Vaginal Discharge & STIs Flashcards

Question

Nugent criteria of bacterial vaginosis

Answer 1

Based on the proportion of anaerobic species giving a quantitative score between 0 and 10.  Less than 4: Normal  4 to 6: Intermediate  More than 6: Bacterial vaginosis

Answer 2

Non-Pregnant Women PID * Post-hysterectomy infection * May enhance HIV transmission In Pregnancy Postabortal infections * Preterm labor and delivery * Premature rupture of membranes * Intramniotic infection * Histological chorioamnionitis * Postpartum endometritis * Spontaneous abortion in 1 st trimester

Answer 3

Parasites can harbor in the vagina usually lie in between the rugae, in asymptomatic state in 25%.  With impaired local defence e.g., during and after menstruation, after coitus, and following illness, the pH of the vagina is raised to 5.5–6.5 making trichomonads to thrive.  Organisms produce surface inflammatory reaction when the defence is lost.  Can be isolated, from urethra, skene’s tubules, or even from Bartholin’s glands in about 75% cases

Answer 4

Metronidazole 400 mg BD PO /5days  Metronidazole 2 g PO stat  Metronidazole gel 0.75%  Clindamycin cream 2%  Initial cure rates are at 80%  30% have a relapse within 1 month of treatment

Answer 5

Vaginal trichomoniasis is the most common and important cause of vaginitis in the childbearing period  Usually sexually transmitted infection  Causes Vulvovaginitis that can be severe  Accompanied by purulent, offensive discharge  Associated with PID, endometritis, infertility, ectopic pregnancy, and preterm birth  Punctate haemorrhages occur on the cervix i.e. strawberry Cervix  Caused by Trichomonas vaginalis, a pear-shaped unicellular flagellate protozoa.

Answer 6

Vulval soreness and itching  Foul smelling vaginal discharge, at times frothy yellowish green in nature  Dysuria and abdominal discomfort  Asymptomatic carriers  Appearances of strawberry cervix due to the presence of punctate haemorrhages

Answer 7

Wet mount- vaginal discharge is mixed with saline and examined microscopically  Show motile protozoal organism with the typical flagellae  Has 60-70% sensitivity for detecting the organism  Culture in a specific medium such as Fineberg-Whittington or Diamond’s medium  DNA amplification test  Screen for other STDs in women diagnosed with trichomoniasis

Answer 8

Term cervicitis reserved to infection of the endocervix including the glands and the stroma  A clinical diagnosis based on detecting purulent mucous discharge at the cervical os  It is often accompanied by contact bleeding  Infection may be acute or chronic  Often caused by sexually transmissible agent: 1) Chlamydia 2) Gonorrhoeae  Tests for chlamydia and gonorrhoeae should be performed

Answer 9

Metronidazole 2 g stat  Metronidazole 400mg BD PO for 5 days  Tinidazole 2 g stat  Treat both partners and both screened for other STI  Avoid unprotected intercourse

Answer 10

Organisms gain entry into the glands of the endocervix and produce acute inflammatory changes.  Infection may be localised or spread upwards to involve the tube or sidewards involving the parametrium  Infection occurs due to elementary bodies which enter the cells through specific receptors  Once inside, they form inclusion bodies which divide rapidly by binary fission  These then reform into elementary bodies and get released from the cell  This destroys the cell and the damage that occurs is due to the inflammatory response to the infection

Answer 11

Organism: An obligate intracellular, gram-negative bacterium affecting columnar epith of genital tract  They’re several serovars of chlamydia:  A–C infect conjunctiva causing trachoma  D–K infect the genitourinary system.  Other chlamydia species, such as psittaci and pneumonia, infect the lungs causing pneumonia.  L1–L3 lymphogranuloma venereum strain which can cause rectal infection and proctitis.  Transmission: sexually via penile, vaginal, anal, perinatal. Most prevalent STD  Sites infected: urethra, cervix, rectum (eyes, resp tract-neonates/infants)  If untreated, 40% will develop PID  Incubation: approx 1-3 weeks though most cases are asymptomatic ( F>M)

