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Dip GUM > Genital Infestations > Flashcards

Genital Infestations Flashcards

1
Q

What is phthirus pubis

A

Pubic lice

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2
Q

How is phthiriasis diagnosed?

A

Pubic lice - Can be seen by the naked eye
Nits (eggs) - seen with naked eye - adhere to hairs
Examination under light microscopy can confirm morphology if necessary

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3
Q

Treatment of phthiriasis

A

Malathion lotion or permethrin cream.
All body hair should be treated.
All bedding should be washed at high temperatures.
Sexual partners need treatment.

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4
Q

Transmission of phthirus

A

public lice transmitted by close body contact

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5
Q

incubation period for phthirus (lice)

A

incubation period usually 5 days to several weeks

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6
Q

Symptoms / signs of phthirus (lice)

A

itching
can be asymptomatic
visible lice or nits (eggs)
Blue macules (maculae caeruleae) may be visible at feeding sites

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7
Q

What areas can be affected by phthirus (lice)

A

Adult lice infest coarse hairs of the pubic area, body hair and, rarely, eyebrows and eyelashes
Eggs (nits) are laid which adhere to the hairs

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8
Q

Management of phthirus pubis (lice)

A

Lotions more effective than shampoos
apply to all body hair including beard + moustache
A second application after 3-7 days

  • Malathion 0.5%. Apply to dry hair- wash out 2 - 12hrs
  • Permethrin 1% cream - Apply to damp hair- wash out 10min
  • Phenothrin 0.2% - apply to dry hair - wash out 2hr
  • Carbaryl 0.5 and 1% - Apply to dry hair - wash out 12 hr

avoid close body contact until they + partner(s) completed treatment + follow-up
full STI screen

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9
Q

Treatment of pubic lice infestation of eyelashes

A

permethrin 1% lotion - keep eyes closed - 10 minute application
OR
inert ophthalmic ointment with white / yellow paraffin base applied to the eyelashes BD for 8-10 days - works by suffocating lice - avoids risk of eye irritation

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10
Q

treatment of phthirus pubis (lice) in pregnancy or breastfeeding

A

Permethrin is safe

Permethrin 1% cream - Apply to damp hair- wash out 10min

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11
Q

Advice for sexual partners of patients with phthirus pubis (lice)

A

Examine and treat current sexual partners should be examined and treated
Contact tracing - partners in last 3 months

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12
Q

follow up for patients treated for phthirus pubis (lice)

A

Review at 1 week - re-examine for absence of lice
Treatment failure should be given an alternative
Dead nits may remain adherent to hairs - does not imply treatment failure - nits can be removed with a nit comb

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13
Q

What is scabies

A

Sarcoptes scabiei var hominis

human itch mite

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14
Q

Lifecycle of scabies mite

A 
lifecycle of sarcoptes = 4-6 weeks
Mites burrow into skin + lay eggs
eggs hatch 
~10% grow into adults in 10 - 15 days
female lays ~25 eggs and dies
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15
Q

Transmission of scabies

A

close skin contact
frequently sexually acquired
mites can live off a host for 24-36 hours
Fomite transmission is uncommon but can occur

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16
Q

Why is format transmission more common in crusted scabies

A

greater number of mites present

and mites can survive longer - up to 7 days

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17
Q

Symptoms of classical scabies infection

A

intense generalised itching
worse at night
due to delayed type-IV hypersensitivity reaction to mites, and mite faeces + eggs

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18
Q

How long after primary infestation do symptoms of scabies occur

A

Symptoms begin 3-6 weeks after primary infestation
earlier ( 1-3 days) in a re- infested person
Scabies is infectious before the rash develops

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19
Q

signs of scabies infestation

A 
most common = erythematous papules
excoriation 
characteristic distribution 
pathognomonic lesion= burrow -linear intra-epidermal tunnel = short wavy greyish/ white threadlike elevations of 2-10mm length
Nodular lesions
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20
Q

Anatomical sites commonly affected by scabies

A

interdigital webspaces / sides of fingers / under finger nails
flexor aspects of wrists / extensor aspects of elbows
anterior + posterior axillary folds
around nipples / penis + scrotum / umbilicus
upper medial thighs / buttocks / sides + back of feet

Spares face + scalp

21
Q

what is Norwegian scabies

A

Crusted scabies / Scabies crustosa / Norwegian scabies) occur in immunocompromised states

22
Q

When does crusted scabies occur

A

occur in immunocompromised states

e.g. in AIDS, leprosy, lymphoma, systemic or potent topical steroids, organ transplant recipients, elderly

23
Q

what proportion of patents with crusted scabies have no identifiable risk factor (e.g. no immunocompromised)

A

40%

suggests possible genetic susceptibility

24
Q

Symptoms / signs of crusted scabies

A 
Erythematous 
scaly 
crusted lesions 
can be malodorous 
associated with fissuring 
can affect any part of the body including the face and scalp 
itching may be mild or absent
25
Q

If a healthy patient contracts scabies from a patient with crusted scabies what type of scabies will they develop?

A

classical scabies

unless also immunocompromised / genetically susceptible to crusted scabies

26
Q

complications of crusted scabies

A

Sepsis - as fissures associated with crusted scabies provide an entry point for bacteria

27
Q

Can humans contract animal scabies?

