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General practice > ID and Sexual health > Flashcards

ID and Sexual health Flashcards

1
Q

What is chlamydia caused by

A

Chlamydia is the most prevalent sexually transmitted infection in the UK and is caused by Chlamydia trachomatis, an obligate intracellular pathogen.

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2
Q

Features of chlamydia

A

asymptomatic in around 70% of women and 50% of men

women: cervicitis (discharge, bleeding), dysuria
men: urethral discharge, dysuria

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3
Q

Potential complications of chlamydia

A

epididymitis
pelvic inflammatory disease
endometritis
increased incidence of ectopic pregnancies
infertility
reactive arthritis
perihepatitis (Fitz-Hugh-Curtis syndrome)

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4
Q

IX for chalmydia

A

nuclear acid amplification tests (NAATs) are now the investigation of choice
urine (first void urine sample), vulvovaginal swab or cervical swab may be tested using the NAAT technique

for women: the vulvovaginal swab is first-line
for men: the urine test is first-line
Chlamydiatesting should be carried out two weeks afte

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5
Q

How long after exposure should chlamydia testing be done

A

Two weeks after a possible exposure

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6
Q

What might be seen in a Pap smear that is typical of chlamydia

A

red inclusion bodies

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7
Q

Mx of chlamydia

A

Doxycycline (7 day course) if first-line

if doxycycline is contraindicated /pregnant/ not tolerated then either azithromycin (1g od for one day, then 500mg od for two days) should be used

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8
Q

Guidance regarding contacting sexual partners - chlamydia

A

for men with urethral symptoms: all contacts since, and in the four weeks prior to, the onset of symptoms

for women and asymptomatic men all partners from the last six months or the most recent sexual partner should be contacted
contacts of confirmed

Chlamydia cases should be offered treatment prior to the results of their investigations being known (treat then test)

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9
Q

What is bacterial vaginosis

A

Bacterial vaginosis (BV) refers to an overgrowth of bacteria in the vagina, specifically anaerobic bacteria.

It is not a sexually transmitted infection

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10
Q

What is BV caused by

A

Loss of the lactobacilli “friendly bacteria” in the vagina. Bacterial vaginosis can increase the risk of women developing sexually transmitted infections.

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11
Q

Purpose of lactobacilli in the vagina

A

Lactobacilli are the main component of the healthy vaginal bacterial flora.

These bacteria produce lactic acid that keeps the vaginal pH low (under 4.5).

The acidic environment prevents other bacteria from overgrowing. When there are reduced numbers of lactobacilli in the vagina, the pH rises.

This more alkaline environment enables anaerobic bacteria to multiply.

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12
Q

Examples of anaerobic bacteria associated with BV

A

Gardnerella vaginalis (most common)
Mycoplasma hominis
Prevotella species

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13
Q

Risk factors for BV

A

Multiple sexual partners (although it is not sexually transmitted)
Excessive vaginal cleaning (douching, use of cleaning products and vaginal washes)
Recent antibiotics
Smoking
Copper coil

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14
Q

In which women does BV occur less frequently in

A

Bacterial vaginosis occurs less frequently in women taking the combined pill or using condoms effectively.

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15
Q

BV presentation

A

Fishy-smelling watery grey or white vaginal discharge. Half of women with BV are asymptomatic.

Itching, irritation and pain are not typically associated with BV and suggest an alternative cause or co-occurring infection.

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16
Q

Appropriate examination in BV

A

Speculum examination

High vaginal swab to exclude other causes of symptoms

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17
Q

IX for BV

A

Vaginal pH can be tested using a swab and pH paper. The normal vaginal pH is 3.5 – 4.5. BV occurs with a pH above 4.5.

A standard charcoal vaginal swab can be taken for microscopy. This can be a high vaginal swab taken during a speculum examination or a self-taken low vaginal swab.

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18
Q

What is seen on microscopy in BV

A

Bacterial vaginosis gives “clue cells” on microscopy. Clue cells are epithelial cells from the cervix that have bacteria stuck inside them, usually Gardnerella vaginalis.

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19
Q

Mx of BV

A

Asymptomatic BV does not usually require treatment.

Metronidazole for symptomatic BV(given orally, or by vaginal gel)

Clindamycin is an alternative antibiotic

Provide advice and information about measures that can reduce the risk of further episodes of bacterial vaginosis, such as avoiding vaginal irrigation or cleaning with soaps that may disrupt the natural flora.

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20
Q

Complications of BV

A

Increased risk of STIs

Miscarriage
Preterm delivery
Premature rupture of membranes
Chorioamnionitis
Low birth weight
Postpartum endometritis
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21
Q

What is vaginal candidiasis commonly referred to as

A

Thrush

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22
Q

What is vaginal candidiasis

A

vaginal infection with a yeast of the Candida family. The most common is Candida albicans.

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23
Q

Risk factors for thrush

A

Increased oestrogen (higher in pregnancy, lower pre-puberty and post-menopause)
Poorly controlled diabetes
Immunosuppression (e.g. using corticosteroids)
Broad-spectrum antibiotics

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24
Q

Presentation of vaginal candidiasis

A

Thick, white discharge that does not typically smell

Vulval and vaginal itching, irritation or discomfort

25
Q

What can more severe vaginal candidiasis lead to

A 
Erythema
Fissures
Oedema
Pain during sex (dyspareunia)
Dysuria
Excoriation
26
Q

IX for thrush

A

Testing the vaginal pH using a swab and pH paper can be helpful in differentiating between bacterial vaginosis and trichomonas (pH > 4.5) and candidiasis (pH < 4.5).

