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3002 > 90 Sexually transmitted infections > Flashcards

90 Sexually transmitted infections Flashcards

1
Q

STI Syndromes

A
  • Genital discharge
  • Genital warts
  • Genital ulcers
  • Sexually transmitted and bloodborne viruses
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2
Q

STIs: “Top 10”

A 
􏰀1. Human papilloma virus
􏰀2. Chlamydia trachomatis
􏰀3. Candida albicans
4.􏰀 Trichomonas vaginalis
5.􏰀 Herpes simplex virus
6.􏰀 Neisseria gonorrhoeae
7.􏰀 Human immunodeficiency virus
8.􏰀 Treponema pallidum
9.􏰀 Hepatitis B
10.􏰀 Haemophilus ducreyi
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3
Q

What is the main presentation of Human Papilloma Virus?

A

Genital warts:
• Shaft of penis (male)
• Vagina, vulva, cervix (female)

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4
Q

What is the main presentation of Chlamydia Trachomatis?

A

Urethritis

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5
Q

What is the main presentation of Candida Albicans?

A

Vaginal thrush

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6
Q

What is the main presentation of Trichomonas Vaginalis?

A
  • Vagintis

* Lymphogranuloma venereum

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7
Q

What is the main presentation of Herpes Simplex Virus?

A

Genital herpes

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8
Q

What is the main presentation of Neisseria Gonorrhoeae?

A

Gonorrhoea

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9
Q

What is the main presentation of Human Immunodeficiency Virus?

A

AIDS

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10
Q

What is the main presentation of Treponema Pallidum?

A

Syphilis

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11
Q

What is the main presentation of Hepatitis B?

A

Hepatitis

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12
Q

What is the main presentation of Haemophilus Ducreyi?

A

Chancroid

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13
Q

Epidemiology

A

• Young people: >1/2 of the STIs diagnosed in UK
• 16-24 year-olds have been found to have many more new partners
• Average no. of new heterosexual partners in the previous
5 years was 3.8 (men) and 2.4 (women)
• 1/3 men and 1/5 women reported at least 10 partners in life ‘so far’
• 4.3% of men reported having paid for sex at some time
• 14% of men and 9% of women were currently having ‘affairs’
(concurrent relationships)
• 5.4% of men and 4.9% of women reported homosexual contact
• 12% of men and 11% of women reported heterosexual anal sex in the preceding year

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14
Q

STI Risk Factors

A
  • Young age
  • Failure to use barrier contraceptives
  • Non-regular sexual relationships
  • Homosexuality (MSM)
  • Intravenous drug use
  • African origin (Sub-Saharan Africa)
  • Social deprivation
  • Prostitution
  • Poor access to advice and treatment of STIs
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15
Q

What individual factos predispose to risky sexual behaviour?

A
  • Low self-esteem
  • Lack of skills
  • Lack of knowledge of the risks of unsafe sex
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16
Q

What external influences predispose to risky sexual behaviour?

A
  • Peer pressure

* Attitudes and prejudices of society

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17
Q

Which service provisions predispose to risky sexual behaviour?

A
  • Accessibility of sexual health services

* Lack of resources e.g. condoms

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18
Q

Samples and Lab Investigations of STI

A
  • Urethral swab
  • Vaginal swab
  • Cervical swab
  • Ulcer scrape
  • Uterine secretions
  • Pelvic aspirates
  • Urine sample
  • Laparoscopy specimens
  • Charcoal transport medium for swabs
  • Culture for gonococci, yeasts, aerobic + anaerobic bacteria
  • Susceptibility testing of microbial cultures
  • Culture in cells
  • NAATs
  • EIAs
  • Direct microscopy
  • Urine test
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19
Q

HPV mechanism

A
  • Induces hyperplastic epithelial lesions

* Types exhibit tissue/cell specificity

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20
Q

Which HPV types are most important?

A

HPV types 6, 11, 16, 18 most important of the120 types

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21
Q

Incubation period of HPV

A

1-6 months

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22
Q

What are the variety of consequences of HPV?

A
  • Cervical carcinoma
  • Urogenital warts
  • Laryngeal papillomas
  • Common, flat and plantar warts
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23
Q

How can HPV virus be identified?

A

Seen on colposcopy after staining

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24
Q

Treatment of HPV

A
  • Podophyllum
  • Cryo
  • Laser
  • Surgery
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25
Q

What is HPV vaccine based on?

