Session 6 Flashcards

Question

What infections can cause urethral dischrge in men?

Answer 1

Sexually transmitted infections that cause urethral discharge: Chlamydia: Chlamydia trachomatis The most common STI in the UK ◦ Obligate intracellular bacterium (lets itself be phagocytosed) ◦ Unique cell wall (gram negative but doesn't follow the exact criteria of gram negative); inhibits phagolysosome fusion (virulence factor) Typically asymptomatic in men ◦ Can cause testicular pain, dysuria ◦ May have discharge Gonorrhoea: Neisseria gonorrhoeae “Gonococcus” ◦ Gram negative ◦ Diplococci ◦ Unencapsulated, pilated (has projections that help it adhere to mucosal membranes) 90% of men are symptomatic so easier to detect (~50% of women) Most common cause of male urethral discharge Causes thick, yellow discharge +/dysuria Can cause reactive arthritis (infection disseminates to cause painful joints) Non sexually transmitted infections that cause male urethral discharge: Non-gonococcal urethritis (NGU) Inflammation of the urethra caused by anything other than gonorrhoea along with associated discharge Can be sexually transmitted (common) ◦ Chlamydia trichomatis ◦ Mycoplasma genitalium ◦ Trichomonas vaginalis Can be ‘pathogen negative’(cant find causative organism) (less common, older men)

Answer 2

Urine sample - use first portion of urine (first catch urine) ◦ Gonorrhoea: Microscopy & culture, nucleic acid amplification tests (NAATs) ◦ Chlamydia: NAATs (most sensitive & specific) ◦ Urethritis: NAATS ◦ Excludes UTI as a cause of dysuria Urethral swab ◦ Gonorrhoea Also look at general markers for infection so, temperature, FBC, C reactive protein etc

Answer 3

Could be physiological Menstrual cycle - Progesterone in the secretory phase (post-ovulation) causes thicker cervical mucus so can casue discharge. Features of this are: ◦ Cyclical ◦ No other associated symptoms ◦ Clear Sexually transmitted infections As per men: (More women are asymptomatic) ◦ N. gonorrhoeae ◦ C. trachomatis (Chlamydia) Can cause neonal conjunctivitis during prgenancy or delivery ◦ May have discharge ◦ May have postcoital/ intermenstrual bleeding ◦ May have dyspareunia Trichomoniasis: Trichomonas vaginalis Protozoa (‘Flagellates’) ◦ Presence of flagella (mobility) ◦ Optimal growth ~ pH 6.0 ◦ Vaginal pH ~4.0 so increased alkalinity of vagina favours acquisition of disease. Causes copious, yellow, odourous discharge Can also cause non gonnacoccal urethritis in men Treatment: Metronidazole Non-sexually transmitted infections Candidiasis: Candida sp. (albicans) Yeast: normal vaginal flora ◦ Activated in immunocompromised states, diabetes ◦ Favours high oestrogen (can be associated with COCP) VERY ITCHY! ◦ White discharge ◦ Typically non-offensive (odour) Bacterial vaginosis Gardnerella vaginalis Lactobacilli is protective against infection and normal flora of vagina 95% Altered flora (excessive washing) can cause bacterial proliferation ◦ Increased risk of contracting STIs Offensive smelling, white discharge Insert slide 24

Answer 4

If infection is suspected ask about other features of the discharge: Itchy, colour, sexual history and vaginal hygiene? Can be asymtomatic so screening is important Risk of pelvic inflammatory disease Vaginal swabs Chlamydia: Vulvo-vaginal swabs (VVS), endocervical Gonorrhoea: VVS, endocervical Trichomoniasis: High vaginal swab (HVS) (posterior fornix) Bacterial Vaginosis: Gram staining, KOH test (add drops of potassium hydroxide and positive test will give "fishy smell") Candida: HVS; Microscopy \> Culture Urine dip not as effective for detecting STIs in women

