Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

repro > HIV testing > Flashcards

HIV testing Flashcards

1
Q

RFs of HIV

A 
MSM
multiple partenrs
history of STI hep B or C
anal sex or sex clubs or chem sex
female sexual contacts of MSM
current or former partner with HIV
IV drug use
tattoos
HIV positive mothers
needlestick injury 
from HIV country prevalent
prostiturtes
rape.sexual assault
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

who are recommended to have a test for HIV

A 
MSM
female contacts
IVDU
Black african men and women
born high risk countries
DD
partner with HIV
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

can someone with HIV treatment can have sex with someone who doesnt have

A

undetectable viral load for 6 months = untrasmissable

take meds properly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

methods for HIV testing

A 
1) venepuncture - highly sensitive and highly specific
P24 Antigen
HIV Antibody
BEST TEST
ELISA on blood or saliva

2) rapid point if care test and dried blood spot - comes back within 20 minutes
drawback - looks for ABs against HIV virus ABs take time to build up. delay in picking up the infection
not specific or sensitive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

window period for HIV

A

high risk exposure

- 45 days days later for result

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

if initial test is negative for HIV

A

repeat test in a few weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what other tests would you offer in HIV patient

A 
HEP B/C
chlamydia
gon
syphillis
HIVA
HEP A
viral load and CD4 count 
- offer hep B vaccination
- HPV vaccination - upto age of 45 to - prevent warts adn cancer of genital skin
- discuss PEPSE/PrEP (take one tablet daily to reduce risk of HIV acquisition)
- discuss safe sec
- Window Period testing - infectious period 45 days
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

where will you take swabs for HIV

A

oral
rectal
urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

window period for chlam or gonoe

A

takes 2 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

windown period for syphillis, hepB orC

A

12 weeks

hep C is 9 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

fequency of HIV testing

A

every 3 months - MSM

- USING pREp

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Annual test for HIV is recommeded to who

A

commerucal sex workers
IVDU
hetero changin partner
Black african men

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

in which condition which will you recommend HIV testing

A

mononucleosis-like syndrome

recurrent bacterial pneumonia

recurrent or severe shingles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is bacterial vaginosis

A

most common cause of abnormal vaginal discharge in women of reproductive age.

CAUSE

  • imbalance of vaginal flora
  • loss of lactobacilli that maintain acidic pH of vagina >4.5

Triggers

  • sex
  • menses
  • receptive oral SI
  • vaginal douching
  • perfumed bath products
  • change in sexual partners
  • presence of STI

The most common organisms include Gardnerella vaginalis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

presentation of bacterial vaginosis

A

Offensive, fishy-smelling vaginal discharge without soreness or irritation.

On examination, there is usually a thin layer of white discharge covering the vaginal wall.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Ix and diagnosis fro bacterial vaginosis

A

Hay-Ison criteria
Gram stain post fornix
0= no bacteria
1=normal
2= reduced lactobacilli plus mixed flora (intermediate)
3= few or absent lactobacilli and mixed flora, predom Gardnerella morphotypes
4=Gram positive Cocci dominate

Amsel’s criteria require at least three of the following for diagnosis:

  • Homogeneous discharge as described above.
  • Microscopy showing vaginal epithelial cells coated with a large number of bacilli (“clue cells”).
  • Vaginal pH >4.5.
  • Fishy odour on adding 10% potassium hydroxide to vaginal fluid. (WHIFF TEST)
17
Q

Mx and complications of BV

A

General advice e.g. avoiding vaginal douching, use of shower gels.
Asymptomatic women usually do not need treatment, unless they are pregnant.

If symptomatic - oral metronidazole 400-500 mg bd for 5-7 days. Treatment of choice (and can be used in pregnancy).

complications
BV can increase the risk of acquiring and transmitting HIV and other STIs.
In pregnancy, BV is associated with various complications including preterm delivery, premature rupture of membranes and postpartum endometritis.

DDx

  • chlamydia and gonorrhoea
  • trichomonad vaginalis
  • vaginal candidiasis
18
Q

factors ass w vaginal candidiasis

A 
diabetes mellitus
recent antibiotics upto 3m before
steroids
- high oestrogen levels -> pregnancy, luteal phase, COCs
immunosuppression: HIV
19
Q

features of vaginal candidiasis

Mx

A
  • ‘cottage cheese’, - non-offensive discharge
  • vulvitis: superficial dyspareunia, dysuria
    itch

Examination
vulval erythema, fissuring, satellite lesions may be seen, pH - 4

Ix

  • swabs taken from high vaginal walls
  • microscopy shows pores, pseudohyphae -> active then neutrophils too

Mx
1. fluconazole 150mg PO stat -> avoid in pregnancy/breastfeeding or clotrimazole pessary 500mg PV stat

PLUS clotrimazole 1% cream top BD for 2 weeks

20
Q

recurrent vaginal candidiasis

A

4 or more episodes per year
compliance with previous treatment should be checked
confirm the diagnosis of candidiasis
high vaginal swab for microscopy and culture
consider a blood glucose test to exclude diabetes
exclude differential diagnoses such as lichen sclerosus
consider the use of an induction-maintenance regime

induction: oral fluconazole every 3 days for 3 doses
maintenance: oral fluconazole weekly for 6 months

