GUM Flashcards
HIV stages and signs
HIV- retrovirus for CD4 Tcells. Stage 1- acute primary/seroconversion = 1-6 wks after infection. 2-60% are symptomatic. P24 antigen ands HIV RNA is detectable on PCR. Followed by asymptomatic stage.
Symptoms are glandular fever like- fever, myalgia, pharyngitis, headaches, diarrhoea, neuralgia, neuropathy, lymphadenopathy, maculopapular rash.
Consider HIV seroconversion illness if unusual signs like: oral candidiasis, recurrent shingles, leukopenia, CNS signs.
Asymptomatic stage is followed by symptomatic HIV: fever, night sweats, diarrhoea, weight loss, opportunist infections like candida, oral hairy leucoplakia, herpes zoster, recurrent herpes simplex, seborrheic dermatitis, tinea infections. At this stage, antibodies are detectable on ELISA.
These symptoms are part of an AIDs related complex and a prodrome to AIDs. AIDs has opportunist infections, disease, severe immunodeficiency, life threatening infection, tumours.
HIV investigation results and treatments
Blood results for HIV might show anaemia, thrombocytopenia, lymphocytopenia, dec CD4 and raised ESR. Monitor viral load and CD4.
Treatments are Antiretroviral therapy/ART. Commonly used drugs are efavirenz and (tenofovir OR abacavir) and (lamivudine OR emtricitabine).
Prophylaxis is tenofovir and emtricitabine. If pregnant, HIV treatment is the same but the PEPSE is raltegravir and truvada.
Treatments can sometimes cause haemolysis in those with G6PD deficiency. Antiretroviral therapy may cause lipodystrophy syndrome of fat redistribution, insulin resistance and dyslipidaemia.
AIDs associated/defining conditions
Candidiasis- resp tract, oesophagus , oral. Invasive cervical cancer, lymphoma, mycobacterium avium, TB, CMV, jirovecii pneumonia, CMV retinitis with vision loss, recurrent pneumonia, salmonella septicaemia, progressive multifocal pneumoencephalopathy, toxoplasmosis of brain, herpes, histoplasmosis, wasting syndrome, Kaposi sarcoma.
Pelvic inflammatory disease
Upper genital tract infection. Risk factors less well known about = termination of pregnancy, insertion of IUD within 4-6weeks, hysterosalpingography, IVF.
Complications of PID = tubal infertility, ectopic pregnancy, chronic pelvic pain.
Signs and symptoms- lower abdominal pain, usually bilateral and flank. dyspareunia, abnormal vaginal bleeding, abnormal discharge, RUQ abdominal pain, dysmenorrhoea, adnexal tenderness, +/- fever.
Admit to hospital if cant rule out ectopic or something like appendicitis, severe symptoms, signs of pelvic peritonitis, tuboovarian abscess.
Treatment- ceftriaxone im once and doxycycline and metronidazole orally twice a day for two weeks. If UTI- ofloxacin (or levofloxacin) and metronidazole. If HIV, still treat the same. If has an IUD, consider removal is symptoms do not get better within 72hours.
Urethritis in men
Urithiritis in men is most commonly caused by STD. can be diagnosed with any of the following- (muco)purulent meatus discharge, gram stain of urethral smear with >5 PMN/high power field OR first pass urine >10 PMN. Can also do a NAAT test.
Urithritis can be gonococcal, NGU (chlamydia or mycoplasma genitalium or trichomonas vaginalis if not white, over 30, not in UK. UTIs account for 6.4%. If asymptomatic, it is more likely gonococcal.
Treatment-
NGU = doxycycline 100mg x2 a day for 7 days with 1g azithromycin after. If UTI give ofloxacin x2 daily for 7 days. If Gonorrhoea, give ceftriaxone 1g IM injection.
Scabies, signs, treatment
Transmittable skin disease from ectoparasitic mite sarcoptes scabiei vor hominis. Only infects humans. From close body contact eg sex acts, rarely towels or brief touch unless is crusted.
Intense itching worse at night. Symmetrical rash on hands, wrists, axillae, thighs, butt, soles and palms, nipples and genitals. Can look like eczema or red spots. Usually granulomatous nodules on dark skin. Starts within 4-6 weeks after infection. Also shows burrows like a line with a vesicle.
