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RB Y3 3 Reproduction & Sexual Health > Microbiology GU Tract > Flashcards

Microbiology GU Tract Flashcards

1
Q

all of the organisms are passed human-human, except one which has the potential to be sourced from an object - which ones?

A

trichomonas vaginalis - eg towels

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2
Q

what 3 things influence the susceptibility to infection>

A
  • Concentration and phenotype of organism in genital tract
  • Susceptibility of the sexual partner
  • Resistance of the host – acquired, hereditary or innate
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3
Q

co infections are common with STIs - which 2 organisms commonly co infect

A

chlamydia and gonorrhoea

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4
Q

what is the standard group of organsisms screened for at STI clinic

A

chlamydia, gonorrhoea, HIV, syphilis and hepatitis B and C

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5
Q

what is the predominate clonozing bacteria in the healthy vagina

A

Lactobacilllus

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6
Q

how does Lactobacillus exert its anti bacterial action in the vagina

A

glycogen secreted from the stratified squamous epithelium of the vagina is metabolized to produce lactic acid and hydrogen peroxide which help tp suppress bacterial growth

HO has anti microbial properties

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7
Q

outline the type of epithelium found in the uterus, cervix and vagina

A
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8
Q

does candida colonisation always cause symtpoms

A

no, 30% of females are colonised with no symptoms

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9
Q

what things can predispose to candida infection

A
  • recent ABx therapy
  • high oestrogen levels - pregnancy, contraceptives
  • poorly controlled diabetes
  • IC
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10
Q

how does thrush rpesent

A

very itchy white vaginal discharge

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11
Q

what is it called when candida infects the head of the penis

A

candida balanitis

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12
Q

which group of patients is candida balnitis typically seen in

A

diabetics, other immunosuppressed too

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13
Q

how is thrush diagnosed

A

the diagnosis is clinical

if you want to do a culture can take a high vaginal swab

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14
Q

which type of candida causes most cases of thrush

A

candida albicans

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15
Q

management of thrush

A

topical clotrimazole (pessary/cream) or oral fluconazole

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16
Q

management of thrush in pregnancy

A

topical clotrimazole, oral fluconzole CI as it is associated with congenital abnormalities

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17
Q

do cases of thrush need partner notification

A

NO

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18
Q

general advice for avoiding thrush

A

avoid tight clothing and soap etc

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19
Q

BV

A

replacement of the normal vaginal flora with lots of anaerobes, aprticularly Gardnelle vaginalis

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20
Q

is BV sexually transmitted?

A

no, but it is more common in the sexually active

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21
Q

how does BV present

A

a homogenous, creamy discharge that may contain bubbles, and has a strong odour (‘fishy’)

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22
Q

BV whiff test

A

10% potassium hydroxide + BV discharge = amine like fishy odour

= positive whiff test

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23
Q

what is seen on microscopy of BV

A

vaginal epithelial cells with coccobacili (anaerobes) stuck to them = clue cells

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24
Q

leucocytes (WBCs) are not normally seen on microscopy of BV, if they are what does this suggest

A

presence of intercurrnet infection

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25
Q

BV and pregnancy

A

it is assocated with premature births and adverse outcomes, routine screening not offered - no benefit shown

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26
Q

management of BV - drug and course length

A

metronidazole for 7 days

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27
Q

relapse rate of BV high?

A

30%

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28
Q

what is the most common STI in the UK

A

chlamydia

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29
Q

what abnormal features does the chlamydia bacteria have

A
  • biphasic life cycle so only reproduces inside the host cell
  • has no peptidoglycan in the cell wall so doesnt stain with Gram stain = PCR
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30
Q

outline what the 3 serological groupings of chlamydia are respondible for: A-C, D-K L1-L3

A
  • A-C = trachoma eye infection
  • D-K = genital infection
  • L1-3 = lymphogranuloma verenum
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31
Q

what is lymphogranuloma vereneum

A

an infection of the lymphatic system that can manifest primarily as inflammation and ulcers in genitals

is it only really seen in MSM with prococolitis - rectal pain, discharge and bleeding

