Flashcards in Repro 6 STIs and PID Deck (105)
Why is the term STI instead of STD used?
STI - symptomatic and asymtomatic infection - still potential problems and potential to spread it
STD - symptomatic infection only
Where is the national data for STIs collected from?
GUM clinics - Gentio Urinary Medicine, which notify STDs centrally
Why is there a gradual and sustained increase in STI prevalence from 1995 to 99?
Acceptability of GUM services
Greater public awareness
Development in diagnostic methods
Behavioural, socio-economic, healthcare provision and biological factors all contribute
What is the suspected reason for the fall in STI diagnosis prior to 95?
Thought to reflect changes in behaviour in response to the HIV epidemic
Why is data from GUM clinics an underestimation of the true incidence of STIs?
Patients may be seen in other settings e.g. GP or family planning clinics
Many infections are asymptomatic and only approx 10% of cases attend GUM
Who are the at risk groups in society of contracting STIs?
Ethnic minority (stigma)
Low socio-economic status
Teenage mothers (at risk behaviour)
What factors contribute to the risk of contracting STIs?
Age at first intercourse
Total number of sexual partners
Frequency of change of partners
Sexual orientation (with other factors)
Practice of unsafe sex
Lack of skills ad confidence to negotiate safe sex
What STIs might cause genital ulcers?
HSV (herpes simplex virus)
Chanchroid (Haemophilus ducreyi)
What STIs might cause vesicles of bullae?
When might an STI cause genital papules? Give some examples.
Transient manifestation of STIs - condylomata acuminata (anogenital warts), umbilicated lesions of Molluscum contagiosum virus
What should aspects of genital ulcers should be assessed?
What are the various types of urethritis and what might cause them?
NGU (nongonococcal urethritis) - chlamidia trachomatis, ureaplasma, mycoplasma, trichomonas HSV
What is vulvovaginitis and what might cause it?
Vaginal infection - candidias, trichomoniasis, staphylococcal, foreign body, HSV
What might cause cervicitis?
C. trachomatis, N. gonorrhoeae, HSV, HPV
What is bartholinitis and what might cause it?
Inflammation of one or both of the bartholin glands. Caused by polymicrobial infections with endogenous flora or rarely STIs
What are the symptoms of bacterial vaginosis?
How is bacterial vaginosis diagnosed?
Vaginal pH >4.5
Pungent odour with KOH (whiff test)
Presence of clue cells on a wet mount lacking many PNMs
What is the cause of bacterial vaginalis?
Thought to be the result of a synergistic infection involving the overgrowth of normal flora including gardnerella vaginalis
What are the potential pregnancy related causes of infections of the female pelvis?
Peurperal ovarian vein thrombophlebitis
What are the different types of prostatitis?
Chronic pelvic pain syndrome
What are the different types of epididymitis?
What are the causes of orhchitis?
(inflammation of the testes)
Viral (mumps, coxsackie B)
Why do chlamydia trachomatis not grow on routine lab media?
They are obligate intracellular bacteria
What is the infective form of chlamydia trachomatis?
Elementary body which develops within the host cell into the reticulate body
What does the reticulate body of chlamydia trachomatis do?
Replicates eventually reverting back to elementary bodies which leave the cell to infect other cells
Where in the female reproductive tract does chlamydia replicate?
Epithelium of the cervix and urethra
What are the consequences of an infection of C. trachomatis?
An ascending infection with involvement of the upper genital tract occurs and can result in clinical or subclinical PID presenting as endometritis or salpingitis. Perihepatitis is a rare complication (more likely from gonorrhoea)
What results from a cervical infection of C. trachomatis?
The majority of infections are symptomatic but it is an important cause of muopurulent cervicitis
What are the manifestations of a urethral infection of chlamydia?
Acute urethral syndrome - dysuria and frequency (most common in young sexually active women)