A 
Humans can rarely contract scabies from pet dogs 
(canine scabies = Sarcoptes scabiei var canis)
or cats (feline scabies = Notoedres cati.)

incubation period is shorter
lesion distribution confined to sites of contact with the animal
burrows not seen
self-limiting as mites do not reproduce in humans hosts

treatment of animal only

28
Q

what is Scabies Incognito

A 
altered clinical presentation 
following use of topical steroids 
widespread atypical papular lesions
may mimic generalized eczema
Symptoms are masked but patient remains infectious
29
Q

Diagnosis of scabies

A

clinical history and distribution / appearance of skin lesions.
+/- Microscopic identification of mites / eggs / faecal pellets (scybala) from scrapings
+/- burrow ink test
+/- dermoscopy

30
Q

Preparation of a skin scraping for microscopy in suspected scabies

A 
Scraping of the skin burrows with a scalpel blade 
Place specimen on a glass slide 
Add 10% potassium hydroxide
( dissolves excess keratin) 
OR

Apply a drop of mineral oil to the lesion
Scrape away the entire lesion with the scalpel blade
transfer to slide

31
Q

What is the burrow ink test for suspected scabies

A

Apply black / blue ink to suspected papule
remove surface ink with alcohol wipe t

positive test = characteristic dark zigzagged line running away from the lesion = ink tracking down mite burrow

32
Q

Differential diagnosis for scabies

A 
Impetigo
folliculitis
papular urticaria
atopic dermatitis
contact dermatitis
dermatitis herpetiformis
psoriasis
seborrhoeic dermatitis
pytiriasis rosea
secondary syphilis 
lymphoma
33
Q

Complications of scabies

A

Secondary bacterial infection - staph aureus / group A β-haemolytic strep / peptostreptococci
resulting in impetigo / folliculitis / furunculosis / ecthyma / abscess

Secondary eczematisation due to constant scratching / irritant effects of medication

glomerulonephritis
leucocytoclastic vasculitis

34
Q

what is furunculosis

A

a deep infection of the hair follicle leading to abscess formation with accumulation of pus and necrotic tissue
= furuncle (i.e. boil)

35
Q

treatment options for scabies

A
  • permethrin 5% cream
  • malathion aqueous 0.5% liquid
  • benzyl benzoate 25% emulsion (not recommended)
  • oral ivermectin (less effective than permethrin) [topical ivermectin not available in UK]
36
Q

why is benzyl benzoate 25% emulsion not recommended as treatment for scabies

A

not as effective as Permethrin or Malathion

may cause skin irritation

37
Q

General advice for patients with scabies

A

Hot wash (60°C) - bedding / clothing / towels used during the previous four days before
or by dry-cleaning
or by sealing in a plastic bag for at least 72 hours

38
Q

Recommended regimen for Permethrin 5% cream to treat scabies

A

Permethrin 5% cream

  • apply to whole body from the chin + ears downwards
  • pay special attention to areas between the fingers / toes / under nails
  • apply treatment to cool dry skin
  • allow lotion / cream to dry before dressing in clean clothing
  • Wash off cream after 8 - 12 hr
  • reapply 1 week later.
  • if hands are washed with soap within 8 hours then reapply cream
39
Q

Which groups of patients with scabies should be advised to apply permethrin cream to the whole body including face + scalp

A

people who are immunosuppressed
the very young
the elderly people

40
Q

Recommended regimen for Malathion 0.5% aqueous lotion to treat scabies

A

Malathion 0.5% aqueous lotion

  • apply to whole body from the chin + ears downwards
  • pay special attention to areas between the fingers / toes / under nails
  • apply treatment to cool dry skin
  • allow lotion / cream to dry before dressing in clean clothing
  • Wash off cream after 24 hr
  • reapply 1 week later.
  • if hands are washed with soap within 24 hours then reapply
41
Q

Alternative regimen for scabies treatment

i.e not Malathion or Permethrin

A

Ivermectin - oral - dose 200 mcg/kg 2 weeks apart -
available on a named patient basis.
- used in the treatment of crusted scabies that does not respond to topical treatment alone
- adverse events associated with ivermectin = rash / vomiting / abdominal pain

42
Q

Treatment of crusted scabies

A

Combination treatment
topical permethrin cream OD for 7 days
then 2x weekly until cure
+ oral ivermectin (200 mcg/kg) on days 1,2,8,9 and 15

should be isolated + barrier nursing
Treat all household members

43
Q

Management of post scabetic itch

A

crotamiton 10% cream (2-3 times a day)

Or - if the scabies mites have definitely been eradicated - use topical hydrocortisone 1%

Night time sedative antihistamine may help
emollients for dry skin/eczema

44
Q

What is post scabetic itch

A

Itching may continue up to 2 weeks after successful scabies treatment
Treatment failure suspected if new burrows appear or if itching persists >2-4 weeks

45
Q

Treatment of scabies in pregnancy and breastfeeding

A

Permethrin 5% cream.
Alternatively use Malathion 0.5% aqueous liquid

remove the liquid or cream from the nipples before
breastfeeding and reapply afterwards

Avoid oral antihistamines during pregnancy

46
Q

Treatment of sexual partners of patients with scabies

A

Examine and treat

  • Current sexual partners
  • household members
  • others with close personal contact

Contact tracing = 1 month

47
Q

Follow-up for scabies

A

not generally required

Return if pruritus persists >2 weeks
Return if new burrows appear

48
Q

for scabies which treatments has there been documented resistance to?

A

documented resistance for both permethrin and ivermectin

Dip GUM (27 decks)

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