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3a > WH: Genitourinary Medicine > Flashcards

WH: Genitourinary Medicine Flashcards

(106 cards)

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1
Q

What is bacterial Vaginosis ? what type of bacteria

A

over growth of bacteria in the vagina, specifically anaerobic bacteria
- Not an STI

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2
Q

what causes BV (pathophys) ?

A

caused by loss of lactobacilli (friendly bacteria)
- usually produce lactic acid => low pH => prevent other bacteria overgrowing
- low lactobacilli => high pH => anaerobic bacterial growth

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3
Q

what is normal vaginal pH ? what is it in BV ?

A

normal 3.5-4.5
BV > 4.5

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4
Q

is BV an STI ?

A

no but it can increase STI risk

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5
Q

What is the most common causative organs of BV ?

A

gardurella vaginalis (anaerobic bacteria)

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6
Q

BV RF ? (3)

A
  • multiple sexual parterns
  • excessive vaginal cleaning
  • recent Abx
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7
Q

BV presentation ?

A

fishing smelling white or grey vaginal discharge

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8
Q

BV Ix ?

A
  • vaginal pH >4.5
  • charcoal swab
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9
Q

vaginal swab shows clue cells found on microscopy - what condition ?

A

bacterial vaginosis

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10
Q

BV management ?

A
  • asymtopatttic: does not usually require treatment
  • metronidazole (works against anaerobic bacteria), need to avoid alcohol with this one (B V careful)
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11
Q

BV complications ? and in pregnancy ?

A
  • increase STI risk
  • preterm delevery
  • Prematur ROM
  • low birth weight
  • post partum endometritis
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12
Q

what is candidiasis ? and what is it also known as ?

A

thrush
- vaginal infection wiht a yeast of the candida family

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13
Q

what is the most common causative organism of thrush ?

A

Candida albicans

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14
Q

when might candida colonisation progress to infection ? (2)

A

candida may colonise vagina without symptoms => progress to infection when right environment occurs
- during pregnancy
- after broad spectrum Abx

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15
Q

thrush RF ? (4)

A
  • pregnancy
  • poorly controlled DM
  • Immunosuprresion
  • Broad spectrum Abx
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16
Q

candidiasis presentation ?

A
  • thick white discharge (doesn’t typically smell)
  • vaginal + vulval itching + discomfort
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17
Q

candidiasis Ix ? diagnostic ?

A

vaginal pH
charchoic swab with microscopy (diagnostic)

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18
Q

what would pH>4.5 indicate ? below 4.5 ?

A

pH>4.5 => BV or trichomonas
pH<4.5 => candidiasis or normal

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19
Q

What pathogen causes chlamydia? name and type of pathogen?

A

STI caused by bacterium chlamydia trachomatis

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20
Q

what kind of gram staining is chlamydia ? what is unique about this bacterium? how spread?

A

gram -ve bacteriarod shaped
- obligate, intracellular organism (enter + replicate within cells => rupture cell => spread to others)

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21
Q

Describe chlamydia transmission (2)

A
  • via unprotected vaginal/anal or oral sex
  • Can be skin-to-skin: infected semen/vaginal fluid enters eye => chlamydial conjunctivitis
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22
Q

What is the most common STI in UK

A

Chlamydia: significant cause of infertility

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23
Q

What can charcoal swabs be used for? (3) what makes them special/useful?

A

Used for microscopy, culture + sensitivities
- Contains amines transport medium + chemical solution to keep microorganisms alive during transport

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24
Q

How does NAAT test work? what does it stand for? for which infections are they useful ?

