28. Sexually Transmitted Infections Flashcards
What are some issues of STIs?
What are some risk factors for STIs?
What is the most common STI in England?
Always >1 pt, vertical transmission, partner notification, confidentiality, high rates of re-infection, may be life-long, stigma and psychological morbidity.
Age, sexual partner/practice, condom usage, ethnicity, area of residence. Risk decreases as age. Young women tend to have older sexual partners. Cluster around big cities.
Chlamydia. Large increase in STI diagnoses in MSM - syphilis, gonorrhoea.
Describe Chlamydia trachomatis and what it causes in males, females and neonates.
What are some complications and treatment?
Obligate intracellular pathogen. Asymptomatic infection common. Serovars D-K: urethritis, epipdidymitis, prostatitis in males, cervicitis, PID, Fitz-Hugh Curtis in females, conjunctivitis, pneumonia in neonates. Serovars L1-3: lymphogranuloma venereum - buboes, proctitis.
Complications: reactive arthritis, INFERTILITY. Tx: azithromycin, doxycycline
What is this condition?
Chlamydia.
Top L: discharge clear and watery. Top R: cervix down speculum
Bottom L: arthritis. Bottom R: advanced PID - massive ovarian abcess on L, lifethreatening.
What are genital warts?
How are they managed?
What does Neisseria gonorrhoea cause in males, females and neonates?
What are some complications and management?
HPV (DNA virus), 90% asymptomatic, multiple sites, some associated with carcinoma, increasing incidence ano-genital and pharyngeal carcinoma.
Vaccination. Mx: Topical podophyllotoxon. Cryotherapy.
Males: urethritis, proctitis, sore throat, epididymitis, prostatitis. Females: cervicitis, PID, peri-hepatitis, septic abortion. Neonates: conjunctivitis.
Complications: septic arthritis, blindness, infertility, septic abortion. Mx: ceftriaxone (but resistance increasing).
Overlapping clinical condition with chlamydia but tends to be more painful ‘like peeing razorblades’
What is this condition?
Genital warts (HPV)
Top 2: warts
Bottom L: laryngeal infection, oropharyngeal HPV, warts on folds
Bottom R: cervix neck
What is this condition?
Neisseria gonorrhoea.
Top L: thick purulent discharge from urethra
Bottom R: disseminated gonorrhoea - arthritis
What are the 2 different types of HSV (herpes simplex virus)?
How is it treated?
What does the spirochete Treponema pallidum cause, and how is it diagnosed and treated?
HSV-1 oral (salivary contact - cold sores), HSV-2 genital. Both interchangable. DNA virus. Latent in head and neck ganglia or sacral plexus. Can be reactivated.
Aciclovir, famciclovir, valaciclovir.
Syphilis - 10, 20, latent, 30, congenital (foetal loss/congenital foetal syndrome). Often asymptomatic early on. Diagnosis: serology. Tx: penicillin, doxycycline.
What is this condition?
Far L: HSV1 - oral herpes (cold sore).
Middle and far R: HSV2 - genital herpes (ulcers and blisters).
Distinguish between primary and secondary syphillus.
How is HIV epidemiology evolving?
10: Ulcer usually single and painless, dark ground +ve, lymphadenopathy, serology may be -ve (so repeat test later), infectious +++.
20: rash, lesions on palms and soles, fever, lymphadenopathy, condyloma lata (warty lesions on genitals), serology +ve, infectious ++.
Decreasing incidence, increasing prevalence - ppl aren’t dying of it anymore. Antiretroviral therapy. PEP reduces risk massively. Treatment in pregnancy. Lots of routine testing e.g. GUM, antenatal, oppotrtunistic testing and diagnostic testing. Death rate plummeted when combination therapy (HAART) became available.
What is this condition?
Top 2: primary syphilis (single ulcer (chancre) and dark ground +ve)
Bottom 2: secondary syphilis (condyloma lata and lesions of palms and soles)
Describe primary HIV infection.
How does HIV cause disease?
Acute retroviral syndrome: headache, lymphadenopathy, pharyngitis, nausea, oral/genital ulceration, rash, myalgias, fatigue, weight loss, night sweats. 75% develop symptoms in 2-6w of infection, wide differential diagnosis (flu-like), increased viral replication and decreased CD4 count, high transmission risk, may be HIV Ab -ve (can take up to 3m to go +ve).
Infects CD4+ T-cells, macrophages and dendritic cells -> massive loss of CD4+ (10 HIV), on-going loss and decline in immune function and immunospression = chronic. Direct effect: wasting, diarrhoea, neurological problems. Opportunistic infections: viral, fungal, bacterial. Malignancies: lymphoma, carcinoma.
What causes this condition?
HIV
What are the aims of antireteroviral therapy?
What is antiretroviral therapy?
What are some short and long term side effects of HAART?
Suppression of HIV replication -> CD4 count recovery -> immune reconsitution (transient overreaction of inflammatory response) -> long term reduced risk of morbidity and mortality.
HAART, 6 classes of antiretroviral drugs available, act at diff points during viral replication cycle to prevent production of new HIV particles. Combination therapy, at least 3 drugs from 2 classes. Lifelong. Adherance vital for success (resistance can develop quickly).
Short-term: nausea, vomiting, headache, sleep disturbance. Long-term: lipodystrophy, renal dysfunction, peripheral neuropathy, lactic acidosis. Other problems inc. drug interactions and complex regimens.
What are the 2 indications for PEP and PEPSE use?
How is HIV managed in pregnancy?
High risk sexual exposure <72h, needlestick. Available via virology/GUM/AandE.
Early screening, antiretroviral therapy for mum (immediate and continued if low CD4), elective C section (vaginal delivery only if undetectable HIV load), antiretrovial therapy for child, no breastfeeding. Reduction in trasmission risk from 25% to <1%.