Treatment is 5% topical permethrin overnight cream. Repeats use after 7 days. If resistant, use 25% benzyl benzoate. There is also an oral option of ivermectin given once then again 2 weeks later, but that isn’t suitable during pregnancy.
Types of scabies
Crusted- if massive infection, hyperkeratosis, HIV, leprosy, Downs.
Bullous- elderly males and can occur with staph
Nodular- genitals, breasts, armpits, butt. Can persist months with treatment.
Scabies with secondary bacterial infection- staph or strep impetigo, pustules, toxic shock, glomerulonephritis, rheumatic fever. Might looks like vesicles surrounded by yellow pustule.
Pubic lice
Pthirus pubis- transmitted from close contact and sexually. Less common if shaved. Can infect other body hair. Shows red dots of blood and moving lice.
Give permethrin, topical ivermectin or malathion as a shampoo leave on for 5 minutes, comb away lice and rinse. Repeat in seven days. Treat sexual partner even if asymptomatic.
Rules of HIV Pep and Prep
If viral load is undetectable, only give pep for anal sex from high prevalence country.
Don’t pep if oral, bite, eye splash. Do pep for all else if viral load is detectable or unknown.
Ghb and gbl
GHB (Gamma hydroxybutyrate) is an anaesthetic with primarily sedating rather than painkilling properties. It is often sold as ‘liquid ecstasy’ because of its relaxant and euphoric effects, although it has no relationship to ecstasy.
GBL (Gamma butyrolactone) and 1,4-BD (1,4-butanediol) are precursors that rapidly convert to GHB. GHB, GBL and 1,4-BD are clear, odourless, oily liquids that taste slightly salty. Users often swallow them mixed with water or other soft drinks, often sold as small bottles or capsules.
Poppers
Poppers is a common slang term for a range of chemical psychoactive drugs called alkyl nitrites, and in particular, the inhalant drug amyl nitrite. Poppers are typically sold in small bottles and are often marketed as room aromas or deodorizers These products cause blood vessel dilation and muscle relaxation and are used for sexual enhancement.
Summary of menstrual cycle hormones
GNRH from hypothalamus stims LH and FSH from anterior pituitary -> acts on ovary- FSH for granulosa cells for follicular growth and LH on theca cells to increase androgens.
Theca’s androgens convert to oestrogen in follicular phase. Progesterone and oestrogen rise together, the coinciding peak at end of follicular to start of luteal thickens endometrium.
Granulosa cells begin to produce inhibin to stop FSH at the end of this phase and stop follicular growth. FSH and LH reaches peak with oestrogen at point of ovulation in the follicular phase, causes follicle to rupture.
In Luteal phase, the corpus luteum regresses over 14 days. Progesterone keeps rising initially (takes time for FSH to knock on and reduce LH to decrease androgens). All hormones finish on low. The basal body temperature in the luteal phase rises by nearly a degree.
Herpes simplex type 1 vs 2
HSV-1 is mainly transmitted by oral-to-oral contact, causing oral herpes (including symptoms known as cold sores), but it can also lead to genital herpes.
HSV-2 is a sexually transmitted infection that causes genital herpes.
Congenital Syphilis
Congenital Syphilis results from transplacental transmission or contact with the infectious lesions during birth and can be acquired at any stage, causing stillbirth or neonate congenital infection.
There are many presentations of congenital syphilis, including nasal cartilage destruction (saddle nose), frontal bossing (olympian brow), bowing of the tibia (saber shins), morbilliform rash, rhinitis (snuffles), sterile joint effusion (Clutton joints), peg-shaped upper central incisors (Hutchinson teeth).
Many of the neonates born with congenital syphilis are asymptomatic at birth. Early signs can manifest up to 48 months as rash, hepatosplenomegaly, fever, bulging fontanels, seizures, or cranial nerve palsies. Those untreated neonates enter a latent period.
Routine screening is recommended at the first prenatal visit and during the third trimester and delivery in high-risk women.
STI test
Basic STI tests involve HIV, Syphilis, Gonorrhea and Chlamydia.
