Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 4 - Reproductive Health > 3.01 - Sexually Transmitted Infections > Flashcards

3.01 - Sexually Transmitted Infections Flashcards

1
Q

What is bacterial vaginosis?

A

An overgrowth of anaerobic bacteria in the vagina, due to loss of lactobacilli.

It is not a STI, but it does increase the risk of women developing STIs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Give some examples of anaerobic bacteria associated with bacterial vaginosis.

A
  • Gardnerella vaginalis (most common)
  • Mycoplasma hominis
  • Prevotella species
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Risk factors for bacterial vaginosis.

A
  • multiple sexual partners
  • excessive vaginal cleaning
  • recent antibiotics
  • smoking
  • copper coil
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Presentation of bacterial vaginosis.

A

Discharge:
- fishy-smelling
- grey or white

Half of women with BV are asymptomatic.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Investigations for bacterial vaginosis.

A

Speculum examination to confirm the type of discharge and complete a high vaginal swab.

Self-taken low vaginal swab.

Vaginal pH (>4.5)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Microscopy findings in bacterial vaginosis.

A

Clue cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Management of bacterial vaginosis.

A

Asymptomatic = no treatment.

Metronidazole targets anaerobic bacteria, so is abx of choice.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Counselling advice when prescribing metronidazole.

A

Avoid alcohol for the duration of treatment, due to disulfiram-like reaction:
- n+v
- flushing
- shock
- angioedema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What lifestyle advice can be given to avoid bacterial vaginosis?

A

Avoid vaginal douching.

Avoid cleaning vagina with soaps that disrupt the flora.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Complications of bacterial vaginosis.

A

Increases the risk of catching STIs.

Associated with complications in pregnancy:
- miscarriage
- preterm delivery
- premature rupture of membranes
- chorioamnionitis
- low birth weight
- postpartum endometritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the causative organism for vaginal candidiasis?

A

Candida albicans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Risk factors for vaginal candidiasis?

A
  • increased oestrogen (pregnancy)
  • poorly controlled diabetes
  • immunosuppression
  • broad-spectrum antibiotics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Presentation of vaginal candidiasis?

A

Vaginal discharge:
- thick and white
- no smell

Commonly associated with vulval and vaginal itching, irritation and discomfort.

Severe infection may lead to:
- erythema
- fissures
- dyspareunia
- dysuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Investigations for vaginal candidiasis.

A

Vaginal pH (<4.5).

Charcoal swab with microscopy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Management of candidiasis.

A

Empirical antibiotics based upon presentation:

Antifungal cream (clotrimazole) inserted into the vagina with an applicator.

Antifungal pessary (clotrimazole).

Oral antifungal tablets (fluconazole).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What over-the-counter treatment is available for candidiasis?

A

Canesten Duo - contains a single fluconazole tablet and clotrimazole cream.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What contraception advice should be given for women using antifungal creams and pessaries?

A

They may damage latex condoms and prevent spermicides from working, so alternative contraception is required for at least five days after use.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the most common STI in the UK?

A

Chlamydia trachomatis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Risk factors for chlamydia infection.

A
  • young
  • sexually active
  • multiple sexual partners
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What proportion of

a) males

b) females

are asymptomatic with chlamydia infection?

A

a) 50%

b) 75%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the National Chlamydia Screening Programme (NCSP)?

A

Screen every sexually active person under 25 years of age for chlamydia annually or when they change their sexual partner.

Everyone that tests positive should have a re-test after three months, to ensure they have not contracted chlamydia again.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the types of swabs involved in sexual health testing?

A

Charcoal swabs - allow for microscopy, culture and sensitivities.

NAAT swabs - check directly for the DNA or RNA of the organism.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Charcoal swabs can be used for endocervical swabs and high vaginal swabs to confirm:

A
  • bacterial vaginosis
  • candidiasis
  • Gonorrhoea (endocervical)
  • Trichomonas vaginalis (HVS)
  • group B streptococcus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

In women, NAAT tests can be performed on which swabs?

