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PR3151 (cleefy) > IC18b PR3151 STI > Flashcards

IC18b PR3151 STI Flashcards

1
Q

what are the bacteira STIs?

A

syphilis
gonorrhea
nongonococcal urethritis
chancroid
LGV (lyphogranuloma venereum)
Granuloma inguinale

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2
Q

what is the bacteria causing syphilis?

A

treponema pallidum

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3
Q

what is the bacteria causing gonorrhoea?

A

Neisseria gonorrheae (gram negative intracellular diplococci)

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4
Q

what is the bacteria causing nongonococcal urethritis?

A

CUM:
- chlamydia trachomatis
- ureaplasma
- mycoplasma genitalium

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5
Q

what is the bacteria causing chancroid

A

haemophilus ducreyi

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6
Q

what is the bacteria causing LGV

A

chlamydia trachomatis

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7
Q

what is the bacteria causing granuloma inguinale

A

calymmatobacteria granulomatis

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8
Q

what are the viral STIs?

A

anogenital herpes
anogenital warts
viral hepatitis
HIV/AIDS
molluscum contagiosum

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9
Q

what is the virus causing anogenital herpes

A

HSV type 1 -2 (herpes simplex)

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10
Q

what is the virus causing ano genital warts

A

HPV

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11
Q

what is the virus casuing hepatitis

A

hep A B C

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12
Q

what is the virus causing molluscum contagiosum

A

molluscum contagiosum virus

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13
Q

what are fungal STIs?

A

vaginal candidiasis

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14
Q

what is the fungi causing vaginal candidiasis

A

candida albicans

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15
Q

what are the parasite STIs?

A

scabies
pediculosis pubis

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16
Q

what is the parasite causing scabies

A

Sarcoptes scabiei

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17
Q

what is the parasite causing pediculosis pubis

A

Phthirus pubis

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18
Q

what are the two STIs that can also be transmitted via non-sexual contact?

A

vaginal candidiasis and
scabies

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19
Q

what STis need to be reported for MD131 under the infectious diseases act?

A

syphilis
gonorrhea
nongonococcal urethritis
chlamydia
genital herpes
viral hepatitis
HIV/AIDS

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20
Q

when should MD131 be reported?

A

within 72 hours

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21
Q

what is the purpose of MD131?

A

for monitoring and evaluation of national control programmes

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22
Q

what is collected in MD131?

A

demographic data (age, gender, ethnicity, nationality)

not for contact tracing or case detection

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23
Q

what special actions must be taken for HIV/AIDS?

A

partner notification is mandatory

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24
Q

what are the modes of transmission of STIs?

A

1) contaminated blood
2) sexual intercourse with a contaminated individual
3) contact of broken skin with eg open sores, genital discharge
4) mother to child

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25
Q

relate pathogen to transmissio
1) pregnancy
2) child birth
3) breast feeding

A

1) pregnancy: HIV, syphilis
2) child birth: chlamydia, HSV, gonorrhea
3) breast feeding; HIV

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26
Q

what are the risk factors for STIs

A

unprotected sex
multiple sex partners
illicit drug users
commercial sex workers
male-male sex

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27
Q

what are the individual prevention methods for STIs?

A

abstinence and reduction in number of sex partners
barrier contraceptives
avoid drug abuse and sharing needles
pre exposure vaccination: HPV, hepB
pre and post exposure prophylaxis:

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28
Q

gonorrhea transmission method

A

mother to child during childbirth
sexual intercourse

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29
Q

diagnostic test for gonorrhea

A

culture
gram stain
NAAT nucleic acid amplification test

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30
Q

infection sites for gonorrhea

A

Urethritis

Cervicitis

Proctitis (rectal)

Pharyngitis

Conjunctivitis

Disseminated

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31
Q

symptoms of uncomplicated urogenital gonorrhoea? (male and female)

A

male: purulent urethral discharge, dysuria, urinary frequency

female: mucopurulent vaginal discharge, dysuria, urinary frequency

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32
Q

complications of gonorrhea if untreated?