CI - clotrimazole pessaries used

21
Q

HIV Mx

A

antenatal care
- before pregnancy they have to take all their antiretroviral therapy
do blood test to check CD4 count
HIV obstetrics clinic

never been on therapy

  • need to be started
  • tenofovir

less than 50 CD4 before giving birth

during birth
>50 viral load C section -> give IV antiretrovirals zidovudine
<50 normal vaginal delivery

once u get baby wash the baby and cord clamp

postnatally
- really low viral load and compliant w therapy - baby has to be on one retroviral 2-4 weeks

high risk pregnancy 3-4 weeks
test HIV delivered, upon discharge,

Mum cant breastfeed

22
Q

factors which reduce vertical transmission of HIV in pregnancy

A
  • maternal antiretroviral therapy
  • mode of delivery (caesarean section)
  • vaginal delivery is recommended if viral load is less than 50 copies/ml at 36 weeks, otherwise caesarian section is recommended
    a zidovudine infusion should be started four hours before beginning the caesarean section
  • neonatal antiretroviral therapy
  • > zidovudine is usually administered orally to the neonate if maternal viral load is <50 copies/ml. Otherwise triple ART should be used. Therapy should be continued for 4-6 weeks.
  • infant feeding (bottle feeding)
23
Q

RFs of STI

A

aged under 25
>1 sexual partner in the last 12 months
new sexual partner
UPSI

24
Q

Ix for STI

A

endocervical swab p wet mount - trichomonas
gram stain microscopy, culture -> BV/candida

vulvovaginal swab

  • NAAT for N. gonorrhoeae
  • C. Trachomatis

Other tests
- culture - endocervical culture

25
Q

DDx for vaginal discharge

A

physiological

  • sexual arousal
  • menstrual cyclical variation
  • pregnancy
pathological
vaginal 
- candidiasis 
- trichomonas
- BV
- foreign body
- PM vaginitis

Cervical

  • gonorrhoea
  • non-specific infection
  • herpes
  • cervical ectopy
  • cervical neoplasm
26
Q

what is trichomonas vaginalis

A

flagellated protozoan
STI -> vagina urethea in paraurethral glands

clinical features
- frothy vaginal discharge
- dysuria
- vulval soreness/itching-> vulvitis/vaginitis
strawberry cervix - 2%

infections in males present as non specific (urethritis)

complications
- pregnancy ->preterm, low birth weight
increase HIV transmission

Ix - swab from posterior fornix
- wet mount
- charcoal culture
- NAATS -> 98-100%
TV testing -> persistent urethritis w urethral culture or culture of first void urine

Mx
1st - metronidazole 400mg BD 5-7 days
2nd - metronidalzole stat
treat partners prophylatically

avoid sex til Mx complete

27
Q

Ix for male urethral discharge

A
  • urine NAAT for gonorrhoea/chlamydia
  • gram-stained smear from urethra (having held urine)
    +/- polymorphonuclear leucocytes (urethritis)
    +/- gram negative intracellular diplococci
    (Gonorrhoea)
  • Gonorrhoea culture - Mx or if suspecting
28
Q

Non specific urethritis

A

make this diagnosis in the absence of chalmydia/gonorrhoea

urethral discharge, dysuria, penile irritation

Diagnosed thru gram stain and microscopy of urethral sample
>5 polymorphonuclear leucoyctes

Mx
Doxycycline for 7 days

29
Q

chlamydia trachomatis

A

asymptomatic

  • cervicitis, urethritis
  • obligate intracellular bacterium

complications
- PID, epididymoorchitis, SARA, tubal factor infertility, increase risk of ectopics pregnancy

30
Q

clinical features of chlamydia

A

asymptomatic
- conjuncitivits, pharyngitis, SARA, proctitis

men

  • discharge
  • dysuria
  • testicular pain

women

  • discahrge
  • postcoital bleeding
  • IMB
  • lower abdominal pain/PID
  • dysuria

Mx
1st line -> doxycycline 100mg BD for 7 days CI in PREGNANCY

2nd line Azithromycin

complicated infections
PID/epidiymoorchitis

retest at 3-6 months in under 25s

31
Q

Neisseria Gonorrhoeae

A

Gram negative ontracellular diplococci

asymptomatic
proctitis
DI rash joint pain or erythema

men

  • purulent urethral discharge
  • epididymoorchitis

women

  • purulent discahrge
  • IMB/PCB
  • PID

diagnosis

  • > near patient testing microscopy
  • > NAAT testing
  • > cultures

Mx

  • ceftriaxone 1g Stat IM single dose
  • if sensitivities are back then we can gibe ciprofloxacin

Pregnant - azithromycin FAILS erythromycin
no sex until 1 week post treatment

they come back after one week

32
Q

mycoplasma genitalum

A

same as normal in terms on Sx

doxycyline 1 weeks followed by 3 days of azithromycin

alternative moxifloxacin

33
Q

what are genital warts

A

benign lesions cause by HPV - 6/11
STI

incubation period 2-8w

HPV affects the basal layer

warty growth - asymptomatic painless

itchy

urethral - urinary Sx

bleedings

signs

  • soliatry/multiple
  • broad/penduculated/pigmented
  • non keratinised on warm moist skin
  • keratinised on hairy skin firm

Ix
speculum - women

DDx
molluscum contagiosum
condylomata lata - secondary syphillis

34
Q

features of cancerous warts

A 
pigmentation
depig
pruritus 
immune defifcicny
previous Hx of intraepithelial neoplasia 
refer
- internal lesions
- do not respond to Mx
- immunosuppressed pts
pregnant women
children
elderly pts
35
Q

Mx of genital warts

A

screen for other STs
encourage condom use

await sponataneous resolution
cryotherapy
surgery
anti-miotic agents

36
Q

cervical smears in HIV positive women

A

every year

Women who are HIV positive are at an increased risk of cervical intra-epithelial neoplasia (CIN) and cervical cancer due to a decreased immune response and decreased clearance of the human papilloma virus. (1) HIV positive women who have low-grade lesions (CIN1) do not clear these lesions and these can progress to high-grade CIN or cervical cancer. Even those women who are effectively treated with antiretrovirals have a high risk of abnormal cytology and an increased risk of false-negative cytology. (1)

repro (28 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions