HIV, Sexually Transmitted Diseases and Tropical Infections Flashcards
what are the 6 methods of contracting an STD?
Direct inoculation Trauma IVDU Fomites Ingestion Sexual/genital secretions
what are the risk factors for contracting an STD?
<25 years old several sexual partners Non condom use Gay men History of STI Large urban areas social deprivation Black ethnicity
how is rectal gonorrhoea spread?
direct contact of mucosal surface
anal sex
transmucosal spread
fomite
what are the symptoms of rectal gonorrhoea?
short incubation (5-10 days) lower abdo pain diarrhoea rectal bleeding anal discharge tenesmus maybe assoc symptoms - urethral/vaginal discharge, dysuria
what will appear on proctoscopy in rectal gonorrhoea?
inflamed mucosae
purulent exudate
what are the possible complications of rectal gonorrhoea?
abscess formation
Increased HIV risk
Who is chlamydia more common in?
females
Gay Men
how is chlamydia spread?
transmucosal spread
fomite
anal sex
(same as gonorrhoea)
what is the most common location for chlamydia in gay men?
confined to rectum
what are the symptoms of rectal Chlamydia?
70% asymptomatic
milder than gonorrhoea
anal discomfort/itch and discharge
how is rectal chlamydia diagnosed?
proctoscopy
gram stain rectal swab
how is chlamydia treated?
azithromycin (single dose)
doxycycline (1 week)
Test for cure after 6 weeks
how does primary syphilis present?
solitary painless ulcer
how does secondary syphilis present?
mucosal patches and ulcers mouth, anogenital, rectal Condylomata lata Systemic inflammation Hepatitis
how is herpes simplex virus spread?
ano-genital
oro-anal
where does herpes simplex virus usually affect?
peri-anal mucosa
may extend into rectum
what is the most common type of herpes simplex virus?
HSV2
what are the symptoms of herpes simplex virus?
pain ulcers painful defaecation bleeding mucus viraemic symptoms
how is human papillomavirus spread?
ano-genital
oro-anal
what are the types of HPV?
HPV 6, 11, 16, 18
what are the symptoms of HPV?
anal warts
can extend into rectum
increasing prevalence of anal cancers and Acute interstitial nephritis (in MSM and HIV+)
What groups is Lymphogranuloma venereum associated with?
MSM (often HIV+) Group sex Drug use Syphilis Hep C
what are the clinical features of lymphogranuloma venereum?
primary (3-30 days) = ulcer
Secondary (3-6/12) = inguinal syndrome, ano-rectal syndrome
Tertiary = strictures, fistulae and genital elephantiais
who gets tested for LGV?
MSM with haemorrhagic proctitis
HIV + MSM with rectal chlamydia
Failed chlamydia test of cure
Contact of LGV
what are LGV patients also tested for?
HIV
Hepatitis C
Syphilis
what is the largest immune compartment in the body?
gut associated lymphoid tissue
where are most mucosal lymphocytes?
rectum
foreskin
cervico-vagina
what does HIV infection do to the GI tract?
tract in constant state of physiological inflammation
dense clustering of lymphocytes (cell-cell transmission)
Depletion of gut associated lymphoid tissue
what are the clinical results of GALT loss?
unknown HIV enteropathies Opportunistic infection Persistent immune activation - microbial translocation Accelerated immunosenescence
how might STIs present, generally?
peri-anal pathology
Proctitis
Proctocolitis
Hepato-biliary problems
