GUM (-treatments) Flashcards
Why does taking the oral contraceptive pill increase your chances of getting chlamydia?
It increases cervical ectopy
Is partner notification required for HSV and HPV?
No - they can be latent and subclinical. Should disclose to their current sexual contacts though.
What do 4th generation HIV tests detect? How long may it take for these to be present in the blood? Does the test have to repeated?
Detect HIV antigen and Ab
There is a window period of 4-6 weeks
Repeat tests @ 3 months BUT if a pt has signs of seroconversion illness and a negative HIV test, repeat after 2 weeks.
How does PEPSE work?
It inhibits viral replication and prevents the virus entering the blood
How do you determine HIV risk?
Risk of source being positive x risk of exposure (Act)
What is the most important factor influencing transmission?
VIRAL LOAD
What medications are used as PEPSE?
Truvada (once a day) and Raltegravir (twice a day) for 28 days
In what period must PEP be taken by to be effective?
72 hours
What follow up is required after a patient has received PEPSE?
Review 2 months after completing PEPSE for repeat HIV test
Why are rates of genital warts decreasing?
Due to quadivalent HPV vaccination
What is the most common STI in MSM?
Syphilis
What can lymphogranuloma venerum (LGV) lead to in MSM?
Severe proctitis
In which vaginal infection would you expect the pH of the discharge to be <4.5?
Candida
In which vaginal infections would you expect the discharge to smell fishy?
Bacterial vaginosis and trichomoniasis
In which vaginal infections would you expect to have associated itchy/soreness?
Candida and trichomoniasis
In which vaginal infection would you expect the vaginal discharge to be thin/frothy?
Trichomoniasis
In which vaginal infection would you expect to see associated vulval oedema?
Candida
What are the 4 features in the Amsels Criteria and how many are needed for the diagnosis of bacterial vaginosis?
1) Thin grey/white discharge
2) Positive amine test
3) Clue cells on microscopy
4) pH over 4.5
3/4 are needed for diagnosis
What is the Hay-Ison score used to diagnose? What is it based on? What does a grade or 2 and 3 mean?
Used to diagnose Bacterial vaginosis Based on gram stain Grade 2 = intermediate vaginal flora Grade 3 = Mixed bacterial flora Grades 2 and 3 = BV
What signs are associated with candida?
Itch, superficial dyspareunia, linear fissures, satellite lesions
What are some risk factors for candida?
DM, corticosteroids, frequent antibiotics, pregnancy
How is candida treated in pregnant women?
Topical azoles as oral TX is contraindicated
How may candida present in a man?
Mild balanitis w/ pruritis
What signs and symptoms are associated with chlamydia trachomatis in a woman?
- 80% asymptomatic
- Post-coital or inter-menstrual bleeding
- Purulent vaginal discharge
- Lower abdo pain
- Proctitis
- Cervicitis
- Cervical contact bleeding
- Bartholinitis
Name 3 complications of chlamydia
PID, Peri hepatitis, Reiter’s syndrome
What signs and symptoms are associated with chlamydia trachomatis in a man?
- Asymptomatic in around 50%
- Urethral discharge
- Dysuria
- Testicular/ epidydimal pain
- Proctitis
- Epididymitis
How is chlamydia diagnosed?
NAATs. Swab taken from urethra/ endocervix/ vulvovaginal swab. Rectal swab if anal sex. Oral swab if oral sex.
NAATs on 1st void urine sample.
How does epididymo-orchitis typically present?
Usually unilateral, scrotal swelling and pain. tender, erythema
A 25 year old male presents with epididymo-orchitis - what are the most likely causative organisms?
N. gonorrhoea, C. trachomatis (STI more likely if young and no significant urinary symptoms)
A 45 year old male presents with epididymo-orchitis - what are the most likely causative organisms?
E. Coli, Enterobacteriaceae
How is gonorrhoea diagnosed in men?
Gram stain from urethral swab if symptomatic
NAATs on first void urine if asymptomatic
Culture both to check for antibiotic resistance
How is gonorrhoea diagnosed in women in primary care?
Primary care: Endocervical swab
How is gonorrhoea diagnosed in asymptomatic women in secondary care?
NAATs from vulvo vaginal swab
How is gonorrhoea diagnosed in symptomatic women in secondary care?
Endocervical swab for culture + NAAT +/- urethral swab
When should a test of cure occur in people treated with chlamydia?
At least 4 weeks after the completion of treatment. A test of cure is essential in pregnant women.
When should a test of cure occur in people treated with gonorrhea?
2-4 weeks after treatment
When can someone transmit the herpes simplex virus to someone else?
Only when they are shedding the virus - this happens sporadically, not necessarily in association with symptoms
What are the symptoms of a primary attack of herpes simplex virus?
Febrile (prodrome) lasting 5 - 7 days, dysuria, painful inguinal lymphadenopathy, tingling/neuropathic pain in genitals/buttocks/legs, genital ulcers.
How common is a primary attack of herpes (NB this is different to the 1st clinical episode), and when would it occur?
A primary attack of herpes is uncommon and would occur 2 - 12 days after acquiring the virus.
How long may a 1st episode of herpes last? When would you start suspecting immunodeficiency?
1st episode may last 3 weeks
Suspect immunodeficiency if symptoms last over 4 weeks
List 3 complications of the primary infection of herpes
Acute urinary retention
Constipation
Aseptic meningitis