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4th Year > GUM > Flashcards

GUM Flashcards

1
Q

HSV 1 and 2 causing anogenital/oral infections

A

HSV 1 is most commonly associated with oral infection (coldsores), and is now the most common cause of anogenital infections in the UK

HSV 2 can cause oral but is mostly associated with anogenital infections, it is the most common cause of recurrent anogenital infections.

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2
Q

R/Fs for HSV transmission?

A

Multiple sexual partners

Prev STI

Unprotected sexual encounters

Multiple sexual partners

Early age of sexual first contact

MSM

Female gender

HIV infection

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3
Q

Primary infection presentation of HSV?

A

The first time the virus presents, may be asymptomatic

Febrile flu symptoms (5-7 days)

Tingling neuropathic pain in buttocks/genital area

Painful blisters and ulcers

Tender lymph nodes

Local oedema

Dysuria

Vaginal/urethral discharge

Can last up to four weeks.

Usually bilateral lesions

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4
Q

Presentation of recurrent HSV infection?

A

Usually unilateral

Last about 10 days, usually mild and may be self-limiting

Can be asymptomatic shedding (infective at this point)

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5
Q

Tests for HSV?

A

Viral culture
Swab & PCR

Serology (however take 12 weeks after primary infection)

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6
Q

HSV infection management?

A

Supportive:

  • Saline bathing
  • Oral analgesics
  • Lidocaine gel/cream
  • Pee while in a bath

Antiretroviral:
- Topicals not very good and not recommended

Primary: Acyclovir (400mg TDS) 5d
Recurrence: Acyclovir 800mg TDS 2d
Suppressive: Acyclovir 400mg BD PO

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7
Q

Types of HPV?

A

120 HPV types, 30 cause anogenital infection

16 & 18 are oncogenic (cervical cancer risk)

Non oncogenic (warts) 6 & 11

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8
Q

Difference in keratinised and non-keratinised genital warts?

A

Non-keratinised arise from areas of mucosa i.e. urethra, anus and vagina

Keratinised arise from keratinised epithelium (e.g. coronal sulcus (bit just below foreskin, labia)

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9
Q

Management of warts?

A

Should be referred to sexual health clinic always, as can more accurately test for other STIs, and may be able to contact trace.

All treat growth, not HPV infection:

Podophyllotoxin self application:

  • Non-keratinised warts
  • NO IN PREGNANCY

Imiquimod:

  • Kertinised/non-keratinised
  • NO PREGNANCY
  • Expensive
  • Hyper/hypopigmentation

Physical ablation (Hyfrecation, cryo and excision)
- safe in pregnancy
-

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10
Q

R/Fs for HPV infection

A

Smoking

Multiple sexual partners

Early loss of virginity

Other STIs

Anoreceptive intercourse

Manual sexual practices (fisting, fingering)

Immunosuppression

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11
Q

Viral STIs?

A 
HPV
HSV
HIV
Molluscum contagiosum
EBV 
Hepatitis (A-E)
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12
Q

What cells does HIV bind to?

A

CD4 positive cells, this includes t-helper cells, macrophages, monocytes and neural cells.

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13
Q

What specific marker predicts risk of progression to AIDS in HIV+ individuals?

A

Viral load.

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14
Q

Stages of HIV infection?

A

Seroconversion illness

  • initial presentation, 4-6 weeks after infection
  • Triad of Rash, Fever and pharyngitis
  • Increased inflammatory markers

Asymptomatic
- Can have lymphadenopathy

Symptomatic

  • Fever, diarrhoea, weight loss, night sweats
  • Opportunistic infections

AIDS:
- severe immunodeficiency

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15
Q

Investigations?

A

Detection of anti-HIV antibodies (ELISA) - diagnostic

Viral load assessment

FBC: may see anaemia, thrombocytopaenia, lymphocytopaenia, reduced CD4 cell count.

Raised ESR,

Assess for other infections and other STIs

CXR & cervical smear

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16
Q

Three satges of HIV infection and their CD4 count?

A

Early CD4 > 500

Symptomatic CD4 200-499

Complications 50-199

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17
Q

Some complications typically associated with a CD4 count 50-200?

A

Oral & oesophageal candidiasis

Cervical dysplasia (cervix)

PCP pneumonia

Kaposi sarcoma/lymphoma

Mycobacteria avium intercellulare

Histoplasmosis

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18
Q

What infection can seriously complicate treatment of AIDS?

A

Hepatitis

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19
Q

Late stage complications in HIV?

A

Cervical cancer

CMV retinitis

Disseminated mycobacterium avium intercellulare

Cerebral toxoplasmosis

Primary brain lymphoma

Multifocal leuko-encephalopathy and dementia

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20
Q

General management of HIV+ patients?

A

Make early diagnosis

ART (anti-retroviral Therapy)

Prophylaxis if CD4 < 200

Reduce transmission

prevent and treat long term complications

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21
Q

General categories of ART drugs in HIV?

A

Entry inhibitors

NRTIs (nucleoside reverse transcriptase inhibitors)

Non-NRTIs

Protease inhibitors

Integrase inhibitors

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22
Q

Prevention for HIV?

A

Behavioural:

  • Condoms
  • Abstinence
  • Sero-sorting

Medical:

  • Circumcision
  • Treatment as prevention
  • Prevention of mother to child transmission
  • PEP/PEPSE (post exposure prophylaxis)
  • PREP (pre exposure prophylaxis)
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23
Q

How effective is treatment as prevention?

A

Pretty effective about 96% has no transmission

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24
Q

In occupational needle stick injury what factors may make you consider PEP?

A

Deep injury
Visible blood on device
Injury with needle been in artery or vein
Terminal HIV related illness/ high viral load
Large volume blood transferred

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25
Q

Time window for PEP?

A

72 hours

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26
Q

6 point plan for STIs?

A

Make diagnosis

Treat infection

Exclude other infections

Screen contacts

Test of cure

Patient education

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27
Q

HIV Risk Factors?

A 
MSM
IVDU
Large HIV infection prevalence in area where they are from
Been paid/paid for sex
Condomless sex
Partner positive
(Illicit drugs)
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28
Q

Causative organism for gonorrhoea?

A

Neisseria gonorrhoea

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29
Q

Complications of gonorrhoea infection?

A

Complications worse in women

Dissemination

PID (infertility)

Conjunctivitis

Perihepatitis

Bartholin’s abscess

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30
Q

Diagnosis of gonorrhoea?

A

Nucleic acid (urine/swab)

Culture

Microscopy (only really if urethritis)

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31
Q

Areas gonorrhoea and chlamydia may infect?

A

Rectum

Urethra

Pharyngeal

Endocervical (in women)

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32
Q

Genital gonorrhoea presentation?

A
  • discharge (80% in men)
  • dysuria (can be bad)
  • proctitis

Women can be asymptomatic (50-70%), small number have pelvic pain.

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33
Q

Management of gonorrhoea?

A

6 point plan

Diagnose: NAAT (nucleic acid)

Treat: check local sensitivities, however: ceftriaxone 500mg IM stat plus azithromycin 1 g orally stat.

Screen for others (60% will have)

Contact tracing

TOC (>72 hours culture, 2 weeks NAAT)

Educate (condoms etc.)

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34
Q

Causative organism for chlamydia?

A

Chlamydia trachomatis

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35
Q

Chlamydia and Gonorrhoea gram positive or negative?

A

Negative

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36
Q

Chlamydia symptoms?

A

Can often be asymptomatic

Female:

  • Discharge
  • Dysuria
  • Vague lower abdo pain
  • Fever
  • Deep dyspareunia

Men:
Classically urethritis with dysuria and urethral discharge or unilateral testicular pain & swelling (epididymo-orchitis)

Can also be rectal, pharyngeal and present as reactive arthritis.

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37
Q

Chlamydia signs?

A

Female:

  • inflamed cervix
  • discharge
  • abdo tenderness
  • adnexal tenderness (uterine pain)
  • cervical excitation

Male:

  • Epididymal tenderness.
  • Mucoid or mucopurulent discharge.
  • Perineal fullness due to prostatitis.
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38
Q

Testing for chlamydia?

A

NAATS tests

First catch urine for men
Vulvovaginal swab for women

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39
Q

Treatment for chlamydia?

A

1g STAT azithromycin

Doxy 100mg BD for 7 days

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40
Q

What is mycoplasma genitalium?

A

Very low grade bacterium causing similar problems to chlamydia, picked up on NAATS, hard to culture.

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41
Q

Causative organism of syphilis?

A

Treponema Pallidum

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42
Q

Complications of chlamydia?

A 
Endometritis
Salpingitis
PID
Infertility (need a few infections)
Ectopic preg
Fitz-curtis (abdominal pain - perihepatitis)
Reactive arthritis
43
Q

What is NSU?

A

non-gonococcal, non-chlamydial urethritis

Normally due to Mycoplasma

44
Q

Risks of chlamydia in pregnancy?

A

Transmission to the newborn:

  • eyes
  • chlamydial pneumonitis
45
Q

Symptoms of chlamydial pneumonitis in the newborn?

A

Staccato cough
Failure to thrive
Tachypnoea

46
Q

Disseminated gonococcal infection presentation?

A

Rare

Females

Fever, rash

Arthritis, tendonitis

47
Q

Genital lump Ddx?

A

Normal anatomy

Sebaceous cyst, or other benign cause

STIs:

  • Molluscum
  • Warts
  • Papular or nodular phase: Syphilis, LGV, Scabies, Herpes)
48
Q

Procto-colitis causative organisms? When does this occur? What does it cause?

A

Generally in MSM populations, through oro-anal contact

Cause bowel symptoms

Giardia, shigella, Entamoeba

49
Q

What is TV (simply)?

A

TV is an STI caused by Trichomonas vaginalis (protozoa)

50
Q

What causes syphilis?

A

Treponema pallidum

51
Q

What is cervical inra-epithelial neoplasia (CIN)?

A

Premalignant squamous cell lesion

52
Q

Three settings in which Molluscum contagiosum occur?

A

Routine physical contact

  • Most common (90% in GPs)
  • Children <15yrs
  • Face, Neck Trunk or limbs

STI
- young adults

Immunocompromised
- Serious infection, often on face and neck

53
Q

What is LGV?

A

Lymphogranuloma venereum:
- complication of certain (tropical) types of chlamydial infection where the infection spreads to the inguinal lymph nodes.

54
Q

Features of Molluscum lesions?

A
  • 1-30 lesions in clusters
  • Occassionally itch/discomfort
  • Projecting, pearly, umbilicated, round lesions with erethematous edge
55
Q

Management of Molluscum?

A

Warn about formites and autoinoculation

Often no treatment, however can podophylotoxin, imiquimod, cryo it.

56
Q

How is molluscum diagnosis made?

A

Clinically

57
Q

Progression of herpes lesions?

A
  1. Erythema and (possibly) swelling of skin
  2. Vesicles and pustules
  3. Ulcers
  4. Scabbing
  5. Healed skin
58
Q

Management of HSV in pregnancy?

A

1st episode in 3rd trimester:

  • Oral Acyclovir 400mg TDS until delivery
  • C-section

If acquired before pregnancy or in 1st/2nd trimester then can deliver vaginally, considering prophylaxis from 36weeks: acyclovir 400mg TDS

59
Q

HSV complications in pregnancy?

A

Disease in skin/eye/mouth:
- with treatment <2% neuro-ocular morbidity

Disease in CNS causing encephalitis:
- 6% mortality, 70% neuro morbidity

Disseminated:
- Mortality 30% with treatment, neuro morbidity 17%

60
Q

Stages of syphilis?

