1: Genital Tract Infection - STIs Flashcards
1
Q
What are the 8 STIs
A
- Gonorrhoea
- Chlamydia
- HSV
- HIV
- Genital Warts
- Syphillis
- Trichomonas vaginalis
- PID
2
Q
What are 2 non-sexually transmitted infections
A
- Bacterial vaginosis
2. Vulval candidiasis
3
Q
How will discharge present in vulvovaginal candidiasis
A
Thick white curdle discharge
4
Q
Aside from curd-like discharge what are two other symptoms of vulvovaginal candidiasis
A
Itchy vulva
Superficial dyspareunia
5
Q
How can candidiasis be investigated for
A
Vaginal pH on exam
6
Q
How is candiasis managed
A
Co-trimoxazole
7
Q
What discharge is present in trichomonas vaginalis
A
Green-yellow discharge
8
Q
What may be seen OE in trochomonas vaginalis
A
Strawberry cervix
9
Q
Aside from green discharge, what are 3 other symptoms of TV
A
- Dysuria
- Dysparuia
- Pruritus
10
Q
How is TV investigated
A
High vaginal-swab
11
Q
How is TV managed
A
Metronidazole
12
Q
What discharge will be present in bacterial vaginosis
A
Fishy-discharge
13
Q
What are two tests for BV
A
High vaginal swab
Koh Whiff Test
14
Q
How is BV managed
A
Metronidazole
15
Q
What % of chlamydia is asymptomatic
A
70
16
Q
How may chlamydia present
A
- Deep Dyspareunia
- Intermenstrual bleeding
- Post-coital bleeding
17
Q
How is chlamydia diagnosed
A
Vulvovaginal swab for NAAT
18
Q
How is chlamydia managed
A
Azithromycin
19
Q
In what % is gonorrhoea asymptomatic
A
50
20
Q
How may discharge in gonorrhoea present
A
Thin green-yellow discharge
21
Q
What are symptoms of gonorrhoea
A
Dysuria
Dyspareunia
IM bleeding
Post-coital bleeding
22
Q
How is gonorrhoea diagnosed
A
Endocervical swab for NAAT
23
Q
How is gonorrhoea managed
A
IM Ceftriaxone
24
Q
How does herpes present clinically
A
- Painful red blisters
- Abnormal discharge
- Fever
- Myalgia
25
How is herpes diagnosed
PCR
26
How is herpes managed
Acyclovir
27
How does a genital wart present clinically
Fleshy discolouration of skin
28
What may be used to look for genital warts
Colposcopy
| Protoscopy
29
How does syphillis present initially
Primary chancre
30
What is used to investigate syphillis
Dark ground microscopy
31
What type of pelvic pain does chlamydia cause
Deep dyspareunia
32
What type of pelvic pain does trichomonas vaginalis cause
Superficial dyspareunia
33
What type of pelvic pain does gonorrhoea cause
Deep dyspareunia
34
What type of pelvic pain does pelvic inflammatory disease cause
Deep dyspareunia
35
What are 3 causes of urethras discharge in males
Chalmydia
Gonorrhoea
TV
36
What is the most common STI in the UK
Chalmydia
37
Explain contact tracing
Clinician has conversation with individual about informing own partners (patient referral) or getting anonymous source to inform the, (provider referral)
38
What is vulvovaginal candidiasis also known as
Thrush
39
What is vulvovaginal candidiasis
Fungal infection of lower female genital tract
40
What is the peak age for vulvovaignal candidiasis
20-40years
41
How common is vulvovaginal candidiasis
Common
42
What causes 90% of vulvovaginal candidiasis
Candida albicans
43
What are 5 risk factors for vulvovaginal candidiasis
1. Diabetes
2. Corticosteroids
3. Immunosuppression (HIV, Malignancy)
4. Broad-spectrum antibiotics
5. Pregnancy
44
Why are broad-spectrum antibiotics a risk factor for vulvovaginal candidiasis
Destroys normal flora permitting overgrowth of candida
45
What is the main symptom of vulvovaginal candiasis
Pruritic vulva
46
How else may vulvovaginal candiasis present
Thick curd-like white discharge
| Superficial dysuria - due to irritation skin
47
How will vulva appear on exam in vulvovaginal candidiasis
Erythematous and Oedematous
48
What are satellite lesions
Red, pustular lesions with superficial pseudomonas plaques that can be scraped off
49
Where is candida albicans found normally
Normal flora of GI tract
50