A

Based on VLP1 (papillomavirus-like particle) a major capsid protein

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26
Q

Name the 2 killed HPV vaccines available

A
  1. Cervarix (bivarent)

2. Gardasil (quadrivalent)

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27
Q

What is the current administration plan for HPV (group - age)?

A

To girls 12-13yrs before they are sexually active

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28
Q

What does HPV vaccine protect against?

A

Protection against most cases of cervical cancer

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29
Q

Characteristics of chlamydia trachomatis?

A
  • Obligate
  • Intracellular
  • Gram negative
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30
Q

What do the following serotypes of chlamydia cause:
• A,B, C
• D-K
• L1, L2, L3

A
  • A, B, C: trachoma
  • D-K: genital infection
  • L1, L2, L3: lymphogranuloma venereum, cancer
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31
Q

What is trachoma?

A

A contagious bacterial infection of the eye, causing inflamed granulation on the inner surface of the lids

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32
Q

Asymptomatic infection is common in chlamydia. What % in men and women?

A
  • 50% men infected

* 80% women infected

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33
Q

How are ocular infections of chlamydia acquired in neonates?

A

During delivery

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34
Q

Female chlamydia symptoms?

A
  • Vaginal / anal discharge
  • Post-coital bleeding
  • Abdominal tenderness
  • Pelvic tenderness
  • Infertility
  • Reiter’s syndrome (arthritis, cervicitis, urethritis + conjunctivitis)
  • Proctitis
  • Pharyngitis
  • Perihepatitis – upper abdominal pain
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35
Q

Male chlamydia symptoms?

A
  • Urethral / anal discharge
  • Epididymal tenderness
  • Prostatitis
  • Reiter’s syndrome (arthritis, urethritis + conjunctivitis)
  • Proctitis
  • Pharyngitis
  • Perihepatitis – upper abdominal pain
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36
Q

What is a NAAT test?

A

Nucleic Acid Amplification Test (NAAT) is a technique used detect a particular nucleic acid, virus, or bacteria which acts as a pathogen in blood, tissue, urine, etc

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37
Q

What are the investigations available for chlamydia?

A
  • Urine - NAATs

* Endocervical swab - cell culture

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38
Q

Treatment of chlamydia?

A

• Treat with azithromycin and tetracycline
(doxycycline)
• Azithromycin resistance increasing

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39
Q

What is thrush/ yeast infection?

A
  • Intensely itchy vaginitis

* May present as UTI

40
Q

What causes thrush/ yeast infection?

A

Candida albicans

41
Q

How is thrush/ yeast infection diagnosed?

A

By microscopy / culture

42
Q

Treatment of thrush/ yeast infection

A

Oral fluconozole + topical nystatin

43
Q

Recurrence and symptomatic rates of thrush/ yeast infection in women vs men

A
  • Recurrence common in women

* Rarely symptomatic in men

44
Q

What is trichomonas vaginalis?

A

Anaerobic, single cell, flagellated protozoa

45
Q

MoA of trichmonas vaginalis?

A

Attaches to squamous epithelium

46
Q

Incubation period of trichomonas vaginalis?

A

4 days - 3 weeks

47
Q

What structures are infected by trichomonas vaginalis?

A

Vagina and urethra

48
Q

What parasite causes trichomoniasis?

A

Trichomonas vaginalis

49
Q

Symptomatic infection rates of trichomonas vaginalis in women vs men

A
  • Symptomatic infection common in women

* Uncommon in men

50
Q

Presentation of trichomonas vaginalis infection?

A

Yellowish vaginal discharge

51
Q

Diagnosis of trichomonas vaginalis?

A

By dark-phase microscopy

52
Q

Treatment of trichomonas vaginalis infection?

A

Metronidazole

53
Q

What are the 2 types of Herpes simplex viruses? What do they affect?

A
  1. HSV type 1 (HSV-1) - usually affects the oral region and causes cold sores
  2. HSV type 2 (HSV-2) – associated with genital infection (penis, anus, vagina)
54
Q

Transmission of genital herpes?

A
  • Sexual contact

* During birth (30-40% risk)

55
Q

What can neonatal genital herpes infection result in?

A

Disseminated infection often involving CNS

56
Q

Presentation of genital herpes during the primary infection?

