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Gynaecology > 1: Genital Tract Infection - STIs > Flashcards

1: Genital Tract Infection - STIs Flashcards

1
Q

What are the 8 STIs

A
  1. Gonorrhoea
  2. Chlamydia
  3. HSV
  4. HIV
  5. Genital Warts
  6. Syphillis
  7. Trichomonas vaginalis
  8. PID
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2
Q

What are 2 non-sexually transmitted infections

A
  1. Bacterial vaginosis

2. Vulval candidiasis

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3
Q

How will discharge present in vulvovaginal candidiasis

A

Thick white curdle discharge

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4
Q

Aside from curd-like discharge what are two other symptoms of vulvovaginal candidiasis

A

Itchy vulva

Superficial dyspareunia

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5
Q

How can candidiasis be investigated for

A

Vaginal pH on exam

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6
Q

How is candiasis managed

A

Co-trimoxazole

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7
Q

What discharge is present in trichomonas vaginalis

A

Green-yellow discharge

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8
Q

What may be seen OE in trochomonas vaginalis

A

Strawberry cervix

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9
Q

Aside from green discharge, what are 3 other symptoms of TV

A
  1. Dysuria
  2. Dysparuia
  3. Pruritus
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10
Q

How is TV investigated

A

High vaginal-swab

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11
Q

How is TV managed

A

Metronidazole

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12
Q

What discharge will be present in bacterial vaginosis

A

Fishy-discharge

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13
Q

What are two tests for BV

A

High vaginal swab

Koh Whiff Test

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14
Q

How is BV managed

A

Metronidazole

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15
Q

What % of chlamydia is asymptomatic

A

70

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16
Q

How may chlamydia present

A
  • Deep Dyspareunia
  • Intermenstrual bleeding
  • Post-coital bleeding
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17
Q

How is chlamydia diagnosed

A

Vulvovaginal swab for NAAT

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18
Q

How is chlamydia managed

A

Azithromycin

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19
Q

In what % is gonorrhoea asymptomatic

A

50

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20
Q

How may discharge in gonorrhoea present

A

Thin green-yellow discharge

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21
Q

What are symptoms of gonorrhoea

A

Dysuria
Dyspareunia
IM bleeding
Post-coital bleeding

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22
Q

How is gonorrhoea diagnosed

A

Endocervical swab for NAAT

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23
Q

How is gonorrhoea managed

A

IM Ceftriaxone

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24
Q

How does herpes present clinically

A
  • Painful red blisters
  • Abnormal discharge
  • Fever
  • Myalgia
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25
Q

How is herpes diagnosed

A

PCR

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26
Q

How is herpes managed

A

Acyclovir

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27
Q

How does a genital wart present clinically

A

Fleshy discolouration of skin

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28
Q

What may be used to look for genital warts

A

Colposcopy

Protoscopy

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29
Q

How does syphillis present initially

A

Primary chancre

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30
Q

What is used to investigate syphillis

A

Dark ground microscopy

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31
Q

What type of pelvic pain does chlamydia cause

A

Deep dyspareunia

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32
Q

What type of pelvic pain does trichomonas vaginalis cause

A

Superficial dyspareunia

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33
Q

What type of pelvic pain does gonorrhoea cause

A

Deep dyspareunia

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34
Q

What type of pelvic pain does pelvic inflammatory disease cause

A

Deep dyspareunia

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35
Q

What are 3 causes of urethras discharge in males

A

Chalmydia
Gonorrhoea
TV

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36
Q

What is the most common STI in the UK

A

Chalmydia

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37
Q

Explain contact tracing

A

Clinician has conversation with individual about informing own partners (patient referral) or getting anonymous source to inform the, (provider referral)

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38
Q

What is vulvovaginal candidiasis also known as

A

Thrush

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39
Q

What is vulvovaginal candidiasis

A

Fungal infection of lower female genital tract

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40
Q

What is the peak age for vulvovaignal candidiasis

A

20-40years

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41
Q

How common is vulvovaginal candidiasis

A

Common

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42
Q

What causes 90% of vulvovaginal candidiasis

A

Candida albicans

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43
Q

What are 5 risk factors for vulvovaginal candidiasis

A
  1. Diabetes
  2. Corticosteroids
  3. Immunosuppression (HIV, Malignancy)
  4. Broad-spectrum antibiotics
  5. Pregnancy
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44
Q