A

Primary:
- painless ulcer (chancre), lymphadenopathy, serology can be negative.

Secondary:

  • Mucosal lesions
  • Rash
  • Arthralgia
  • Lymphadenopathy
  • Meningitis
  • Iritis
  • CN palsy

Latent:
- Asymptomatic, detectable on serology

Tertiary: (after 4 years)

  • CVS syphilis: Aortoi aneurysm, Aortic regurg,
  • Neurosyphilis
61
Q

How do you diagnose syphilis?

A

Microscopy (in primary)

Antigen assay (EIAs) (IgM, in acute infection, not very accurate)

Non-specific VDRL/RPR

Specific: TPPA/TPHA

Specific remains positive for life

Non-specific is useful for monitoring the disease activity, if negative then not infectious and:

  • Very early infection, or;
  • Old infection (treated)
62
Q

Tx for syphilis?

A

Penicillin, IM preferred

if allergic then doxy

63
Q

Tropical STIs?

A

Chancroid - haemophilus ducreyi
- Soft ulcer unlike syphilis

LGV
- Chalydial subtypes

Donovanosis
- Bacterial disease caused by Klebsiella granulomatis

64
Q

Vaginal discharge Ddx?

A

Infective STIs:

  • TV
  • HSV
  • Gonorrhoea
  • Chlamydia

Infective non-STI:

  • BV
  • vulvovaginal candiasis

From the vagina:

  • Vaginitis
  • malignancy

From cervix:

  • Ectopy
  • Polyp
  • Malignancy

From endometrium:

  • Malignancy
  • Polyp
65
Q

What is BV?

A

Bacterial vaginosis:

  • Imbalance in normal vagina flora
  • not considered to be an STI

Overgrowth of anaerobic bacteria with a pH rise

66
Q

BV R/Fs?

A
  • Smoking
  • Vaginal Douching
UPSI
Change of partner
Receptive cunnilingus
Presence of STI
WSW
Increased lifetime partners
67
Q

Presentation of BV?

A

50% fishy discharge
50% asymptomatic

Not assoc. w/ soreness, itching or irritation

68
Q

Complications of BV in pregnancy?

A

Late miscarriage
Preterm
PROM
Post partum endometriosis

Routine screening not recommended

69
Q

Diagnosis of BV?

A

Ison Hay criteria

Gram stained microscopy:

  • Loss of lactobacilli
  • Mixed increased growth
70
Q

Tx for BV?

A

Tx if:

  • risk of ascending infection
  • Symptomatic women

Oral metronidazole 400mg BD 5d

For recurrent BV:
- Vaginal metronidazole gel twice a week

71
Q

Most common causative organism of vulvovaginal candidiasis?

A

Candida albicans

72
Q

Symptoms in Vulvovaginal Candidiasis?

A 
Vaginal itch
Vaginal discharge
Vulval soreness
External dysuria
Superficial dyspareunia
73
Q

Diagnosis of thrush?

A

Microscopy

Culture

74
Q

Tx for thrush?

A

Antifungal topical imidazole, e.g. clotrimazole 500mg pessary stat +/- cream

OR

Oral fluconazole 150mg stat

75
Q

Treatment of recurrent candidiasis?

A

Speciated fungal culture (to identify species)

Vulval care emolients and soap substitute

medication:
- Fluconazole 150mg every 72hrs 3x (eradication)

  • prophylactic fluconazole weekly for 6/52
76
Q

TV common symptoms?

A

Females:

  • Vaginal discharge
  • Vaginal itch
  • Dysuria
  • offensive odour

Males:

  • Urethral discharge
  • Dysuria

10-50% asymptomatic (both sexes)

77
Q

Complications of TV in pregnancy? What should you do?

A

Preterm
Low birth weight
Post partum sepsis

Treatment doesn’t improve complication risk, and is risky itself.

