Neurosyphilis - Onset - Features

Occurs 10+ years after infection Features - Meningitis - Psychosis/ Dementia - Tabes dorsali= dorsal column involvement--> sensory ataxia, weakness, charcot joints

Opportunistic infections in HIV - Skin - Oral - Respiratory - Neurological

Skin - Seborrhoeic dermatitis - Shingles - HSV - Tinea Oral - Candidiasis - Oral hairy leucoplakia (EBV) Respiratory - TB Neurological - Peripheral neuropathy - Myelopathy

Pneumocystis pneumonia - Causative agent - Presentation

Pneumocystis jirovecci - Unicellular eukaryotic fungus - AIDS defining illness (CD4< 200) Presentation - SoB on exertion - Chronic, drug cough -

PCP prophylaxis - Indications - Drug and dose

Following 3 weeks of treatment in patients with CD4 < 200 - Septrin 480mg OD - 2nd line = Dapsone 100mg OD Other indications - CD4 % < 14 - Previous PCP diagnosis on 2 occasions

GUM Flashcards by aderonke adesanoye

Secondary syphilis features

Generalised polymorphic, maculopapular rash
- Can be on palms, soles and face

Lymphadenopathy

Generalised
Painless

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Diagnosis of syphillis

Swabs from ulcer

Dark ground microscopy
PCR

Treponemal antibodies

CSF antibody testing

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Treatment of syphilis

first line
second line

1st line
- IM benzathine penicillin

2nd line
- Oral doxycycline/ azithromycin

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Jarisch–Herxheimer reaction

Phenomenon that can occur after IM benzathine penicillin treatment for syphilis due to release of endotoxins

Typically resolves within 24 hours
Common in early syphilis

Features

Headache
Myalgia
Chills/ rigors
Tachycardia

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Neurosyphilis

Onset
Features

Occurs 10+ years after infection

Features

Meningitis
Psychosis/ Dementia
Tabes dorsali= dorsal column involvement–> sensory ataxia, weakness, charcot joints

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Latent (tertiary) syphilis features

Neurosyphilis

Cardiovascular

Aortic regurgitation/ aneurysm
Angina

Gummata
- fibrous nodules/ plaques in connective tissue

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Argyll-Robertson pupil

Bilateral, small pupils that accommodate to near object but does not constrict to light.

Features of neurosyphilis

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HIV seroconversion presentation

Viral-like illness

Fever
Myalgia, arthralgia
Pharyngitis
Lymphadenopathy

Maculopapular rash

GI
- Diarrhoea, vomiting

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Incubation period for secondary syphilis

6 weeks +

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Incubation period for seroconversion illness in HIV

2-12 weeks

- Most commonly in 2-4 weeks

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Opportunistic infections in HIV

Skin
Oral
Respiratory
Neurological

Skin

Seborrhoeic dermatitis
Shingles
HSV
Tinea

Oral

Candidiasis
Oral hairy leucoplakia (EBV)

Respiratory
- TB

Neurological

Peripheral neuropathy
Myelopathy

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AIDS defining illnesses

Pulmonary
Neurological
Malignancy
Dermatology

Pulmonary

Pneumocystic pneumonia
Gram-negative Bacterial pneumonia

Neurological

Cryptococcus
Cerebral toxoplasmosis
HIV encephalopathy

Malignancy

Kaposi sarcoma
Hodgkins Lyphoma
Hepatocellular carcinoma

Dermatology
- Molluscum contagiosum

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Pneumocystis pneumonia

Causative agent
Presentation

Pneumocystis jirovecci

Unicellular eukaryotic fungus
AIDS defining illness (CD4< 200)

Presentation
- SoB on exertion
- Chronic, drug cough
-

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Investigation findings for pneumocystic pneumonia

Chest X-ray

Bilateral hilar shadowing/ infiltrate
Interstitial shadowing

Bronchoalveolar lavage
- Silver stain microscopy

Exercise oximetry
- Below <90% on exertion

ABG
- Type 1 respiratory failure

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First line treatment of pneumocystic pneumonia

Co-trimoxazole (Septrin)
- 2-3 weeks
- Add antiemetics
High flow Oxygen
Steroids if pO2 < 8kPa

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Alternative therapies for pneumocystic pneumonia

Septin allergy

- Clindamycin and Promaquine

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PCP prophylaxis

Indications
Drug and dose

Following 3 weeks of treatment in patients with CD4 < 200

Septrin 480mg OD
2nd line = Dapsone 100mg OD

Other indications

CD4 % < 14
Previous PCP diagnosis on 2 occasions

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3 Largest risk groups for HIV in UK

MSM
Heterosexual sex in Sub-Saharan Africa
IVDU

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Septrin side effects

Common= Nausea and vomiting.

rash
bone marrow suppression
hepatotoxicity
hypoglycaemia and haemolytic anaemia in patients with G6PD deficiency.

