HIV GUM Flashcards
SYPHILIS
i) what bacteria causes it? what type of bac is this? how does it get into the body? what is incubation?
ii) name three ways it can be contracted? how does primary syph present?
iii) what does secondary syph involve? what is latent syph? when does it occur? what is tertiary?
iv) when does secondary dev? name four symptoms? name three symp of teritary syph?
v) when may neurosyph occur? name three symptoms? what pupil may be seen?
i) treponema pallidum - spirochete
gets in thro skin or mucous mem > dissem
incubation is around 21d
ii) contract through oral/vag/anal sex, vertical, IVDU, blood transfusion
primary px with painless ulcer at infec site (usually genitals)
iii) secondary involves systemic symps
latent occ 3-12 weeks after secondary - pt is asymp (early up to 2 years after infec)
tertiary - many years after initial infection and affects many organs
iv) secondary starts after the inital ulcer has healed - macpap rash, condylomata lata (warty lesions on gen and anus), low grade fever, LNs, alopecia, oral lesions
tertiary - gummatous lesions (granulomatous lesions of skin and bone), aortic aneurysms, neurosyph
v) neuro can occur at any stage of infection when syph reaches the CNS
px with headache, alt behavs, dementa, tabes dorsalis. (demylination of post spinal columns), ocular syph, paralysis
may see argyll robertson pupil - constricted, accomodates but doesnt react to light
SYPHILIS DX AND MX
i) what is the screening test? which two lab tests can confirm it?
ii) which two non spec but sensitive tests are used to confirm active infection? what do they assess?
iii) where should pts be referred? name four things that patients need.
iv) what drug tx is given as standard tx?
i) screen with antibody testing to t pallidum
confirm with dark field microscopy and PCR
ii) rapid plasma reagin aand VDRL
look at quantity of antibodies
iii) refer to GUM
pts need full screen for other STIs, avoid sexual contact whilst being tx (2 weeks), contact tracing, prevetion of future infections
iv) deep IM dose of benzathine benpen
GENITAL HERPES
i) what type of HSV is assoc with genital? what is assoc with cold sores? where does infection lay latent? name three other px the HSV can cause?
ii) how quick do symptoms of initial infection usually appear? name four symptoms?
iii) how is dx made? what can confirm it? who should pt be referred top?
iv) what drug is used to tx genital herpes? name three other things that may be given to mx symptoms
i) HSV2 genital and HSV cold sore
infection lays latent in sensory nerve ganglia
can cause apthous ulcers, herpes keratitis (inflam cornea) and herpetic whitlow (painful finger)
ii) symptoms appear within 2 weeks
ulcer/blister around genitals, neuropathic pain, flu like symptoms, dysuria, ingnuinal LNs
iii) clinical dx confirmed with viral PCR
iv) aciclovir
also give paracetamol, topical lidocaine, topical vaseline, loose clothing, avoid intercourse
PREGNANCY AND GENITAL HERPES
i) what is the main risk? what type of immunity may the baby dev?
ii) is aciclovir safe in pregnancy? when is vaginal delivery considered safe? when may CS be done?
iii) how is primary (first infec) treated after 28 weeks tx? how must the baby be delivered?
i) risk of neonatal herpes simplex infection
baby may dev passive immunity from abs passed across placenta
ii) acic is safe in pregnancy
vaginal is safe is asymp and more than 6 weeks post initial infection
CS if symptoms are present
iii) tx with acic and then prophylactic acic
must be delivered with CS
LYMPHOGRANULOMA VENEREUM
i) what is it caused by? name three RF
ii) what occurs in the three stages of infection?
iii) how is it tx?
i) caused by chlamidya
RF are MSM, HIV, tropical location
ii) 1- small painless pustule > ulcer
2- painful inguinal LNs
3- proctocolitis (inflam rectum and colon)
iii) tx with doxy
CHLAMIDYA
i) what type of bacteria is it? what type of organism? what does the national chlam screening programme aim to do?
ii) what type of swabs allow for micro culture and sensitivity? what two areas can be swabbed? name four things this type of swab can test for
iii) what type of testing is used specifically for chalm and gon? what type of swab is taken in F? (2) what urine can be done? what is best? what sample can be taken in men?
iv) which two other areas may be swabbed? name three px symptoms in women? name three px symp in men?
v) name three things that may be found on exam?
i) gram negative intracellular organism (rep in cell > rupture)
national screening - screen every sex active person under 25 annually/when change partner
if positive - test again 3m post tx
ii) charcoal swab - endocervical or high vaginal
charcoal for BV, candida, gon, TV, GBS
iii) chlam and gon - NAAT which tests for DNA/RNA directly
best is endocervical, then vulvovaginal then first catch urine
men - first catch urine or urethral
iv) also swab rectal and pharynx if anal or oral sex has occured
female - abnormal dc, pelvic pain, abnormal bleeding, dysparunia, dysuria
male - urethral discharge/discomfort, dysuria, epididymoorch, reactive arth
v) pelvic/abdo tender, cervical motion tender, inflamed cervix, purulent dc
CHLAMIDYA DX AND MX
i) how is it dx?