How is vulvovaginal candidiasis normally diagnosed
Clinical. However, if women examined vaginal pH should be measured
51
If the women is examined in vulvovaginal candidiasis, what is recommended
Vaginal pH
52
what is first-line for vulvogvaginal candidiasis
Vaginal anti-fungal (Co-trimoxazole, Fenticonazole)
53
what is second-line for vulvovaginal candidiasis
Oral anti-fungal (fluconazole, itraconazole)
54
when should topical imidazole for vulvovaginal candidiasis only be prescribed
If in conjunction with vaginal or oral treatment
55
what is a note when using anti-fungal treatments
Anti-fungal treatments are oil based and there do
56
why is there an increased risk of vulvovaginal candidiasis In pregnancy
Increased oestrogen
57
explain management of vulvovaginal candidiasis in pregnancy
Vagina co-trimoxazole and topical imidazole for vulva. NEVER give oral anti-fungals
58
what is trichomonas vaginalis
anaerobic protozoan
59
how is trichomonas vaginalis transmitted
sexual intercourse
60
what are 4 risk factors for trichomonas vaginalis
1. Unprotected intercourse
2. Multiple partners
3. History STIs
4. Age - older women have a higher risk
61
how do most people with trichomonas vaginalis present
Asymptomatic
62
in what time period after sexual intercourse do symptoms of trichomonas vaginalis present
28d
63
what are 5 symptoms of TV in women
1. Vaginal odour
2. Green-Yellow discharge
3. Vulval pruritus
4. Dyspareunia
5. Dysuria
64
how will the cervix present in TV
Strawberry cervix
65
what is a strawberry cervix
Punctate and papilliform appearance of the cervix
66
what are symptoms of TV in males
Urethral discharge
Dysuria
Frequency
67
what are 2 signs of TV in males
Urethral discharge
| Balanoposthitis = enlargement glans penis
68
can TV be transmitted through oral and anal sex
No
69
can TV be transmitted vertically
Yes - rare
70
how is TV investigated for in females
vaginal swab of posterior fornix
71
how is TV tested for in males
- urethral swab
| - first void urine sample
72
explain sexual intercourse when being treated for TV
- do not have sexual intercourse during treatment
| - abstain for one week if taken single dose metronidazole
73
what is used to manage TV
Metronidazole as:
- Single dose PO (2g)
- 400mg BD for 5-7d
74
what does TV in pregnancy increase risk of
- Maternal Post-partum sepsis
| - Pre-mature labour
75
what is used to treat TV in pregnancy
Metronidazole
76
what is the risk with metronidazole in pregnancy and how is this overcome
Changes taste of breast milk
| Do not breast feed for 12-24h after last dose
77
what is bacteria vaginosis
non-STI genital tract infection
78
what is the most common cause of vaginal discharge in women
BV
79
in which ethnicity is BV more common
afro-carribean
80
what organism causes BV
Gardenella Vaginosis
81
explain pathophysiology of BV
When normal flora are killed, including lactobacilli, means acid is no longer produced causing increase in vaginal pH and overgrowth of gardnerella vaginosis
82
what are risk factors for BV categorised into
Factors that lead to change in vaginal pH
83
what are 5 risk factors for BV
```
Sexual activity - new partner or multiple
Showergel
Smoking
STI
Receptive Oral Sex
IUD
Recent antibiotic use
```
84
what. % of individuals are asymptomatic with BV
50
85
what are the symptoms of BV
- Fishy like vaginal discharge
86
what are the signs of BV
- With-Grey discharge
87
what is the first investigation for BV
High vaginal swab
88
what type of cells will be seen in BV
Clue cells
| Pus cells
89
what are clue cells
Epithelial cells that contain cocci
90
what is another test for BV not used in clinical practice
Koh Whiff test
91
what does the KOH whiff test entail
add alkali to the vaginal discharge - if gardenella is overgrown will cause fishy vaginal odour
92
what are 3 conservative methods for BV
- No vaginal douching
- Remove IUD
- Avoid shower gels on vagina
93
what is a pharmacological method for BV
Metronidazole: 2g one off dose OR 400-500mg BD for 5-7d
94
what does BV in pregnancy increase risk of
Pre-maturity
Miscarriage
Chorioamnionitis
95
what is treatment of BV in pregnancy
Metronidazole:
96
what are risks of metronidazole in puerperium
Metronidazole changes taste breast milk - do not breast feed 12-24h after taking
97
what is chlamydia
STI causes by infection with chlamydia trichomatis
98
what is the most common STI in the UK
Chlamydia trichomatis
99
how is chlamydia transmitted
STI : vaginal, oral and anal
100
what are 5 risk factors for chlamydia infection
- New sexual partner
- +ve sexual partner
- Multiple partners
- Lack of barrier contraception
- <25-years
- Other STI
101
what. % of chlamydia is asymptomatic in women
70
102
what % of chlamydia is asymptomatic in men
50
103
how long does it take for symptoms to appear after unprotected sexual intercourse for chlalmydia
7-21d
104
what are 5 symptoms of chlamydia in women
1. Discharge
2. Inter-menstrual bleeding
3. Post-coital bleeding
4. Deep dyspareunia
5. Low abdominal pain
6. Dysuria
105
what may be seen on examination in chlamydia in women
Chandelier sign
| Cervicitis with contact bleeding
106
what is chandelier sign
Cervical excitation = severe pain on palpating the cervix
107
what are symptoms of chlamydia in men
Urethritis: dysuria and frequency
| Epididymo-orchitis
108
how does chlamydia conjunctivitis present
Red-pink eye
109
how does chlamydia infection of the rectum present
Discharge
| Discomfort
110
how does chalmydia infection of the pharynx present
Asymptomatic
111
What type of organism is chalmydia trachomatis
Intracellular gram-negative
112
What chlamydia serotypes cause genital infection
D-K
113
Where are chalmydia tests available from
GP
GUM
Sexual Health Clinic
114
What is first-line investigation in women for chalmydia
Vulvovaginal swab for NAAT
115
What is performed on vulvo-vaginal swab
NAAT
116
What is first-line to investigate for chlamydia in men
First-pass urine sample for NAAT
117
What should all patients presenting with chalmydia have and why
Full STI Screen - due to increased risk other STIs
118
What is the the chlamydia national screening program (2003)
All individuals under 25 at each GP consultation should be offered an STI screen
119
What is first-line for chalmydia
Doxycycline
120
What is second-line for chlamydia
Azithromycin
| Erythromycin if CI
121
When should individuals be re-tested following treatment
3m if under-25
122
What are 4 risks of chlamydia infection during pregnancy
- Stillbirth
- Miscarriage
- Pre-maturity
- Low birth weight
123
How do you treat chlamydia in pregnancy
Azithromycin
124
Why is azithromycin used to treat chlamydia in pregnancy
As doxycycline is CI
125
If a baby contracts chlamydia during delivery, how will they present
Neonatal conjunctivitis
126
If a neonate contracted chlamydia during delivery how can it present at 1-3 months
Neonatal pneumonia
127
How are neonates with chalmydia managed
Oral erythromycin
128
What do ascending chlamydia infections cause
PID: causes salpingitis and endometritis
129
What are 3 complications of PID
1. Perihepatitis
2. Ectopic pregnancy
3. Infertility
130
What may chalmydia infection cause in men
Epididymitis
| Epididymo-orchitis
131
What is reiter's syndrome
Can't see, pee or climb a tree - secondary to STI
132
What is arthritis in reiter's syndrome classified as
Reactive arthritis
133
What causes gonorrhoea
Niesseria Gonorrhoea
134
What type of organism is gonorrhoea
Gram-negative diplococci
135
What is the second most common STI in the UK
Gonorrhoea
136
Which two populations are more at risk of gonorrhoea
MSM
| <25
137
How can gonorrhoea be transmitted
Oral
Vaginal
Anal sex
138
What are 4 risk factors for gonorrhoea infection
1. MSM
2. Previous gonorrhoea
3. Multiple partners
4. <25-years
139
What % of females are asymptomatic with gonorrhoea
50
140
What are 4 symptoms of gonorrhoea in females
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
What are 2 symptoms of gonorrhoea in males
1. urethritis: discharge and frequency
| 2. dysuria
142
How will rectal infection with gonorrhoea present
discharge
| discomfort
143
How will pharyngeal infection with gonorrhoea present
asymptomatic 50%
144
What swab is taken for gonorrhoea and what is performed
endocervical swab: NAAT and microscopy + culture
145
What sample is taken to test for gonorrhoea in males and what is performed
first-pass urine sample for NAAT
| urethral swab: M+C
146
What should be performed if individual has gonorrhoea
Full STI screen - due to increased risk
147
What is first line for gonorrhoea
IM Ceftriaxone (1g)
148
What is recommended following treatment gonorrhoea
Test-to-cure
149
When may individuals be referred to hospital with gonorrhoea and why
Systemic symptoms: malaise, fever, joint pain. This indicates disseminated gonococcal infection which can lead to gonococcal meningitis
150
What are 4 complications of gonorrhoea during pregnancy
- Pre-mature labour
- Spontaneous labour
- PROM
- Perinatal mortality
151
What can gonorrhoea lead to if left untreated
PID
152
What are 3 complications of PID
Perihepatitis
Chronic pain
Infertility
Ectopic pregnancy
153
What can gonorrhoea cause in males
Epididymo-orchitis
154
What can disseminated gonococcal infection causes
Reiter's syndrome
155
What is renter's syndrome associated with
Gonorrhoea infection
156
What type of herpes simplex virus causes genital infections
HSV2
| Number 2 = Poo - which is in the genital region
157
How is herpes transmitted
Skin-Skin contact
158
Explain herpes and barrier contraception
Barrier contraception - reduces risk herpes. However could still be transmitted by areas not covered eg. thigh s
159
What are two risk factors for herpes simplex
Partner cold-sores
| MSM
160
Explain time period from exposure to symptoms
Variable - can be immediately, months, years
161
How does primary infection with herpes present
- Itchy, painful red blisters around the genitals.
- Malaise
- Myalgia
- Flu-like symptoms
162
What does secondary herpes infection refer to
Re-activaiton of herpes
163
Explain recurrent outbreaks with herpes
Often recurrent episodes are shorter. As time goes on episodes become shorter and less severe
164
Explain clinical presentation of recurrent outbreaks
Starts with burning and itching around the genitals. Then painful red blisters
165
What is the main cause of cold sores
HSV1
166
How do cold sores present
Tingling/itching around the mouth that progresses to red sores
167
What does HSV1 mainly cause
Herpes labialis (Cold sores)
168
What does HSV2 mainly cause
Herpes genitalis
169
How is HSV investigated
Swab open sore
170
If primary infection, what is first-line management
Oral acyclovir
171
What may be used to reduce recurrence
- Analgesia
- Ice pack
- Petroleum jelly
172
If outbreaks are regular, what can be done
Prophylactic acyclovir as soon as symptoms begin
173
If more than 6-outbreaks a year what should be done
Daily acyclovir
174
Explain risk to foetus if women has recurrence of herpes
As mother already has antibodies to herpes these are transmitted via the placenta - meaning foetus is at low risk
175
What is offered to women with active herpes at time of birth
C-Section
176
What is risk of transmitting herpes during vaginal delivery
0-3%
177
If mother contracts new-herpes infection during third trimester, why is there a greater risk
As mother does not have antibodies to pass to foetus. Therefore C-section recommended
178
What are the 3 presentations of herpes in neonates
