GUM Flashcards
What are the RF in a sexual health history for HIV?
- MSM
- Those diagnosed w an STI
- Having multiple sexual partners
- High risk sexual practices - group sex, chemsex
- Female sexual contacts of MSM
- Current of former sexual partner known to be HIV affected
- Current or former sexual partner w IVDU hx
- Individuals who have paid or have been paid for sex
- Rape/sexual assault from those w HIV
What are non sexual related RF of HIV?
- IVDU
- Individuals from a country w high HIV prevalence
- Received a blood transfusion or other risk prone procedures in countries that don’t screen for HIV
- Babies w mothers who have untreated HIV
- Dodgy piercing and tattoo shop
Who is recommended a HIV test?
- MSM
- Female sexual contacts of MSM
- Individuals diagnosed w STI
- Those w hx of IVDU
- Black African men and women
- Born or partner from a country of high HIV prevalence
- Where HIV enters the differential diagnosis
- W HIV positive sexual partner
What are the different methods of testing HIV?
- Lab testing - venepuncture sample
- Self sampling and rapid point of care tests - POCTs
- CD4 count
- HIV viral load
- General bloods to see how patient is
- Screen for other STIs and blood borne viruses
What is the window period for HIV testing?
45-90 days for most tests. Is the window between exposure to HIV and when a test gives and accurate result.
For HIV ab detection and HIV p24 antigen detection tests you have to wait 45 days from potential exposure for the result to be accurate.
Positive tests are confirmed w HIV-1/HIV-2 differentiation immunoassay.
What are the routes of transmission of HIV?
- Sexual transmission
- Vertical transmission - in utero, peri-natal period or breast feeding
- Contaminated needles
- Contaminated blood products and organs
What increases risk of transmission and what decreases risk?
- Anal intercourse is more common to transmit HIV
- More likely to transmit HIV if you are receiving
- Female to male transmission is less efficient
- Transmission less common w oral sex
- Concomitant STIs increase risk of transmission
What is the natural history of HIV?
- Acute infection
- Chronic infection
- Late stage HIV/AIDs
What is involved in acute infection of HIV?
- Initial infection = flu or mononucleosis type infection
- Non specific sx, mild and often dismissed
- 1-6 weeks after infection
- Due to seroconversion = development of Ab to HIV
- Lots of pt are asymptomatic during early phases
- Fever, lymphadenopathy, myalgia, malaise
- Diarrhoea, sore throat, oral ulcers
- Rash, headache
What happen in the chronic infection stage of HIV infection?
- Around 6 months viraemia reaches a steady state
- Viral load is steady but CD4 lymphocyte count slowly falls
- Pt tend to be asymptomatic, in the absence of treatment the length of this phase varies but on avg it is 8-10 years
What is involved in AIDs/late stage HIV?
- CD4 count <200cells/mm3
- Increase in risk of developing AIDs defining illnesses
- Fatigue, malaise, weight loss, opportunistic infections and malignancies
- Untreated pt w late stage HIV have a median survival of 12-20 months
- If diagnosed at this stage pt need detailed exam and ix
- After treatment initiation they are at risk of IRIS
What are the AIDs defining illnesses?
Neoplasms - Non Hodgkin lymphoma, Kaposi’s sarcoma, cervical cancer
Bacterial infection - M.tuberculosis, MAC, recurrent pneumonia
Viral infection - cytomegalovirus, herpes simplex, progressive multifocal leukoencephalopathy
Fungal infection - PCP, Candidiasis, Cryptococcosis, histoplasmosis
Parasitic infection - cerebral toxoplasmosis, cryptosporidiosis, atypical disseminated leishmaniasis
What is IRIS?
Immune reconstitution inflam syndrome - elevated inflam response as the immune system recovers against pre existing opportunistic infections
What are the baseline ix into HIV?
Confirm diagnosis, assess degree of immunosuppression, co existing conditions and drug resistance:
- HIV-1/HIV-2 differentiation immunoassay
- HIV-1 viral load
- Genotypic resistance
- CD4 T cell count
- Viral hepatitis serology
- Full STI screen
- Bloods - FBC, renal func, LFT, bone profile
- Urine dip
- Cervical cytology
What is the management of HIV?
- Psychological support and counselling
- ART - reduced morbidity and mortality and minimises treatment SEs
- PREP and PEP
- ARTs have many complex interactions w other meds, pt and clinicians must be aware
What is a typical ART regime?
- Two nucleoside reverse transcriptase inhib NRTIs
- Third agent - PI/r (protease inhib), NNRTI, INI (integrase inhib)
Eg. tenofovir-DF and emtricitabine + atazanavir boosted w ritonavir
What is involved in the monitoring of HIV?
- Viral load, aim to achieve and undetectable viral load, testing will be repeated every 6-12 months
- CD4 count, once established on treatment w suppressed viral load and 2 readings >350 a year apart routine testing is not needed
What is PrEP and PEP?
PrEP - pre exposure prophylaxis, for those at risk of getting HIV, if have a HIV positive partner or take part in risky sexual behaviours, reduces risk of getting HIV from sex by 90%+ and 70% for IVDU but need to take every day, test every 3 months
PEP - post exposure prophylaxis, only for emergency situations, must be started w/i 72 hours after possible exposure - truvada and raltegravir 28 days and will have HIV screening tests
What are the CFs of gonorrhoea?
Neisseria gonorrhoea
- Women - discharge, dysuria, abnormal bleeding
- O/E - discharge from os, Skene’s gland or Bartholin’s gland
- Extra genital complications - pharyngitis, rectal pain and discharge, disseminated infection
What are Skene’s and Bartholin’s glands?
Skene’s - x2 glands either side of the urethra, help w lubrication during intercourse and potentially antimicrobial
Bartholin’s - lubricant during sex, near to the vaginal opening
What are the ix into gonorrhoea and what is the management?
- Vulvovaginal swab
- Microscopy - gram negative diplococci w polymorphonuclear leukocytes
- NAATs and culture
Treat - 1g ceftriaxone IM injection then test of cure
What are the CFs of chlamydia?
Chlamydia trachomatis
- Women usually asymptomatic
- Dysuria, intermenstrual bleeding, vaginal discharge
- Neonates - pneumonia and conjunctivitis