A

Nucleic acid amplification tests (NAAT)
- check directly for DNA or RNA
- only used in chlamydia + gonorrhoea

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25
Describe chlamydia presentation? men, women
asymptomatic ! (50% men, 75% women) (when sexually active) - Women: abnormal vaginal discharge, pelvic pain, AVB, dyspareunia, dysuria - Men: urethral discharge or discomfort, dysuria, epididimo-orchitis
26
What would be found on examination of female patient with chlamydia ? (4)
might find nothing - Pelvic/abdo tenderness - Cervical motion tenderness - Inflamed cervix - Prurulent discharge
27
How is chlamydia diagnosed? first choice? (men, women)
- Women: NAAT (vulvovaginal- first choice) - Men: first catch urine sample
28
Describe chlamydia management (4)
- Doxycycline 100mg BD for 7 days - Abstain from sex for 7 days of treatments - Refer to GUM for contact tracing - Test + treat for other STIs
29
Describe the complications of chlamydia (8)
most common STI in UK - PID, chronic pelvic pain, infertility, ectopic pregnancy, epididymo-orchitis, conjunctivitis, reactive arthritis, - Infertility - lymphongranuloma venerium
30
How can chlamydia affect pregnancy? (5)
- preterm labour - Premature ROM - Low birthweight - post partum endometritis - neonatal infection
31
What type of neonatal infection can chlamydia cause ? (2)
- conjunctivits - Pneumonia
32
What chlamydia complication is associated with MSM ? briefly what is it ?
lymphogranuloma venerium (genital ulcer disease)
33
what abs are used in chlamydia treatment during pregnancy ?
azithromycin and erythromycin (doxycycline is contraindicated)
34
how is the neonate managed if neonatal chlamydial conjunctivas is suspected ?
- swabs taken from the eyelid (or nasopahrnx if indicated) - oral erythromycin
35
What is gonorrhoea ? what is it caused by ? describe the causative organism
curable STI caused by gram -ve diplococcus bacteria (Neisseria Gonorrhoea)
36
Where cell type does gonorrhoea infect - give example? explain this
Spreads via contact with mucus membranes with columnar epithelium (endocervix, urethra, rectum, conjunctiva + pharynx) - adheres to mucus membrane => invade host cell => acute inflam - N. gon has surface proteins that bind to receptors of immune cells => prevent immune response
37
How is gonorrhoea spread?
spreads via contact with mucus secretions from infected areas 9unprotected vaginal/oral/anal sex, vertical transmission (mother => child))
38
gonorrhoea Epi ? how common ? most common among who ?
sendon most common STI in UK (after chlamydia) - Predominantly MSM
39
gonorrhoea RF ?
- age<25 - MSM - Multiple sexual partners - Non-barrier sex - prev gonorrhoea Hx
40
gonorrhoea presentation? men + women
usually symptomatic and depends site of infection - Female: odourless prurient discharge (green/yellow), dysuria, pelvic pain - Male: odourless prurulent discharge (green/yellow), dysuria, testicular pain or swelling (epididymo-orchitis)
41
How is gonorrhoea diagnosed?be specific - for men ? women ?
NAAT (endocervical, first catch urine sample)
42
How is gonorrhoea managed? (5)
(high level of Abx resistance) - Abx (often broad spectrum as high level of Abx resistance) - Follow up test-of-cure - Abstain from sex (7 days) - Test for other STIs - Contact tracing
43
gonorrhoea complications ? M + F
lots of em - PID - Chronic pelvic pain - Inferitility - epididymis-orchitis(M) - prostatic (M) - Disseminated gonococcal infeciton - neonatal compicaltions - Pregnancy complications
44
What pregnancy associated gonococcal complications are there ? (3)
perinatal mortality spontaneous abortion early ROM
45
what neonatal complications are there associated with gonorrhoea ?
gonococcal conjunctivitis (ophthalmica neonartum)
46
what is ophthalmica neonartum ? can lead to what ?
complications of gonorrhoea during pregnancy (spread by vertical transmission) - medical emergency - can lead to perforation of eye, sepsis, blindness
47
what is disseminated gonococcal infection ? caused by what ?