A

Males –epididymitis, prostatitis, urethral stricture, disseminated disease

Females –Pelvic inflammatory disease, ectopic pregnancy, infertility, disseminated disease

Both -Disseminated –skin lesions, tenosynovitis, monoarticular arthritis

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33
Q

treatment recommendations for uncomplicated gonorrhoea

A

avoid fluoroquinolones due to high rates of resistance

add on therapy (doxycycline); treatment of gonorrhoea should be accompanied by anti-chlamydial therapy (typically occur together)

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34
Q

what is the first line regimen for gonorrhea treatment?

A

for adults <150kg
- ceftriaxone IM 500mg single dose
for adults ≥150kg
- ceftriaxone IM 1g single dose

concurrent anti-chlamydia treatment (if not excluded)
- doxycycline PO 100mg BD x 7days

35
Q

what is the alternative regimen for gonorrhea treatment?

A

1)
gentamicin 240mg IM single dose
AND
azithromycin 2g PO single dose

OR
2)
cefexime 800mg PO single dose
ADD on doxycycline PO 100mg BD x7 days if chlamydia not excluded

36
Q

management of sex partners for gonorrhoea?

A

Sex partners in the last 60 days should be evaluated and treated. If last sexual exposure > 60 days, the most recent partner to be treated.

To minimize disease transmission, persons treated for gonorrhoea should be instructed to abstain from sexual activity for 7 days after treatment (ie. 7 days after receiving treatment and resolution of symptoms, if symptom was present).

To minimize risk for reinfection, patients also should be instructed to abstain from sexual intercourse until all their sex partners have been treated.

37
Q

chlamydia description? pathogen, mode of transmission, symptoms

A

by chlamydia trachomatis
similar mode of transmission and presentation as gonorrhoea

38
Q

first line treatment regimen for chlamydia?

A

PO doxycycline 100mg BD x 7 days

39
Q

alternative treatment regimen for chlamydia?

A

PO azithromycin 1g single dose

OR

PO levofloxacin 500mg OD x7days

40
Q

which drug no longer recommended for chlamydia?

A

erythromycin due to GI side effects affecting adherence

other FQs are also ineffective (minus levofloxacin)

41
Q

management of sex partners for chlamydia?

A

Sex partners in the last 60 days should be evaluated and treated. If last sexual exposure > 60 days, the most recent partner to be treated.

To minimize disease transmission, persons treated for chlamydia should be instructed to abstain from sexual intercourse for 7 days after single-dose therapy, or until completion of a 7-day regimen and resolution of symptoms if was present.

To minimize risk for reinfection, patients also should be instructed to abstain from sexual intercourse until all their sex partners have been treated.

42
Q

transmission methods for syphilis

A

mother to child (during pregnancy)
sexual contact

43
Q

what is the diagnosis test used for syphilis

A

darkfield microscopy of exudates from lesions

44
Q

how many tests (and type of tests) are needed for syphilis?

A

2 serological tests:
1 treponemal and 1 non-treponemal test

45
Q

describe the treponemal tests used for syphilis

A

Uses treponemalantigen to detect treponemalantibody

EgT. pallidum Haemaggluntinationtest (TPHA), T. pallidum passive particle agglutination assay(TPPA)

Treponemal tests are more sensitive and specific than nontreponemal tests, used as confirmatory tests.

May remain reactive for life, hence not for monitoring response to treatment

46
Q

describe the non-treponemal tests used for syphilis

A

Uses nontreponemalantigen (cardiolipin) to detect treponemalantibodies

2 different commonly used test
a) Venereal Disease Research Laboratory (VDRL) slide test
b) Rapid plasma reagin(RPR) card test

The result reported in the quantitativeVDRL/RPR test is the most dilute serum concentration with a positive reaction (eg result 1:16 positive means at 1:32 no reaction seen)

Antibody titres correlates with disease activity and hence used as a tool to monitor response to treatment(VDRL/RPR are not interchangeable; need to use the same test for monitoring)

Nontreponemal test titres usually declines after treatment and can become non-reactive with time

47
Q

first-line treatment regimen for primary, secondary or early latent (<1yr) syphilis?