Answer 12

Men-dysuria, clear or cloudy urethral discharge, rectal pain &/or bleeding  womena) Most commonly asymptomatic - infection leading to detrimental effects on female genital tract b) Vaginal discharge, c) Dysuria with urethral discharge d) Dyspareunia, e) Spotting or postcoital hemorrhage, f) Intermenstrual bleeding g) Mucopurulent cervical discharge with contact bleeding h) Lower abdominal pain i) Culture-negative urinary tract infection

Answer 13

diagnosis: culture, antigen detection, a) NA amplification tests (NAATs), e.g. PCR: >90% sensitive- used on Endocervical or vaginal swab specimen or urine for screening purposes b) Nucleic acid hybridization tests: endocervical c) Enzyme immunoassays d) Aptima Combo 2 and BD Probetec are recommended tests for chlamydial infection. e) Real-time PCR f) Culture: 100% specificity but around 60% sensitive. It’s expensive with limited availability and so not routinely recommended

Answer 14

a) Pelvic inflammatory disease b) Perihepatitis: Fitz–Hugh–Curtis syndrome c) Neonatal conjunctivitis and pneumonia d) Adult conjunctivitis e) Reiter’s syndrome: reactive arthritis: characterized by a triad of urethritis, conjunctivitis and arthritis

Answer 15

 Azithromycin 1 g orally in a single dose  Doxycycline 100 mg orally twice a day × 7days  Ofloxacillin, 200 mg orally twice a day or 400 mg once a day × 7 days.  Erythromycin, 500 mg orally four times a day × 7 days  amoxicillin 500 mg three times a day × 7 days

Answer 16

a) Abstinence – before treatment of both partners is complete. b) Barriers – Use of condoms should be encouraged c) Monogamy d) Test of cure should be routine in pregnancy e) Contact tracing of all partners when possible

Answer 17

 Organism: Gonorrhoea is a STD caused by the Gram-negative, aerobic diplococcus Neisseria gonorrhoea.  Has affinity to infect the genital tract mucosa, cuboidal and columnar epithelium of endocervix and urethra.  May lead to ascending infection causing endometritis, endosalpingitis and PID.  Concomitant infections with Chlamydia and Trichomonas are common  If untreated, can lead to PID  Transmission: penile, vaginal, pharyngeal, perinatal, rarely anal  Sites infected: urethra, cervix, pharynx (eyes neonates / infants), rectum  Incubation: approx 10 days though most nonurethral infections are asymptomatic ( F>M)

Answer 18

Symptoms:  Men- dysuria/ urethritis, purulent urethral discharge, rectal discharge pain and /or bleeding  Women * Asymptomatic * Increased vaginal discharge vaginal * With lower abdominal/pelvic pain * Dysuria with urethral discharge * Dyspareunia * Spotting or postcoital hemorrhage * Proctitis with rectal bleeding, discharge and pain * Endocervical mucopurulent discharge and contact bleeding * Mucopurulent urethral discharge * Pelvic tenderness with cervical excitation * Frequently (5–10%) is associated with acute PID and may spread to the; a) Liver capsule and cause perihepatitis, forming adhesions with abdominal wall b) Septicemia- characterized by low grade fever, polyarthralgia, tenosynovitis, septic arthritis, perihepatitis, meningitis, endocarditis, and skin rash

Answer 19

1. Gram staining: visualization of Gram-negative intracellular diplococci 2. Culture- using an agar medium with antimicrobials to reduce growth of other organisms 3. Nucleic acid amplification tests (NAATs) 4. Nucleic acid hybridization tests

Answer 20

treatment: Cephalosporins are the mainstay of treatment 1. Cefixime 400 mg oral dose stat 2. Ceftriaxone 250 mg IM stat 3. Ciprofloxacin, 500 mg or ofloxacin 400 mg 4. Ampicillin 2 g or amoxycillin 1 g with probenecid 2 gm as a single oral dose. NB: Penicillins and Cephalosporin’s are safe to use in pregnancy, but avoid tetracycline and ciprofloxacin/ofloxacin