complication of untreated gonococcal infection (concerning complication) - bacteria spread to skin + joints
48
disseminated gonococcal infection presentation ? (3)
- skin lesions - polyarthralgia - systemic symptoms
49
What is trichomanoiasis ? what is the causative organism ?
trichomonas vaginalis is a parasite spread through sexual intercourse
50
describe the pathogen in trichomoniasis ?
protozoan (single celled organism) with flagellum - parasite
51
where does trichomanas vaginaliss live ?
lives in urethra (M+F) + vagina
52
complications of Trichomoniasis ? (5)
- increase risk of HIV, BV, crevice cancer, PID - Greg complicaitons
53
what pregnancy associated complications are there with Trichomoniasis ? (3)
- preterm delivery - low birth weight - post partum sepsis
54
Trichomoniasis presentation ?
50% asymptomattic - non specific: vaginal discharge (yellow/green i think) n, itching, dysuria, dyspareunia
55
what would be seen on examination inf Trichomoniasis? (2)
- frothy hello/green discharge (with a fishy smell) - strawberry cervix (due to tiny haemorrhage)
56
how is Trichomoniasis diagnosed ?
charcoal swab + microscopy
57
what would the vaginl pH be in Trichomoniasis ?
>4.5
58
Trichomoniasis management ?
metronidazole + contract tracing
59
What is mycoplasma agenitalium ?
bacterial STI that causes non-gonococcal urethritis
60
mycoplasma genitalium presentation ? key feature?
mostly asympttmttic - urethritis (key features) - epididymitis - cervicitis - PID
61
mycoplasma genitalium Ix ?
- NAAT: vaginal swab (F), first uric sample (M)
62
mycoplasma genitalium Mx?
doxycycline followed by azithromycin
63
mycoplasma genitalium Mx in pregnancy ?
azithromycin alone (doxycycline is contraindicated in pregnancy)
64
What is syphilis ? name the causative organism ?
STI caused by Treponema Pallidum (spirochete)
65
Where does the syphilis pathogen enter ?
natter enters by skin or mucus membrane
66
syphilis transmission (4) ?
- sexual (oral, vaginal, anal - any involving direct contact with infected area) - vertical transmission (during pregnancy) - IV drug use - Blood trasfusions (rare due to screening)
67
What are the 4 stages of syphilis ?
- primary - secondary - latent - tertiary
68
describe the sx in primary syphilis ? how long does this last ?
- painless ulcer (chacre) - usually on genitals - lymphadenopathy (last 3-8 weeks)
69
describe the sx in secondary syphilis ? (4) how long does this last ?
systemic sx (3 - 12 weeks) - maculo-papular rash (hands and feet) - wart like lesions round genitals - low grade fever - alopecia
70
describe the sx in latent syphilis ? how long does this last ?
sx disappear + patient is asymptotic despite being infected
71
describe the sx in tertiary syphilis ? how long does this last ?
can occur many yrs after + affects many organs of body - gumatous lesions - aortic aneuysms - neurosyphilis
72
describe the sx in neurosyphilis ?
neurosyphilis is if tertiary syphilis affects CNS (=> neuro symptoms) - headache, altered behaviour, dementia, ocular syphilis, paralysis
73
Syphilis Ix ? diagnostic ?
- antibody testing for T.Palidum bacteria (screening) - Diagnostic: sample form infection site (PCR)
74
syphilis Mx ?
GUM, Sti screening, avoid sexual intercourse, contract tracing - Deep IM bensathine bensylpenecillin
75
what is done to prevent syphilis in pregnancy ?
screening at first antenatal appointment
76
syphilis pregnancy complications ?
- misscarriage - still birth - preterm labour - congenital syphilis
77
congenital syphilis presentation ?
sever + debilitating (I think risk of death)
78
What is PID ? what structures affected ?
pelvic inflammatory disease - inflammation + infection of organs of the pelvis (upper genital tract - uterus, Fallopian tubes + ovaries)
79
PID important complications ? (2)
- significant cause of tubular inferility - chronic pelvic pain
80
PID causes ? (5)
- STI: gonorrhoea, chlamydia, mycoplasma genitalium - non-STI: garderella vaginalis (BV), E.COli
81
PID RF ? (6)
same as other STI - multiple patterns - non-barrier sex - existing STI - PID HX - IUD - 15-24
