9: HIV and STIs of the GI tract

Question 1

How are infections transmitted during sex?

Answer 1

Sexual/genital secretions

Direct innoculation (e.g HSV through skin-skin contact)

Trauma (e.g HCV)

Ingestion (e.g shigella)

Fomites (e.g gonorrhoea, objects)

Injecting drugs (e.g HIV, HCV)

Question 2

Sex under the influence of ___ is becoming more common.

Answer 2

drugs

Question 3

What are some risk factors for developing STIs?

Answer 3

< 25 years old

Different sexual partners

Sex without condoms

MSM

PMX

Deprivation

Question 4

Where in the GI tract can STIs present?

Answer 4

All the way down

Question 5

What is an endoscopy which examines the rectum only?

Answer 5

Proctoscopy

Question 6

20-40% of people with gonorrhea will also have ___.

Answer 6

chlamydia

Question 7

How is an STI like gonorrhoea treated?

Answer 7

Antibiotics

Abstinence

Contacting partners

Education

Question 8

Who needs to be informed following a diagnosis of STI?

Answer 8

Sexual partners

Question 9

Which microorganism causes rectal gonorrhoea?

Answer 9

Neisseria gonorrhoea

Question 10

What transmits Neisseria gonorrhoea?

Answer 10

Direct contact of mucosal surfaces / mucosa-fomite

Question 11

What are the symptoms of rectal gonorrhoea?

Answer 11

Lower abdominal pain

Diarrhoea

Rectal bleeding

Anal discharge

Tenesmus

Question 12

What symptoms may also be associated with rectal gonorrhoea?

Answer 12

Urethral/vaginal discharge

Altered urinary habits

Question 13

What may be seen upon proctoscopy of someone with rectal gonorrhoea?

Answer 13

Inflammation

Pus

Question 14

What is a complication of rectal gonorrhoea if untreated?

Answer 14

Abscesses

Question 15

Which microorganism causes rectal chlamydia?

Answer 15

Chlamydia trachomatis

Question 16

Rectal chlamydia has a similar presentation to gonorrhoea but generally there is less ___.

Answer 16

pus

Question 17

Chlamydia has a similar presentation to gonorrhoea (abdo. pain, rectal bleeding, tenesmus) but tends to be (more / less)severe with(more / less) pus.

Answer 17

less severe

less pus

Question 18

How is chlamydia treated with drugs?

Answer 18

Azithromycin or doxycycline (better clearance)

Question 19

___ is a multi-system disease.

Answer 19

Syphilis

Question 20

___ is often the cause of multi-system presentations which don’t make much sense.

Answer 20

Syphilis

Question 21

Which specific antibiotic is used to treat syphilis?

Answer 21

Benzathene (benzyl)penicillin

Question 22

How does primary syphilis present?

Answer 22

Solitary painless ulcer at site of infection

Question 23

How does secondary syphilis present?

Answer 23

Mucosal ulcers, patchy inflammation - mouth, anogenital, rectal

Condylomata lata - warty lesions in warm, moist regions

Systemic inflammation - nausea, fever, lymphadenopathy

Hepatitis

Question 24

Where does herpes simplex infection occur?

Answer 24

Peri-anal mucosa extending into the rectum

Question 25

What type of drug is used to treat herpes simplex infection?

Answer 25

Antivirals

e.g acyclovir

Question 26

Which infection is now vaccinated against in girls and presents as anal warts?

Answer 26

HPV

Question 27

slide 37 - chlamydia +ve but wouldn’t cause fever

LGV - mimics IBD, common in HIV+ men

treatment is doxycycline

Question 28

Which immune-related infection causes loss of GALT tissue?

What complications can this lead to?

Answer 28

HIV

Opportunistic infection

Question 29

Which infection is common in HIV+ men who partake in sex with other men?

Answer 29

Lymphogranuloma venerum (LGV)