Why are broad-spectrum antibiotics a risk factor for vulvovaginal candidiasis

A

Destroys normal flora permitting overgrowth of candida

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45
Q

What is the main symptom of vulvovaginal candiasis

A

Pruritic vulva

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46
Q

How else may vulvovaginal candiasis present

A

Thick curd-like white discharge

Superficial dysuria - due to irritation skin

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47
Q

How will vulva appear on exam in vulvovaginal candidiasis

A

Erythematous and Oedematous

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48
Q

What are satellite lesions

A

Red, pustular lesions with superficial pseudomonas plaques that can be scraped off

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49
Q

Where is candida albicans found normally

A

Normal flora of GI tract

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50
Q

How is vulvovaginal candidiasis normally diagnosed

A

Clinical. However, if women examined vaginal pH should be measured

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51
Q

If the women is examined in vulvovaginal candidiasis, what is recommended

A

Vaginal pH

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52
Q

what is first-line for vulvogvaginal candidiasis

A

Vaginal anti-fungal (Co-trimoxazole, Fenticonazole)

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53
Q

what is second-line for vulvovaginal candidiasis

A

Oral anti-fungal (fluconazole, itraconazole)

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54
Q

when should topical imidazole for vulvovaginal candidiasis only be prescribed

A

If in conjunction with vaginal or oral treatment

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55
Q

what is a note when using anti-fungal treatments

A

Anti-fungal treatments are oil based and there do

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56
Q

why is there an increased risk of vulvovaginal candidiasis In pregnancy

A

Increased oestrogen

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57
Q

explain management of vulvovaginal candidiasis in pregnancy

A

Vagina co-trimoxazole and topical imidazole for vulva. NEVER give oral anti-fungals

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58
Q

what is trichomonas vaginalis

A

anaerobic protozoan

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59
Q

how is trichomonas vaginalis transmitted

A

sexual intercourse

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60
Q

what are 4 risk factors for trichomonas vaginalis

A
  1. Unprotected intercourse
  2. Multiple partners
  3. History STIs
  4. Age - older women have a higher risk
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61
Q

how do most people with trichomonas vaginalis present

A

Asymptomatic

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62
Q

in what time period after sexual intercourse do symptoms of trichomonas vaginalis present

A

28d

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63
Q

what are 5 symptoms of TV in women

A
  1. Vaginal odour
  2. Green-Yellow discharge
  3. Vulval pruritus
  4. Dyspareunia
  5. Dysuria
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64
Q

how will the cervix present in TV

A

Strawberry cervix

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65
Q

what is a strawberry cervix

A

Punctate and papilliform appearance of the cervix

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66
Q

what are symptoms of TV in males

A

Urethral discharge
Dysuria
Frequency

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67
Q

what are 2 signs of TV in males

A

Urethral discharge

Balanoposthitis = enlargement glans penis

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68
Q

can TV be transmitted through oral and anal sex

A

No

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69
Q

can TV be transmitted vertically

A

Yes - rare

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70
Q

how is TV investigated for in females

A

vaginal swab of posterior fornix

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71
Q

how is TV tested for in males

A
  • urethral swab

- first void urine sample

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72
Q

explain sexual intercourse when being treated for TV

A
  • do not have sexual intercourse during treatment

- abstain for one week if taken single dose metronidazole

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73
Q

what is used to manage TV

A

Metronidazole as:

  • Single dose PO (2g)
  • 400mg BD for 5-7d
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74
Q

what does TV in pregnancy increase risk of

A
  • Maternal Post-partum sepsis

- Pre-mature labour

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75
Q

what is used to treat TV in pregnancy

A

Metronidazole

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76
Q

what is the risk with metronidazole in pregnancy and how is this overcome

A

Changes taste of breast milk

Do not breast feed for 12-24h after last dose

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77
Q

what is bacteria vaginosis

A

non-STI genital tract infection

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78
Q

what is the most common cause of vaginal discharge in women

A

BV

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79
Q

in which ethnicity is BV more common

A

afro-carribean

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80
Q

what organism causes BV

A

Gardenella Vaginosis

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81
Q

explain pathophysiology of BV

A

When normal flora are killed, including lactobacilli, means acid is no longer produced causing increase in vaginal pH and overgrowth of gardnerella vaginosis

