Microbiology - STIs etc Flashcards
(147 cards)
1
Q
Which species predominates in the healthy vagina?
A
Lactobacillus species
2
Q
What does lactobacillus species produce?
A
Lactic acid +/- hydrogen peroxide
- which suppresses the growth of other bacteria
3
Q
Name 3 Non-STIs
A
Candida
Bacterial vaginosis
Prostatitis
4
Q
Candida infection - definition
A
Vaginal thrush
5
Q
Candida is a fungal infection. True or false?
A
False
- yeast infection
6
Q
Candida infection - Most likely causative organism
A
Candida albicans
7
Q
Candida infection - predisposing factors (name 4)
A
Recent antibiotic therapy
High oestrogen levels
Poorly controlled diabetes
Immunocompromised patients
8
Q
More likely to get a candida infection if you are pregnant. True or false?
A
True
- due to high levels of oestrogen
9
Q
Candida infection -clinical features
A
Intensely itchy
Thick, white vaginal discharge
10
Q
Candida infection - investigations
A
Clinical diagnosis
High vaginal swab for culture
11
Q
Candida infection - management
A
Topical clotrimazole
- either pessary or cream
Oral fluconazole
12
Q
The presence of candida always indicates infection and should be treated. true or false?
A
False
- don’t treat if asymptomatic as some people always have low levels of candida app
13
Q
Candida balanitis - definition
A
Candida of the male penis
14
Q
Oropharyngeal candida gives risk of HIV. True or false?
A
true
15
Q
Bacterial vaginosis - definition
A
Imbalance of bacteria in the vagina. unable to see the healthy organisms (lactobacilli)
16
Q
Bacterial vaginosis is an STI. True or false?
A
False
17
Q
Bacterial vaginosis is most common in sexually active people. True or false?
A
True
18
Q
Bacterial vaginosis - clinical features
A
Fishy smell
Thin, watery, creamy coloured discharge
19
Q
Bacterial vaginosis - investigations
A
Clinical diagnosis
High vaginal swab
- look for clue cells
20
Q
Bacterial vaginosis - if you add potassium hydroxide to the discharge what happens?
A
Fishy odour, yielding a positive whiff test
21
Q
High vaginal swab for bacterial vaginosis findings
A
Absence of bacilli and replacement with clumps of coccobacilli
Few polymorphonuclear leukocytes
22
Q
Bacterial vaginosis - acidic/alkaline pH?
A
alkaline
23
Q
Bacterial vaginosis - management
A
Oral metronidazole, 7 days
24
Q
Bacterial vaginosis infection leads to increased rate of upper genital tract infections. True or false?
A
True
25
Prostatitis - clinical features
```
Symptoms of UTI
Also
- lower abdominal pain
- back pain
- perineal pain
- penile pain
```
26
Prostatitis - investigations
MSSU for C+S
27
Prostatitis - management
Ciprofloxacin for 28 days
28
Prostatitis - management in patients at high risk of C diff
Trimethoprim
29
Syphilis is a bacterial/viral/parasitic STI
Bacterial
30
Name 3 bacterial STIs
Chlamydia
Gonorrhoea
Syphilis
31
Name 4 viral STIs
Human papilloma virus (genital warts)
Herpes simplex (genital herpes)
Hepatitis
HIV
32
Name 2 parasitic STIs
Pubic lice
| Trichomonas vaginalis
33
STI re-infection is common/uncommon
Common
34
With STIs it is common to have a co-infection. True or false?
True
35
What is the commonest bacterial STI in the UK?
Chlamydia
36
Chlamydia - highest incidence in which age group?
20-24
37
Chlamydia - transmission
Vaginal
Anal
Oral
38
Chlamydia - which sites does it infect?
```
Urethra
Rectum
Throat
Eyes
Endocervix
```
39
Chlamydia - causative organism
Chlamydia trachomatis
40
Does chlamydia trachoma's stain with gram stain?
No, there is no peptidoglycan in the cell wall
41
Chlamydia - which serovars are most common to cause genital infection?
Serovars D-K
42
Chlamydia - clinical features (female)
Post coital or intermenstrual bleeding
Lower abdo pain
Dyspareunia
Mucopurulent cervicitis
43
Chlamydia - clinical features (male)
```
Milky urethral discharge
Dysuria
Urethritis
Epididymo-orchitis
Proctitis
```
44
Chlamydia is often asymptomatic. true or false?
True
45
Chlamydia discharge
Milky, watery
46
Which STI is associated with pelvic inflammatory disease?
Chlamydia
47
Investigate for chlamydia ___ days after sexual exposure?
14 days
48
Chlamydia investigations are combined with what other STI ?
