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CLINICAL PATHOLOGY > HIV and STIs > Flashcards

HIV and STIs Flashcards

1
Q

What is the most common diagnosed STI in the UK?

A

Chlamydia

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2
Q

What has led to a decrease in the prevelance of chlamydia in young people?

A

Increased testing

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3
Q

How are STIs spread?

A

Mucous membrane contact or exchange of bodily fluids

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4
Q

What is meant by the fact that pathogens causing STIs are often fastidious organisms?

A

Don’t survive for long when isolated from a membrane or sight of infection

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5
Q

In what 4 ways can STIs be passed from mother to baby - ie vertical transmission?

A

1) In utero - transplacental
2) Peri natal - passage through infected birth canal
3) Eye mucous membrane - conjunctivitis
4) Present in breast milk

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6
Q

Risk of transmission/acquisition is related to which 2 factors?

A

1) Acquisition is primarily related to number of sexual partners
2) Increased risk with no use of barrier contraception
(Also patients with one STD is more likely to have other STDs)

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7
Q

What process is important in reducing transmission of STIs?

A

Contact tracing

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8
Q

Neisseria gonorrhoea is also known as what?

A

Gonococcus

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9
Q

What kind of bacteria is Neisseria gonorrhoea?

A

Gram negative coccus - diplococcus - ie sits in pairs

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10
Q

What are the 2 other common Neisseria species?

A

1) Neisseria meningitides

2) Non pathogenic Neisseria species - normal commensal flora of the throat and genital tract

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11
Q

How does Neisseria gonorrhoea multiply?

A

Intracellularly
Neutrophils engulph the organism in phagocytosis but are unable to kill the organism and it replicates within the neutrophils

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12
Q

What adaption does Neisseria meningitidis have to increase its ability to attach to mucosal epithelial cells, and what epithelium does it primarily infect?

A

Pilli on the cell surface (piliated cells more virulent)

Primarily infects columnar/ cuboidal epithelium

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13
Q

How many layers is the ‘cell envelope’ of Neisseria gonorrhoea made up of?

A

3 layers as a gram negative bacteria

Has a thin peptidoglycan wall but an outer membrane

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14
Q

What are the 3 most common bodily sights of infection of Neisseria gonorrhoea?

A

1) GU tract
2) Rectum
3) Oropharynx

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15
Q

How long is the intubation period of Neisseria gonorrhoea and what percentage of women are asymptomatic?

A

2-5 days incubation period

60% of women are asymptomatic

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16
Q

What are the 2 main symptoms of gonorrhoea?

A

1) Urethral discharge

2) Dysuria (painful urination)

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17
Q

What are the 7 local complications of gonorrhoea?

A

1) Epididymitis
2) Prostatitis
3) Barthonilitis
4) Salpingitis (inflammation of uterine tubes)
5) PID (pelvic inflammatory disease)
6) Peritonitis
7) Fitz-Hugh-Curtis syndrome (perihepatitis)

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18
Q

People who suffer Fitz-Hugh-Curtis syndrome (perihepatitis) as a complication of gonorrhoea are usually co infected with what organism?

A

Chlamydia trachomatis

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19
Q

What are the 4 components of disseminated gonococcal infection (in what percentage of people does it occur)?

A

1) Bacteraemia
2) Arthritis
3) Dermatitis
4) Meningitis
Occurs in 0.5-3% of the untreated

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20
Q

Gonorrhoea in pregnancy can lead to which 2 things?

A

1) Spontaneous abortion

2) Premature labour

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21
Q

Gonorrhoea can cause what 2 conditions in the neonate?

A

1) Ophthalmia neonatorum

2) Acute purulent conjunctivitis (

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22
Q

What are the 3 steps in diagnosis of gonorrhoea?

A

1) Microscopy - urethral swab (male)
2) Culture - endocervical, urethral swab
3) Nucleic acid amplification test (PCR) - urine or vaginal swab

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23
Q

Neisseria gonorrhoea has widespread resistance against which antimicrobial?

A

Tetracycline

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24
Q

What are the 3 types of antibiotics used to treat gonorrhoea?

A

1) Beta-lactams (benzylpenicillin, amoxicillin)
2) Cephalosporins (cefixime -PO, ceftriaxone IV or IM)
3) Fluoroquinolones - (ciprofloxacin)

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25
Q

What is the emerging problem with treating gonorrhoea?