A
  • vulvovaginal swab
  • endocervical swab
  • first-catch urine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

In men, NAAT tests can be performed on which swabs?

A
  • first-catch urine
  • urethral swabs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is NAAT testing used to test for?

A
  • Chlamydia trachomatis*
  • Neisseria gonorrhoea

*Rectal and pharyngeal NAAT swabs can be used to diagnose chlamydia in the rectum and throat, where anal and oral sex has occurred.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Presentation of chlamydia (female).

A

Consider chlamydia in women that are sexually active and present with:
- abnormal vaginal discharge
- pelvic pain
- abnormal vaginal bleeding
- dyspareunia
- dysuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Presentation of chlamydia (male).

A

Consider chlamydia in men that are sexually active and present with:
- urethral discharge or discomfort
- dysuria
- epididymo-orchitis
- reactive arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Examination findings suggestive of chlamydia.

A
  • pelvic / abdominal tenderness
  • cervical motion tenderness
  • inflammed cervix
  • purulent discharge
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

How is chlamydia diagnosed?

A

NAAT tests:
- vulvovaginal swab (F)
- endocervical swab (F)
- first-catch urine sample (M/F)
- urethral swab (M)
- rectal swab (after anal sex)
- pharyngeal swab (after oral sex)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

BASHH guidelines recommend uncomplicated chlamydia infection be treated how?

A

Doxycycline 100mg BD for 7 days.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

BASHH guidelines recommend chlamydia infection in pregnancy be treated how?

A

Doxycycline is contraindicated in pregnancy and breastfeeding.

Prescribe erythromycin 500mg QDS for 7 days.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Aside from antibiotic prescription, how should chlamydia diagnosis be managed?

A
  • abstain from sex for seven days of treatment
  • refer to GUM for contact tracing and notification of sexual partners
  • test for and treat other STIs
  • provide advice about ways to prevent future infection
  • consider safeguarding issues and sexual abuse in children and young people
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Complications of chlamydia.

A
  • PID
  • chronic pelvic pain
  • infertility
  • ectopic pregnancy
  • epididymo-orchitis
  • reactive arthritis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Pregnancy-related complications of chlamydia.

A
  • preterm delivery
  • premature rupture of membranes
  • low birth weight
  • postpartum endometritis
  • neonatal infection (conjunctivitis, pneumonia)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is Lymphogranuloma venereum (LGV)?

A

A condition affected the lymphoid tissue around the site of infection with chlamydia, developing in three stages:

1) painless ulcer

2) inguinal / femoral lymphadenitis

3) proctitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

How is Lymphogranuloma Venereum treated?

A

Doxycyline 100mg BD for 21 days.

Erythromycin and azithromycin are alternatives.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

How is chlamydial conjunctivitis contracted?

A

When genital fluid comes in contact with the eye, for example, through hand-to-eye spread.

It can also affect neonates with mothers infected with chlamydia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Presentation of chlamydial conjunctivitis.

A

Unilateral erythema, irritation and discharge lasting longer than two weeks.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Gram stain for Gonorrhoea.

A

Gram-negative diplococcus.

Neisseria gonorrhoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Common sites of gonorrhoea infection.

A

Infects mucous membranes with a columnar epithelium:
- endocervix
- urethra
- rectum
- conjunctiva
- pharynx

42
Q

What percentage of

a) men

b) women

are symptomatic with gonorrhoea infection?

A

a) 90%

b) 50%

43
Q

Presentation of gonorrhoea.

A

Discharge:
- odourless
- green / yellow

Dysuria.

Pelvic pain (F) or testicular pain (M).

44
Q

How is gonorrhoea diagnosed?

A

NAAT to dertect DNA or RNA of gonorrhoea*:
- endocervical
- vulvovaginal
- urethral
- first-catch urine

Standard charcoal endocervical swab taken for MC&S before initiating abx.