ii) what is first line tx for uncomplicated? how much for how long? is test of cure reccomended? how long should sex be abstined from?
iii) why is azithromycin no longer used?
iv) when is the first line drug CI? what can be used instead?
v) name four complications? name three pregnncy related complications? what is common in MSM? what can occ in neonates?
i) dx with NAAT
ii) first line is doxy 100mg BD for 7 days
dont reccom test of cure
abstain for 7 days
iii) azithro not used due to m gen resis
iv) doxy is CI in pregnancy - use azithro, erythro, amox
v) complicats = PID, chronic pelvic pain, infert, ectopics, EO, conjunctivitis, LV, reactive aarth
preg - pre term delivery, PROM, LBW, PP endometritis, neonatal infection
MSM = LV
neonates can get chlam conjunctivitis
GONORRHOEA
i) what type of bacteria is it? what does it infect? name four body areas?
ii) how may females px? (3) how can men px? (3) which two areas may be infected?
iii) how is it dx? what should be done before initiating abx? why?
iv) what is tx if sensitivity is not known? what if sens is known? should pts have test of cure? how long should abstinence be for?
i) gram negative diplococci that infects mucous membranes with a column ep eg endocervix, urethra, conjunc, pharynx
ii) F - odourless purulent discharge, dysuria, pelvic pain
M - discharge, dysuria, testicular pain
can also infect rectum and pharynx
iii) dx by NAAT - RNA and DNA but dont know sensitivity
before abx - do charcoal swab for MCS due to high level of abx resistance
iv) unknown sens - IM ceftriaxone 1g
known sens - oral ciprofloxacin 500mg
test of cure due to high abx resis
72hrs after tx for culture, 7 days if tx for RNA NAAAT or 14d after tx for DNA NAAT
abstain for 7 days
COMPLICATIONS OF GONORRHEA
i) what is a key complication? what is this called in neonates? how quick does it need to be tx
ii) name four other complications
iii) what happens when bac spreads to skin and joints?
i) key complicat is gonococcal conjunctivitis in neonates = opthalmia neonatorum
medical emergency - assoc with sepsis, eye perf and blindness
ii) PID, chronic pelvic pain, infert, EO, prostatitis, conjunc, urethral strictures, dissem infec, fitz hugh curtis, endocarditis
iii) dissem gonococcal infec - skin lesionsm polyarthralgia, migratory polyarth, tenosynovitis, systemic symp
NON GONOCCOCAL URETHRITIS
i) what is it? name two symptoms that may be seen?
ii) name three possible causaatives? what is most common?
iii) how is it managed?
i) urethritis when a non gonococcal bac is identified
px with purulent discharge and dysuria
ii) chlamidya is most common, mycoplas genitalium
iii) mx with contact tracing and oral azithro/doxycycline
MOLLUSCUM CONTAGIOSUM
i) what is it? how is it transmitted? (2) who do most cases occur in?
ii) what type of lesions are seen? how do they appear? name two places lesions may be seen?
iii) does it need treatment? how long does it take to resolve? name three self care advice
iv) name two tx if they are problematic?
v) what needs to be considered if extensive lesions? what needs to be doen if lesions are on the eye?
i) skin infec caused by mollsuc contag virus > transmit by personal contact or by fomites (contam surfs) eg shared towels
often occ in children with atopic eczema
ii) pink/pearly white papules with central umbillication
appear in clusters anywhere on body except palms and soles
iii) doesnt need tx and should resolve in 18m
self care - dont share towels, dont scratch, no need for school exclusion
iv) squeeze then bath, cryotherapy, if itching give topical cs
v) consider HIV if extensive lesions
eye > refer to opthal
MOLLUSCUM CONTAGIOSUM
i) what is it? how is it transmitted? (2) who do most cases occur in?
ii) what type of lesions are seen? how do they appear? name two places lesions may be seen?
iii) does it need treatment? how long does it take to resolve? name three self care advice
iv) name two tx if they are problematic?
v) what needs to be considered if extensive lesions? what needs to be doen if lesions are on the eye?
i) skin infec caused by mollsuc contag virus > transmit by personal contact or by fomites (contam surfs) eg shared towels
often occ in children with atopic eczema
ii) pink/pearly white papules with central umbillication
appear in clusters anywhere on body except palms and soles
iii) doesnt need tx and should resolve in 18m
self care - dont share towels, dont scratch, no need for school exclusion
iv) squeeze then bath, cryotherapy, if itching give topical cs
v) consider HIV if extensive lesions
eye > refer to opthal
EPIDIDYMO ORCHITIS
i) what is it? what is most commonly caused by in young? in adults?
ii) name three features? what needs to be ruled out?
iii) what ix is done if young or old?
iv) what is given in mx if STI is caause? what is given if enteric organism is cause?
i) infection of epidid with or without testes > pain and swelling
young - STI eg chlam and gon
old - bladder infec eg ecoli
iii) unilat testic pain and swell, discharge
need to rule out torsion - <20 years with severe pain and acute onset
iii) young - STI test
old - msu for micro and culture
iv) STI - if uknown organism give ceftriaxone 500mg IM plus doxy 100mg BD for 2 weeks
enteric - oral quinolone for 2 weeks eg oflox