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82
Q

what are risk factors for BV categorised into

A

Factors that lead to change in vaginal pH

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83
Q

what are 5 risk factors for BV

A 
Sexual activity - new partner or multiple 
Showergel 
Smoking 
STI 
Receptive Oral Sex 
IUD 
Recent antibiotic use
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84
Q

what. % of individuals are asymptomatic with BV

A

50

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85
Q

what are the symptoms of BV

A
  • Fishy like vaginal discharge
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86
Q

what are the signs of BV

A
  • With-Grey discharge
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87
Q

what is the first investigation for BV

A

High vaginal swab

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88
Q

what type of cells will be seen in BV

A

Clue cells

Pus cells

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89
Q

what are clue cells

A

Epithelial cells that contain cocci

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90
Q

what is another test for BV not used in clinical practice

A

Koh Whiff test

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91
Q

what does the KOH whiff test entail

A

add alkali to the vaginal discharge - if gardenella is overgrown will cause fishy vaginal odour

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92
Q

what are 3 conservative methods for BV

A
  • No vaginal douching
  • Remove IUD
  • Avoid shower gels on vagina
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93
Q

what is a pharmacological method for BV

A

Metronidazole: 2g one off dose OR 400-500mg BD for 5-7d

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94
Q

what does BV in pregnancy increase risk of

A

Pre-maturity
Miscarriage
Chorioamnionitis

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95
Q

what is treatment of BV in pregnancy

A

Metronidazole:

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96
Q

what are risks of metronidazole in puerperium

A

Metronidazole changes taste breast milk - do not breast feed 12-24h after taking

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97
Q

what is chlamydia

A

STI causes by infection with chlamydia trichomatis

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98
Q

what is the most common STI in the UK

A

Chlamydia trichomatis

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99
Q

how is chlamydia transmitted

A

STI : vaginal, oral and anal

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100
Q

what are 5 risk factors for chlamydia infection

A
  • New sexual partner
  • +ve sexual partner
  • Multiple partners
  • Lack of barrier contraception
  • <25-years
  • Other STI
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101
Q

what. % of chlamydia is asymptomatic in women

A

70

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102
Q

what % of chlamydia is asymptomatic in men

A

50

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103
Q

how long does it take for symptoms to appear after unprotected sexual intercourse for chlalmydia

A

7-21d

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104
Q

what are 5 symptoms of chlamydia in women

A
  1. Discharge
  2. Inter-menstrual bleeding
  3. Post-coital bleeding
  4. Deep dyspareunia
  5. Low abdominal pain
  6. Dysuria
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105
Q

what may be seen on examination in chlamydia in women

A

Chandelier sign

Cervicitis with contact bleeding

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106
Q

what is chandelier sign

A

Cervical excitation = severe pain on palpating the cervix

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107
Q

what are symptoms of chlamydia in men

A

Urethritis: dysuria and frequency

Epididymo-orchitis

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108
Q

how does chlamydia conjunctivitis present

A

Red-pink eye

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109
Q

how does chlamydia infection of the rectum present

A

Discharge

Discomfort

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110
Q

how does chalmydia infection of the pharynx present

A

Asymptomatic

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111
Q

What type of organism is chalmydia trachomatis

A

Intracellular gram-negative

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112
Q

What chlamydia serotypes cause genital infection

A

D-K

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113
Q

Where are chalmydia tests available from

A

GP
GUM
Sexual Health Clinic

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114
Q

What is first-line investigation in women for chalmydia

A

Vulvovaginal swab for NAAT

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115
Q

What is performed on vulvo-vaginal swab

A

NAAT

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116
Q

What is first-line to investigate for chlamydia in men

A

First-pass urine sample for NAAT

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117
Q

What should all patients presenting with chalmydia have and why

A

Full STI Screen - due to increased risk other STIs

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118
Q

What is the the chlamydia national screening program (2003)