*rectal and pharyngeal swabs taken in MSM, and those who have oral / anal sex.

45
Q

All patients with gonorrhoea should have a test of cure when?

A
  • 7 days after treatment for RNA NAAT
  • 14 days after treatment for DNA NAAT
46
Q

Medical management of gonorrhoea.

A
  • 1g ceftriaxone IM (sensitivities not known)
  • 500mg ciprofloxacin PO (sensitivities known)
47
Q

Aside from the medical management of gonorrhoea, what else should be considered in management?

A
  • contact tracing
  • abstain from sex for seven days of treatment of all partners
  • test for and treat other STIs
  • provide advice about ways to prevent future infection
  • consider safeguarding issues and sexual abuse in children and young people
48
Q

Complications of gonorrhoea.

A
  • pelvic inflammatory disease
  • chronic pelvic pain
  • infertility
  • epidydmo-orchitis (M)
  • prostatitis (M)
  • conjunctivitis
  • septic arthritis
  • endocarditis
49
Q

What is the key complication of maternal gonorrhoea infection close to delivery?

A

Gonococcal infection can be contracted from the mother during birth, causing neonatal conjunctivitis.

This is a medical emergency associated with sepsis, perforation of the eye and sepsis.

50
Q

What is disseminated gonococcal infection?

A

A complication of untreated gonococcal infection, spreading to the skin and joints.

Presentation:
- non-specific skin lesions
- polyarthralgia
- migratory polyarthritis
- tenosynovitis
- systemic symptoms (e.g. fever, fatigue)

51
Q

Presentation of Mycoplasma genitalium (MG).

A

Most cases of MG do not cause symptoms.

Presentation:
- urethritis
- epididymitis
- cervicitis
- endometritis
- PID
- reactive arthritis
- preterm delivery in pregnancy
- tubal infertility

52
Q

How is mycoplasma genitalium diagnosed?

A

NAAT testing to look for the DNA or RNA of the bacteria:
- first urine sample in the morning for men
- vaginal swabs for women

53
Q

Management of MG.

A

1) Doxycycline* 100mg BD 7/7

then

2) Azithromycin 1g stat

then

3) Azithromycin 500mg OD 2/7

*contraindicated in pregnancy; azithromycin alone used in pregnancy and breastfeeding.

54
Q

What is pelvic inflammatory disease?

A

Inflammation and infection of the organs of the pelvis, caused by infection spreading up through the cervix.

55
Q

Causes of pelvic inflammatory disease.

A
  • Neisseria gonorrhoea
  • Chlamydia trachomatis
  • Mycoplasma genitalium
  • Gardnerella vaginalis
  • Haemophilus influenzae
  • Escherichia coli
56
Q

Risk factors for PID.

A
  • no barrier contraception
  • multiple sexual partners
  • younger age
  • existing STIs
  • previous PID
  • intrauterine device (e.g. copper coil)
57
Q

Presentation of PID.

A
  • pelvic abdominal pain
  • abdominal vaginal discharge
  • abnormal bleeding
  • dyspareunia
  • fever
  • dysuria
58
Q

Examination findings of PID.

A
  • pelvic tenderness
  • cervical motion tenderness
  • inflamed cervix
  • purulent discharge
59
Q

Investigations for PID.

A

Testing for causative organisms and other STIs:
- NAAT (gonorrhoea, chlamydia, MG)
- HIV test
- syphilis test

HVS to look for BV, candidiasis and trichomoniasis.

Microscopy to look for pus cells on swabs from the vagina or endocervix. The absence of pus cells is useful for excluding PID.

Pregnancy test to exclude ectopic pregnancy.

60
Q

Medical management of PID.

A

IM ceftriaxone 1g single STAT dose

AND

PO doxycycline 100mg BD 2/52

AND

PO metronidazole 400mg BD 2/52

61
Q

Aside from medical management of PID, what else should be considered?

