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Flashcards in Micro Deck (33):
1

Normal vaginal flora

Lactobacillus spp. which produces lactic acid, hydrogen peroxide which suppress growth of other bacteria

strep viridian's, group B beta haemolytic strep, candida sep

2

normal pH of vagina

acidic

3

non sexually transmitted genital tract infection

candida infection (thrush)
bacterial vaginosis - more common in sexually active people but not sexually transmitted
prostatitis - can also be associated with sexually transmitted infections

4

candida infection - is it normal to be have candida
predisposing factors

30% woman have candida and are fine
recent AB therapy, high oestrogen levels, poorly controlled DM, immunocompromised px

5

candida presentation
dx
rx

intensely itchy white vaginal discharge - discharge looks like cottage cheese
clinical diagnosis - high vaginal swabs for culture - was into the posterior of the cervix

topical clotrimazole pessary or cream, oral fluconazole

6

microscopy of candida albicans

fungus
yeast with hyphae (budding)

7

how does an infection of Candida look like in males

spotty rash of candida balanitis
settles with cream
common in males with poorly controlled DM

8

bacterial vaginosis organisms
symptoms
dx
why is it distressing

Gardnerella vaginalis/mobiluncus sp. /other organisms incl anaeorbes

thin watery fishy smelling discharge

clinical dx raised vagina pH >4.5

people will try wash the vagina out which will worsen the imbalance and the smell

9

lab testing for BV
treatment

HVS sent to lab and examined miscroscopically to look for clue cells - high subjective test. Hay - Son scoring system estimates proportions of clue cells to epithelial cells and lactobacillus

PO metro

10

prostatitis classification

acute bacterial
chronic bacterial
chronic/chronic pelvic pain syndrome

11

acute bacterial syx
what can it be a cx of
organisms
dx
rx

symptoms of UTI but may have lower abd pain/back/perineal/penile pain and tender prostate on examination

rare cx of UTI in men

E.Coli and other coliforms, check for STI in <35s gonorrhoea, chlamydia

clinical signs and MSSU for C&S. STI suspected then first pass urine

cipro for 28 days, if high C Diff risk then Trimethoprim for 28 days

12

bacterial STIs
viral
parasites

chlamydia trachoma's
neirssera gonorrhoea
treponema pallidum (syphilis)

HPV (genital warts)
herpes simplex (herpes)
hep and HIV

trichomonas vaginalis
phthirus pubis
scabies

13

chlamydia
what does it infect
who
how
gram stain
groupings
rx

commonest bacterial STI in the UK

urethra, rectum, throat and eyes and endocervix in females

biggest poor in males who have sex with other males

obligate intracellular bacteria with biphasic life cycle - does not reproduce outside a host cell

does not stain with a gram stain as there is no peptidoglycan in the cell wall

serovars A-C = trachoma eye infection (not an STI)
servers D-K - genital infection - commonest STI
Servers L1-L3 - lymphogranuloma vnerum - can mimic IB S

azithomycin 1g PO for uncx chlamydia

14

gonorrhoea
more common that chlamydia?
infects what?
gram stain?
what about the organism

less common

urethra, rectum, throat and eyes and endocervix in females

gram neg diplococcus - looks like two kidney beans facing each other, easily phagocytksed by polymorphs so often appear intracellularly on a gram film

fastidious organism that does not survive well in less than ideal conditions so outside the body

15

discharge from a gonorrhoea infection

purulant discharge - dripping tap

16

dx of chlamydia and gonorrhoea

combined nucleic acid amplification tests or PCR-test for both organisms in one test

17

who are the tests for both done on

male - first pass urine sample
females - HVS or vulvo vaginal swab
rectal and swabs
eye swabs for babies and adults - babies for when the mothers have gonorrhoea as eyes can be full of pus

18

what other tests can be for for gonorrhoea

microscopy of urethral/endocervical swabs
culture on selective agar plates - done on endocervical, rectal and throat swabs but not on vaginal swabs

19

advantages of PCR/NAATs over culture
disadvantages

less invasive
more sensative
will be positive even if organisms die
takes hours not days

cannot test AB sensitivities without culture
will detect dead organisms - have to wait 5 weeks to do a test of cure tests

20

AB resistance in N. gonorrhoea
what are they resistant to
recommended treatment
what is recommended for all px

resistant to pencillins, tetracyclines, quinolone and oral cephalosporins

IM ceftriaxone and oral azithromycin

test of cure

21

syphilis caused by what
gram stain
tests

treponema pallidum
does not stain with gram stain
cannot be grown in artificial culture media so dx PCR or blood test to detect antibodies

22

stages of syphilis

1 - organism multiplies at inoculation site and gets into the blog stream - chancre can heal without treatment
2 - large numbers of bacteria circulating in the blood with manifestations at different sites (snail track ulcers, rash, flu like)
Latent stage - no symptoms but low level multiplication of spirochete in intima of small blood vessels. can be early and late latent stages
late stage - cardiovascular or neurovascular cx years later

23

syphilis dx

dark ground microscopy to look for spirochetes in exudate from 1 and 2 lesions
swab of 1 and 2 lesions for PCR
serology - test for antibodies non specific and specific

24

non specific tests

VDRL
RPP

indicate tissue inflammation
may be falsely positive
how active the disease is
useful for monitoring response to therapy
usually become negative after treatment

25

specific serological tests

IgM and IgG ELISA used as the screening test for syphilis then the following tests can be done if +ve

TPPA
TPHA
specific for syphilis but remain positive for life
not useful for monitoring response in therapy

26

syphilis treatment

injectable long acting preparations of penicillin provided px not penicillin allergic

27

genital warts
cause
organism
tests
types

commonest viral STI
HPV
non enveloped icocohedral virus containing double stranded DNA
cannot be grown in culture media or maintained in lab animals so difficult to study
>100 types 6 and 11 - genital warts
16 and 18 cervical cancer

28

genital warts
spread
dx
recur
vaccine

spread by close genital skin contact
clinical dx
cryotherapy, podophyllotoxin cream/lotion
often re occur
11-13 yo girls that immunise against 6,11,16 and 18

29

genital herpes cause
organism
transmission
spread

HSV 1 and 2
enveloped virus containing double stranded DNA
transmitted by close contact with someone shedding the virus
spread by either genital/genital or oropharyngeal/genital contact

30

genital herpes pathogenesis
primary infection
virus replication

primary infection may be asymp
replicates in dermis and epidermis
gets into sensory nerve ending to sensory and autonomic nerves
inflammation at nerve endings - painful multiple small vesicles which are easily deroofed
virus migrates to sacral root ganglion and hides there
can be reactivated causing recurrent genital herpes attack
intermittent virus shedding can occur in the absence of symptoms

31

GH dx and rx
what does it look like

swab in viral transport medium
acyclovir and pain relief

shallow ulcers - very painful

32

trichomonas vaginalis micro
transmission
causes what
dx
rx

single cell protozoal parasite - divided by binary fission - human host only

transmitted by sexual contact

vaginal discharge and irritation in females (urethritis in males)

high vaginal swab for microscopy

oral metro

33

pubic lice - phthirus pubis
how is it acquired
how long do they live for
treatment

close genital skin contact
males live for 22 days and females for 17
malathion lotion