A

All individuals under 25 at each GP consultation should be offered an STI screen

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119
Q

What is first-line for chalmydia

A

Doxycycline

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120
Q

What is second-line for chlamydia

A

Azithromycin

Erythromycin if CI

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121
Q

When should individuals be re-tested following treatment

A

3m if under-25

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122
Q

What are 4 risks of chlamydia infection during pregnancy

A
  • Stillbirth
  • Miscarriage
  • Pre-maturity
  • Low birth weight
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123
Q

How do you treat chlamydia in pregnancy

A

Azithromycin

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124
Q

Why is azithromycin used to treat chlamydia in pregnancy

A

As doxycycline is CI

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125
Q

If a baby contracts chlamydia during delivery, how will they present

A

Neonatal conjunctivitis

126
Q

If a neonate contracted chlamydia during delivery how can it present at 1-3 months

A

Neonatal pneumonia

127
Q

How are neonates with chalmydia managed

A

Oral erythromycin

128
Q

What do ascending chlamydia infections cause

A

PID: causes salpingitis and endometritis

129
Q

What are 3 complications of PID

A
  1. Perihepatitis
  2. Ectopic pregnancy
  3. Infertility
130
Q

What may chalmydia infection cause in men

A

Epididymitis

Epididymo-orchitis

131
Q

What is reiter’s syndrome

A

Can’t see, pee or climb a tree - secondary to STI

132
Q

What is arthritis in reiter’s syndrome classified as

A

Reactive arthritis

133
Q

What causes gonorrhoea

A

Niesseria Gonorrhoea

134
Q

What type of organism is gonorrhoea

A

Gram-negative diplococci

135
Q

What is the second most common STI in the UK

A

Gonorrhoea

136
Q

Which two populations are more at risk of gonorrhoea

A

MSM

<25

137
Q

How can gonorrhoea be transmitted

A

Oral
Vaginal
Anal sex

138
Q

What are 4 risk factors for gonorrhoea infection

A
  1. MSM
  2. Previous gonorrhoea
  3. Multiple partners
  4. <25-years
139
Q

What % of females are asymptomatic with gonorrhoea

A

50

140
Q

What are 4 symptoms of gonorrhoea in females

A
  1. Vaginal discharge (green-yellow, watery)
  2. Dysuria
  3. Dyspareunia
  4. Lower abdominal pain

IM and post-coital bleeding can occur but are not common

141
Q

What are 2 symptoms of gonorrhoea in males

A
  1. urethritis: discharge and frequency

2. dysuria

142
Q

How will rectal infection with gonorrhoea present

A

discharge

discomfort

143
Q

How will pharyngeal infection with gonorrhoea present

A

asymptomatic 50%

144
Q

What swab is taken for gonorrhoea and what is performed

A

endocervical swab: NAAT and microscopy + culture

145
Q

What sample is taken to test for gonorrhoea in males and what is performed

A

first-pass urine sample for NAAT

urethral swab: M+C

146
Q

What should be performed if individual has gonorrhoea

A

Full STI screen - due to increased risk

147
Q

What is first line for gonorrhoea

A

IM Ceftriaxone (1g)

148
Q

What is recommended following treatment gonorrhoea

A

Test-to-cure

149
Q

When may individuals be referred to hospital with gonorrhoea and why

A

Systemic symptoms: malaise, fever, joint pain. This indicates disseminated gonococcal infection which can lead to gonococcal meningitis

150
Q

What are 4 complications of gonorrhoea during pregnancy

A
  • Pre-mature labour
  • Spontaneous labour
  • PROM
  • Perinatal mortality
151
Q

What can gonorrhoea lead to if left untreated

A

PID

152
Q

What are 3 complications of PID

A

Perihepatitis
Chronic pain
Infertility
Ectopic pregnancy

153
Q

What can gonorrhoea cause in males

A

Epididymo-orchitis

154
Q

What can disseminated gonococcal infection causes

A

Reiter’s syndrome

155
Q

What is renter’s syndrome associated with

A

Gonorrhoea infection

156
Q

What type of herpes simplex virus causes genital infections

A

HSV2

Number 2 = Poo - which is in the genital region

157
Q

How is herpes transmitted

A

Skin-Skin contact

158
Q

Explain herpes and barrier contraception

A

Barrier contraception - reduces risk herpes. However could still be transmitted by areas not covered eg. thigh s

