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GUM > Bacterial STIs > Flashcards

Bacterial STIs Flashcards

1
Q

Types of bacterial and protozoa STIs

A

Neisseria gonorrhoea
Chlamydia trachomatis
Mycoplasma genitalium
Treponema pallidum
Ureaplasma urealyticum
Haemophilus ducreyl

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2
Q

Pathophysiology of neisseria gonorrhoea

A

Gram negative intracellular diplococcus, infects mucus membranes and can disseminate

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3
Q

Symptoms of neisseria gonorrhoea

A

Dysuria, discharge from urethra or vagina, proctitis, pharyngitis, conjunctivitis

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4
Q

Complications of neisseria gonorrhoea

A

Can ascend to cause PID, epididymitis and can disseminate, fetal loss, conjunctivitis, Bartholins abscess, perihepatiic, appendicitis, worse and more common in women

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5
Q

How is neisseria gonorrhoea diagnosed

A

Nucleic acid test from urine/swabs

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6
Q

Difficulties in diagnosis of gonorrhoea

A

Culture only grows 1/3 but this allows resistance testing. Microscopy can be used for immediate diagnosis but needs lots of organism (urethritis valuable)

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7
Q

Pathophysiology of chlamydia trachomatis

A

Small intracellular bacteria not seen by light microscopy

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8
Q

Symptoms of chlamydia trachomatis

A

Dsyuria, discharge, acute illness milder than in neisseria gonorrhoea, inflamed genital tract

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9
Q

Diagnosis of chlamydia trachomatis

A

NAATs from urine or swabs as it is very difficult to grow

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10
Q

Complications of chlamydia trachomatis

A

SARA, PID, epididymitis, some strains cause LGV, endometritis, salpingitis, infertility, ectopic pregnancy, adhesions, Fitz-Hugh Curtis syndrome, conjunctivitis, arthirits

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11
Q

Pathophysiology of mycoplasma genitalium

A

Low grade pathogen very difficult to culture

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12
Q

Pathophysiology of treponema pallidum

A

Spirochaete bacteria seen on dark field microscopy. Causes syphilis.

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13
Q

How is treponema pallidum diagnosed

A

PCR from early lesions or serology

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14
Q

Populations at risk of treponema pallidum

A

Homosexual men especially if HIV positive
Sexual contact with person from endemic area
Pregnancy or tissue donation

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15
Q

Symptoms of treponema pallidum

A

Ulcers, rashes and problems associated with syphilis

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16
Q

Pathophysiology of trichomonas vaginalis (TV)

A

Flagellated protozoan parasite

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17
Q

Symptoms of TV in women

A

Vaginal discharge
Vulval itching
Dysuria
Offensive odour

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18
Q

Signs of TV in males

A

Affect urethra, supreputial sac and lesions of penis

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19
Q

What can TV increase the risk of

A

Problems in pregnancy and risk of HIV

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20
Q

What bowel diseases are primarily in MSM

A

Giardia, Shigella, Entamoeba

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21
Q

Bacterias that can cause urethritis

A

Chlamydia, mycoplasma, gonorrhoea, trichomonas

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22
Q

Where is TV most commonly found in women

A

Vagina, urethra, paraurethral glands

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23
Q

Signs of TV in women

A

None in 10% women
Vaginal discharge which can be profuse and frothy yellow (>30%) or thin and scanty

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24
Q

Symptoms of TV in men

A

15-50% asymptomatic
Discharge
Dysuria
Irritation of urethra
Urinary frequency

25
Q

Complications of TV

A

Vaginitis or salpingitis due to concurrent infections, in men rarely causes balanoposhitis or penile ulceration

26
Q

Diagnosis of TV in females

A

NAAT from swab of posterior fornix, wet mount microscopy, acrinidine orange

27
Q

Diagnosis of TV in males

A

Male urethral culture, acridine orange, NAAT

28
Q

Treatment of TV

A

Metronidazole 2g oral dose or 400-500mg twice daily for 5-7 days
Tinidazole 2g orally in single dose
Do not take alcohol for duration of treatment and 48 hours afterwards
Partners should complete treatment before sexual intercourse

29
Q

What is the spontaneous cure rate of TV

A

20-25%

30
Q

What can you do if there is no response to TV treatment

A

If not responded to first treatment then repeat course once more

31
Q

How to diagnose the cause of urethritis

A

Symptoms, signs, urine and microscopy (evidence of polymorphs in urethral discharge)

32
Q

Causes of urethritis %

A

5% gonococcal
45% chlamydial
50% non chlamydia non gonococcal - most commonly mycoplasma

33
Q

Incubation time of chlamydial infection

A

7-21 days

34
Q

% of asymptomatic males with chlamydia

A

50%

35
Q

% of asymptomatic females with chlamydia

A

70-80%

36
Q

What is Reiter’s syndrome

A

Complication of chlamydia causing arthritis

37
Q

What is Fitz-Hugh Curtis Syndrome

A

Complication of chlamydia which affects the liver giving an acute cholecystitis presentation

38
Q

% of women who get PID from chlamydia

A

10-30% of women with untreated chlamydia

39
Q

What percentage of PID is caused by chlamydia

A

60%

40
Q

What percentage of ectopic pregnancies are caused by chlamydia

A

60%

41
Q

Diagnosis of chlamydia

A

First catch urine, 15ml needed. Self taken vulvovaginal swab, cervical, urethral, rectal and pharyngeal swabs also taken. Then NAAT test

42
Q

Is chlamydia visible under microscope

A

No

43
Q

Is gonorrhoea visible under microscope

A

Yes

44
Q

When is chlamydia retested for

A

After 4 weeks

45
Q

Treatment of chlamydia

A

Erythromycin 100mg BD for 7 days or azithromycin 1g STAT then 500mg OD for 2 days

46
Q

How is non gonococcal non chlamydia urethritis treated (NSU)

A

Diagnosis of exclusion as not seen on microscopy but many due to mycoplasma genitalium

47
Q

Treatment of mycoplasma genitalium

A

Prime wit doxycycline 100mg BD for 1 week then extend to azithromycin 1g STAT then 500mg OD for 2 days

48
Q

What is the main concern for treating mycoplasma

A

There is resistance starting against azithromycin (50%) so now having to use quinolones but these have bad side effects

49
Q

Incubation period for mycoplasma genitalium

A

Longer than chalymdia (>21 days)

50
Q

How contagious is gonorrhoea

A

Very - one contact from male to female can have 60-80% transmission, female to male is 20%

51
Q

Incubation period for gonorrhoea

A

5-8 days

52
Q

Specific symptoms of gonorrhoea in males

A

80% profuse purulent discharge, 50% dysuria, asymptomatic in 10%

53
Q

Specific symptoms of gonorrhoea in females

A

50-70% asymptomatic, mucupurulent discharge <50%, pelvic pain <5%

54
Q

Other sites that gonorrhoea can infect

A

Pharynx - asymptomatic in 90%. Mild pharayngitis.
Rectum - asymptomatic in 90%. Can cause purulent rectal discharge

55
Q

Symptoms of disseminated gonococcal infection

A

Rare <1%, fever, rash, arthritis, tendonitis

56
Q

Treatment of gonorrhoea

A

3rd generation cephalosporin such as ceftriaxone 1g IM - but check local guidelines

57
Q

When should a test of cure be done for gonorrhoea

A

2 weeks

58
Q

When should gonorrhoea be treated empirically

A

Only treat if sex in past 2 weeks with symptoms otherwise tests as needed - could be another STI due to short incubation period

GUM (8 decks)

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