A

• Febrile flu-like prodrome (5-7 days)
• Tingling neuropathic pain in genital area/ buttocks/ legs
• Extensive bilateral crops of painful blisters/ ulcers in the
genital area including the vagina and cervix in women
• Tender lymph nodes (inguinal)
• Local oedema
• Dysuria
• Vaginal or urethral discharge

57
Q

Treatment of genital herpes primary infection?

A

Aciclovir

58
Q

What is the process of genital herpes recurrence?

A

• Following primary infection, virus becomes latent in local sensory ganglia
• Periodic reactivation which can cause symptomatic lesions or asymptomatic, but still infectious, viral shedding
• Episodes are usually shorter (≤10 days)
• Median recurrence rate after a symptomatic 1st episode:
– HSV-2: approx. 4 attacks in the subsequent 12 months.
– HSV-1: approx. 1 attack in the subsequent 12 months.
• Attacks usually become less frequent over time

59
Q

Diagnosis of HSV?

A

• Clinical appearance
• Viral culture
• DNA detection using NAAT of a swab from the base of an ulcer / vesicle fluid
• Serology
- identify those with asymptomatic infection
-distinguish between the2 types of HSV
• May take up to 12 weeks to become antibody +ve after primary infection

60
Q

Features of neisseria gonorrhoeae infective agent?

A
  • Gram -ve
  • Intracellular diplococcus
  • Humans only host
  • Infects epithelial cells of mucous membrane of GU tract or rectum
  • Development of localised infection with production of pus
  • Possible asymptomatic carriage in women
61
Q

Name a bacteria that is gram negative diplococcus

A

Neisseria gonorrhoeae

62
Q

Describe the consequences of gonorrhoea (presentation)?

A
  • Acute inflammation and discharge in male patients
  • Cervical discharge in female patients
  • Rectal infections in male homosexuals
  • Oral pharyngitis contracted by oral-genital contact
  • Disseminated infection - septic arthritis
63
Q

Female presentation/symptoms of gonorrhoea?

A
  • Dysuria
  • Rectal infection - asymtomatic
  • Sapingitis, PID
  • Pharyngeal infection
  • Post-coital bleeding
  • Septic arthritis
64
Q

Male presentation/symptoms of gonorrhoea?

A
  • Urethral discharge
  • Anal discharge, +/- pain and bleeding
  • Epididymal tenderness
  • Pharyngeal infection
  • Septic arthritis
65
Q

Babies presentation/symptoms of gonorrhoea?

A

Ophthalmia neonatorum - blindness

66
Q

What is ophthalmia neonatorum?

How do babies get it?

A
  • Conjunctivitis contracted by newborns during delivery
  • Mother infected with Neisseria gonorrhoeae or Chlamydia trachomatis
  • Can cause blindness without treatment
67
Q

Lab diagnosis of gonorrhoea?

A
  • Light microscopy of Gram-stained genital specimens to look for Gram-negative diplococci
  • NAAT-can use urine or swabs
  • PMN in urethral pus
68
Q

Treatment of gonorrhoea?

A

• Treatment for confirmed, uncomplicated gonococcal infection in adults is one of the following (all given as a single dose):

  1. Ceftriaxone
  2. Cefixime
  3. Ciprofloxacin (if beta lactam allergy)
  • Increasing resistance to penicillin, tetracycline + ciprofloxacin
  • Most strains respond to ceftriaxone
  • Doxycyline also given as many patients have concomitant chlamydial infection
  • Azithromycin resistance increasing
69
Q

What drugs is also given in treatment of gonorrhoea to patients with concomitant chlamydial infection?

A

Doxycline

70
Q

What drugs is given to treat gonorrhoea if beta lactase allergic?

A

Ciprofloxacin

71
Q

Transmission of HIV

A
  1. Via blood/ blood products or contaminated needles
  2. Sexually
  3. Perinatally
72
Q

HIV:
• Family
• Genus
• HIV types

A
  • Family - retroviridae
  • Genus - lentivirus
  • HIV-1 and HIV -2 pathogenic for humans
  • HIV-1: most common
  • HIV-2: less virulent
73
Q

HIV viral features

A
  • Spherical (80-100nm)
  • Enveloped
  • RNA genome
  • Retrovirus - uses reverse transcriptase to make DNA copy from viral RNA
74
Q

HIV progression to AIDS

A
  • Exposure to HIV
  • Seroconversion
  • Asymptomatic
  • Persistent generalised lymphadenopathy
  • AIDS-related clinical features
  • AIDS
75
Q

Treatment of HIV infection

A
  • Nucleoside Reverse Transcriptase Inhibitors (NRTIs)
  • Non-nucleoside Reverse Transcriptase Inhibitors (NNRTIs)
  • Protease Inhibitors (PIs)
76
Q

What is HAART?

A

• Highly Active Anti-Retroviral Therapy

• Many possible regimens and combinations
• Initial treatment often contain:
- 1NRTI + 1 PI
OR
- 2 NRTIs + 1 NNRTI
77
Q

Diagnosis of HIV infection

A

• Diagnosis of HIV-specific antibodies:
- ELISA
- Western Blotting
• NAAT used to detect viral RNA in serum
• Quantitative NAAT used to measure viral load
• Individual testing must be preceded by counselling
• An initial -ve result should always be followed up

78
Q

Prevention of HIV infection

A
  • Screening of blood products
  • Needle exchange programmes
  • Anti-retroviral prophylaxis for needlestick injuries
  • Avoiding high-risk sexual partners
  • Use of barrier contraception
  • Elective caesarian section
79
Q

HBV viral features

A
  • Hepadnavirus
  • Double-stranded DNA genome
  • Enveloped
80
Q

HBV antigens

A
  1. HBsAg – surface antigen
    • Indicates infectivity
    • Anti-HBsAg provides immunity + appears late
  2. HBcAg – core antigen
    • Appears early in infection
  3. HBeAg – pre-core antigen
    • Indicates high transmissibility
81
Q

HBV transmission

A
  • Blood or blood products
  • Contaminated needles and equipment used by IV drug users
  • Association with tattooing, body piercing and acupuncture
  • Sexual intercourse
  • Intra-uterine, peri- and post-natal infection
  • Contaminated haemodialysis equipment
82
Q

HBV stages of infection

A

• Long incubation period - up to 6 months
• Development of acute hepatitis
• Fulminant disease carries 1-2% mortality rate
• 50% patients develop chronic active hepatitis
– Cirrhosis
– Hepatocellular carcinoma

83
Q

Difference between HBV acute and chronic infection

A
  • HBV - acute infection (self-limited)

* HBV - chronic infection (persistent)

84
Q

HBV clinical features

A 
1. Pre-icteric Stage 
• Malaise
• Anorexia
• Nausea
• Pain in right upper quadrant (tender liver)

2 Icteric Stage
• Jaundice
• Dark urine (bilirubin)

85
Q

HBV treatment

A
  • Pegylated interferon (peginterferon)

* Antiviral activity of nucleoside analogues (e.g. oral lamivudine) - may be successful even in chronic HBV patients

86
Q

HBV prevention

A
  • HBsAg vaccine - good protection following 3 injections over 6 month period
  • HBV immunoglobulin
  • Blood screening
  • Needle exchange programmes
  • Sexual health education
87
Q

Infection of treponema pallidum leads to..

A

Syphilis

88
Q

What are the three stages of syphilis?

A
  1. Primary
    • Hard genital or oral ulcer (chancre) at site of infection after ~ 3 weeks
    • Asymptomatic for up to 24 weeks
  2. Secondary
    • Red maculopapular rash anywhere
    plus pale moist papules in urogenital region and mouth (condylomas)
    • Latent for 3 – 30 years
  3. Tertiary
    • Degeneration of nervous system, aneurysms and granulomatous lesions in liver, skin and bones (gummas) in about 40% of patients
89
Q

Congenital syphilis

A
  • Placental transfer after 10-15 weeks of pregnancy
  • Infection can cause death or spontaneous abortion of foetus
  • Survivors develop secondary syphilis symptoms
90
Q

Diagnosis of syphilis

A
  • From lesions or infected lymph nodes in early syphilis
  • Dark field microscopy
  • Direct fluorescent antibody (DFA) test
  • NAAT
  • EIA - can be for immunoglobulin M (IgM) for early infection or immunoglobulin G (IgG - positive at 5 weeks) or both
91
Q

What is chancroid caused by?

A

Haemophilus ducreyi

• Gram negative bacterium

92
Q

What is chancroid characterised by?

A

Painful, necrotising genital ulcers

93
Q

What can chancroid be accompanied by?

A

Inguinal lymphadenopathy

94
Q

Diagnosis and treatment of chancroid

A
  • Diagnosed by microscopy/ culture

* Treatment with a macrolide (e.g. erythromycin) or ceftriaxone

95
Q

How to reduce risk of STIs?

A
  • Fewer sexual partners

* Use condoms

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