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Bench to bedside and beyond > 9. Sexual health > Flashcards

9. Sexual health Flashcards

1
Q

what is sexual health?

A
  1. it is fundamental to the overall health and well-being of individuals
  2. it requires a positive respectful approach to sexuality and sexual relationships free of coercion, discrimination and violence.
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2
Q

what does the ability to achieve sexual health and wellbeing depend on?

A
  1. access to comprehensive and good quality information about sex and sexuality
  2. knowledge about the risks and vulnerability to adverse consequences of unprotected sex
  3. ability to access sexual health care
  4. living in an environment that affirms and promotes sexual health
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3
Q

what are some common sexual health issues?

A
  1. HIV
  2. STIs
  3. reproductive tract infection
  4. cancer and infertility
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4
Q

what stigma is attached to STIs?

A
  1. view the person is careless or irresponsible
  2. cultural stigmas
  3. dirty
  4. different groups are viewed differently like LGBT being perceived as higher risk without a lot of data (AIDS)
  5. other people might treat you differently
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5
Q

what are some other animals with STIs?

A

koala = chlamydia
dolphins = herpes

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6
Q

what is neisseria gonorrhoeae (as an STI)?

A
  1. gram negative diplococcus
  2. Principle transmission from direct contact
  3. over 78 million new infection per year
  4. human restricted
  5. can form micro colonies
  6. can form biofilms
  7. has outer membrane ruffles
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7
Q

what is atomic force microscopy?

A

a probe that goes over the surface of the bacteria
used on live bacteria

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8
Q

what can N. gonorrhoea cause?

A
  1. pelvic inflammatory disease
  2. trans ovarian cysts
  3. ocular infections
  4. oropharyngeal infections
  5. epididymitis
  6. septicaemia
  7. spetic arthritis
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9
Q

what can gonorrhoea infect?

A

any mucosal surface

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10
Q

what is a disseminated gonorrhoea infection?

A

spread through the blood through the body
septic arthritis - knees
deep tissue infections

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11
Q

how did we used to treat gonorrhoea?

A

just get penicillin or another antibiotic and then you are good to go

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12
Q

how do we now treat gonorrhoea?

A

treatment options have narrowed so there is only a few available

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13
Q

what is the trend in gonorrhoea case numbers in the last 10 years in the UK?

A
  1. the first MDR gonorrhoea outbreaks in 2015
  2. steep increase in infections due to PrEP becoming available and people being less careful, rise in unprotected sex, rise in other STIs
  3. drop again due to COVID: not that big of a drop considering we were in lockdown, testing resources were diverted
  4. sharply increasing again due to having fun after lockdown and improved testing
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14
Q

should we develop vaccines against STIs?

A

Mostly yes but…
STIs can be prevented with condoms so should we spend the money on sex education?
is education alone enough?
would a vaccine for an STI be accepted?
would prophylaxis/contraception be accepted by everyone?
would the government offer/fund it?

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15
Q

why is antigen selection important?

A
  1. determines carriage vs herd immunity
  2. antigen conservation intraspecies
  3. antigen expression during infection
  4. direct vs indirect protection
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15
Q

does the OMV meningococcal vaccine (bexsero) impact gonorrhoea?

A

OMV components are very similar to the gonorrhoea ones
seen a decrease of gonorrhoea in populations that have do bexsero
only about 30% effective so not great but it is a start

16
Q

how does gonorrhoea use complement inhibitors?

A
  1. host mimicry
  2. stop the innate and adaptive immunity working together
  3. evolved over a long time
    HOWEVER
    these can be used a vaccine targets
17
Q

what is a correlate of protection?

A

a specific measure of something in the body that tells us that we are protected against the specific infection
eg antibody titre
it doesn’t tell us if all surfaces are protected or you don’t need to be vaccinated

18
Q

what is a model of effectiveness?

A
  1. somethings that shows you the effectiveness of a treatment
  2. easy for things like skin diseases where you can just do animal testing
  3. hard for human restricted pathogens due to ethical reasons
19
Q

why is it hard to do a model of effectiveness for human resitricted pathogens?

A
  1. it is high risk especially for the control group
  2. need to have a very effective plan B
  3. only works for non serious diseases
20
Q

what is human papilloma virus (HPV)?

A

a virual that normally doesn’t cause any problems but some types of HPV can cause
1. Genital warts
2. Abnormal cells that can turn into cancer
you can have HPV even if you haven’t been sexually active

21
Q

what types of cancer are linked to high risk HPV?

A
  1. cervial cancer
  2. anal cancer
  3. penile cancer
  4. vulval cancer
  5. vaginal cancer
  6. some head and neck cancers
22
Q

what does the HPV vaccine protect against?

A

9 types of HPV that cause more then 80% of the cervical cancers and most of the anal cancers in the UK

2 of these also cause gential warts so it protects against them too.

23
Q

who needs to be vaccinated against HPV?

A

research shows it needs to happen before an sexual interaction to prevent them having already acquired HPV
hard to sell to parents vaccinating their kids against an STI so all the marketing was done from the cancer angle

24
Q

expanding and promoting HPV vaccines

A
  1. arms against cervical cancer
    - young girls thought the vaccination was into the cervix so marketing helped prevent misconceptions
  2. Vaccination of young boys was introduced in 2019
  3. effects all genitals
  4. huge drop in cervical cancer rates
25
Q

will everyone accept vaccines and STI vaccines?

A

no and everyone’s point of view needs to be considered:
it is a personal risk and its hard to convince people to take something when they are not ill and there is no benefit unless you get ill which most people don’t expect.
Better vaccines means less disease so the knowledge and the fear in the populus goes away which can lead to vaccine uptake to fall

26
Q

why must vaccines be affordable?

A

More vaccines available = a bigger cost burden on the healthcare system

27
Q

what should the goal of a lot of vaccines be?

A

true eradication of the disease as this means the vaccines are not needed

28
Q

why do we need better diagnostics for STIs?

A

to make more informed treatment strategies
1. giving antibiotics vs antivirals
2. no sex if +ve for on STI
3. limiting spread

29
Q

what causes N. Gonorrhoea to move?

A

pili contracting in and out causing movement

30
Q

how does N. gonorrhoea acquire antibiotics resistance genes?

A
  1. has a DNA uptake sequence present 1000s of times in the genome (this is rare)
  2. DNA uptake sequence protein allow binding of the DNA to the pili
  3. it is more effective if the DNA comes from other neisseria
  4. spread resistance quickly through the population
31
Q

Gold nano particle for DNA detection and diagnosis

A
  1. Red gold nanoparticles are coated with the DNA uptake sequence
  2. lyse the bacteria
  3. any free complementary DNA with hybridise to the DNA uptake sequence
  4. the nanoparticles are unstable so want to aggregate
  5. DNA uptake sequence bound = no aggregation = remains red
  6. No DNA uptake binding = aggregation = turns blue
  7. this allows for very fast and visual diagnosis as you can see the change with the naked eye
32
Q

what is the future for STIs?

A
  1. cases and AMR is increasing
  2. vaccines could be useful to prevent several STIs
  3. better diagnostics are needed to detect and inform treatment of STIs until vaccines can be developed

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