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REGUB > 23. STI + HIV > Flashcards

23. STI + HIV Flashcards

1
Q

Why is STI important?
(4)

What is STD role in HIV transmission?
(3)

A

IMPORTANCE

  1. Transmissible
  2. Indicative of increased levels of unsafe sex / Inter-relationship with HIV
  3. Long term sequelae
  4. Psychosocial implications

STD ROLE

  1. Disruption of mucosal surfaces
  2. Increased HIV secretion
  3. Increased numbers of HIV cell receptors
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2
Q

How do you diagnose it?
(4)

What questions do you asking when taking a history?
(6)

A

DX

  1. DNA amplication tests (NAAT)
  2. Microscopy
  3. Culture
  4. Serology

HX

  1. Who: regular / casual
  2. When: most recent / past year / total partners
  3. Where: Ireland / abroad
  4. How: A / V / O
  5. Protection: recent / general (condom use, pre exposure, prophylaxis)
  6. History of risk factors in partner: bisexual / IVDU
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3
Q

What is syphilis?

How is it transmitted?
Incubation period?

What is the clinical presentation?

How do you diagnose it?

What is the treatment?

A

Trepenoma pallidum

TRANSMISSION

  1. Sexual
  2. Vertical
  3. Parenteral

INCUBATION: 3-90d

CLINICAL
PRIMARY
- Chancre
- Regional lymphadenopathy

SECONDARY

  • 2 - 12 weeks post primary
  • Parenchymal
  • Constitutional
  • CNS (35%)

LATENT

  • Early
  • Late

LATE SYPHLLIS

  • Cardiovascular
  • Neurosyphilis
  • Gummatous Syphillis

DX
1. Dark ground microscopy - acute infection
2. Serology
—> Specific
a. Treponema pallidum EIA
b. Trepomema pallidum particle agglutinatin test TPPA
c. T. pallidum immunoblot assay
—> Non-specific (non-treponemal reaginic antibodies)
—> R.P.R: rapid plasma reagin test

  1. CSF Serology

TX

  1. Benzathin penicillin
  2. Doxycycline

Jarish Herhemier reaction: following antibiotic dose —> fever, chills, rigor, hypotension, headache, tachycardia, hyperventilation, vasodilation

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4
Q

What is gonorrhoea?

What is the clinical presentation in males and females?
(3)

How do you diagnose it?
(3)

What is the treatment?
(3)

A

Neisseria gonorrhoea

CLINICAL

  • Asymptomatic
  • Anorectal, pharyngeal and disseminated infection —> septicaemia, septic arthritis, endocarditis
  • M: urethritis, epidemic is
  • F: cervicitis, PID
  • Neonatal

DX

  1. Nucleic Acid Amplificatin Test (NAAT)
  2. Microscopy
  3. Culture: sensitivity testing

TX

  1. Ceftriaxone: 500mg IM
  2. Azithromycin: 1g PO
  3. Antimicrobial resistance
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5
Q

What is HSV?

What is the clinical presentation?
(4)

What is the diagnosis?
(2)

What is the treatment?
(3)

A

Genital herpes

CP
Primary Attack
1. Genital ulceration
2. Dysuria
3. Flu like symptoms
4. Neonatal HSV: generalized infection, skin mucous membranes associated with primary infection in late pregnancy
- Recurrent attacks more common with HSV2

DX

  1. NAAT
  2. Type specific antibodies

TX

  1. Acyclovir
  2. Famciclovir
  3. Valaciclovir
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6
Q

What is HPV?

What is the clinical presentation?
(3)

When does it cause oncogenesis?

What is the diagnosis?
(3)

What is the treatment?
(7)

A

Human Papilloma Virus
- Commonest STI

CP

  1. Anal warts
  2. Genital warts
  3. Low grade cervical dysplasia —> HPV 6 + 11

ONCOGENESIS

  1. High grade cervical dysplasia
  2. Anogenital carcinoma
  3. HPV 16 + 18

DX

  1. Clinical
  2. Biopsy
  3. HPV DNA

TX

  1. Cryotherapy
  2. Podophyllotoxin
  3. Trichloroacetic acid
  4. Imiquimod
  5. Laser therapy
  6. Electrocautery
  7. Surgical excision
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7
Q

What is chlamydia? How is it screened?

What is the clinical presentation?
(5)

What are the long term complications?
(4)

How do you diagnose it?
(1)

What is the treatment?
(2)

A

SCREENING
CDC SCREENING
- Annual screening of sexually active adolescents
- Annual screening of sexually active women aged 20- 25
- More frequent screening if significant risk factors
- Screening of older women with risk factors (new partner, multiple partners)

CP

  1. Cervicitis PID
  2. Urethritis
  3. Epididymis
  4. Proctitis
  5. Reiter’s syndrome

DX
1. NAAT

TX

  1. Azithromycin (1 dose)
  2. Doxycycline (7d)
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8
Q

What are examples of non gonoccocal urethritis?

3

A
  1. Chlmaydia trachomatis (D,E,F,G)
  2. Urepalsma urealyticum
  3. Mycoplasma genitalium
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9
Q

What is Trichomonas Vaginalis?

What is the clinical presentation?
(3)

What are the complications?
(2)

How do you diagnose it?
(1)

How do you treat it?
(3)

A

Flagellated protozoan

CP

  1. Vaginal discharge
  2. Vuval itching
  3. Dysuria

COMPLICATIONS

  1. Premature rupture of membranes
  2. LBW

DX
1. NAAT

TX

  1. Metronidazole (2g)
  2. Metronidazole (400mgs BD x 5-7 days)
  3. Tinidazole
    - Partners should be treated b/c men get urethritis
    - Abstinence until both partners treated and for 7d after single dose regime
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10
Q

What is chancroid?

What is the incubation period?

What is the clinical presentation?
(4)

What are the differentials?
(3)

How do you diagnose it?
(3)

How do you treat it?
(2)

A

Haemophilus ducreyi

Incubation: 1-6weeks

CP

  1. Ulcer
  2. Tender inguinal lymphadenopathy
  3. Suppurations and adenitis
  4. Sinus formation

DDX

  1. Syphilis
  2. Herpes
  3. LGV

DX

  1. NAAT
  2. Microscopy
  3. Culture

TX
1. Aspiration
2. Antibiotics:
—> Azithromycin
—> Ceftriaxone
—> Ciprofloxacin
—> Erythromycin

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11
Q

How do you prevent HIV?

5

A
  1. Sexual Contact
    - Education
    - Changes in sexual behaviour
    - Condom usage
    - Pre – exposure prophylaxis
    - Decrease in number of Partners
    - Management of other sexually transmitted diseases
  2. Vertical Transmission
    - Ante natal Screening
    - Anti Retrovirals
    - Mode of delivery - Caesarian Section
    - Breast Feeding
  3. IVDU
    - Education
    - Drug Treatment Programmes
    - Needle Exchange
  4. Blood Transfusion / Tissue Organ Transplant
    - Voluntary self exclusion
    - Screening
    - Residual risk 1:15,000,000 in Ireland
  5. Occupational Exposure
  6. Safe work practice
  7. Personal protective wear
  8. Education / training
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12
Q

What are indications for HIV testing?
(6)

What are factors affecting disease presentation?
(6)

What are risk factors?
(6)

What is the clinical spectrum?
(6)

A
  • Asymptomatic carriage —> AIDS

INDICATIONS

  1. Behavioural risk
  2. Clinical conditions associated with HIV
  3. Other sexually transmitted diseases
  4. Ante natal screening
  5. Children born to HIV positive mothers
  6. Those who received blood between 1978 and 1985 in Ireland

FACTORS

  1. Age
  2. Sex
  3. Geographic location
  4. Behavioural history
  5. Treatment status
  6. CD4 count - important role in staging disease

RISK FACTORS

  1. Sexual contact (hetero / homo sexual)
  2. Vertical transmission
  3. Contaminated needles
  4. Blood transfusion
  5. Tissue / organ donation
  6. Occupational exposure

CLINICAL SPECTRUM

  1. Oral: oral candidasis, oral hairy leukoplakia
  2. Cutaneous: HSV, fungal infections
  3. GIT: Candida or HSV, oesophagitis, Cryptosporidum
  4. Pulmonary: PCP, TB
  5. Neuro: cryptococcal meningitis, cerebral toxoplasmosis, HIV neuropathy
  6. Malignancies: Kaposi’s sarcoma, Non Hodgkin’s Lymphoma (CNS, Peripheral), Hodgkin’s Disease, Cervical Cancer
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13
Q

What factors contribute to decline of AIDS numbers?

3

A
  1. Use of potent anti-retroviral drugs
  2. Improved prophylaxis against opportunistic infection
  3. Growing experience amongst health care professionals
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REGUB (22 decks)

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