HIV window testing period

Serology

May take up to 3 months for postive results (point of care, rapid test)
45 days in lab

4th generation lab test

95% sensitivity
Should be offered initially

Everyone retested after 12 weeks,

Lymphogranunolma venereum is caused by…

C. trachomatis L1-3

Presentation of LGV

Painless ulcers/ pustules in anus/ genital region

Painful, regional lymphadenopathy

Rectal symptoms

Proctitis
Purulent rectal discharge
Tenesmus
Rectal pain

Treatment of Chlamydia

Oral doxycycline 100mg BD
- 1 week

PID/ Epididymo-orchitis
- 2 weeks

LGV
- 3 weeks

Bacterial vaginosis risk factors [7]

New/ multiple sexual partners
Smoking
Douching/ washing with soap
IUD/ IUS insertion
Concurrent STI
Receptive oral sex
Afro-Caribbean

Presentation of BV

Malodorous, thin grey vaginal discharge | - pH < 4.5

Investigation findings for BV

pH of discharge >4.5 Gram staning of vulvovaginal swab, using Hay/Ison criteria - Clue cells

Investigation for trichomoniasis

Posterior fornix swab | - Wet mount microscopy

Treatment for bacterial vaginosis

First line= metronidazole - 400mg BD for 5 days - Oral 2g STAT - Intravaginal gel 0.75% Clindamycin - 300mg BD PO for 7 days - Intravaginal 2% OD Tinidazole 2g STAT

Thrush treatment

Clotrimazole - Vaginal pessary 500mg STAT - 200mg pessary 3/7 - Topical cream + oral fluconazole/ clotrimazole pessary Fluconazole - 150mg PO STAT

Thrush in pregnancy - Prevalence - Treatment

Prevalence - Asymptomatic Candida colonisation is more common (30-40%) - Symptomatic presentation is more prevalent Treatment= longer courses - Clomitrazole pessary 500mg OD 7 days

Recurrent vulvovaginal candidiasis - Definition - Pathology - Investigation - Treatment

At least 4 episode of thrust a year with some resolution in between Pathology - Linked to allergy and pro-inflammatory markers - Risks: diabetes, immunosuppression, hyperoestrogenaemia, distruption of flora. Investigations - Gram-staining and culture for speciation Treatment - Induction: Fluconazole 150mg every 3 days x3 - Maintenance= Oral Fluconazole 150 mg OW for 6 months

Treatment of C glabrata thrush

Fluconazole/ boric acid vaginal pessaries Longer anti-fungal courses

Causes of haematospermia

Urethritis Proctitis Prostate biopsy Severe hypertension Malignancy

In patients infected with syphillis, _____ serology will always be positive

Treponemal enzyme immunoassay (EIA)

____ and ____ are markers of active syphyllis infection

VDRL and RPR | - Higher dilution = more active infection

Causes of genital warts

HPV 6 and 11

_________ is used first line for keratinised genital warts

Podophyllotoxin

________ is used first line for keratinised warts, whilst _______ is second-line

``` 1st= imiquimod cream 2nd= Ablative cryotherapy ```

______ or _______ are first line for urethral HPV warts with visible base.

Topical imiquimod or cryotherapy ablation

________ is required to treat urethral HPV warts with a base that is not visible.

Urological referral

_______ is first line for internal HPV warts whilst ______ is second-line

Cryotherapy is first line Surgical excision is 2nd line.

Transmission of genital herpes

Can be transmitted whilst asymptomatic (asymptomatic shedding)

Acute management of genital herpes

Symptomatic relief - Saline baths - Simple analgesia - Topical anaesthesia Oral aciclovir

Management of recurrent genital herpes

Counselling HIV test = rule out immunosupressive cause Aciclovir - Daily for suppressive treatment - During attacks for episodic treatment

Neonatal herpes has a _____ mortality, especially if mother contracts herpes ______

High mortality | - Worse if herpes is contracted during pregnancy