159
Q

What are two risk factors for herpes simplex

A

Partner cold-sores

MSM

160
Q

Explain time period from exposure to symptoms

A

Variable - can be immediately, months, years

161
Q

How does primary infection with herpes present

A
  • Itchy, painful red blisters around the genitals.
  • Malaise
  • Myalgia
  • Flu-like symptoms
162
Q

What does secondary herpes infection refer to

A

Re-activaiton of herpes

163
Q

Explain recurrent outbreaks with herpes

A

Often recurrent episodes are shorter. As time goes on episodes become shorter and less severe

164
Q

Explain clinical presentation of recurrent outbreaks

A

Starts with burning and itching around the genitals. Then painful red blisters

165
Q

What is the main cause of cold sores

A

HSV1

166
Q

How do cold sores present

A

Tingling/itching around the mouth that progresses to red sores

167
Q

What does HSV1 mainly cause

A

Herpes labialis (Cold sores)

168
Q

What does HSV2 mainly cause

A

Herpes genitalis

169
Q

How is HSV investigated

A

Swab open sore

170
Q

If primary infection, what is first-line management

A

Oral acyclovir

171
Q

What may be used to reduce recurrence

A
  • Analgesia
  • Ice pack
  • Petroleum jelly
172
Q

If outbreaks are regular, what can be done

A

Prophylactic acyclovir as soon as symptoms begin

173
Q

If more than 6-outbreaks a year what should be done

A

Daily acyclovir

174
Q

Explain risk to foetus if women has recurrence of herpes

A

As mother already has antibodies to herpes these are transmitted via the placenta - meaning foetus is at low risk

175
Q

What is offered to women with active herpes at time of birth

A

C-Section

176
Q

What is risk of transmitting herpes during vaginal delivery

A

0-3%

177
Q

If mother contracts new-herpes infection during third trimester, why is there a greater risk

A

As mother does not have antibodies to pass to foetus. Therefore C-section recommended

178
Q

What are the 3 presentations of herpes in neonates

A
  • Skin, eye, mouth
  • Disseminated infection (affects internal organs)
  • CNS - causes encephalitis
179
Q

What are genital warts

A

Benign fleshy outgrowths caused by HPV

180
Q

What was the most transmitted viral STI and why are rates decreasing

A

HPV

- due to HPV vaccine

181
Q

What HPV types cause genital warts

A

HPV 6 and 11

182
Q

What causes transmission HPV 6 and 11

A

Skin-to-skin contact

183
Q

What are 5 risk factors for HPV

A
  • Smoking
  • Diabetes
  • Early first sexual encounter
  • Multiple partners
  • Immunosupressed
184
Q

Explain diabetes as a risk factor for HPV

A

Does not increase risk of genital warts - but increases risk of them persisting

185
Q

How do majority of cases of HPV infection present

A

Asymptomatic

186
Q

How does HPV 6 and 11 present

A

Benign fleshy-outgrowth

187
Q

What causes condylomata acuminatum

A

HPV 6 and 11

188
Q

What HPV sub-types cause cervical cancer

A

HPV 16 and 18

189
Q

Explain condoms as protective against HPV

A

Only partially protective as still risk skin-skin contact outside condom

190
Q

What cancers does HPV 16 and 18 increase risk of

A

Cervical
Vulval
Vaginal
Anal

191
Q

Explain work-up in HPV

A
  • Examine for lesions, including speculum for Intenal lesions
  • If anal bleeding - perform proctoscopy
  • If unusual lesions: biopsy
192
Q

If females have multiple external genital warts what are they treated with

A

Podophyllotoxin

193
Q

If multiple external genital warts in females are not managed by podophyllotoxin, what is given

