Flashcards in Session 6 - Genitalfections Deck (59)
Name two sources of epidemiological date for assesing rates of infection of the genital tract
Genitourinary medicine clinics
Communicable disease surveillance centres
What is the issue with data from a GUM clinic?
Data is an underestimate, as does not take into account people presenting through their GPs
Give five groups at particular risk of STI
o Young people
o Minority ethnic groups
o Those affected by poverty and social exclusion
o Low socio-economic status groups
o Those with poor educational opportunities
o Unemployed people
o Individuals born to teenage mothers
What five conditions are associated with STI?
o Pelvic Inflammatory Disease (PID)
o Impaired fertility
o Reproductive tract cancers
o Risk of infection with blood-borne viruses – HBV, HIV
o Risk of congenital or peripartum infection of neonate
Give four differential diagnosis for genital skin and mucous membane lesions
o Genital ulcers
o Vesicles or bullae
o Genital papules
o Anogenital warts
Give five differential diagnosis for urethritis
o Gonococcal urethritis
o Chlamydial urethritis
o Non-specific urethritis
o Post-gonococcal urethritis
o Non-infectious urethritis
Give one main differential for vulvo-vaginitis
How much has the following increased since '95?
o Uncomplicated Gonorrhoea
o Genital Chlamydia –
o Infectious Syphilis –
o GUM clinic workload
o Uncomplicated Gonorrhoea – 102% Increase
o Genital Chlamydia – 107% Increase
o Infectious Syphilis – 57% Increase
o GUM clinic workload – 34% Increase
What organism causes chalmydia?
Describe chlamydia trachomatis
Gram -'ve obligate intracellular bacterium
How does chalmydia present in males?
o Urethritis, epididymitis, prostatitis, proctitis
How does chlamydia present in females?
o Urethritis, cervicitis, salpingitis, perihepatitis
How is chlamydia diagnosed?
o Doxycycline or Azithromycin
What causes gonorrhoeae?
Neisseria Gonorrhoeae is a Gram –‘ve intracellular diplococcus
What is the clinical presentation of gonnorohoea in men?
o Urethritis, epididymitis, prostatitis, proctitis, pharyngitis
What is the clinical presentation of gonnorohoea in women?
o Asymptomatic, endocervicitis, urethritis, PID
What does disseminated gonococcal infection present as?
o Bacteraemia, skin and joint lesions
How is gonnorohoea diagnosed?
o Smear and culture
What is the treatment of gonorrhoeae?
What causes herpes?
Herpes Simplex Virus, an encapsulated, double stranded DNA virus.
What is the clinical presentation of primary genital herpes
o Extensive, painful genital ulceration, dysuria, inguinal lymphadenopathy, fever
What is the clinical presentation of recurrent genital herpes?
o Asymptomatic Moderate
How is genital herpes diagnosed?
o Smear and swab of vesicle fluid and/or ulcer base
How is genital herpes treated?
What causes genital warts?
What HPV strains cause the highest risk?
16 and 18
What is the clinical presentation of HPV?
o Cutaneous, mucosal and anogenital (anus and genital) warts
o Benign, painless, verrucous epithelial or mucosal outgrowths
o Penis, vulva, vagina, urethra, cervix, perianal skin
How is HPV diagnosed?
Clinical, biopsy and genome analysis, hybrid capture
How is HPV treated?
o None – frequent spontaneous resolution
o Topical podophyllin, cryotherapy, intralesional interferon
What causes syphilis?
What are the four stages of syphillis?
1. Indurated, painless ulcer (chancre)
2. 6 – 8 weeks later
Fever, rash, lymphadenopathy, mucosal lesions
Latent – Symptom free years
3. Chronic Granulomatous lesions
4. Cardiovascular and CNS pathology
How is syphilis diagnosed?
Dark field microscopy, serology
How is syphilis treated?
Penicillin and test of cure follow up
What is trichomonas vaginitis caused by?
Flagellatd protozoan, trichomonas vaginalis
What are the key features of trichomonas vaginalis?
o Thin, frothy, offensive discharge
o Irritation, dysuria, vaginal inflammation
What is the treatment of trichomonas vaginitis?
What are two types of parasites which cause genital infection?
Give two infections which occur post partum
What causes vulvovaginal candidiasis?
Give six risk factors for vulvovaginal candidiasis
Antibiotics, oral contraceptives, pregnancy, obesity, steroids, diabetes
Give symptoms vulvovaginal candidiasis
o Profuse, white, curd-like discharge
o Vaginal itch, discomfort and erythema
How is vulvovaginal candidiasis diagnosed?
High vaginal smear and culture
How is vulvovaginal candidiasis treated?
Topic azoles or oral fluconazole
What distinguished bacterial vaginosis from vaginitis?
No inflammation of vaginal wall
- Caused by unsetlled normal flora
What is the main symptom of bacterial vaginosis?
Offensive fishy discharge
How does one diagnose bacterial vagnosis
pH > 5, KOH whiff test
High Vaginal Smear – Gram variable coccobacilli, reduced numbers of lactobacilli
How does one treat bacterial vaginosis
Give five types of pelvic inflammatory disease
o Pelvic peritonitis
o +/- tubo ovarian abscess
Give five PID risk factors
o Young age at first intercourse
o Multiple sexual partners (polygyny)
o High frequency of sexual intercourse
o High rate of acquiring new partners within pervious 30 days
o Alcohol/Drug use
o Cigarette smoking (2x increased risk)
o IUDs increase risk at point of insertion/removal for a few weeks
Give 5 bacteria that can cause PID
o Nesseria Gonorrhoea
Gram –‘ve intracellular diplococci
o Chlamydia Trachomatis
Gram –‘ve extracellular (infective) organism
o Bacterial Vaginosis
Anareobes, Enteric Gram –‘ve Bacteroides
o Haemophillis Influenzae
o Mycobacterium Tuberculosis
Give two immediate sequelae of PDI
Give five long term sequlae of PID
Ectopic Pregnancy (1 episode of PID 7x increased risk)
Infertility (1 episode of PID 12% increase, 2 25%, 3+ 50-75%)
Dyspareunia (Painful sexual intercourse)
Chronic PID / Chronic pelvic pain
What is the pathogenesis of PID
Infection of the cervix (endocervicitis) spreads, either directly or via lymphatics to the endometrium, uterine tubes and the pelvic peritoneum
Give four factors associated with the ascent of bacteria in PID
Cervical dilation, coil insertion
o Hormonal changes associated with menstruation
Lowers bacteriostatic effect of cervical secretion
o Retrograde menstruation
Infection more common after a period
o Virulence of the organisms in acute chlamydial and gonococcal PID
Give four laboratory tests for PID
Triple and urethral swabs
What is a triple swab?
High vaginal swab – Bacteria vaginosis organisms
Endocervical swab – Neisseria gonorrhoea
Endocervical swab - Chlamydia trachomatis
Give six differential diagnoses for PID
o Ectopic pregnancy
o Acute appendicitis
o Irritable Bowel Syndrome (IBS)
o Ovarian cyst accidents (torsion, rupture, haemorrhage)
o Urinary Tract Infection (UTI)
o Functional pelvic pain of unknown origin
What is chronic pelvic inflammatory disease?
Symptoms >6 months duration
o Pelvic pain
o Secondary dysmenorrhoea
o Deep dyspareunia
o Menstrual disturbance
o Recurrent acute painful exacerbations