Flashcards in Repro Session 6 Deck (64):
Nongonococcal causes of urethritis?
causes of genital ulcers?
pregnancy related infections of pelvis?
puerperal ovarian vein thrombophlebitis- vein inflammation due to blood clot
viral causes of orchitis?
*coxsackie virus is resitant to gastric acid, along with polio, Hep A, and M.TB
what must be considered in difficulty determining method of diagnosis for chlamydia?
obligate IC bacteria so do not grow on routine lab media
infective form of chlamydia?
what is salpingitis?
fallopian tube inflammation
most important causes of pelvic inflammatory disease in western world?
major PID complication?
tubal damage, leading to infertility and ectopic pregnancy
most common neonatal infection due to cervical infection in pregnant women being source of chlamydia trachomatis?
what is pelvic inflammatory disease?
result of infection ascending from endocervix, causing endometritis, salpingitis, parmetritis, oophortis, tubo-ovarian abscess and/or pelvic peritonitis
2 organisms causative of PID?
pathophysiology of PID?
infection ascends from endocervix and vagina into uterus, inflammation causes adhesions of mucosa to form ,and damage to tubal epithelium
behavioural RFs for PID?
sexual behaviour: multiple partners, unsafe sex
type of contraception used: intrauterine contraceptive device increases risk in 1st few wks of insertion
alcohol/drug use- more likely to have unsafe sex
cigarette smoking- immunocompro?*
contraception thought to be protective against symptomatic PID?
clinical features of PID?
pain: bilateral lower abdominal tenderness
abnormal vaginal/cervical discharge
abnormal vaginal bleeding
gyanecological causes of pelvic pain other than PID?
ectopic pregnancy- would do a preg test
endometriosis- history will be of cyclical pain- before periods, continuous pain in PID
complications of an ovarian cyst- tends to be unilateral ovarian involvement so unilateral pain
GI causes of pelvic pain?
irritable bowel syndrome
renal causes of pelvic pain?
length of time antobiotics continued for in PID?
antibiotics used in PID?
tment of trichomonas vaginalis?
tment for chlamydia trachomatis?
doxycycline or azithromycin
features of history of patient with PID?
lower abdom pain
abnormal vaginal bleeding/discharge
history of STIs in past
features of examination of patient with PID?
pyrexia >38 C
lower abdom tenderness- bilateral
discharge- vaginal or cervical, on speculum exam.
investigations in PID?
endocervical swab: gonorrhoea, chlamydia
high vaginal swab: bacterial vaginosis, trichomonas vaginalis, candida- picked up, but not causative of PID
+ve swabs support diagnosis but -ve don't exclude it
general medical management of PID?
analgesia- paracetemol- fever and pain
antibiotics- oral for mild to mod, IV if severe
when to admit PID patient to hospital?
surgical emergency cannot be excluded, causing acute abdomen
clinically severe disease
PID in pregancy (v.rare as foetus in way for ascending infection)
lack or response/intolerance to oral therapy
when might laparoscopy/laparotomy be considered for PID?
if no response to therapy
clinically severe disease
presence of a tubo-ovarian abscess
an US-guided aspiration of pelvic fluid collections would be less invasive
possible SEs of metronidazole?
vomiting, this would be made worse if alcohol taken
what is a patient with PID at risk of in the future?
ectopic pregnancy as pelvic scars and adhesions
infetility as tubal adhesions
chronic pelvic pain- may need counselling
Fitz Hugh Curtis syndrome- adhesions by liver
what is fitz hugh curtis syndrome?
perihepatitis presenting with R upper quadrant pain- acute in onset and sharp, due to transabdominal spread of infection from PID e.g. chlamydia trachomatis.
The spread of disease from the pelvis to the liver may be due to circulation of fluid along the paracolic gutter- infracolic compartment of greater sac, it may be due to lymphatic drainage or it may be via the bloodstream.
How can risk of PID be reduced in patients who have had it previously?
use of barrier contraception
clinical presentation of primary genital herpes?
extensive, painful genital ulceration
if recurrent genital herpes, may be asymptomatic to moderate
diagnosis of genital herpes?
smear (IF) and swab (viral culture) of vesical fluid and/or base of ulcer, and send for viral PCRs
How can risk of HSV transmission be reduced?
tment of primary genital herpes and severe disease?
aciclovir- only activated within virally-infected cells as molecule produced by virus necessary for drug activation, so therefore minimses damage to cells not infected by the virus
what management can be given for frequent recurrences of genital herpes?
clinical presentation of genital warts?
cutaneous, mucosal and anogenital warts caused by HPV. Benign, painless, verrucous epithelial or mucosal outgrowths- penis, vulva, vagina, urethra, cervix, perianal skin
diagnosis of genital warts?
clinical, biopsy + genome analysis, hybrid capture- detect viral DNA
tment of genital warts?
frequent spontaneous resolution
imiquimod- immune response modifier
what infections might N.gonorrhoea cause in men?
epididymitis, prostatitis, proctitis- inflammation of lining of rectum, urethritis, pharyngitis
what infections might N.gonorrhoea cause in women?
PID, endocervicitis, urethritis
may be asymptomatic with N.gonorrhoea
tment of N gonorrhoea infection?
ceftriaxone (IM)-cephalosporin also used to treat N.meningitidis
ciprofloxacin (oral) used till very recently but has been superseded by resistance*
features of disseminated gonococcal infection?
bacteraemia, skin and joint lesions
diagnosis of gonorrhoea?
smear and culture
clinical presentation of chlamydial infections in females?
urethritis, cervicitis, salpingitis, perihepatitis
clinical presentation of chlamydial infections in males?
urethritis, epididymitis, prostatitis, proctitis
diagnosis of chlamydial infections?
endocervical and urethral swabs
1st void urine
what is trichomonas vaginalis?
causes trichomonas vaginitis: thin, frothy, offensive discharge
irritation, dysuria, vaginal inflammation
diagnosis of trichomonas vaginalis?
vaginal wet preparation +/- culture enhancement
causative agent of syphilis?
tment of syphilis?
penicillin and 'test of cure' follow-up
tment of bacterial vaginosis?
causes of bacterial vaginosis?
perturbed normal flora- gardnerella, anaerobes, mycoplasmas
RFs for vulvovaginal candidiasis?
antibiotics, oral contraceptives*, pregnancy, obesity, steroids, diabetes
tment of vulvovaginal candidiasis?
topical azoles or nystatin
specific at risk groups for STIs?
minority ethnic groups
those affected by poverty and social exclusion
low SE status
poor education opps
individuals born to teenage mothers- unprotected sex
stages of syphilis disease?
primary= indurated, painless ulcer
secondary- 6 to 8wks later- fever, rash, lymphadenopathy, mucosal lesions
tertiary- chronic granulomatous lesions
quaternary- CVS and CNS pathology
diagnosis of syphilis?
dark field microscopy, serology
tment of trichomonas vaginalis infection?
bacteria, viruses, protozoa, and fungi can cause STIs? which arthropods can cause STIs?
why is bacterial vaginosis different from vaginitis?
bacterial vaginosis from perturbed normal flora, no inflammation