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32
Q

clinical features of chlamydia

A

asymptomatic in many

inflammation, discharge, pain, dysuria

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33
Q

management of chlamydia

A

doxycycline 100mg bd for 7 days

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34
Q

why have the recent guidelines changed from azithromycin to doxycycline for chlamydia

A

to reduce the risk of resistnace to treatment - rates were increasing

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35
Q

management of LV (chlamydia)

A

doxycycline for 3 weeks

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36
Q

what is the major complication of chlamydia

A

pelvic inflammatory disease

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37
Q

chalnydia and pregnancy

A

there are assoicated risks and risk of transmission to neonate, but screening is not routinely offered

warn women <25 that they are in the at risk age group and direct them towards screening

38
Q

what presentation would make you suspected PID

A

lower pelvic pain, raised temperature and pulse, peritonism, cervical excitation and raised WCC

39
Q

N Gonorrhoeae - gram stain, intra/extra cellular, type

A

gram negative intracellular diplococci - 2 kidneys beans facing each other

40
Q

what is the significance of gonorrhoea being a fastidious organism

A

it doesnt survive long in less than ideal growth conditions - falesely negative samples

41
Q

is Gonorrhoeae more commonly asymptomatic in men or women

A

up to 50% females are asymptomatic, <10% males

42
Q

how do males tend to present with Gonorrhoeae

A

urethral discharge in 80%

43
Q

how do females tend to present with Gonorrhoeae

A

vaginal discharge in 40%, up to 50% asymptomatic

44
Q

how do rectal and pharyngeal infections with Gonorrhoeae present

A

mostly asymptomatic

45
Q

what are the significant complications of Gonorrhoeae

A

PID

epididymitis

prostastitis etc

abscess

46
Q

which STI is the most common cause of PID

A

chlamydia

47
Q

what are the long term risks of PID

A

infertility - inflammation of tubes creates scar tissue tha blocks the fallopian tubes

48
Q

what is a major complication of PID in the liver

A

Fitz-Hugh-Curtis syndrome

liver capsule and diaphragm inflammation leads to the formation of adhesions

49
Q

how does FHC present

A

with RUQ pain and pleuritic chest pain

note there may be no signs of PID

50
Q

chlamydia and gonorrhoea frequently co-infect - they are tested for together

how long after infection can they be picked up on test

A

14 days

51
Q

how do you test for chlamydia and gonorrhoea?

A

NAAT or PCR - combined in 1 test

52
Q

why do you not use a culture for chlamydia and gonorrhoea?

A

chlamydia cannot be grown on normal culture

can do culture for gonorrhoea, see later

53
Q

what samples are taken for chlamydia and gonorrhoea test for - males, females, rectal, throat and eye

A

males - first pass urine

females HVS/VVS taken by patient

rectal, throat or eye swabs

54
Q

rectal adn throat gonorrhoeae is asymtpomatic - when would you take swabs for testing

A

if indicated in MSM

55
Q

when would you use an endocervical swab for chlamydia and gonorrhoea

A

the clinician may do one if they were already performing eg a speculum examination

56
Q

what 2 other tests can be done for gonorrhoea

A

microscopy and culture

57
Q

what swabs can be used for culture of gonorrhoea

A

all but VVS/HVS - need endocervical

58
Q

name one advantage and disadvantage of culture>NAATs for gonorrhoea diagnsois

A
  • check for ABx sensitivites - this is useful as gonorrhoea has cases of resistance
  • much more invasive - important if patient is asymptomatic
59
Q

name 2 benefits of NAATS

A
  • increased sensitivity
  • much less invasive, can test VVS and male first pass urine sample
60
Q
A
61
Q

what is the main disadvantage of NAATs

A
  • it detects the dead genetic material of chlamydia so you have to wait around 5 weeks to test for eradication of infection
  • also deskilling and more expensive
62
Q

is NAAT sensitive

A

it is slightly more sensitive than cultures

however, there is the possibility of a false-positive result

63
Q

management of gonorrhoea, and problems with treatment

A

IM ceftriaxone - have to have in hospital

a test of cure must be done as there are lots of concerns around resistnace - super gonorrhoeae