A

Imiquimod

194
Q

If one or few genital warts what is first-line

A

Cyrotherapy

195
Q

If cyotherapy is unsuccessful what is second-line

A

Podophyllotoxin or imiquimod

196
Q

If pregnant, what is used to treat genital warts

A

Cyrotherapy

197
Q

If multiple peri-anal externa genitall warts in males, what is first-line

A

Podophyllotoxin

198
Q

If podophyllotoxin is unsuccessful, what is seocnd-line

A

Imiquimod

199
Q

If few external genital warts, what is first-line

A

Cryotherapy

200
Q

If cryotherapy is unsuccessful, what is offered

A

Podophyllotoxin

201
Q

What should be checked if a urethral genital wart in males

A

Whether base is visible

202
Q

If able to see the base of urethral genital wart what is first line

A

Cryotherapy

203
Q

If unable to see the wart of urethral genital wart what is first line

A

Cryotherapy and refer to urology

204
Q

What is the vaccine for HPV

A

Gardasil

205
Q

When is HPV vaccine offered

A

Boys AND Girls age 12-13

206
Q

What strains of HPV does Gardasil protect against

A

6, 11, 16 and 18

207
Q

When is HPV vaccine most effective

A

Given before first episode sexual intercourse

208
Q

What complications does HPV cause during pregnancy

A

No complications

209
Q

What may happen to genital warts in pregnancy

A

Increase in size due to hormonal changes

210
Q

What should be used to treat genital warts in pregnancy

A

Physical methods - cryotherapy

211
Q

Explain risk of HPV transmission to neonates

A

Rare

212
Q

In rare cases what can neonates develop

A

Respiratory papillomatosis (Genital warts of the throat)

213
Q

What causes syphillis

A

Treponema pallidum pallidum infection

214
Q

What is treponema palladium palladium

A

Gram negative spirochete

215
Q

Which group are at risk of syphilis

A

MSM

216
Q

What is happening to prevalence of syphilis

A

Increasing

217
Q

What causes syphilis

A

Treponema Pallidum Pallidum - which infects through body fluids

218
Q

What are the two types of syphilis infection

A

Acquired syphilis

Congenital syphilis

219
Q

What causes acquired syphilis

A

Spreading of treponema pallidum pallidum through body fluids

220
Q

What can enable syphllis to enter body

A
  • Breaks in oral or genital mucosa
  • Direct contact with lesions
  • Sharing contaminated needles
  • Sexual contact
221
Q

What causes congenital syphilis

A

Either:

  • In-utero infection
  • Transmission by vaginal delivery
222
Q

What are the three types of acquired syphilis

A

Primary syphillis
Secondary syphillis
Tertiary syphillis

223
Q

Explain clinical presentation of primary syphilis

A

Starts with a papule which then ulcerates to a chancre

224
Q

What is a papule

A

Raised lesion that does not contain fluid

225
Q

What is a chancre

A

Painless ulcer at primary site infection

226
Q

How long does it take for a chancre to develop

A

9-90d

227
Q

How long does it take for a chancre to heal

A

3-10W

228
Q

When does secondary syphilis develop

A

3m post-infection

229
Q

How does secondary syphillis present

A
  • Maculo-papular rash over hands and soles
  • Condylomata lata over moist areas (genitals)
  • Silver-grey mucous membranes
  • Malaise
  • Painless lymphadenopathy
230
Q

Where will macula-papular rash in secondary syphillis present

A

Hands and Feet

231
Q

What are condylomata lata

A

Painless fleshy outgrowths

232
Q

What mucous membranes will appear silver-grey

A

Pharynx
Genitals
Oral

233
Q

When does tertiary syphillis occur

A

Years following infection

234
Q

What are the 3 types of tertiary syphilis

A

Neurosphyllis
Gummatous
Cardiovascular

235
Q

What is gummatous syphillis

A

When granulomas deposit in skin and internal organs

236
Q

How do signs and symptoms present in gummatous syphilis

A

Depending on organ affected

237
Q

What are 4 features of neurosyphilis

A
  1. Tabes dosralis
  2. Meningovascular complications
  3. Argyll Robertson pupil
  4. Dementia
238
Q

What is tabes dorsals

A

Demyleination of spinal cord - paticualrly the dorsal roots

239
Q

How does tabes dosralis present clinically

A
  • Ataxia
  • Numbness legs
  • Loss pain and temperature
  • Loss deep tendon reflexes
  • Lightening-type shooting pain
240
Q