78
Q

TV diagnosis?

A

Microscopy

Culture

NAAT

79
Q

Management of TV?

A

6 point plan

Metronidazole 500mg bd 5d/ 2g stat

Screen and contact trace (4/52)

80
Q

What is epididymo-orchitis (epididymitis)

Presentation?

A

Inflammation of the epididymides and/or testicular inflammation triggered by an infectious agent

Usually unilateral (but may be bilateral) - scrotal swelling, erythema and pain.

O/E: testicular discomfort, tender swollen epididymis

81
Q

Cause of epididymitis?

A

Gonorrhoea, chlamydia

E coli, enterobacteriaceae (>35, ?structural abnormality)

M. tuberculosis (rare) - chronic epididymitis

82
Q

Epididymitis Tx?

A

Doxy 100mg bd 14d

83
Q

What is pediculosis?

A

Lice there are two types, genital and body (corporis & capitus)

84
Q

Stages of genital lice?

A

The nit

The nymph

The adult

85
Q

Clinical features of pediculosis?

A

Infests thighs, perineum, abdo, axilla also eyebrows and lashes

Symptoms:

  • intense irritation & movement noticed
  • blue macules, black spots, lice & nits
86
Q

Pediculosis management?

A

6 step plan

Medication:

  • Malathion 0.5%
  • In pregnancy: Permethrin 1%

All body hair treated and left for 12 hours, then repeated 1 week later

Wash clothes and bed linen at 50

Full STI screen

87
Q

Presentation of scabies?

A

Symptoms result from a hypersensitivity reaction

Pruritis (itch - worse at night)

Eczematous looking lesions

Burrows (fine grey channels)

Indurated (hard) nodules

88
Q

How is scabies transmitted?

A

Prolonged skin-skin contact

Formite spread

Sexually transmitted

89
Q

What is norweigan scabies?

A

Highly contagious form, found in elderly and immunocompromised, kyperkeratotic lesions.

90
Q

Scabies management?

A

Permethrin 5%

Malathion 0.5% lotion

Apply to body from neck down and leave for 12 hours

Wash linen and clothes at 50

Treat partner and household contacts of 8 weeks

91
Q

Why worry about asymptomatic STIs in MSM?

A

increased likelihood of HIV transmission

92
Q

LGV proctolitis problems?

A

Proctocolitis with scarring adhesions and fistula formation

Histologically indistinguishable from IBD

93
Q

Hepatitis types associated with MSM?

A

Hep A - outbreaks in MSM, but prevalence similar to population. Not routinely vaccinated for.

Hep B - All MSM should be vaccinated

Hep C - Current MSM outbreak, associated with traumatic sexual practices & cocaine, majority HIV+

94
Q

Chemsex drugs?

A

MDMA, Ketamine, Mephedrone, Crystal meth and GHB/GBL.

95
Q

2 situations where confidentiality can be breeched in GUM?

A

Beastiality

Court order

96
Q

Non-STI causes of genital ulceration?

A

Trauma
Apthosis
Erythema multiforme
Behcets disease

97
Q

STIs that cause genital ulceration?

A 
Herpes
Syphilis 
LGV
Chancroid
Donovanosis
98
Q

STIs with vaccines?

A

Hep A/B, HPV

99
Q

What other conditions can give rise to a false positive syphilis test?

A

Lupus/autoimmune

Acute febrile illness

Autoimmune

100
Q

Clinical features of congenital syphilis?

A

Hutchinsons teeth
Keratitis
Deafness

101
Q

Drugs in PREP?

A

tenofovir and emtricitabine, tablet is truvada

One pill a day

102
Q

What treatment for warts is unsuitable for people with dark skin?

A

Cryo

103
Q

What determines your choice of treatment for warts?

A

Site

Keratinised/non-keratinised

Number

Pregnant or not

Patient choice

Pigment of skin

4th Year (15 decks)

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