
68
Describe secondary syphilis
- Can develop weeks later - associated rash but symptoms will often disappear
69
Describe tertiary syphilis
- infection can remain latent and reactive later in life - *e.g. in pregnancy > Congential syphilis*
70
Presentation of genital warts
**Painless** genital warts on penis, vulva, vagina, cervix or perianal skin
71
Presentation of herpes
- **Painful** ulcers - dysuria - discharge
72
Causes of PID which are not STI related
- gynaecological *e.g. ectopic pregnancy, ovarian cyst, endometriosis* - GI *e.g. appendicitis, IBS* - UTIs
73
What is Fitz Hugh Curtis syndrome?
Inflammation of liver capsules causes peri-hepatitis RUQ pain + scarring
74
What is used for contact tracing for STIs?
GUM clinics
75
What STIs present with discharge in men? Describe the discharge in each
- **chlamydia**: urethral discharge - **gonorrhoea**: thick yellow discharge - **non-gonococcal urethritis**: urethral discharge
76
What STIs + non STIs are treated with *metronidazole*?
- trichomoniasis - BV - PID (+ *ofloxacin*)
77
Gram stain of chlamydia trachomatis
Gram stain obligate intracellular bacterium
78
Describe chlamydia trachomatis
-Obligate intracellular bacterium - Gram negative - Unique cell wall (inhibits phagolysosome fusion)
79
Why is chlamydia trachomatis immune to penicllins?
It does not have a peptidoglycan layer Penicillins work by inhibiting cell wall synthesis
80
Why can doxycycline not be given to a pregnant woman?
It is highly teratogenic

Reproductive System (22 decks)

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