Gonorrhoea
49
Combined chlamydia and gonorrhoea investigations
NAATs
| PCR
50
Combined chlamydia and gonorrhoea investigations - females
Vulvovaginal swab or
| high vaginal swab
51
Combined chlamydia and gonorrhoea investigations - males
First void urine
52
Advantages of NAATs and PCR over culture ?
Faster
| Increased sensitivity
53
Disadvantages of NAATs and PCR
Tell you genetic material of chlamydia when there is not particularly an active infection as it can detect dead organisms
54
Should you do a test of cure for chlamydia and gonorrhoea patients ?
Yes
| - 5 weeks after diagnosis
55
Chlamydia - management
Doxycycline 100mg bd x 7 days
56
Why is azithromycin no longer used for management of chlamydia?
Rate of resistance has increased
57
Clinical features of chlamydia transmission to neonate?
Conjunctivitis
| Pneumonia
58
Gonorrhoea - transmission
Sex
59
Higher risk of transmitting gonorrhoea if spreading from woman -> man. True or false?
False
| - Man -> woman
60
Gonorrhoea - incubation period
2-5 days
61
Gonorrhoea - what sites does it infect?
```
Urethra
Rectum
Throat
Eyes
Endocervix
```
62
Gonorrhoea - causative organism
Neisseria gonorrhoeae
63
Neisseria gonorrhoea microbiology
Gram -ve diplococcus
64
Microscopy of which organism looks like 2 kidney beans facing each other?
Neisseria gonorrhoea
65
Gonorrhoea - clinical features (males )
Purulent dischage
Urethritis
Dysuria
66
Gonorrhoea - clinical features (female)
Altered/increased vaginal discharge
Dysuria
Pelvic pain
67
Gonorrhoea - more likely to be asymptomatic in males/females?
Females
68
Gonorrhoea - which other STI do you co-test for?
Chlamydia
69
Combined gonorrhoea and chlamydia testing
NAATs
| PCR
70
Gonorrhoea - investigations
NAATS
PCR
Microscopy of urethral/endocervical swabs
Culture
71
If doing a culture for gonorrhoea, which agar should be used?
Non selective chocolate agar
72
Gonorrhoea - management
IM ceftriaxone 500mg
73
Gonorrhoea - Why must patients be managed in hospital?
Route of ceftriaxone is IM
74
Gonorrhoea - when should you do a test of cure?
2 weeks after
75
Gonorrhoea - why should you do a test of cure?
Untreatable gonorrhoea has been described in many parts of the world
76
Humans are the only hosts of syphilis. True or false?
True
77
Name the 4 stages of syphilis
Primary lesion
Secondary stage
Latent stage
Late stage
78
Syphilis - what is the primary lesion called?
Chancre
79
Syphilis - what is a chancre?
Painless ulcer at the site of contact with the vulva (inoculation site)
80
Syphilis - a chancre must be treated?
False, will heal without treatment
81
Syphilis - incubation period
21 days
82
Syphilis - secondary stage clinical features
Snail track mouth ulcers
Generalised rash on palms and soles of feet
Flu like symptoms
Patchy alopecia
Condylomata lata (genital wart like lesions which ooze fluid)
83
Syphilis - latent stage clinical features
None
84
Syphilis - late stage clinical features
Cardiovascular or neurovascular complications occur many years later
85
Syphilis - causative organism
Treponema Pallidum
86
Treponema pallidum - which kind of organism is it ?
Spirochete - cork screw appearance
87
Treponema pallidum stains with gram stain. True or false?
False
88
Syphilis - transmission
Sexual contact
Vertical
Blood transfusions
Non-sexual contact (healthcare workers and needles)
89
Syphilis - clinical features
```
Painless ulcer (chancre)
Snail track mouth ulcers
Generalised rash on palms and soles
Non tender local lymphadenopathy
Flu like symptoms
```
90
Syphilis - investigations of chancre
Swab for PCR
91
Syphilis - investigations to demonstrate organism
Dark field microscopy or PCR
| - demonstrates treponema pallidum
92
Syphilis - serological testing (non specific)
```
Used to monitor response to treatment and measure disease activity
IgG
IgM - active infection
VDRL - indicates tissue inflammation
RPR - indicates tissue inflammation
```
93
Which 2 non specific serological tests are useful to monitor response to therapy?
VDRL
RPR
- they usually become negative after treatment
94
Specific serological tests for syphilis
```
Confirm the diagnosis but levels often remain positive for life
EIA - screening test
TPHA
TPPA
CLIA
FAT
```
95
Syphilis - it is possible to self cure. True or false?