A

benzathine pen G IM 2.4 mu single dose

48
Q

first line treatment regimen for late latent (>1yr) or unknown duration syphilis?

A

benzathine pen G IM 2.4 mu once a week x 3 doses

49
Q

first line treatment regimen for neurosyphilis?

A

iv crystalline pen G 3-4 mu q4 x10-14 days
OR
iv crystalline pen G 18-24 mu continuous infusion x10-14 days
OR
im procaine pen G 2.4 mu OD + PO probenecid 500mg QD
x10-14 days

50
Q

(pen allergy) alternative treatment regimen for primary, secondary or early latent (<1yr) syphilis?

A

PO doxycycline 100mg BD x10-14days

51
Q

(pen allergy) alternative treatment regimen for late latent (>1yr) or unknown duration syphilis?

A

PO doxycycline 100mg BD x28days

52
Q

(therapeutic response syphilis) what is an accompanying reaction after syphilis therapy?

A

The Jarisch-Herxheimer reaction is an acute febrile reaction frequently accompanied by headache, myalgia, and other symptoms that usually occur within the first 24 hours after any therapy for syphilis.

Antipyretics will help but not prevent.

53
Q

(pen allergy) alternative treatment regimen for neurosyphilis?

A

IV/ IM ceftriaxone 2g daily x 10-14 days

If concern for cross-sensitivity –skin test to confirm penicillin allergy, desensitize if necessary

54
Q

(therapeutic response syphilis) monitoring for Primary / secondary/ Latent syphilis?

what indicates tx success?

HOW frequent should monitoring be?

A

Quantitative VDRL or RPR at 3, 6, 12, 18 and 24months

treatment success = decrease of VDRL or RPR titre by at least fourfold (eg1:64 to 1:16)

55
Q

(therapeutic response syphilis) monitoring for neurosyphilis?

A

CSF examination every 6 month until CSF normal

56
Q

what indicates treatment failure for syphilis?

A

Treatment failure at 6 mths

  • show sign and symptoms of disease or
  • Failure to decrVDRL or RPR titre by fourfold OR incr(1:16 to 1:64)

Retreat and re-evaluate for unrecognised neurosyphilis

57
Q

Managementof sexual partners for syphilis?

A

All at risk sexual partners should be evaluated for STIs and treated if tested positive.

Persons who receive syphilis treatment must abstain from sexual contact with new partners until the syphilis lesions are completely healed. Patient with syphilis need careful assessment of whether they have responded and if their symptoms resolved by the doctor, it is goodto advise patient to check with the doctor if they have been fully treated.

57
Q

what are the characteristics of genital herpes?

A

caused be HSV type 1 and 2
mainly type 2

chronic and lifelong infection,
may be asymptomatic while shedding (of epithelial cells) and transmission occurs.

58
Q

what is the cycle of infection for genital herpes?

A

five stages:
primary mucocutaneous infection,
infection of the nerve ganglia,
establishment of latency,
reactivation, and
recurrent outbreaks/flairs.

59
Q

how long do genital herpes vesicles take to develop and heal?

A

7-10 days
2-4 weeks to heal

60
Q

method of transmission for genital herpes?

A

body fluids
intimate skin contact

61
Q

presentation/symptoms of genital herpes?

A

classical painful multiple vesicular or ulcerative lesions

Also local itching, pain, tender inguinal lymphadenopathy

Flu-like symptoms (e.g., fever, headache, malaise) during first few days after appearance of lesions.

Prodromal symptoms like mild burning, itching or tingling are seen in approximately 50% of patients prior to appearance of recurrent lesions (in recurrent disease).

Symptoms less severe in recurrent disease (less lesions, heal faster, milder symptoms)

62
Q

what are the diagnostic tests for genital herpes?

A

virologic

type specific (hsv1 or2) serology tests

63
Q

what are the virologic tests used for genital herpes?

A

viral cell culture
NAAT(pcr)

to identify hsv dna from genital lesions

64
Q

what is the purpose and indication for type-specific tests for genital herpes?

A

to test for HSV antibodies = hsv-2 atb = anogenital infection

not recommended for the first episode as takes 6-8weeks for antibodies to develop and serological detection

64
Q

when best to initiate antiviral tx for genital herpes?