82
PID presentation ? (6)
- pelvic of lower bod pain - abnormal vaginal discharge - abnormal bleeding - dyspareunia - fever - dysuria
83
PID OE ?
- pelvic tenderness - cervical motion tenderness - inflamed cervix - prurulent discharge - sings of sepsis (fever + tachy)
84
PID Ix ? which test for which thing ?
test for causative organisms - NAAT (for gonorrhoea, chlamydia, mycoplasma) - HIV test - Syphilis test - preg test - TVUS
85
PID Mx ? when admission ?
- empirical Abx (ceftrioxone) started before swab result (avoid complications) - if sever/signs of sepsis/pregnant: admit + IV Abx - contact tracing, no sexu til Abx finished
86
PID complications ?
- sepsis - Abscess - Infertility - Chronic pelvic pain - Ectopic pregnancy - Fitz-hugh-Curtis syndrome
87
what is Fitz-hugh-Curtis syndrome ? associated with what ?
complication of PID - inflammation + infection of liver capsule => adhesions between liver + peritoneum => RUQ pain
88
What is HIV ? what is AIDS ?
HIV => when not treated => AIDS (immunocompromised + opportunistic infections + ADIS-defining illnesses)
89
what type of pathogen is HIV ? most common strain ? targets what ?
RNA retrovirus (HIV 1 most common): virus enters + destroys CD4 T helper cells
90
describe HIV disease Course ?
- Initial seroconversion: flue like illness occurs within few weeks of infection - asymptomattic - immunodeficiency (destroyed enough CD4 cells => opportunist ADIS defining illnesses)
91
Describe AIDS transmission ?
- unprotected anal/vaginal/oral sex - vertical transmission (during birth, pregnancy, breast feeding) - mucous membranes, blood, open wound (needles, blood in eye)
92
what are AIDS defining illnesses ? name some ? (5)
when CD4 count so low, allows for opportunistic infection + malignancies - Kaposis sarcoma - cytomegalovirus - Candidiasis (oesophageal) - lymphoma - TB
93
what screening tests for HIV ? (2)
- check for antibodies to HIV - P24 antigen
94
what do you monitor in HIV ?
- CD4 count (low => increased risk of opportunistic infection) - HIV RNA per ml of blood (viral load)
95
what is normal CD4 count ? undetectable viral load ?
CD4: 500-1200 cells/mm3 normal range, <200 => increase risk of opportunistic infection) - HIV RNA per ml of blood: undetectable about <20
96
HIV Tx ? (4)
- Anitretroviral therapy (ART): + genotypic resistance testing to identify HIV strain) - prophylactic co-trimoxazole - avoid live vaccines - Correct use of condoms
97
HIV prohpyslasi ?
- Condons - PEP (reduce risk of transmission after exposure) - PrEP: emtricitabin/tenofovir
98
what is HSV ? what strains ? disease course ?
HSV commonly responsible for coldsore + genital herpes (HSV 1 + HSV 2) - after initial infection, virus is latent in associated sensory nerve ganglia
99
how is HSV spread ?
spread through direct contact with affected muscle memebraes (even when person is asymptomatic)
100
HSV presentaiton ? (5)
initial ep most severe + recurrent eps are milder - ulver/blistering lesions (of genital area) - neuropathic pain - flu like sx - dysuria - inguinal lymphadenopathy
101
HSV Dx ?
can be made clinically - viral PCR swab can confirm diagnosis
102
HSV Mx ?
- GUM referral - Aciclovir
103
what can pregnancy and genital herpes lead to ?
not pre or congenital abnormalities but... - neonatal herpes simplex infection (contracted during labour) - high mortality and morbidity (CNS hopers affects NS + brain => encephalitis)
104
pregnancy + genital herpes Mx ? primary ? recurrent?
- primary genital herpes < 28 weeks: Aciclovir + prophylactic Aciclovir from 36 weeks - primary genital herpes > 28 weeks: Aciclovir + immediate aciclor + CS recommended - recurrent genital hepres (low risk of neonatal infection): consider acicloier from 36 weeks
105
What are genital warts ? what strains ?
benign epithelial/mucosal out growths caused by the DNA HPV - HPV 6 + 11 responsible for 90% cases
106
genital warts Mx ?
treatment not always necessary as will resolve spontaneously overtime

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