How does dementia in neurosyphilis present

A

Cognitive impairment and mood change

241
Q

What are meningovascular complications of neurosyphillis

A

Stroke

CN palsies

242
Q

What pupils are present in tertiary syphillis

A

Argyll Robertson

243
Q

What is argyle robertson pupil

A

Irregular small pupils that can accommodate but unresponsive to light

244
Q

What are 3 cardiovascular complications of tertiary syphillis

A

Aortic regurgitation
Ascending aorta aneurysm
Angina

245
Q

What are the two types of congenital syphilis

A
  1. Early

2. Late

246
Q

What is early-congenital syphillis

A

Congenital syphills onsets before 2-years

247
Q

What are 5 symptoms of congenital syphilis

A
  1. Jaundice
  2. Hepatosplenomegaly
  3. Painless lymphadenopathy
  4. Osteodystrophy
  5. Sniffles
  6. Desquamatising maculo-papular rash of hands and soles
248
Q

What is late-congenital syphllis

A

Congenital syphillis onsets after 2-years

249
Q

What triad of symptoms are present in late-congenital syphillis

A

Hutchinson’s triad

250
Q

What is hutchinson’s triad

A
  • Saddle nose
  • Hutchinson’s teeth
  • Mulberry molars
251
Q

Aside from hutchinson’s triad, what are 3 other features of late-congenital syphillis

A

Frontal bossing
Saber shins
SNHL

252
Q

In pathophysiology of acquired syphillis what are the 4 stages

A
  1. Primary
  2. Secondary
  3. Latent
  4. Tertiary
253
Q

Explain primary syphillis

A

Spirochetes invade skin. At the site they invade they leave an ulcer called a chancre

254
Q

What is problem with chancres

A

Chancres contain a layer of spirochete-filled fluid which can infect others

255
Q

What happens to spirochetes and chancres

A

Chancre heals over months. As it does so, the spirochetes can migrate from the chancre to lymph nodes

256
Q

Explain secondary syphillis

A

Spirochetes migrate to lymph nodes causing generalised lymphadenopathy.

257
Q

How does a macule-papular rash occur in secondary syphilis

A

Spirochetes attach to epithelial cells of capillaries adjacent to the skin

258
Q

Where does maculo-papular rash start in secondary syphillis

A

Starts on the trunks spreads to arms and legs

259
Q

What is the most infectious stage and why

A

Secondary syphilis. Due to spirochetes in maculo-papular rash adjacent to the skin

260
Q

What is latent syphillis

A

Syphilis enters dormant stage

261
Q

How can latent syphillis be divided

A

Early (1y)

Late (>1)

262
Q

What is early latent syphillis

A

Within 1-year. Spirochetes re-enter circulation causing symptoms of secondary syphillis.

263
Q

What is late latent syphillis

A

> 1 year. Spirochetes remain in epithelial cells of capillaries and tissue organs

264
Q

What does late latent syphillis cause

A

Spirochetes trigger a severe immune response

265
Q

What type of hypersensitivity reaction is tertiary sypgillis

A

Type IV (T-cell mediated)

266
Q

What is a gumma

A

Collection of antibodies raised to spirochetes, surrounded by fibroblasts

267
Q

What do gumma’s not contain

A

Spirochetes

268
Q

What can happen to gummas

A

There is no oxygen entering centre - which can cause coagulative necrosis

269
Q

What causes ascending aortic aneurysms in tertiary syphillis

A

Inflammation vaso-vasum (= blood vessels supply aorta)

270
Q

What causes tabes dorsalis in tertiary syphillis

A

Inflammation arteries that supply posterior spinal cord causing wasting

271
Q

What is tabes dorsalis

A

Wasting posterior spinal cord

272
Q

What does tabes dorsalis cause

A

Loss dorsal column pathway - causing loss proprioception and vibration

273
Q

How do spirochetes infect in congenital syphilis

A

Placenta or during-delivery

274
Q

What is used to detect spirochetes in primary syphills

A

Dark ground microscopy of spirochete fluid

275
Q

How can serology of treponema pallidum pallidum be divided

A
  1. Treponema specific

2. Treponema non-specific

276
Q

What are treponema specific tests

A

Tests specific for treponema

Not necessarily pallidum

277
Q

What are the two treponema specific tests

A

Treponema Pallidum Haemagglutination Test

Elisa (IgM or IgG)