- Skin, eye, mouth
- Disseminated infection (affects internal organs)
- CNS - causes encephalitis
179
What are genital warts
Benign fleshy outgrowths caused by HPV
180
What was the most transmitted viral STI and why are rates decreasing
HPV
| - due to HPV vaccine
181
What HPV types cause genital warts
HPV 6 and 11
182
What causes transmission HPV 6 and 11
Skin-to-skin contact
183
What are 5 risk factors for HPV
- Smoking
- Diabetes
- Early first sexual encounter
- Multiple partners
- Immunosupressed
184
Explain diabetes as a risk factor for HPV
Does not increase risk of genital warts - but increases risk of them persisting
185
How do majority of cases of HPV infection present
Asymptomatic
186
How does HPV 6 and 11 present
Benign fleshy-outgrowth
187
What causes condylomata acuminatum
HPV 6 and 11
188
What HPV sub-types cause cervical cancer
HPV 16 and 18
189
Explain condoms as protective against HPV
Only partially protective as still risk skin-skin contact outside condom
190
What cancers does HPV 16 and 18 increase risk of
Cervical
Vulval
Vaginal
Anal
191
Explain work-up in HPV
- Examine for lesions, including speculum for Intenal lesions
- If anal bleeding - perform proctoscopy
- If unusual lesions: biopsy
192
If females have multiple external genital warts what are they treated with
Podophyllotoxin
193
If multiple external genital warts in females are not managed by podophyllotoxin, what is given
Imiquimod
194
If one or few genital warts what is first-line
Cyrotherapy
195
If cyotherapy is unsuccessful what is second-line
Podophyllotoxin or imiquimod
196
If pregnant, what is used to treat genital warts
Cyrotherapy
197
If multiple peri-anal externa genitall warts in males, what is first-line
Podophyllotoxin
198
If podophyllotoxin is unsuccessful, what is seocnd-line
Imiquimod
199
If few external genital warts, what is first-line
Cryotherapy
200
If cryotherapy is unsuccessful, what is offered
Podophyllotoxin
201
What should be checked if a urethral genital wart in males
Whether base is visible
202
If able to see the base of urethral genital wart what is first line
Cryotherapy
203
If unable to see the wart of urethral genital wart what is first line
Cryotherapy and refer to urology
204
What is the vaccine for HPV
Gardasil
205
When is HPV vaccine offered
Boys AND Girls age 12-13
206
What strains of HPV does Gardasil protect against
6, 11, 16 and 18
207
When is HPV vaccine most effective
Given before first episode sexual intercourse
208
What complications does HPV cause during pregnancy
No complications
209
What may happen to genital warts in pregnancy
Increase in size due to hormonal changes
210
What should be used to treat genital warts in pregnancy
Physical methods - cryotherapy
211
Explain risk of HPV transmission to neonates
Rare
212
In rare cases what can neonates develop
Respiratory papillomatosis (Genital warts of the throat)
213
What causes syphillis
Treponema pallidum pallidum infection
214
What is treponema palladium palladium
Gram negative spirochete
215
Which group are at risk of syphilis
MSM
216
What is happening to prevalence of syphilis
Increasing
217
What causes syphilis
Treponema Pallidum Pallidum - which infects through body fluids
218
What are the two types of syphilis infection
Acquired syphilis
| Congenital syphilis
219
What causes acquired syphilis
Spreading of treponema pallidum pallidum through body fluids
220
What can enable syphllis to enter body
- Breaks in oral or genital mucosa
- Direct contact with lesions
- Sharing contaminated needles
- Sexual contact
221
What causes congenital syphilis
Either:
- In-utero infection
- Transmission by vaginal delivery
222
What are the three types of acquired syphilis
Primary syphillis
Secondary syphillis
Tertiary syphillis
223
Explain clinical presentation of primary syphilis