A

Contact tracing.

62
Q

Complications of PID.

A
  • sepsis
  • abscess
  • infertility
  • chronic pelvic pain
  • ectopic pregnancy
  • Fitz-Hugh-Curtis syndrome
63
Q

What is Fitz-Hugh-Curtis syndrome?

A

Inflammation and infection of the liver capsule leads to adhesions between the liver and the peritoneum.

This results in right upper quadrant pain that can be referred to the right shoulder tip if there is diaphragmatic irritation.

64
Q

What causes trichomonas?

A

Trichomonas vaginalis - a protozoa.

65
Q

Complications of trichomonas.

A

Increases the risk of:
- contracting HIV
- bacterial vaginosis
- cervical cancer
- PID
- pregnancy-related complications

66
Q

Presentation of trichomonas.

A

Asymptomatic in 50% of cases.

Non-specific symptoms if they do occur:
- vaginal discharge (frothy, yellow-green and offensive)
- itching
- dysuria
- dyspareunia
- balanitis

67
Q

Examination of the cervix in trichomonas.

A

Strawberry cervix.

68
Q

How is trichomonas diagnosed?

A

Charcol swab with microscopy, taken from the posterior fornix.

Urethral swab or first-catch urine is used in men.

Vaginal pH >4.5

69
Q

Management of trichomonas.

A

Metronidazole prescription.

Referral to GUM specialists for diagnosis, treatment and contact tracing.

70
Q

What infections are commonly caused by HSV?

A
  • cold sores (HSV-1)
  • genital herpes (HSV-2)
71
Q

Does HSV infection clear completely?

A

No - after initial infection, the virus becomes latent in the associated nerve ganglia.

Trigeminal nerve ganglion = cold sores.

Sacral nerve ganglion = genital herpes.

72
Q

How is HSV spread?

A

Direct contact with affected mucous membranes, or viral shedding in mucous secretions.

73
Q

Presentation of genital herpes.

A
  • blistering lesions
  • neuropathic type pain
  • flu-like symptoms
  • dysuria
  • inguinal lymphadenopathy
74
Q

How is genital herpes diagnosed?

A

Ask about sexual contact, including those with cold sores, to establish source of transmission.

Diagnosis can be made clinically based upon history and examination.

A viral PCR can confirm the diagnosis and causative organism.

75
Q

Management of genital herpes.

A

Aciclovir to clear genital herpes.

Additional measured used to manage the symptoms include:
- paracetamol
- topical lidocaine 2%
- cleaning with warm salt water
- topical vaseline
- additional oral fluids
- avoid intercourse with symptoms

76
Q

How is primary genital herpes treated in pregnancy?

a) below 28 weeks gestation

b) above 28 weeks gestation

A

a) aciclovir during initial infection, plus prophylactic aciclovir from 36 weeks gestation onwards.

b) aciclovir during initial infection, followed immediately by prophylactic aciclovir. Caesarean section in recommended in all cases.

77
Q

What are the risks of primary herpes infection during pregnancy?

A

Neonatal herpes simplex infection is associated with high morbidity and mortality.

78
Q

How is recurrent herpes infection treated in pregnancy?

A

Low risk of neonatal infection, even if lesions are present during delivery.

This is because antibodies to the virus can cross the placenta, giving passive immunity to the baby.

79
Q

What is the causative organism of syphilis?

A

Treponema pallidum

80
Q

How can syphilis be contracted?

A
  • sexual contact with infection area
  • vertical transmission
  • IVDU
  • blood transfusions or other transplants
81
Q

Stages of syphilis.

A

Primary syphilis - painless ulcer at original site of infection.

Secondary syphilis - systemic symptoms.

Latent syphilis - symptoms disappear and patients becomes asymptomatic despite still being infected.

Tertiary syphilis - occur many years after infection and can have cardiovascular and neurovascular complications.

Neurosyphilis - involves CNS, presenting with neurological symptoms.