278
Q

How long does treponema haemagglutination test (THPA) remain to positive

A

For life

279
Q

How long does treponema ELISA for IgM and IgM remain positive

A

For life

280
Q

What are non-treponema specific tests

A

Cardiolipin tests including:

  • VDRL (venereal disease research laboratory)
  • RPR (rapid plasmin reagin)
281
Q

Explain non-treponema specific tests

A
  • Non-sensitive in tetiary syphilis

- Decrease post treatment

282
Q

What other tests should someone have if syphills

A

LP if suspect neurosyphilis

283
Q

If someone has had treatment for syphillis how will the following appear

a. VDRL
b. TPHA

A

a. Decrease

b. Remain raised

284
Q

Give 5 causes of false-positive cardiolipin tests

A
  • Pregnancy
  • SLE, anti-phospholipid syndrome
  • TB
  • HIV
  • Malaria
  • Leprosy
285
Q

What is first-line for syphillis

A

Benzathine penicillin

286
Q

If early syphillis what dose of benzathine penicillin is given

A

2.4IU IM Single-Dose

287
Q

If late syphillis what dose of benzathine penicillin is given

A

2.4 IM - 3 doses over 3 weeks

288
Q

If neurosyphillis what is given

A

Procaine Penicillin and Probenecid for 14d

289
Q

What is an alternative or procaine penicillin and probenecid

A

IV benzylpenicillin every 4h for 14d

290
Q

What is a risk following treatment of syphillis

A

Jarish-Herxheimer Reaction

291
Q

What is a Jarish-Herxheimer reaction

A

Flu-like illness 24h following treatment due tot death or treponema

292
Q

When does jarish-hexrheimer reaction occur

A

24h after initiating treatment

293
Q

How is jarish-herxheimer reaction managed

A

Supportive. Unless cardiovascular syphillis or neurosyphillis - then use steroids

294
Q

How is jarish-herheimer reactions managed if person has cardiovascular or neurosyphillis

A

Steroids

295
Q

What 3 conditions are women offered antenatal screening for routinely

A
  • Syphillis
  • HIV
  • Hep B
296
Q

What is PID

A

Infection of the upper genital tract

297
Q

What is included in the upper genital tract

A

Ovaries, Fallopian tubes, Uterus

298
Q

When is peak incidence of PID

A

15-25

299
Q

What is the most common cause of PID

A

Chlamydia

300
Q

What else can cause PID

A

Gonorrhoea

301
Q

What are 5 risk factors for PID

A
  • 15-25
  • New sexual partner
  • Previous PID
  • Previous STIs
  • Intercourse without barrier contraception
302
Q

How does PID present

A
  • Lower abdomen pain
  • Deep dyspareunia
  • Menstrual abnormalities (menorrhagia, dysmenorrhea,
    IM bleeding)
  • Post-coital bleeding
  • Dysuria
  • Purulent discharge w/odour
303
Q

What is associated with 10% of PID

A

Fitz-Hugh-Curtis Syndrome

304
Q

What is Fitz-high-curtis syndrome

A

Peri-hepatitis

305
Q

How may Fitz-high Curtis

A

RUQ pain and symptoms PID

306
Q

What may be present on examination in PID

A
  • Adnexa tenderness

- Cervical excitation

307
Q

What swabs are taken in PID and what is examined

A

Vulvovaginal swab = chlamydia
Endocervical swab = gonorrhoea

Both undergo NAAT

308
Q

If swabs are negative in suspected PID what does this mean

A

Does not exclude diagnosis

309
Q

What should happen in PID

A

Full STI screen

Minimum: Gonorrhoea, Syphillis, Chalmydia, HIV

310
Q

How is PID managed

A

Antibiotics:

  • Oral oxafloxacin
  • Oral metronidazole
  • IM Ceftriazone
  • Oral doxycycline
311
Q

What should the history of contact tracing be in PID

A

6m previous

312
Q

What are 5 complications of PID

A
  1. Infertility
  2. Ectopic
  3. Tubovarian abscess
  4. Chronic pain
  5. Fitz-Hugh-Curtis syndrome

Gynaecology (22 decks)

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