A

within 72hours

64
Q

what is the supportive care for genital herpes

A

1) Warm saline bath relieves discomfort

2) Symptoms management –analgesia, anti-itch

3) Good genital hygiene to prevent superinfection

4) Counseling regarding natural history, e.g., it is a chronic lifelong condition with possible recurrences

65
Q

treatment regimen for 1st episode of genital herpes?

include serious illness

A

acyclovir
PO 400mg TDS for 7–10 days

OR

IV 5-10 mg/kg q8h x 2-7 days, complete with PO for a total 10 days (for severe disease or complications that requires hospitalisation)

or

valacyclovir
PO 1g BD for 7–10 days

65
Q

counselling for acyclovir

A

Counselling:
Take without regard to food, after food if GI upset. SE: Malaise, headache, NVD.

Maintain adequate hydration to prevent crystallisation in renal tubules.

65
Q

moa of acyclovir

A

inhibit viral synthesis and replication by inhibiting viral dna polymerase

66
Q

how to manage recurrent genital herpes?

A

Antiviral as Chronic Suppressive or Episodic Therapy

Choice is based on patient’s preference

66
Q

counselling for valacyclovir

A

Counseling: Per acyclovir including hydration. Headache is main SE.

67
Q

pros of chronic suppression therapy for genital herpes?

A

many patients report no symptomatic outbreaks

reduces the frequency of recurrences by 70%–80% in patients who have frequent recurrences (i.e.>6 recurrences per year)

hence improved quality of life

established long-term safety & efficacy

decr risk of transmission (in combination with consistent condom use and abstinence during recurrences)

67
Q

regimen for chronic suppression therapy for genital herpes?

A

acyclovir 400mg BD

or

valacyclovir 1g OD
(can go down to 500mg OD if patients <10 recurrences per year)

or

famicyclovir 250mg BD

67
Q

cons of chronic suppression therapy for genital herpes?

A

Cost

Compliance

68
Q

what is the duration of chronic suppressive therapy for genital herpes

A

patients to discuss with physician on length of therapy as recurrence diminishes over time

note that patients with complicated disease e.g., disseminated disease (encephalitis, meningitis, keratitis) OR immunocompromised may require indefinite therapy

69
Q

pro of episodic therapy for genital herpes?

A

Shorten duration and severity of symptoms

Less costly vs chronic suppression

Patient more likely to be compliant

70
Q

con of episodic therapy for genital herpes?

A

Requires initiation of therapy within 1 day of lesion onset or during the prodrome that precedes some outbreaks

Does not reduce risk of transmission

70
Q

counselling for genital herpes

A


Educate concerning the natural history of the disease

Encourage them to inform their current and future sex partners

Sexual transmission of HSV can occur during asymptomatic periods.

All persons with genital herpes should remain abstinent from sexual activity with uninfected partners when lesions or prodromal symptoms are present.

The risk of HSV sexual transmission can be decreased by the daily use of valacyclovir or acyclovir by the infected person.

Recent studies indicate that latex condoms, when used consistently and correctly, might reduce the risk for genital herpes transmission.

Risk for neonatal HSV infection

Increased risk for HIV acquisition

70
Q

regimen for episodic therapy for genital herpes?

A

PO acyclovir 800mg BD x5 days
or 800mg TDS x2 days

OR

PO valacyclovir 500mg OD x 5 days

71
Q

management of sex partners for genital herpes?

A


Symptomatic sex partners should be evaluated and treated in the same manner as patients who have genital lesions.

Asymptomatic sex partners of patients who have genital herpes should be questioned concerning histories of genital lesions, and encouraged to examine themselves for lesions and seek medical attention early if lesions occur. May be offered type-specific serologic testing for HSV-2.

72
Q

PK of acyclovir vs valacyclovir

A

BA 10-20% vs 50% (valacyclovir)
both t1/2 = 3h

73
Q

when to initiate episodic therapy

A

during prodromal symptoms or within 1 day of lesion onset

PR3151 (cleefy) (12 decks)

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