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Management of Infection > Lecture 17 - Sexually Transmitted Infections > Flashcards

Lecture 17 - Sexually Transmitted Infections Flashcards

1
Q

What are the most common symptoms of an STI?

A 
no symptoms 
a genital rash
urethral discharge 
genital ulceration 
lymph node swelling in groin region 
raised core body temperature
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2
Q

What is the most prominent STI in the uk?

A

chlamydia

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3
Q

What are important drivers of STIs?

A

cognitive

behavioural

biological factors

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4
Q

Cognitive development affecting STI?

A

younger adults tend to have less life experience so have reduced reasoning or judgement capacity

they tend to be more concrete thinkers so focussed on immediate circumstances and have reduced ability to plan ahead

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5
Q

Behaviour that can affect chances of getting an STI?

A

less likely to use a condom

more likely to have multiple/overlapping partners

greater likelihood ob substance use

an older partner predisposes to a relationship power imbalance
(sexual negotiation is more difficult, increased risk of involuntary intercourse and unsafe sex)

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6
Q

Why are younger females more susceptible to STIs?

A

cervical ectopy

decreased local immunity in genital tract

a smaller introitus and/or lack of lubrication can lead to traumatic sex

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7
Q

Increased susceptibility of STI in males?

A

occurs in uncircumcised males regardless of age

phimosis (foreskin cannot retract over the head of the penis)

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8
Q

Sexual health inequalities?

A

disproportionately affects those experiencing poverty and social exclusion

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9
Q

Sexual health inequalities are most prevalent in?

A

asylum seekers and refugees

sex workers and clients

homeless and young people in care

men who have sex with men

some black and minority ethnic groups

young people

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10
Q

What is sensitivity?

A

the proportion of people with a disease who will have a positive result

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11
Q

What is specificity?

A

the proportion of people without the disease who will have a negative result

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12
Q

What is high sensitivity good for?

A

ruling out a disease if a person tests negative

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13
Q

What is high specificity good for?

A

ruling in a disease if a person tests positive

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14
Q

What is the positive predicted value?

A

the proportion of people with a positive result who actually have the disease

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15
Q

What is the negative predicted value?

A

the proportion of people with a negative test who do not have the disease

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16
Q

What is chlamydia trachomatis?

A

an obligate intracellular parasite

small gram negative bacilli with no peptidoglycan layer in cell wall

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17
Q

What are primarily associated with urogenital infections?

A

Serovars D-K

vertical transmission between mother and baby possible

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18
Q

What are associated with lymphogranulosum venereum?

A

Serovars L1, L2, L2a, L3

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19
Q

How does C trachomatis exist?

A

in two forms

elementary body (infective form)

reticulate body (non-infectious form)

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20
Q

Where do C trachomatis elementary bodies infect?

A

columnar epithelial cells

incubation period until symptoms is 1-3 weeks

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21
Q

What % of people with C trachomatis are asymptomatic?

A

50% of infected females

80% of infected males

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22
Q

What might infection with C trachomatis cause?

A

a mucopurulent cervicitis in females and urethritis in males

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23
Q

What can ascending infection with C trachomatic cause?

A

pelvic inflammatory disease (PID) in women

5-10% of PID women develop perihepatitis (Fitz-Hugh-Curtis syndrome)

epididymitis in men

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24
Q

What can untreated C trachomatis lead to in women?

A

10-40% will develop PID

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25
Q

What are the symptoms of PID?

A

vaginal discharge

lower abdominal pain (dull, aching, crampy, bilateral and constant) worsened by motion, exercise or intercourse

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26
Q

What can PID cause?

A

increase in risk of infertility, ectopic pregnancy and chronic pelvic pain

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27
Q

What can untreated C trachomatis cause in men?

A

epididymitis which may result fertility or sterility

prostatitis

urethritis causing painful urination and possible kidney problems

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28
Q

Swabs taken for chlamydia diagnosis?

A

urethral swab, rectal swab, cervical swab, midstream urine

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29
Q

Tests for diagnosis of chlamydia?

