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MD1 - Reproduction Block > 3. Sexually Transmissible Infections > Flashcards

3. Sexually Transmissible Infections Flashcards

1
Q

What infections are transmitted via the Oral-genital contact?

A
  • Chlamydia, Gonorrhoea, HSV, Syphilis, HPV
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2
Q

What infections are transmitted via the Anilingus?

A
  • Amoeba, Cryptosporidia, Giardia, Shigella. HAV
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3
Q

What are the routes of transmission of STI?

A
  • Oral-genital contact - Vaginal intercourse - Anal intercourse - Anilingus
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4
Q

What should you ask about a patient coming in with an STI?

A
  • Partners
    • M/F
    • Number/monogamous
  • Pregnancy prevention?
  • Protection from STI
    • How do you protect against STI and HIV
  • Practices
    • Vaginal, Oral anal
  • Past history of ST
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5
Q

What are the possible causes for discharge?

A
  • Gonorrhea
  • Chlamydia
  • Trichomonas - Frothy green-yellow discharge
  • Bacterial vaginosis - White-grey fishy smell (polymicrobial growth)
  • Candidasis - Cottge cheese (not sexually transmitted)
  • Mycoplasma genitalium
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6
Q

What are the possible causes for STI ulcer?

A
  • HSC
  • Syphillis
  • Chancroid
  • LGV
  • Granuloma inguinale
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7
Q

What are the clinical patterns of STI?

A
  1. Discharge
  2. Ulcer
  3. Pelvic inflammatory disease
  4. Dermatological
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8
Q

What are the diagnostic tools for STI?

A
  • Microscopy
    • Vaginal fluid, gram stain
  • Culture
  • Serology
    • Syphilis, HIV
  • Nucleic acid ampification test
    • Geonorhea, Chlamydia, M.Genitallium
    • Urine, Uretheral, vaginal, cervical swabs.
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9
Q

What are the features of Nisseria gonorrhoeae?

A
  • Gram negative diplococci
  • Adhere to columnar epithelial cells
    • Produce various toxins and immune modulators that help them survive. Also modify surfae protein to hide from immune system.
  • Incubation period: 2-7 days
  • Asymptomatic infection in females (80%)
  • Males - Urethrtis (10%)
  • Increasing antibiotic resistance
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10
Q

What can happen if Gonorrhoea is left untreated?

A

If left untreated dissemination (0.5-3%) could cause

  • Arthritis
  • Macrulopapular rash
  • Meningitis
  • Endocarditis
  • Epididymitis
  • Peri-hepatitis (Fitz-Hugh-Curtis syndrome)
    • Adhesion of liver capsule to abdominal cavity wall
  • Increased risk post menses
  • Violin string adhesion
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11
Q

If Gonorrhoea is left untreated and lead to Pelvic Iflammatory disease what are the sequalae?

A
  • Tubal scarring
  • Infertility (10-20%)
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12
Q

What happens if babies are born with Gonno infected moms?

A

Neonatal gonococcal opthalmia

  • Gross purulent conjunctivitis
  • Day 2-5 of life –> Perforation and blindness
  • Mild disease indistinghuishble from other causes of conjunctivitis

Treatment

  • Cefotaxime IV
  • Topical antibiotic not required
  • Irrigate eyes regularly
  • Treat mother + sexual contacts
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13
Q

What diagnostic specimens are used for Gonno?

A

Cervical swab into charcoal transport

Male urethral swabs

urine

Other specimens: conjunctiva, pharynx, skin lesions, anal, CSF, blood, synovial fluid.

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14
Q

What laboratory investigations can be used to diagnose Gonno?

A
  • Non-selective: Chocolate blood agar in CO2
  • Selective: Thayer-Martin agarTM
    • Colistin (GN), Vancomycin (GP), nystatin (fungi)
  • Culture for antibiotic sensitivies
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15
Q

What is nucleic amplification tests and what is it used for?

A

Use genital (cervial or vaginal) swabs or first void urine.

Used to detect Gonno

Combined Chlamydia and Nisseria detection (Chlamydia co-infection in 50%)

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16
Q

What are the treatments for Gonno?

A

Use high dose, single dose IV

Azithromycin 1g (Chlamydia)

and

Ceftriazone 500mg (IM/IV) (Gonno)

Ciproflaxacin 500mg oral if sensitive

Amoxicillin 3g + Probenecid 1g oral

17
Q

How do you prevent Gonno?

A
  • Barrier contraception
  • Contact tracing
  • Vaccine???
18
Q

What are the features of Chlamydia infection?

A
  • Most common STI (2-20%)
    • Females: Cervicitis
    • Male: Urethritis
    • [Anus, Conjunctivitis]
    • Frequently asymptomatic
  • Obligate intracellular parasite
  • Infects Columnar epithelium
    • Infects young female adults
  • Serovars
    • D-K: Genital Infection
    • L 1-3: Lymphogranuloma venerum (LGV)
    • A-C: Ocular infection (Trachoma)
  • 48-72 hours life cycle
  • Elementary bodies: infectious, non-replicating, hardy
  • Retriculate bodies: Metabolically actve, replicate
19
Q

What is the life cycle of Chlamydia?

A
20
Q

What are the clinical findings of Chlamydia in men?

A
  • Dysuria
  • Meatal erythema
  • Clear urethral discharge (may need to milk to produce discharge)
  • Testicular pain (Epididmo-orchitis)
  • Prostasis
21
Q

What are the clinical findings of Chlamydia in women?