True
96
Syphilis - management
Long acting IM penicillin
| - penicillin has to hang around for a long time enough for the bug to die
97
Syphilis - management in penicilin allergic patients
Desensitisation. Give the patient very small doses and gradually build up whilst being closely monitored
98
Syphilis - follow up
RPR should fall and be negative
| - titres should decrease by 3-6 months in early syphilis
99
Name a new emerging STI
Mycoplasma genitallium
100
Mycoplasma genitalium - clinical features
Persistent urethritis
101
What is the most common viral STI in the UK ?
Genital warts
102
Genital warts - cause
HPV
| - most common types that cause genital warts: type 6,11
103
Genital warts - Transmission
Likely to have acquired it from an asymptomatic partner (80% of population are already exposed to HPV but only 10% have detectable infection)
104
Genital warts - clinical features
Painless warts
Present around sites of friction
Cauliflower appearance
- rough surface
105
Genital warts - investigations
Clinical diagnosis only
106
Genital warts - management
Podophyllotoxin cream/lotion
Imiquimod
Cryotherapy
107
Genital warts are cured after treatment. true or false?
False
| - commonly recur
108
HPV vaccination - which age group is this given to
11-13 year old females
109
What does HPV vaccination immunise against?
Type 6,11,16,18
110
Who gets HPV vaccination?
Females 11-13
| MSM up to and including those age 45
111
Genital herpes - organism
Herpes simplex virus type 1 or 2
112
Genital herpes is most commonly HSV type 1 or 2 ?
Type 2
113
Genital herpes - primary infection
Asymptomatic in many
114
Genital herpes - pathogenesis
Virus replicates in dermis and epidermis
Virus gets into the nerve endings or sensory and autonomic nerves
Inflammation at nerve endings
Virus migrates to sacral root ganglion and hides from immune system
Reactivation of virus
115
Genital herpes - transmission
Close contact with someone shedding the virus
| Spread by either genital/genital or genital/orpharyngeal contact
116
Genital herpes - clinical features
Recurrent
VERY painful ulcers
Blistering and ulceration of external genitalia
Vaginal or urethral discharge
Local lymphadenopathy
Recurrent vesicular rash on thigh or buttocks
117
Genital herpes - investigations
Swab for PCR
| - must derive blisters when taking swab
118
Genital herpes - management
Oral aciclovir 400mg TDS 5 days
| Topical relief - lignocaine
119
Genital herpes and pregnancy
May need caesarean section
120
Trichomonas vaginalis - organism
Single celled protozoa parasite which divides by binary fission
121
Trichomonas vaginalis - transmission
Sexual contact
122
Trichomonas vaginalis - clinical features
Yellow vaginal discharge
Irritation in females
Urethritis in males
123
Trichomonas vaginalis - investigations
Microscopy
- high vaginal swab
- organism will be seen moving about
124
Trichomonas vaginalis - management
Metronidazole
125
Pubic lice - organism
Phthirus pubis
126
Pubic lice - how is it acquired
By close genital skin contact
127
Pubic lice - clinical features
Intense itch
128
Pubic lice - otherwise known as
Crabs
129
Pubic lice - management
Malathion lotion
130
First pass urine or MSU for chlamydia/gonorrhoea?
First pass urine
131
Treatment of prostatitis
Ciprofloxacin 28 days
132
Ophthalmia neonatorum
Chlamydia passed on through birth from mother to child resulting in conjunctivitis in the neonate
133
Testing for chlamydia in asymptomatic male who has sex with woman
first pass urine for NAATS
134
Testing for chlamydia in SYMPTOMATIC male who has sex with woman
microscopy - during clinical examination take urethral swab and will get result in 5 mins
+
first pass urine for NAATS
135
Testing for chlamydia in MSM
First-catch urine (or urethral swab) and
| pharyngeal and rectal swabs (all NAAT)
136
Test of cure is required for chlamydia. True or false?
False
| - only required if patient is pregnant or if treatment compliance is in question
137
First line investigation for ?sypphilis
PCR test
138
Which test is specific for syphilis but not useful for monitoring?
TPPA
139
What is the ELISA test and what is it used for?
Tests for IgG and IgM antibodies for syphilis
140
EILSA test done and comes back negative. What do you do?
Nothing, patient is negative
141
EILSA test done and comes back positive. What do you do`?
Further tests
- TPPA
- IgM EILSA
142
What is the treatment of Primary/Secondary and early latent
| infection
2.4MU benzathenepenicillin IM.
143
Herpes simplex virus is a single/double stranded DNA/RNA
Double stranded DNA
144
Common causative organism for prostatitis?
E coli
145
Patients at risk of having acquired a BBV should be tested for?
Hep B
HIV
Hep C
Syphilis
146
Partner notification is required for HSV. True or false?
False
| - progresses differently in different patients
147
If a young person (under 16) meets the criteria for the X guidelines they are said to have ______ _______
Fraser guidelines
| Gillick competence