82
Q

Presentation of primary syphilis.

A
  • painless genital ulcer
  • local lymphadenopathy
83
Q

Presentation of secondary syphilis.

A
  • maculopapular rash
  • Condylomata lata (grey wart-like lesions around the genitals and anus; see image)
  • low-grade fever
  • lymphadenopathy
  • alopecia
  • oral lesions
84
Q

Presentation of tertiary syphilis.

A
  • Gummatous lesions (see image)
  • aortic aneurysms
  • neurosyphilis
85
Q

Presentation of neurosyphilis.

A
  • headache
  • altered behaviour
  • dementia
  • Tabes dorsalis (demyelination of the spinal cord)
  • Ocular syphilis
  • paralysis
  • sensory impairment
86
Q

What is the pupil finding of neurosyphilis?

A

Argyll-Robertson pupil - constricted pupil which accommodates when focusing on a near object, but does not react to light.

AKA prostitutes pupil because it accommodates, but does not react.

87
Q

What is the screening test for syphilis?

A

Antibody testing for Treponema pallidum.

Patients with suspected syphilis or positive antibodies should be referred to specialist GUM clinic:
- dark field microscopy
- PCR

88
Q

Management of syphilis.

A

Single deep intramuscular dose of benzathine benzylpenicillin.

Patients need:
- full screening for other STIs
- advice about avoiding sexual activity until treated
- contact tracing
- prevention of future infection

89
Q

What is the most common type of HIV?

A

HIV-1 is the most common type.

HIV-2 is found in West Africa.

90
Q

How is HIV transmitted?

A
  • unprotected anal, vaginal or oral sexual activity
  • vertical transmission
  • mucous membrane, blood or open wound exposure to infection blood or bodily fluids
91
Q

What are AIDS-defining illnesses?

A

When the CD4 count drops to a level that allow for opportunistic infections and malignancies to appear:
- Kaposi’s sarcoma
- cytomegalovirus infection
- candidiasis (oesophageal, bronchial)
- lymphomas
- tuberculosis

92
Q

How is HIV screened for?

A

Document verbal consent before HIV test* and screen for antibodies to HIV and the p24 antigen (window period of 45 days).

Point-of-care tests (90 day window period).

93
Q

How is HIV monitored?

A

Testing for CD4 cells count (>500 cells/mm3 normal).

Testing for HIV RNA indicates viral load.

94
Q

A CD4 count below what puts the patient at high risk of opportunistic infection?

A

200 cells/mm3

95
Q

Treatment of HIV.

A

A combination of antiretroviral therapy, irrespective of viral load or CD4 count.

Treatment aims to achieve a normal CD4 count and undetectable viral load.

96
Q

Additional management of HIV.

A

Prophylactic co-trimoxazole is CD4 count <200 cells/mm3.

Monitoring of cardiovascular risk factors.

Yearly cervical smears.

Vaccinations (influenza, pneumococcal, HPV, hepatitis A and B).

Avoid live vaccines.

97
Q

How can the spread of HIV be minimised?

A

Correct use of condoms during sex.

Effective treatment with an undetectable viral load (U=U).

98
Q

According to BHIVA guidelines, what mode of delivery if preferable if maternal HIV +ve infection?

a) viral load <50 copies/ml

b) viral load >50 copies/ml

c) viral load >400 copies/ml

A

a) normal vaginal delivery

b) consider a pre-labour caesarean section

c) pre-labour caesarean section is recommended

99
Q

How is HIV transmission prevented during birth?

A

Zidovudine prophylaxis given to the baby.

Caesarean section if viral load raised.

100
Q

What is post-exposure prophylaxis (PEP) for HIV?

A

ART commenced within 72 hours of intercourse, lasting for 28 days.

101
Q

What is pre-expsure prophylaxis (PrEP) for HIV?

A

ART taken before exposure to reduce the risk of transmission.

Year 4 - Reproductive Health (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions