STIs and PID Flashcards
(83 cards)
1
Q
What type of epithelial cells are found in the prepubertal genital tract?
A
Simple cuboidal
2
Q
What type of epithelial cells are found in the pubertal genital tract?
A
Stratified squamous
3
Q
What type of epithelial cells are found in the postmenopausal genital tract?
A
Atrophic changes to stratified squamous cells
4
Q
What type of bacteria are found in the prepubertal genital tract?
A
Similar to skin commensals
5
Q
What type of bacteria are found in the pubertal genital tract?
A
Lactobacilli dominant
6
Q
What type of bacteria are found in the postmenopausal genital tract?
A
Similar to skin commensals
7
Q
What is the pH of the prepubertal genital tract?
A
Alkaline
8
Q
What is the pH of the pubertal genital tract?
A
3.5 to 4.5
9
Q
What is the pH of the postmenopausal genital tract?
A
Alkaline
10
Q
Give 4 predisposing factors for bacterial vaginosis
A
Sexually active Change of partner IUD Vaginal douching Smoking
11
Q
What is the pathophysiology of bacterial vaginosis?
A
Decrease in lactobacilli and increase of anaerobic and BV associated bacteria in the vagina.
Proteolytic enzymes break down vaginal peptides into amines and the pH rises to favour Gardnerella Vaginalis
12
Q
Give the 2 main clinical features of bacterial vaginosis
A
Grey-white discharge
Fishy smell
13
Q
How is Bacterial Vaginosis investigated?
A
Increased vaginal pH
KOH ‘wiff’ test –> strong odour when KOH added to discharge
High vaginal smear microscopy- can see Clue cells and decrease in lactobacilli
14
Q
How is Bacterial Vaginosis managed?
A
Metronidazole oral/topical
Or Clindamycin cream
15
Q
What are the effects of BV when pregnant?
A
Increased risk of premature birth
Miscarriage
Chorioamnionitis
16
Q
Give 4 predisposing factors for Thrush development
A
Pregnancy Diabetes Broad-spectrum Antibiotics Corticosteroid use Immunosuppression
17
Q
What is the pathophysiology of a Thrush infection?
A
Candida Albicans is a yeast like fungus which exploits opportunities such as a weakened host.
18
Q
Give 3 clinical features of Thrush
A
Vaginal itching
Vaginal discharge- white, thick, non-smelling
Dysuria
Erythema of vulva
19
Q
How is Thrush investigated?
A
Vaginal pH
Vaginal smear
Microscopy
20
Q
How is Thrush managed?
A
Clotrimazole pessary Oral fluconazole (not in pregnant)
21
Q
Give 2 predisposing factors for chlamydia infection
A
<25 years old
Many sexual partners
Recent change in partner
Infrequent use of barrier contraception
22
Q
Which bacteria causes chlamydia?
A
Chlamydia trachomatis (Gram neg)
23
Q
How is chlamydia transmitted?
A
Sexual intercouse
Skin to skin contact of genitals
24
Q
When chlamydia is symptomatic what symptoms may men and women experience?
A
Women= dysuria, vaginal discharge, post-coital bleeding, deep dyspareunia, lower abdominal pain
Men= urethritis, urethral discharge, dysuria, testicular pain
25
How is chlamydia diagnosed in men and women?
Nucleic acid amplification test (NAAT)
Women= vulvovaginal swab, endocervical swab, first catch urine sample
Men= first catch urine sample, urethral swab
26
What medications are given to treat chlamydia?
Doxycycline 100mg BD for 7 days
Azithromycin 1g single dose
27
What advice would you give to a patient with chlamydia?
Avoid sex until the treatment is finished
Contact tracing
Full STI screen
28
Give 3 predisposing factors for Gonorrhoea infection
```
<25 years old
Men who have sex with men
Living in cities
PHx of gonorrhoea infection
Multiple partners
```
29
How is Gonorrhoea transmitted?
Sexual intercourse
| Vertically from mother to child
30
What bacteria causes Gonorrhoea?
Neisseria gonorrhoeae
31
What is the pathophysiology of Gonorrhoea?
Bacteria has a strong affinity for mucous membranes. It adheres and invades the host cells to cause inflammation. The surface proteins prevent an immune response from occurring
32
When Gonorrhoea is symptomatic, what symptoms may be experienced?
Vaginal discharge (thin, watery, green/yellow)
Dysuria
Dyspareunia
Lower abdominal pain
Rectal infection= anal discharge and discomfort
33
How is Gonorrhoea diagnosed in men and women?
Women=
Endocervical/vaginal swab- NAAT
Endocervical/urethral swab- microscopy and culture
Men=
First pass urine- NAAT
Urethral/meatal swab- microscopy and culture
34
How is Gonorrhoea treated medically?
IM ceftriaxone 500mg
| Oral azithromycin 1g- covers any concurrent chlamydia
35
What other advice would you give to a patient with Gonorrhoea?
Screen for other STIs
Contact tracing
Follow up to check treatment has worked
36
Give 2 potential complications of Gonorrhoea
PID
| Males= epididymo-orchitis, prostatitis
37
How can Gonorrhoea when pregnant, affect the pregnancy?
Increased risk of spontaneous abortion
Premature labour
Early fetal membrane rupture
Gonococcal conjunctivitis of the neonate
38
What are the potential complications of a Chlamydia infection?
PID
Reactive arthritis
Can spread to eyes
39
How can chlamydia when pregnant, affect the pregnancy?
Increased risk of premature delivery
Increased risk of miscarriage and stillbirth
Neonatal chlamydial conjunctivitis
40
Give 3 predisposing factors for Genital Warts (HPV)
```
Early age of 1st sexual intercourse
Multiple partners
Immunosuppression
Smoking
Diabetes
```
41
What is the pathophysiology of Genital HPV?
HPV penetrates the epithelial barrier and infects basal keratinocytes. It replicates inside the keratinocytes causing lesions.
Spread via skin to skin contact
42
Which forms of HPV are oncogenic?
16 and 18
Cause precancerous skin changes
43
What are the clinical features of HPV genital warts?
Painless, fleshy growths which can be soft or hard
Found on the penis, scrotum, vulva, vagina, cervix, perianal skin or inside anus
44
How are HPV warts managed?
Can resolve spontaneously
Topical treatments= podophyllotoxin, Imiquimod
Physical ablation= excision, cryotherapy, electrosurgery, laser surgery
45
Give 2 predisposing factors for Genital Herpes
Multiple sexual partners
| Oral sex from a partner with cold sores
46
What is the pathophysiology of Genital Herpes?
HSV enters the body through small cracks in the skin and mucous membranes.
Travels to nearest nerve ganglion and remains dormant.
When reactivated it travels down the nerve to the skin and causes symptoms
47
What are the symptoms of a genital Herpes lesion?
Small red blisters which are painful
Vaginal or penile discharge
Itching
48
How is Genital Herpes managed?
Antiviral- Acyclovir
Painkillers
Petroleum jelly
Ice packs
49
If a mother has HPV before becoming pregnant, how is the pregnancy managed?
Will pass on antibodies to baby. Can take Aciclovir. Can have vaginal birth
50
If a mother has HPV in T3 of pregnancy, how is the pregnancy managed?
Does not have antibodies to pass on
| 40% chance of vertical transmission in vaginal birth so C-section recommended
51
Give 3 predisposing factors for syphilis
Unprotected sex
Multiple sexual partners
MSM
HIV infection
52
What is the pathophysiology of syphilis?
Caused by Gram negative bacterium Treponema pallidum subspecies pallidum. Spread via sex or mother to fetus
Enters through break in the skin or mucous membranes. Bacteria divides and forms an infectious hard ulcer.
If left untreated can cause systemic damage via obliterating arteritis. The endothelial cells of vessels proliferate and cause the lumens to narrow leading to ischaemia of the tissues.
53
What are the symptoms of primary syphilis?
Chancre appears on penis, scrotum, anus, rectum, labia or cervix
Hard painless ulcer which heals in 3-10 weeks
54
What are the symptoms of secondary syphilis?
```
Skin rash on hands
Fever
Malaise
Arthralgia
Weight loss
Headaches
Lymphadenopathy
Grey mucus membranes
Condylomata lata (plaques on the skin)
```
55
What are the symptoms of tertiary syphilis?
Many years after initial infection
Neurosyphilis- dementia, CN palsies, stroke, Argyll-Robertson pupil, tabes dorsalis
Cardiovascular- aortic regurgitation, angina, calcification of AA, aortic root dilation
Gummatous- granuloma formation
56
How is syphilis investigated?
Dark ground microscopy of chancre fluid
PCR of active lesion swab
Serology
Lumbar puncture
57
How is syphilis managed?
Early- Benzathine penicillin 2.4MU IM single dose
Late- Benzathine penicillin 2.4MU IM 3 doses at weekly intervals
Neurosyphilis- procaine penicillin IM OD for 14 days + probenecid 500mg PO QDS for 14 days
58
How can syphilis affect a pregnancy?
Antenatal screening at 1st appointment
Infect baby at delivery
Increased risk of miscarriage, stillbirth, preterm labour, congenital syphilis.
59
Give 2 predisposing factors for HIV
Men who have sex with men
IV drug users
Unprotected sex with someone from a high incidence area eg. Africa
60
What is the pathophysiology of HIV infection
Single stranded RNA retrovirus enters CD4 cell and releases its contents. RNA converted to DNA in the cell and is combined with the cell's DNA. The DNA and virus is replicated by the cell to form viral protein chains.
Protease enzyme cuts viral chain to form a mature virus. CD4 cell destroyed in the process. Drop in CD4 cell number causes drop in immune function.
61
What is AIDS?
Very low CD4 count, high viral load
| AIDs defining illness - eg. TB, non-Hodgkin lymphoma, pneumocystis jiroveci pneumonia
62
Give 4 clinical features of the seroconversion illness experienced 2-6 weeks after HIV infection
```
Malaise
Headache
Fever
Weight loss
Mouth sores
Oral thrush
Pharyngitis
Myalgia
Hepatomegaly
Lymphadenopathy
Oesophageal sores
N+V
Splenomegaly
```
63
Give 3 clinical features of symptomatic HIV after the latent phase
Weight loss
Fever
Diarrhoea
Minor opportunistic infections- cold sores, thrush
64
How is HIV diagnosed?
ELISA testing for serum HIV antibodies + p24 antigen
65
How is HIV managed?
HAART- reduces viral load to undetectable levels. Very good prognosis
Target individual enzymes- NRTIs, PIs, NNRTIs, InSTIs
Manage psychological impact
66
What tests are used to monitor HIV?
CD4, viral load, FBC, U+Es, Urinalysis, ALT, AST, bilirubin
67
When is post-exposure prophylaxis (PEP) taken for HIV?
If suspected to be exposed to HIV in the past 72 hours. Take PEP to lower risk of being infected. Take for 1 month
68
In a mother with HIV what advice would you give her about her pregnancy and after?
HIV can be transmitted in pregnancy and through breastfeeding. With treatment risk is <1%
Antenatal antiretroviral therapy
Do not breastfeed
Neonatal post-exposure prophylaxis
69
Give 3 predisposing factors for trichomonas vaginalis
Multiple partners
Unprotected sex
Hx of other STIs
Older woman
70
What microorganism causes trichomonas vaginalis?
Anaerobic flagellated protozoan, Trichomonas Vaginalis
71
How is Trichomonas Vaginalis spread?
Unprotected vaginal sex
72
What is the pathophysiology of Trichomonas Vaginalis?
Replicates via binary fission and destroys epithelial cells through direct cell contact by release of cytotoxins
73
What are the clinical features of Trichomonas Vaginalis in men and women?
Women= offensive vaginal odour, abnormal vaginal discharge, itchy vulva, dyspareunia, dysuria
Men= urethral discharge, dysuria, urinary frequency, pain and itching around foreskin
74
How is Trichomonas Vaginalis diagnosed in men and women?
Women= high vaginal swab
Men= urethral swab or 1st void urine
Full STI screen
75
How is Trichomonas Vaginalis managed?
Metronidazole- 2g orally in one dose or 400mg BD for 5-7 days
Contact tracing
76
What risks are increased if there is Trichomonas Vaginalis in pregnancy?
Risk of premature labour
Risk of low birth weight
Predisposed to maternal postpartum sepsis
77
Give 5 predisposing factors for Pelvic Inflammatory Disease
```
15-24 years old
Sexually active
Hx of STIs
Recent IUD fitted
Recent TOP
Recent partner change
Unprotected sex
Hx of previous PID
Recent gynae surgery
```
78
What is the pathophysiology of Pelvic Inflammatory Disease?
Spread of vaginal or cervical infection up into the endometrium, uterus, fallopian tubes, ovaries and peritoneum.
Due to Chlamydia trachomatis, Neisseria Gonorrhoea, Streptococcus, Bacteroides and Anaerobes.
79
Give 4 clinical features of Pelvic Inflammatory Disease
```
Lower abdominal pain
Deep dyspareunia
Post-coital bleeding
Menstrual abnormalities
Abnormal vaginal discharge
Dysuria
Fever
N+V
```
80
How is Pelvic Inflammatory Disease diagnosed?
Endocervical + high vaginal swabs for NAAT
Full STI screen
Urine dip + MSU- exclude UTI
Pregnancy test
If unsure:
TV USS
Laparoscopy
81
How is Pelvic Inflammatory Disease managed?
14 days of broad spectrum antibiotics
Doxycycline, Ceftriaxone, Metronidazole
OR Ofloxacin + Metronidazole
Analgesia
Rest
Contact tracing
82
When should a patient with Pelvic Inflammatory Disease be admitted to hospital?
```
Pregnant
Severe symptoms
Signs of peritonitis
Unresponsive to antibiotics
Need emergency surgery
```
83
Give 3 complications of Pelvic Inflammatory Disease
```
Ectopic pregnancy
Infertility- 1 in 10 women
Tubo-ovarian abscess
Chronic pelvic pain
Fitz-Hugh-Curtis syndrome- perihepatitis causing RUQ pain
```