A

Neisseria gonorrhoea is becoming increasingly resistant to many Abx - reaching a point where there are untreatable strains of gonorrhoea

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26
Q

Non gonococcal urethritis (NGU) is caused by what 2 organisms?

A

1) Chlamydia trachomatis types D-K

2) Ureaplasma urealyticum (mycoplasma genitalium)

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27
Q

What is the incubation period of the organisms causing non-gonococcal urethritis?

A

1-2 weeks

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28
Q

How is a diagnosis of non-gonococcal urethritis made?

A

NAAT for chlamydia (nucleic acid amplification test)

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29
Q

What are the 2 possible antibiotic treatments for non gonococcal urethritis?

A

1) Doxycycline

2) Macrolide; erythro-/ azithro-mycin

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30
Q

What kind of pathogen is chlamydia trachomatis?

A

Obligate intracellular pathogen

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31
Q

What is unique about the lifecycle of chlamydia trachomatis?

A

Extracellular infectious form: elementary body

Intracellular replicative form: reticulate body

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32
Q

What are the 4 target cells/tissues of chlamydia trachomatis?

A

1) Squamocolumnar epithelial cells of endocervix/ upper genital tract in females
2) Conjunctiva in both males and females
3) Urethra in both males and females
4) Rectum in both males and females

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33
Q

What is the additional target cells of infection of chlamydia trachomatis in infants?

A

Respiratory epithelium

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34
Q

Chlamydia is often asymptomatic (more so in females than males) - what are the 3 possible symptoms?

A

1) Urethritis - less purulent discharge than gonococcal
2) Cervicitis - mucopurulent
3) May have dysuria/ frequency

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35
Q

Chlamydia is a cause of ‘acute urethral syndrome’, what is acute urethral syndrome?

A

Sterile pyuria (see white cells but cant culture bacteria)on standard analysis

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36
Q

What are the 5 complications of chalmydia?

A

1) PID
2) Perihepatitis
3) Epididymitis
4) Conjunctivitis
5) Reiter’s syndrome

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37
Q

PID is a complications of chlamydia infection, how can this lead to infertility?

A

Tubal infertility - get inflammation of fallopian tubes

Can also lead to ectopic pregnancy and chronic pain

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38
Q

Reiter’s syndrome is a complication of chlamydia, what is Reiter’s syndrome?

A

1) Arthritis
2) Conjunctivitis
3) Urethritis
4) Skin lesions

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39
Q

What are the 2 main complications of chlamydia in the neonate/ infant?

A

1) Conjunctivitis

2) Infant pneumonia

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40
Q

What 4 procedures involved in diagnosis of chlamydia?

A

1) Histology - inculsion bodies
2) Cell culture
3) NAAT (nucleic acid amplification test)
4) Serology - although this has limited value in most oculogenital infections

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41
Q

The normal treatment for chlamydia if one of which 2 antibiotics?

A

1) Azithromycin

2) Doxycyline

42
Q

What antibiotic is used to treat chlamydia causing conjunctivitis/ pneumonia in paediatric patients?

A

Erythromycin

43
Q

By what process is PID usually diagnosed?

A

Laparoscopy

44
Q

What are the 2 low risk HPVs and what do they cause?

A

Types 6 and 11 - cause genital warts

45
Q

What are the 2 high risk HPVs and what do they cause?

A

Types 16 and 18 - cause cervical carcinomas

46
Q

What are condylomata accuminata?

A

The genital warts caused by HSV

47
Q

By what 6 ways can condylomata accuminata be removed?

A

1) Burn
2) Freeze
3) Cut
4) Imiquimod
5) Podophyllin, salicyclic acid, trichloracetic acid
6) Liquid nitrogen

48
Q

Genital herpes are caused by what pathogen?

A

Herpes simplex virus types 1 and 2

49
Q

What kind of virus is HSV?

A

Double stranded DNA virus

50
Q

Which type of herpes simplex virus is more common in women than men?

A

HSV-2

51
Q

What are the 6 symptoms of primary genital herpes?

A

1) Pain
2) Itching
3) Dysuria
4) Vaginal/ urethral discharge
5) Bilateral vesicles/ ulcers
6) Accompanied by constitutional symptoms

52
Q

HSV can remain latent in sacral nerve ganglia, reactivation of HSV can cause what 3 symptoms?

A

1) Local trauma
2) Menstruation
3) Stress

53
Q

What are the 3 steps in diagnosis of HSV?

A

1) Clinical
2) PCR
3) Histology

54
Q

What is the treatment for HSV, what should be considered if frequent recurrence?

A

Treatment = acyclovir

Should consider suppression if frequent recurrence

55
Q

What are the 5 complications of genital herpes?

A

1) Dissemination
2) Meningitis
3) Encephalitis
4) Sacral nerve paraesthesia
4) Urinary retention

56
Q

Syphilis is caused by which pathogen?

A

Treponema pallidum (A spirochaete)

57
Q

What shape is treponema pallidum (causes syphilis)?

A

Slender, helical, tightly coiled

58
Q

What is the pathogenesis of syphilis?

A

1) Treponema pallidum penetrates intact mucous membranes or via abraded skin
2) Disseminates within days via lymphatics or bloodstream
3) Get subsequent clinical symptoms and signs

59
Q

What is the characteristic histology of syphilis?

A

Obliterative endarteritis

60
Q

What does primary syphilis infections result in (after median incubating time of 21 days)?

A

Chancre - painless indurated lesion at the sight of inocultation which will heal spontaneously within 3-6 weeks

61
Q

The secondary phase of syphilis infection occurs 2-8 weeks post onset of chancre, what are the 8 symptoms?

A

1) Skin rash
2) Condylomata lata (wart like lesions)
3) Mucous patches - silvery grey erosions
4) Fever
5) Malaise
6) Weight loss
7) Generalised lymphadenopathy
8) CNS involvement in 40% - headache, meningism

62
Q

In syphilis you can get spontaneous resolution of the secondary phase after 3-12 weeks what are the other 2 outcomes?

A

1) Latent - no clinical manifestation, positive serology

2) Without treatment 30% develop into tertiary syphilis

63
Q

Without treatment 30% of patients with syphilis progress to the third stage, what are the 3 componenets of that?

A

1) Neurosyphilis
2) Cardiovascular
3) Late benign syphilis

64
Q

What are the 3 main changes involved in neurosyphilis?

A

1) meningovascular - hemiplegia, seizures
2) Parenchymatous - general paresis (cortex) - get personality changes and Argyll Robertson pupils (don’t react to light)
3) Parenchymatous - tabes dorsalis (spinal cord) - demyelination of posterior column, ataxic wide based gait, lightening pains in legs and loss of proprioception and vibration sense

65
Q

What are the 3 main changes in the cardiovascular component of tertiary syphilis?

A

1) Aortitis
2) Aortic regurgitation
3) Saccular aneurysm

66
Q

What is late benign syphilis?

A

Non specific granulomatous reaction which involves the formation of gummas which can occur in any organ, most commonly bone/skin/ soft tissue

67
Q

In terms of congenital, in utero transmission, which stage of syphilis is the most dangerous?

A

Spirochaetaemia in early syphilis

68
Q

What are the 3 early signs of congenital syphilis?

A

1) Snuffles
2) Rash
3) Hepatosplenomegaly

69
Q

What are the 4 late signs of congenital syphilis?

A

1) Frontal bosses
2) Saddle nose
3) Sabre shins
4) Hutchinson’s incisors

70
Q

What 2 tests are used for direct detection of syphilis in diagnosis?

A

1) Darkfield microscopy of primary or secondary lesions

2) PCR - nucleic acids

71
Q

As well as the direct tests for syphilis, there are some indirect blood tests, what in general do they detect?

A

Ab against the spirochaete, Treponema Pallidum which causes syphilis

72
Q

What is the standard antimicrobial treatment for syphilis and what is the route of administration?

A

Penicillin based

IM/IV depends on sight and stage

73
Q

When syphilis patients are given penicillin, in some it can cause a Jarish-Herxheimer reaction, particularly in secondary syphilis, what is this?

A

A self limiting, hypersensitivity reaction

Experience fever, chills and myalgia

74
Q

What is trichomoniasis caused by?

A

Trichomonas vaginalis

75
Q

What are the 2 main symptoms of trichomoniasis in men and in women?

A

Women
1) Profuse greenish frothy vaginal discharge
2) Mucosal inflammation
Men - usually asymptomatic but may get urethritis

76
Q

What kind of organism is trichomoniasis?

A

Protozoan (lacks mitochondria)

77
Q

How is a diagnosis of trichomoniasis made?

A

Microscopy/ culture of vaginal swab

78
Q

What anti microbial is used to treat trichomoniasis?

A

Metronidazole

79
Q

Bacterial (anaerobic) vaginosis (BV) is to do with changes in vaginal flora, what are the 2 main changes?

A

1) Reduced vaginal lactobacilli

2) Increased Gardenerella vaginalis and anaerobes

80
Q

How is bacterial vaginosis diagnosed?

A

Watery discharge with has a positive KOH test, vaginal pH >4.5 and clue cells on microscopy

81
Q

With what 3 antimicrobials can bacterial vaginosis be treated?

A

1) Metronidazole
2) Amoxycillin
3) Topical clindamycin

82
Q

Candidiasis includes thrush and balanitis, what 3 factors can lead to the development of candidiasis?

A

Involves multiple factors

1) Oral contraceptives
2) Poorly controlled diabetes
3) Abx - inhibition of normal flora

83
Q

What is the main source of candidiasis and route of transmission?

A

Bowel source - sexual transmission

84
Q

What are the 5 signs and symptoms of candidiasis?

A

1) Vulval, vaginal and penile erythema
2) Itching/ irritation
3) Thick/ adherent discharge
4) White plaques
5) Maculopapular fissuring lesions

85
Q

How is a diagnosis of candidiasis usually made?

A

Mainly a clinical diagnosis but can use microscopy and culture

86
Q

Which pathogen causes candidiasis in 80-90% of cases?

A

Candida albicans

87
Q

What is the treatment for uncomplicated candidiasis (c albicans, not recurrent, not severe)? 2

A

1) Topical agent eg. clo-trimazole

2) Fluconazole (single 150mg oral dose)

88
Q

What is the treatment for complicated candidiasis? 3

A

1) Treatment for 10-14 days (topical or oral)
2) Consider treatment of partner
3) Longterm suppressive treatment if frequent recurrence

89
Q

What 3 factors about the virus HIV have made it so aggressive and hard to treat?

A

1) RNA- based, there is a high rate of mutability so has a survival advantage
2) DNA intermediary - means it can hind from the host and incorporate into host genome
3) It actually infects host immune cells - reduction of host immune cell response

90
Q

What are the 3 transmission routes of HIV?

A

1) Sexual - transmission at genital or colonic mucosa
2) Exposure to other infected fluids: blood/ blood products
3) Mother to infant

91
Q

Which viral molecule reacts interacts with cellular receptor CD4 and chemokine receptor CD5 to gain entry to host cell?

A

Viral Glycoprotein gp120

92
Q

After primary HIV infection what are the 5 possible symptoms of the early symptomatic phase?

A

1) Pulmonary TB
2) Persistent oral candidiasis
3) Unexplained chronic diarrhoea
4) Unexplained persistent fever
5) Severe bacterial infections

93
Q

Which patients are tested for HIV?

A
  • Have universal testing for GUM patients and pregnant women etc.
  • Also suspect and test in high risk patients eg. IVDUs
94
Q

What 2 methods are used to diagnose HIV?

A

1) Antibody testing

2) Viral PCR

95
Q

Why is viral PCR a more useful diagnosis method than Ab testing?

A

Can give you a quantitative value - ie. can obtain a CD4 count from it

96
Q

What are the 5 classes of anti virals used to treat HIV?

A

1) Nucleoside/ reverse transcriptase inhibitors
2) Non nucleoside revers transcriptase inhibitors
3) Protease inhibitors
4) Viral entry inhibitors
5) Integrase strand transfer inhibitors

97
Q

Combinations of drugs are used to treat HIV in HAART (high active anti retroviral therapy), why is it important to use combinations?

A

To prevent resistant mutations emerging

98
Q

How many stages of HIV are there, what are they based on and how is AIDS defined?

A

4 stages of HIV based on CD4 count

AIDS is end stage HIV, equivalent to stage 4 and is when CD4 count is less than 200

99
Q

Is HIV curable?

A

Functionally cured toddler was found in US

100
Q

What are the 2 emerging new treatments for HIV?

A

1) Allogenic stem cell transplants (replace all white cells)

2) Effective vaccine - ongoing but difficult because of high rate of mutability

CLINICAL PATHOLOGY (56 decks)

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