Starts with a papule which then ulcerates to a chancre
224
What is a papule
Raised lesion that does not contain fluid
225
What is a chancre
Painless ulcer at primary site infection
226
How long does it take for a chancre to develop
9-90d
227
How long does it take for a chancre to heal
3-10W
228
When does secondary syphilis develop
3m post-infection
229
How does secondary syphillis present
- Maculo-papular rash over hands and soles
- Condylomata lata over moist areas (genitals)
- Silver-grey mucous membranes
- Malaise
- Painless lymphadenopathy
230
Where will macula-papular rash in secondary syphillis present
Hands and Feet
231
What are condylomata lata
Painless fleshy outgrowths
232
What mucous membranes will appear silver-grey
Pharynx
Genitals
Oral
233
When does tertiary syphillis occur
Years following infection
234
What are the 3 types of tertiary syphilis
Neurosphyllis
Gummatous
Cardiovascular
235
What is gummatous syphillis
When granulomas deposit in skin and internal organs
236
How do signs and symptoms present in gummatous syphilis
Depending on organ affected
237
What are 4 features of neurosyphilis
1. Tabes dosralis
2. Meningovascular complications
3. Argyll Robertson pupil
4. Dementia
238
What is tabes dorsals
Demyleination of spinal cord - paticualrly the dorsal roots
239
How does tabes dosralis present clinically
- Ataxia
- Numbness legs
- Loss pain and temperature
- Loss deep tendon reflexes
- Lightening-type shooting pain
240
How does dementia in neurosyphilis present
Cognitive impairment and mood change
241
What are meningovascular complications of neurosyphillis
Stroke
| CN palsies
242
What pupils are present in tertiary syphillis
Argyll Robertson
243
What is argyle robertson pupil
Irregular small pupils that can accommodate but unresponsive to light
244
What are 3 cardiovascular complications of tertiary syphillis
Aortic regurgitation
Ascending aorta aneurysm
Angina
245
What are the two types of congenital syphilis
1. Early
| 2. Late
246
What is early-congenital syphillis
Congenital syphills onsets before 2-years
247
What are 5 symptoms of congenital syphilis
1. Jaundice
2. Hepatosplenomegaly
3. Painless lymphadenopathy
4. Osteodystrophy
5. Sniffles
6. Desquamatising maculo-papular rash of hands and soles
248
What is late-congenital syphllis
Congenital syphillis onsets after 2-years
249
What triad of symptoms are present in late-congenital syphillis
Hutchinson's triad
250
What is hutchinson's triad
- Saddle nose
- Hutchinson's teeth
- Mulberry molars
251
Aside from hutchinson's triad, what are 3 other features of late-congenital syphillis
Frontal bossing
Saber shins
SNHL
252
In pathophysiology of acquired syphillis what are the 4 stages
1. Primary
2. Secondary
3. Latent
4. Tertiary
253
Explain primary syphillis
Spirochetes invade skin. At the site they invade they leave an ulcer called a chancre
254
What is problem with chancres
Chancres contain a layer of spirochete-filled fluid which can infect others
255
What happens to spirochetes and chancres
Chancre heals over months. As it does so, the spirochetes can migrate from the chancre to lymph nodes
256
Explain secondary syphillis
Spirochetes migrate to lymph nodes causing generalised lymphadenopathy.
257
How does a macule-papular rash occur in secondary syphilis
Spirochetes attach to epithelial cells of capillaries adjacent to the skin
258
Where does maculo-papular rash start in secondary syphillis
Starts on the trunks spreads to arms and legs
259
What is the most infectious stage and why
Secondary syphilis. Due to spirochetes in maculo-papular rash adjacent to the skin
260
What is latent syphillis
Syphilis enters dormant stage
261
How can latent syphillis be divided
Early (1y)
| Late (>1)
262
What is early latent syphillis
Within 1-year. Spirochetes re-enter circulation causing symptoms of secondary syphillis.
