Repro12 - Infections of the Reproductive Tract

Question 1

7 risk factors for developing an STI

4 Sexual
3 Other

Answer 1

1. ) Multiple sexual partners
2. ) No use of barrier contraception (condoms)
3. ) Age - 15-24-year-olds, also lower age of first intercourse
4. ) Certain sexual practices - e.g. anal sex
5. ) Low socio-economic status
6. ) Race/ethnicity - black or black/british
7. ) Lack of immunisation - e.g. for Hep B and HPV

Question 2

3 causes (STIs) of urethral discharge in men

Answer 2

1. ) Gonorrhoea - caused by Neisseria gonorrhoeae
   - gonococcus: gram -ve, diplococcus, pili
   - 90% of men are symptomatic (50% in women)
   - most common cause of discharge in men
   - causes thick, yellow discharge and dysuria
   - treated using ceftriaxone and azithromycin
2. ) Chlamydia (trachomatis) - most common STI in the UK
   - obligate intracellular bacterium, no cell wall so not seen in gram staining
   - can cause testicular pain, dysuria +/- discharge
   - can cause conjunctivitis and reactive arthritis outside the genital tract
   - treated using doxycycline or azithromycin except in pregnancy/allergy where erythromycin is used
3. ) Non-gonococcal Urethritis (NGU) - inflammation of the urethra w/ discharge not caused by gonorrhoea
   - other pathogens: chlamydia trichomatis, mycoplasma genitalium, trichomonas vaginalis
   - can also be ‘pathogen negative’ but this is rare and found in older men

Question 3

Investigations used in men for a first catch urine sample to test for STIs

Gonorrhoea
Chlamydia
Non-gonococcal Urethritis

Answer 3

1. ) Gonorrhoea - microscopy and culutre, NAATs (nucleic acid amplification tests)
   - can also do a urethral swab
2. ) Chlamydia - NAATs (most sensitive and specific)
3. ) NGU - microscopy and culture, NAATs

Question 4

3 groups of causes of discharge in women

Physiological
STIs
Non-STIs (2 types)

Answer 4

1. ) Physiological - progesterone in the secretory phase causes production of thicker cervical mucus
   - discharge is clear, cyclical, and no other symptoms
2. ) Sexually Transmitted Infections
   - gonorrhoea, chlamydia, and trichomonas vaginalis
   - chlamydia may have discharge, as well as dyspareunia, or postcoital/intermenstrual bleeding
3. ) Candidiasis - caused by Candida albicans (yeast)
   - part of normal flora so occurs in immunocompromised
   - favours high oestrogen so associated with the COCP
   - produces very itchy, white, odourless discharge
4. ) Bacterial Vaginosis - due to Gardnerella vaginalis
   - occurs when normal flora is disturbed, removing lactobacilli which are protective against the infection
   - excessive washing can cause bacterial proliferation
   - produces white, odourous discharge
   - treated w/ PO metronidazole for 7 days

Question 5

4 features of trichomonas vaginalis

Pathogen Type
pH Preference
Discharge
Treatment

Answer 5

1.) Parasite - protozoa (flagellates), presence of flagella provides great mobility

2. ) pH Preference - optimal growth is at pH 6.0
   - vaginal pH is 4.0 so increased alkalinity favours the acquisition of the disease
3. ) Discharge - profuse, yellow, odourous (fishy smell)
4. ) Treatment - metronidazole

Question 6

Investigations used in women to detect STIs

Chlamydia
Gonorrhoea
Trichomoniasis
Bacterial Vaginosis
Candida

P.S urine dip is not effective for dectecting STIs in women

Answer 6

1. ) Chlamydia - vulvo-vaginal (VVS), endocervical swabs
2. ) Gonorrhoea - VVS and endocervical swabs
3. ) Trichomoniasis - high vaginal swab (HVS) (posterior fornix)
4. ) Bacterial Vaginosis - gram-staining, KOH test (recreates fishy smell)
5. ) Candida - HVS, microscopy is better than culture

Question 7

3 STIs that can cause genital lesions

HPV
HSV
Syphilis

Answer 7

1. ) HPV - can cause genital or cutaneous warts
   - DNA virus (non-enveloped), different types:
   - 6 and 11 cause 90% of genital infections
   - 16 and 18 have highest association w/ cervical cancer
   - PCR is used to identify high risk types
   - vaccinations available for 6, 11, 16, 18
2. ) Herpes Simplex Virus (HSV) - DNA virus (enveloped)
   - latent infection so initial and then recurrent for life
   - can be asymptomatic or present with painful ulcers (mouth, genitals, anus), dysuria or discharge
   - can also be accompanied w/ systemic symptoms
   - detected using swabs (PCR/NAAT)
   - managed using antivirals e.g acyclovir(won’t eradicate)
3. ) Syphilis - caused by Treponema pallidum
   - susceptible in 25-33 men (many co-infected w/ HIV)
   - primary syphillis produces painless ulcers
   - secondary syphillis occurs weeks after, as an associated rash or affects other systems of the body
   - tertiary syphilis, the infection becomes latent and reactivated in later life e.g. pregnancy
   - detected using swabs microscopy/ PCR, serology
   - managed using penicillin-based antibiotics

Question 8

4 features of pelvic inflammatory disease (PID)

Definition
Signs and Symptoms x5
Complications x5
Management

Answer 8

1. ) Definition - asecending infection (often STIs) reaching the uterus, fallopian tubes, and ovaries
   - infections can also come from intrauterine contraceptives and other uterine interventions

2.) Signs and Symptoms - lower abdominal pain, pyrexia, dyspareunia, purulent discharge, abnormal uterine bleeding

3. ) Complications - chronic pelvic pain, pelvic abscess, peritonitis, peri-hepatitis (Fitz-Hugh Curtis syndrome)
   - subfertility: due to adhesions from inflammation, blocks fallopian tubes (ectopic preganancy)

4.) Management - antibiotics, painkillers, screening to sexual partners