Charcoal swab with microscopy to confirm diagnosis

27
Q

Treatment of candidiasis

A 
Antifungal cream (i.e. clotrimazole) inserted into the vagina with an applicator
Antifungal pessary (i.e. clotrimazole)
Oral antifungal tablets (i.e. fluconazole)
28
Q

What is an over the counter option for thrush

A

Canesten Duo is a

It contains a single fluconazole tablet and clotrimazole cream to use externally for vulval symptoms.

29
Q

Treatment for recurrent thrush infections

A

Can be treated with an induction and maintenance regime over six months with oral or vaginal antifungal medications. This is an off-label use.

30
Q

Advice regarding contraception when using anti fungal creams and pessaries

A

Warn women that antifungal creams and pessaries can damage latex condoms and prevent spermicides from working, so alternative contraceptive is required for at least five days after use.

31
Q

What is CMV retinitis

A

Common in his patients with a low CD4 count(<50)

presents with visual impairment e.g. ‘blurred vision’. Fundoscopy shows retinal haemorrhages and necrosis, often called ‘pizza’ retina

32
Q

Treatment for CMV retinitis

A

IV ganciclovir

33
Q

How is CMV transmitted

A

Cytomegalovirus (CMV) is transmitted in leucocytes.

34
Q

Purpose of irradiating blood products

A

Irradiated blood products are depleted of T-lymphocytes and used to avoid transfusion-associated graft versus host disease (TA-GVHD) caused by engraftment of viable donor T lymphocytes.

35
Q

What precedes rheumatic fever

A

Rheumatic fever develops following an immunological reaction to recent(2-6 weeks ago) strep pyogenes infection

36
Q

Pathogenesis of rheumatic fever

A

Streptococcus pyogenes infection → activation of the innate immune system leading to antigen presentation to T cells

B and T cells produce IgG and IgM antibodies and CD4+ T cells are activated
there is then a cross-reactive immune response (a form of type II hypersensitivity) thought to be mediated by molecular mimicry

the cell wall of Streptococcus pyogenes includes M protein, a virulence factor that is highly antigenic.

It is thought that the antibodies against M protein cross-react with myosin and the smooth muscle of arteries

37
Q

What are Aschoff bodies

A

Describes the granulomatous nodules found in rheumatic heart fever

38
Q

Testing for strep infection in rheumatic fever - ix

A

Raised or rising strep antibodies
Positive throat swab
Positive rapid group A strep antigen test

39
Q

Clinical features of rheumatic fever

A

Erythema marginatum
Sydenham’s chorea: this is often a late feature
Polyarthritis
Carditis and valvulitis (eg, pancarditis)
Subcutaneous nodules

40
Q

Mx of rheumatic fever

A

Antibiotics - oral pen v
NSAIDs
Treatment of any complications(heart failure)

41
Q

What causes glandular fever

A

Epstein-Barr virus

Less frequently - CMV and HHV-6

42
Q

Features of glandular fever

A 
Sore throat 
Pyrexia 
Lymphadenopathy(anterior and posterior triangles of the neck)
Malaise 
Palatal petechiae
43
Q

Complications of infectious mononucleosis

A

Splenomegaly(splenic rupture)
Hepatitis(transient rise in ALT)
Lymphocytosis
Haemolytic anaemia secondary to cold agglutinins(IgM)
Maculopapular, pruritic rash develops in patients taking amoxicillin

44
Q

Diagnosis of infectious mononucleosis

A

Heterophil antibody test(monospot test) - NICE guidelines suggest FBC and Monospot in the 2nd week of the illness to confirm a diagnosis of glandular fever.

45
Q

Management of infectious mononucleosis

A

rest during the early stages, drink plenty of fluid, avoid alcohol
simple analgesia for any aches or pains
consensus guidance in the UK is to avoid playing contact sports for 4 weeks after having glandular fever to reduce the risk of splenic rupture

46
Q

Autoimmune causes of lymphadenopathy

A

SLE

rheumatoid arthritis

47
Q

Common side effects of trimethoprim

A

Rashes, including photosensitivity
Pruritus
Suppression of haematopoiesis

48
Q

What is a common cause of pneumonia in HIV patients

A

Pneumocystis jiroveci is an unicellular eukaryote, generally classified as a fungus but some authorities consider it a protozoa
PCP is the most common opportunistic infection in AIDS

49
Q

At what point should HIV patients receive PCP prophylaxis

A

all patients with a CD4 count < 200/mm³ should receive PCP prophylaxis

50
Q

Features of PCP

A

dyspnoea
dry cough
fever
very few chest signs

51
Q

What is a common complication of PCP

A

Pneumothorax

52
Q

Extrapulmonary manifestations of PCP

A

hepatosplenomegaly
lymphadenopathy
choroid lesions

53
Q

IX for PCP

A

CXR: typically shows bilateral interstitial pulmonary infiltrates

exercise-induced desaturation

sputum often fails to show
PCP, bronchoalveolar lavage (BAL) often needed to demonstrate PCP (silver stain shows characteristic cysts)

54
Q

Management of PCP

A

Co-trimoxazole

55
Q

Most common cause of meningitis 6 yrs - 60 years

A

Neisseria meningitidis

Streptococcus pneumoniae

56
Q

Most common cause of meningitis >60 years

A

Streptococcus pneumoniae
Neisseria meningitidis
Listeria monocytogenes

57
Q

Antibiotic recommendation for meningitis < 50 years

A

Intravenous cefotaxime (or ceftriaxone) + amoxicillin (or ampicillin)

58
Q

Antibiotic - meningitis 3-50 years

A

Intravenous cefotaxime (or ceftriaxone)

59
Q

Mx of meningitis caused by listeria

A

Intravenous amoxicillin (or ampicillin) + gentamicin

General practice (26 decks)

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