Genital Infections

Gonorrhoea Infection

- Usually sexually transmitted

- Woman & neissseria gonorrhoea > if untreated, ascend to reproductive organs > Pelvic inflammatory disease > Infertility, salpingitis (fallopian tubes) and/or ectopic pregnancy

Symptoms/Signs

Males; may present with dysuria & purulent urethral discharge > may progress to disseminated gonococcal infection (spread to joints) & epididymitis

Both genders; may present with rectal infections (asymptomatic) > proctitis (inflam. of anus/rectume)

Females; usually asymptomatic, primary site of infection is the ENDOCERVIC > URETHRITIS, symptoms may include purulent vaginal discharge, dysuria & frequency of urination

Ocular infections; may present with keratoconjunctivitis > cornea perforation, infantile conjunctivitis (opthalmia neonatorum)

Lab testing

1. Examination of smears

2. Culture analysis; difficult due to the very fragile nature of the bacterium

Treatment

- Although bacterium is gram -ve, it is still effectively treated with penicillin < cephalosporin (less antibiotic resistance associated)

- Uses pili to attach to sperm > allows infection of fallopian tubes

- Resistance mechanisms; anti-phagocytic properties, IgA-ase enzyme & LPS

Chlamydia Infection

Aetiological agent; Chlamydia trachomatis

Often community-acquired, also know as NSU (non-specific urethritis) or NGU (non-gonococcal urethritis) - due to no purulent discharge but pain on micturition

Symptoms/Signs

Males; present as urethritis, proctitis or silent/asymptomatic infection

Females; present as cervicitis, or silent/asymptomatic infection

If untreated > salpingitis & PID > T-cell immune response > Scar formation > Infertility

Treatment

Antibiotics are usually ineffective due to unusual cell wall

Mycin & cycline drugs commonly prescribed

Syphilis Infection

PAINLESS ULCERATION

Aetiological agent; Spirochaete Treponema pallidum

Presenting stages; 1. Incubation period, 2. primary stage (papule lesion > chancre (ulcer) > often asymptomatic), 3. Secondary stage (fever, malaise, rash on palms/soles & mucous membrane, nephrotic syndrome, highly infectious), 4. Latent stage (no symptoms), 5. Tertiary stage (progression to cardiovascular, neurological or bone involvement)

Congenital syphilis

Infectious during pregnancy > severe foetal abnormalities , deafness, blindness, cartilage necrosis, bone deformity, mental retardation

Pathogenesis

Lipid rich/poor protein outer membrane > evades immune system

Organism able to hide in the brane, bone & blood vessel walls > difficulty to detect

Symptoms of tertiary syphilis are due to the antigenic response (cell-mediated immunity)

Lab testing

Detected via dark-ground microscopy, cannot be grown in labs & detected with serological testing aka antenatal testing (Nontreponemal tests = screening test, treponemenal tests = confirmatory test)

Chancroid (Painful ulcer)

Infection > genital sores > lymph node enlargement & pus drainage

Aetiological agent; Haemophilus ducreyi

Herpes Infection

Commonly due to HSV-2 (below waist) or HSV-1 (above waste) or other family members (VZV, CMV, EBV) > latent infection > recurrent infection

Treatment; unable to cure infection but able to reduce risk of transmission. Hand hygiene & education critical

In neonates, if mother has infectious virus, caesarean indicated to avoid risk of encephalitis

Genital Warts

Etiological agent; Papillomaviruses (PMV) > carcinoma of the cervix, vulva & penis (predominately due to serotypes 16 & 18)

Diangosis; pap smear required

Vaginitis

Aetiology; Candida albicans (yeast/fungal) or Trichomonas vaginalis (protozoa)

C.a; possibly due to endogenous infection or sexual transmission. May present 'curd'-like discharge & dysuria, thrush. Infections occurs more commonly in pregnant, diabetic or women on 'the pill''. Treatment; washing, anti fungal (canastan) & probiotics (restore normal flora). Diagnoses with M,C&S (Pap smears)

T.v; infects vagina & endocervix without symptoms > vaginitis. Diagnosed with microscopy of vaginal swabs

Vaginosis

NON-INFLAMMATORY CONDITION; dysrupted vaginal ecology

Symptoms; thin/grey/watery vaginal discharge, increased cultivating anaerobes > fishy odour

Pathogenesis; following menses or unprotected sex (alkalinity of semen)

Treatment; Antibiotics vs anaerobes (e.g. Flagyl), probiotic supplement

Diagnosed; microscopy of specimen

Hepatitis B & C

Hep B; via sexual transmission (within semen) & blood

Hep C; via blood to blood contact

HIV & AIDS

Aetiology; HIV-1/2 > AIDS

AIDS = depleted T helper cells (<50m/l) > vulnerable to opportunistic infections (such as P. carinii, C. parvum, T. gondii, Mycobacterium species, C. albicans, C. neoformans, HSV, VZV, EBV & CMV

HIV; comprised of structural & enzymatic proteins (attachment proteins & reverse transcriptase/integrase/proteases)

Treatment & Detection; Prevention!, AZT & HAART, antibody detection (Window period - of infection without positive test) & CD4 blood counts for monitoring

Transmission; via anal intercourse, heterosexual intercourse or direct blood-blood contact, IV drug users