Answer 21

1. Acute pelvic inflammation leads to chronic PID, 2. Unless adequately treated. a) Infertility, b) Ectopic pregnancy (due to tubal damage) c) Dyspareunia d) chronic pelvic pain, e) Tubo-ovarian mass, and f) Bartholin’s gland abscess are commonly seen

Answer 22

1) abstinence – 2) barriers – use condom till both sexual partners are treated 3) monogamy- avoid multiple sex partners 4) contact tracing 5) meticulous follow up - high re-infection rate 6) Adequate therapy for gonococcal infection

Answer 23

1. Syphillis 2. Chachroid 3. Herpes Simplex 4. Lymphogranuloma venereum 5. Granuloma inguinale (Donovanosis) 6. Neoplasm

Answer 24

Organism: caused by the anaerobic spirochete bacteria Treponema pallidum.  Transmission: direct contact with an open primary or secondary syphilitic lesion- perinatal, sexually  Sites infected: sex organs, blood, body tissue, all organ systems  Incubation: approx. 10-90 with average of 21d.

Answer 25

Clinical features: 1. Primary-chancre,  Often painless, about 1cm, start as a reddish small papule, which quickly erodes to form an ulcer  Single or multiple, usually on the labia but can also be on Fourchette, anus, cervix, and nipples  Chancre has raised/indurated, round margins, with smooth shiny floor, without any surrounding inflammatory reaction. * Chancre is a point at which treponema enters the body and highly infective  Markedly enlarged discrete, and painless inguinal glands.  Heals spontaneously in 1–8 weeks leaving behind a scar. 2. Secondary stage – occurs 6 weeks to 6 months from the onset of primary chancre  Evidenced in the vulva in the form of condyloma lata  Pt may have systemic symptoms like fever, headache, and sore throat.  Maculopapular skin rashes are seen on the palms and soles.  Other features include generalized painless lymphadenopathy, mucosal ulcers, and alopecia 3. Latent syphilis- quiescence phase after secondary syphilis stage has resolved.  Varies in duration from 2 to 20 years 4. Tertiary/latent-with no obvious symptoms for 5-20+years destructive lesions targeting bones, heart, CNS etc  Untreated pts progress from late latent stage to tertiary syphilis.  Cause damage to CNS (Neurosyphylis), CVS, and musculoskeletal systems * CNS: cranial nerve palsies (III, VI, VII, and VIII), hemiplegia, tabes dorsalis * CVS: aortic aneurysm, and * MSS: gummas of skin and bones  It’s characterized by gumma; gummatous ulcer is a deep punched out ulcer with rolled out margins

Answer 26

1. H/O exposure to an infected person 2. Physical exam 3. Darkfield microscopy- take smear with a swab dipped in saline & examine under dark ground illumination  Treponema appear as motile bluish white cork-screw shaped organisms 4. CSF and serology tests  VDRL- positive after 6 weeks of initial infection. Used for screening  Specific tests include: a) Treponema pallidum hemagglutination (TPHA) test, b) Treponema pallidum enzyme immunoassay (EIA), c) Fluorescent treponemal antibody absorption (FTA-abs) test. FTA-abs is expensive but a confirmatory test. FTA-IgM is produced only in active treponemal infection d) Treponema pallidum immobilization (TPI) test e) PCR tests

Answer 27

Abstinence –  Barriers –  Monogamy  Treatment of pregnant infected women  Screening for syphilis of blood for BT

Answer 28

Penicillin (Benzathine penicillin G 2.4 mu IM in a single dose, OR procaine 600mg od x 5days)  In penicillin allergic cases,  Tetracycline 500 mg, 4 times od x 14days  Doxycycline 100 mg BID PO for 14 days is effective  Late syphilis: Benzathine penicillin G 2.4 mu IM weekly for 3 weeks

Answer 29

Increased risk of HIV infection  Severe organ damage  Severe illness or death in newborns.

Vaginal Discharge & STIs Flashcards

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