Answer 5

Sexually transmitted infections: Viral: Human Papillomavirus (HPV) DNA virus (non-enveloped) Can cause genital or cutaneous warts Many, many different types! ◦ 6 and 11 cause 90% of genital infections ◦ 16 and 18 have the highest association with cervical cancer Can do PCR to identify high risk types (biopsy/swab) Vaccination exists: ◦ Gardasil (6, 11, 16, 18) ◦ Cervarix (just 16 & 18 Viral: Herpes simplex virus (HSV-1 & -2) DNA virus (enveloped) Lifelong infection - Initial then recurrent infection Can be asymptomatic initially, or present with painful ulcers/blisters ◦ Can be accompanied by systemic symptoms HSV-1: also associated with “cold sores” HSV-2: more likely to become infected with HIV) Both vertical and direct transmission Check all areas ◦ Genitals ◦ Mouth ◦ Anus Swabs: PCR / NAATs Management: Antivirals e.g. aciclovir ◦ Cannot eradicate the infection ◦ Reduce the severity and duration of current episode ◦ Limited effect frequency/severity of repeated episodes Bacterial: Syphilis (Treponema pallidum) Spirochete - gram-negative, motile, spiral bacteria More common in men aged 24-35 and homosexual men. Transmission: ◦ Direct contact ◦ Vertical transmission Not as common generally ◦ 40% co-infected with HIV ``` Primary syphilis ◦ Typically painless ulcer(s) Secondary syphilis (25% of untreated primary cases) presents 4 – 10 weeks after initial infection. Can be multi-system. Can enter a latent phase ``` Identify using microscopy / PCR, Serology Management: Penicillin-based antibiotics

Answer 6

Sexually transmitted infections Co-infections are common - Similar route of transmission May be asymptomatic so consider screening for others Consider presenting complaint so you can arrange ppropriate investigation & therapy Bacterial: Can give multiple antibiotics e.g. azithromycin & ceftriaxone for chlamidia and gonorrhoea. Targets different organisms One antibiotic can augment the effect of the other Patient education Barrier contraception and other ‘safe sex’ advice Avoid sex until course of treatment is completed For non-sexually transmitted infections: Use appropriate therapy for the organism: Candida - anti-fungals BV - antibiotics e.g. metronidazole Try and remove precipitating feature e.g control diabtes/immunocomprimised state. Patient education Advice when taking COCP and vaginal hygiene

Answer 7

Infection of the uterus, fallopian tubes, and ovaries Typically because of ascending infection: ◦ Chlamydia trachomatis ◦ Neisseria gonorrhoeae ◦ Gardnerella sp. ◦ Others e.g. Mycoplasma genitalium Often polymicrobial Other sources of infection: ◦ Intrauterine contraceptives (more to come) ◦ Other uterine interventions Presentation: SYMPTOMS Lower abdominal pain, Dyspareunia, Purulent discharge, Abnormal uterine bleeding ◦ e.g. intermenstrual or postcoital SIGNS Pyrexia (+/-), Pain on palpation of abdomen ◦ Examined using bimanual vaginal examination (pain felt during this examination indicates positive test.) Evidence of discharge/cervicitis (speculum) PID: Complications Chronic pelvic pain, pelvic abscess (tubo-ovarian), can lead to subfertility due to adhesions from chronic inflammation ◦ Increased risk of ectopic pregnancy ◦ Reduced likelihood of successful fertilisation Peritonitis due to further spread Fitz-Hugh Curtis Syndrome (peri-hepatitis) from spread to capsule of liver. Rare. PID: Management Prevention \> Cure Anitibiotics ◦ Give if clinically suspected – don’t delay because of investigations NB: Negative swabs do not exclude PID ◦ Broad spectrum ◦ IV in more severe cases Analgesia Offer screening to sexual partner(s) (genito urinary medicine) In those who fail to respond to treatment, laparoscopy is essential to confirm the diagnosis or to make an alternative diagnosis.

Answer 8

Volume of ejaculate: 2-6 ml Viscosity: liquefaction in 1hr pH: 7-8 Count: equal to or more than 20million/ml Motility: equal to or more than 50% Morphology: 60% normal

Answer 9

Ectopic pregnancy, inflammatory bowel disease, constipation, cholecystitis, appendicitis, UTI, endometriosis, ovarian cysts Intermenstrual bleeding, postcoital bleeding, cancer (use in context with pain, fever and discharge)

Session 6 Flashcards

(34 cards)