Genital tract Infections

• What is the normal flora of the male genitalia like?

  Externally, it consists of skin type commensals, and internally it is essentially sterile.
• Why is the internal male genitalia considered essentially sterile?

  Due to prostate secretions and flushing by urine.
• What influences the normal flora of the female genitalia?

  Hormones, pregnancy, menstruation, etc.
• What types of bacteria are found in neonates?

  Lactobacilli, E. coli, diphtheroids, staphylococci, streptococci.
• What types of bacteria are found in pre-pubescent girls?

  Coliforms and enterococci.
• What is the dominant bacteria in the female genital tract during puberty?

  Lactobacilli.
• How does the normal flora of the female genital tract change after menopause?

  It becomes similar to that of pre-pubescent girls.
• What is wet prep microscopy used to detect?

  Trichomonas vaginalis.
• What is the purpose of culture in enrichment media and microscopy?

  To identify specific pathogens like Neisseria gonorrhoeae.
• What is the significance of Gram stain in diagnosing bacterial vaginosis?


  It helps identify clue cells.

  
• What type of agar is used to culture Candida species?

  Sabouraud dextrose agar.
• What are the incubation conditions for culturing N. gonorrhoeae?

  1. 10% CO2 at 37°C for 48 hours.
• What is the advantage of nucleic acid amplification testing (NAAT)?


  It is sensitive and can detect very low bacterial loads.
• What is a disadvantage of NAAT?

  It does not provide antibiotic susceptibility results.
• What are the differences between sexually transmitted and non-sexually transmitted pathogens?

  • Non-sexually transmitted: Overgrowth of yeast, anaerobes, coliforms.
  • Sexually transmitted: Gonorrhoea, Chlamydia, Syphilis, Trichomoniasis, Genital Herpes, HIV.
• What characterizes bacterial vaginosis (BV)?

  An imbalance in naturally occurring bacterial flora.

  
• What happens to lactobacilli levels in bacterial vaginosis?


  There is a decrease in lactobacilli.

  
• What are the clinical symptoms of bacterial vaginosis?

  Increased vaginal pH, white/grey secretion with fishy odor, presence of clue cells.

  
• What is the pH level associated with bacterial vaginosis?

  Greater than 4.5.
• What is the significance of the fishy odor in bacterial vaginosis?

  It is released upon adding alkali, indicating the presence of BV.
• What was the total number of new STIs reported in England in 2023?

  401,800 cases.

  
• Which STI had the highest number of cases in 2023?

  Chlamydia with 194,970 cases.
• What was the percentage increase in gonorrhoea cases since 2022?


  1. 5% increase.

  
• What demographic is at the greatest risk for STIs?

  Young heterosexuals under the age of 25 years.
• What is Neisseria gonorrhoeae classified as?

  A Gram-negative diplococcus.
• What type of pathogen is Neisseria gonorrhoeae?

  An obligate human pathogen.
• What are the common symptoms of gonorrhoea in males?

  Urethritis, purulent discharge, dysuria.
• What complications can arise from gonorrhoea in males?

  Epididymitis, prostatitis, orchitis.
• What are the symptoms of gonorrhoea in females?

  Urethritis, purulent discharge, dysuria, lower abdominal pain.
• What percentage of women with gonorrhoea are asymptomatic?

  50% of women.
• What complications can arise from gonorrhoea in females?

  Pelvic inflammatory disease (PID), salpingitis, ovaritis.
• What are the typical samples collected for diagnosing gonorrhoea in females?

  Endocervical swab or urethral swab.
• What is the typical sample collected for diagnosing gonorrhoea in males?

  Urethral exudate if symptomatic, urethral swab if asymptomatic.
• What is the significance of quick transportation and processing of samples?

  It is required for accurate diagnosis.
• What is disseminated gonococcal infection (DGI)?

  A rare complication of gonorrhoea affecting 1% of genital tract infections.
• What are the symptoms of disseminated gonococcal infection?

  Rash, fever, myalgia, arthralgia, septic arthritis.
• What is the estimated percentage of infants born to women with gonorrhoea that develop conjunctivitis?

  28% of infants.
• What is the treatment for neonatal gonococcal infection?

  Systemic penicillin G or cephalosporin.
• What is the sensitivity of Gram stain for diagnosing gonorrhoea in symptomatic males?

  90-95% sensitive.
• What is the most sensitive diagnostic method for gonorrhoea?

  Culture on selective medium.