A
  • Cervitis, endometrisis/vaginal discharge
  • Urethritis/Dysuria
  • Irregular bleeding
  • Pelvic pain & dyspaeunia

Pelvic inflammatory disease

  • Acute and chronic
22
Q

What happens when Chlamydia invades the lymph node?

A
  • LGV (Lymphogranuloma venereum)
  • Ulcerative genital lesion –> Suppurative inguinal lymphadenopathy with systemic Sx
  • Proto-colitis with strictures (MSM)
  • Endemic in Africa, India, SE Asia, South America
23
Q

What happens in Neonatal Chlamydia?

A

50% Transmission

  • 25% conjunctivitis
  • 10% pneumonia

Colonization may persists

Conjunctivitis IP 2-28 days

Pneumonia IP 2-8 weeks

24
Q

What laboratory investigations are done for Chlamydia?

A
  • Cervical/Urethral/Anal swab
  • Urine
  • Nucleic Acid detection
  • Culture not routine and requires cell culture techniques
  • Test of cure required
    • Post procedure
    • Prgnancy
25
Q

What are the treatments for Chlamydia?

A

Azithromycin

or

Doxycycline

  • Contact trace partners
  • Doctor must be notified
  • Test of cure 4-6 weeks (If too early may still have trade DNA for up to 3 weeks)
  • Advise retset in 3 months
26
Q

What are the features of Trichomonas vaginalis ?

A
  • Flagellated protozoan
  • Frequently asymptomatic (67% asymptomatic) - Males more likely to be asymptomatic
  • Frothy, green-yellow vaginal discharge
  • ph >5.0
  • Cervical erythema & friability
  • Pruritis, dysuria, abdominal pain
  • Prevalence underestimated
  • Marker for high risk sexual activity
  • Genital inflammation –> Increase risk for HIV acquisition
  • Associated with
    • Non-steady partner/Older partner
    • Marijuana use
  • High in Indegenous community
27
Q

What laboratory testing can be done to test for Trichomonas vagnalis?

A
  • High vaginal swab
    • Wet prep, microscopy - motile
    • Culture
  • Urine - PCR
  • Sometimes seen on PAP smear
28
Q

What are the treatments for Trichomonas vaginalis?

A

Metronidazole 2g oral single dose

Tinidazole 2m oral single dose

Metronidazole 400mg

Clindamycin cream

29
Q

What are the stages of Treponema palladium (syphilis) infection?

A

Primary

  • Initial infection
  • Painless ulcer at site of inoculation
  • Takes 3 weeks, because bacteria takes a long time to replicate (33 hr)
  • This will heal up

Secondary

  • 6-12 weeks later you get secondary symptoms
  • Spread via lymphatic
  • Generate rash, alopecia, hepatitis, generalized lymphadenopathy
  • Eventually heal

Tertiary

  • If untreated organism stays for life and lead to damage of varous organs
  • Gumma - inflammatory reaction that can destroy joint, skin, aorta (aortitis), takes decades to develop
  • So you want to identify people at primary, secondary and tertiary.
30
Q

What are the laboratory detection test for Syphilis (T. Palladium)

A
  • Microscopy
    • Dark field
  • Serology
    • Non-treponemal test (VLRL, RPR)
    • Treponemal test (TPHA, EIHA, FTA-Abs)
31
Q

What is the non-treponemal test (VLRL, RPR) test for T.Palladium testing?

A
  • Antibodies to cellular lipids & lecithin (non-specific antigen)
  • Positive 4-8 weeks post infection
  • 70% positive within 2 weeks of chancre (painless ulcer)
  • 100% positive for secondary & latent infection
  • Useful for screening/monitoring therapy
    • Non-specific antibodies gradually disapere if respond to treament
  • Titrate to detect response to treatment
  • False positive reaction
    • CT disorder, viral infection (hepatitis, vaericella, EBV, measles) IVDU 10%, pregnancy
  • False negativ reaction
    • Prozone effect
32
Q

What is the treponemal test eg. EIA, TPHA, TPPA, FTA-Abs testing?

A
  • Positive slightly earlier
    • If RPR is also present it indicates persistent infection
  • positive for life
  • Immunoglotting and PCR
33
Q

What are the features of Mycoplasma genitalium?

A

Slow growing, takes 2m to grow in culture.

Mycoplasma deform in shape and don’t have a cell wall. So can’t gram stain.

They form flask shape, pertuberanece is what they use to attach to columnar epithelium which they use to enter the cell.

Antibiotic resistant

Prevalence 3-5%

34
Q

What does Mycoplasma genitalium cause?

A
  • Urethritis in men
  • Cervicitis in women
  • Acute endometritis
  • PID post termination of pregnancy
  • Presists for 3-6 months
  • Preterm delivery
  • May presispose to HIV transmission
35
Q

What is the treatment for Mycoplasma genitalium?

A
  • Azithromycin 1gm
    • 85% efficacy
  • Moxifloxacin 400mg daily 7-10 days
    • Expensive
36
Q

What are the indications for STI testing?

A
  • Symptomatic patient investigation
  • Screening asymptomatic infeciton
  • Pre-pregnancy
  • Antenatal screening
  • Blood and organ donation
  • Contact tracing
  • Epidemiological surveillance
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MD1 - Reproduction Block (15 decks)

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