263
What is late latent syphillis
>1 year. Spirochetes remain in epithelial cells of capillaries and tissue organs
264
What does late latent syphillis cause
Spirochetes trigger a severe immune response
265
What type of hypersensitivity reaction is tertiary sypgillis
Type IV (T-cell mediated)
266
What is a gumma
Collection of antibodies raised to spirochetes, surrounded by fibroblasts
267
What do gumma's not contain
Spirochetes
268
What can happen to gummas
There is no oxygen entering centre - which can cause coagulative necrosis
269
What causes ascending aortic aneurysms in tertiary syphillis
Inflammation vaso-vasum (= blood vessels supply aorta)
270
What causes tabes dorsalis in tertiary syphillis
Inflammation arteries that supply posterior spinal cord causing wasting
271
What is tabes dorsalis
Wasting posterior spinal cord
272
What does tabes dorsalis cause
Loss dorsal column pathway - causing loss proprioception and vibration
273
How do spirochetes infect in congenital syphilis
Placenta or during-delivery
274
What is used to detect spirochetes in primary syphills
Dark ground microscopy of spirochete fluid
275
How can serology of treponema pallidum pallidum be divided
1. Treponema specific
| 2. Treponema non-specific
276
What are treponema specific tests
Tests specific for treponema
| Not necessarily pallidum
277
What are the two treponema specific tests
Treponema Pallidum Haemagglutination Test
| Elisa (IgM or IgG)
278
How long does treponema haemagglutination test (THPA) remain to positive
For life
279
How long does treponema ELISA for IgM and IgM remain positive
For life
280
What are non-treponema specific tests
Cardiolipin tests including:
- VDRL (venereal disease research laboratory)
- RPR (rapid plasmin reagin)
281
Explain non-treponema specific tests
- Non-sensitive in tetiary syphilis
| - Decrease post treatment
282
What other tests should someone have if syphills
LP if suspect neurosyphilis
283
If someone has had treatment for syphillis how will the following appear
a. VDRL
b. TPHA
a. Decrease
| b. Remain raised
284
Give 5 causes of false-positive cardiolipin tests
- Pregnancy
- SLE, anti-phospholipid syndrome
- TB
- HIV
- Malaria
- Leprosy
285
What is first-line for syphillis
Benzathine penicillin
286
If early syphillis what dose of benzathine penicillin is given
2.4IU IM Single-Dose
287
If late syphillis what dose of benzathine penicillin is given
2.4 IM - 3 doses over 3 weeks
288
If neurosyphillis what is given
Procaine Penicillin and Probenecid for 14d
289
What is an alternative or procaine penicillin and probenecid
IV benzylpenicillin every 4h for 14d
290
What is a risk following treatment of syphillis
Jarish-Herxheimer Reaction
291
What is a Jarish-Herxheimer reaction
Flu-like illness 24h following treatment due tot death or treponema
292
When does jarish-hexrheimer reaction occur
24h after initiating treatment
293
How is jarish-herxheimer reaction managed
Supportive. Unless cardiovascular syphillis or neurosyphillis - then use steroids
294
How is jarish-herheimer reactions managed if person has cardiovascular or neurosyphillis
Steroids
295
What 3 conditions are women offered antenatal screening for routinely
- Syphillis
- HIV
- Hep B
296
What is PID
Infection of the upper genital tract
297
What is included in the upper genital tract
Ovaries, Fallopian tubes, Uterus
298
When is peak incidence of PID
15-25
299
What is the most common cause of PID
Chlamydia
300
What else can cause PID
Gonorrhoea
301
What are 5 risk factors for PID
- 15-25
- New sexual partner
- Previous PID
- Previous STIs
- Intercourse without barrier contraception
302
How does PID present
- Lower abdomen pain
- Deep dyspareunia
- Menstrual abnormalities (menorrhagia, dysmenorrhea,
IM bleeding)
- Post-coital bleeding
- Dysuria
- Purulent discharge w/odour
303
What is associated with 10% of PID
Fitz-Hugh-Curtis Syndrome
304
What is Fitz-high-curtis syndrome
Peri-hepatitis
305
How may Fitz-high Curtis
RUQ pain and symptoms PID
306
What may be present on examination in PID
- Adnexa tenderness
| - Cervical excitation
307
What swabs are taken in PID and what is examined
Vulvovaginal swab = chlamydia
Endocervical swab = gonorrhoea
Both undergo NAAT
308
If swabs are negative in suspected PID what does this mean
Does not exclude diagnosis
309
What should happen in PID
Full STI screen
| Minimum: Gonorrhoea, Syphillis, Chalmydia, HIV
310
How is PID managed
Antibiotics:
- Oral oxafloxacin
- Oral metronidazole
- IM Ceftriazone
- Oral doxycycline
311
What should the history of contact tracing be in PID
6m previous
312
What are 5 complications of PID
1. Infertility
2. Ectopic
3. Tubovarian abscess
4. Chronic pain
5. Fitz-Hugh-Curtis syndrome