64
Q

how does prostatitis present

A

urinary symptoms and lower abdominal/back pain, tender prostaste on examination

65
Q

what sample si taken for prostatitis

A

MSSU - not first pass

66
Q

management of prostatitis

A

ciprofloxacin for 28 days, trimethoprime if there is a high risk of C diff

67
Q

outline the 4 stages of syphilis

A
  1. painless ulcer = chancre, at inoculation site
  2. red hands and feet, mouth ulcers, flu like symptoms. at this stage there are lots of bacteria in the blood

latent stage

late stage - CV and neurological symotoms often years later

68
Q

what are the ulcers like that are seen in the mouth with 2y syphilis

A

snail track

69
Q

what test can be done to demonstrate the TP organism i syphillis

A

swab lesions etc and do PCR

70
Q

what is the purpose of specific adn non specific tests for syphilis

A

the specific ones confirm the diagnosis, but stay as Ab levels decrease v slowly, they often remain postive for life

the non specific ones are used to tell how active the disease is and monitor treatment response

71
Q

what are the 2 specific tests for syphilis

A

TPPA and TPHA

(TPHA is not actually specific??)

72
Q

what test is used as a screening test, and why cant TPPA + TPHA be used

A

combined IgG and IgM ELISA

they cant be used because Ab take around 6 weeks to form

73
Q

what are VDRL and RPR actuallly markers of

A

tissue inflammation

74
Q

management of syphilis

A

IM penicillin, long acting

75
Q

the injection is often painful, what pain relief can be given

A

lidocaine

76
Q

what types of HSV most commonly cause mouth and genital symptoms

A

1 - mouth 2 - genital

77
Q

how does the HSV virus behave in the body

A

initially, it replicates inside the epi/dermis. it then enters the nerve endings of the sensory nerves and can become latent and remain here for ever

periodically reactivates during times of stress/IC

the first clinical manifestations may actually be years after infection

78
Q

how does genital herpes present

A

painful blistering and ulceration of the external genitalia

79
Q

testing for genital herpes

A

unroof the vesicles and take a swab - PCR

80
Q

management of genital herpes

A

oral acyclovir 400mg TDS

81
Q

what ointment can be used for pain relief in genital herpes

A

topical lidocaine 5%

82
Q

does treatment eradicate herpes?

A

i dont think so, it can fail in the IC population

think it just puts virus to rest

83
Q

is a pregnant mother with genital herpes likely to pass it on to her baby?

A

unlikely (<1%)

there is the highestrisk of transmision if the mother acuiqred the infection late in pregnancy

84
Q

what do genital warts look like and are they painful

A

tend not to be

cauliflower

85
Q

management of genital warts

A
  • some clear spontaenously, some with Tx and some persist (those with IC, diabetes etc)
  • topical salicylic acid or podophyllum can be used
  • cryotherapy and liquid nitrogen therapy - to freeze off wart
  • imiquimod can be used (immune modifier)
86
Q

can you get vaccinations against genital herpes?

A

there are 2 types of vaccine but these protect against cerivcal cancer (types 16 and 18)??

given to girls aged 11-13 and available to MSM <45 years old

87
Q

how can trichomonas vaginalis be spread

A

human to human, but also from objects eg towels

88
Q

what type of organism is trichomonas vaginalis

A

a parasite - protozoal

89
Q

how does trichomonas vaginalis present

A

frothy, green/yellow discharge and musty smell

post coital bleeding

90
Q

management of trichomonas vaginalis

A

metronidazole

91
Q

what is seen on examination with trichomonas vaginalis infection

A

strawberry cervix - lots of small haemorrhagic areas

92
Q
A

RB Y3 3 Reproduction & Sexual Health (21 decks)

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