A

McCoy, Hep 2 or HeLa cell lines treated with cycloheximide (50-85% sensitivity, 100% specificity)

nucleic acid amplification test (85-95% sensitivity, 99-100% specificity)

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30
Q

Treatment for chlamydia patients?

A

prefer a single dose of treatment

until 2018 was 1g single oral dose of azithromycin

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31
Q

Why have guidelines for treating chlamydia changed?

A

in response to mycoplasma genitalium co-infection (3-15% of cases)

concomitant rectal infections in woman with urogenital infection, not related to anal intercourse

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32
Q

Treatment of uncomplicated urogenital infection?

A

doxycycline 100mg bd for 7 days (contraindicated in pregnancy)

azithromycin 1g orally as a single dose, followed by 500mg once daily for two days

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33
Q

Alternative treatment options for urogenital infection?

A

erythromycin 500mg BD for 10-14 days

ofloxacin 200mg BD (or 400mg OD) for 7 days (CI in pregnancy)

34
Q

Treatment for LGV?

A

doxycycline 100mg BD for 21 days

35
Q

What other advice for treatment of chlamydia?

A

abstain from all forms of sex during treatment

contact tracing to minimise transmission

36
Q

Why is doxycycline CI in pregnancy?

A

it has an ability to concentration in the bone structures in babies

37
Q

Vaccine for chlamydia?

A

nasally adminstered vaccine has been developed using a novel fusion protein antigen that covers multiple chlamydia serovars

38
Q

Administration of the chlamydia vaccine?

A

3 x IM followed by 2x instranasal boosters

vaginal antibody responses - humoral immunity

interferon gamma production - cell mediated immunity

39
Q

What is neisseria gonorrhoeae?

A

a gram negative intracellular aerobic diplococcus

40
Q

Female to male transmission of neisseria gonorrhoeae?

A

~20% per vaginal intercourse (60-80% after 4 exposures)

41
Q

Most common presentation of neisseria gonorrhoeae in males?

A

mucopurulent urethritis >80%

50% dysuria

42
Q

Male to female transmission of neisseria gonorrhoeae?

A

~50-70% after vaginal intercourse

includes vaginal discharge <50%, dysuria (10%), dyspareunia and mild abdominal pain (<25%)

43
Q

Rectal infections of neisseria gonorrhoeae?

A

~40% female (similar in MSM)

44
Q

Pharyngeal infections of neisseria gonorrhoeae?

A

~15%

oral sex - fellatio > cunnilngus

45
Q

Incubation period of neisseria gonorrhoeae?

A

1-14 days

46
Q

Primary diagnosis of neisseria gonorrhoeae?

A

by NAAT

sensitivity >96%, specificity 99-100%

47
Q

What else can be used to diagnose neisseria gonorrhoeae?

A

culture swabs for diagnosis and/or resistance profiling on Thayer-Martin plates

sensitivity 90-95% for males and 50-75% for females, specificity 100%

48
Q

Treatment of uncomplicated anogenital and pharyngeal infections of neisseria gonorrhoeae?

A

1g ceftriaxone IM as a single dose (if susceptibility unknown)

500mg ciprofloxacin as a single dose (if susceptibility known)

49
Q

Advice for neisseria gonorrhoeae infection?

A

test of cure in all patients recommended

abstain from all forms of sex for 7 days

50
Q

Alternative regimes for neisseria gonorrhoeae?

A

cefixime 400mg orally as a single dose plus azithromycin 2g orally

gentamicin 240mg IM as a single dose plus azithromycin 2g orally

spectinomycin 2g IM as a single dose plus azithromycin 2g orally

azithromycin 2g as a single oral dose

51
Q

When is cefixime advisable?

A

if an IM injection is contraindicated or refused by the patient

resistance to cefixime is low in the UK

52
Q

When is spectinomycin not recommended?

A

for pharyngeal infection because of poor efficacy

53
Q

Azithromycin use?

A

the clinical efficacy does not always correlate with in vitro susceptibility testing and resistance is high

54
Q

What is anogenital warts (condyloma) caused by?

A

human papilloma virus (HPV)

around 30 associated with anogenital infections

55
Q

What are >90% of anogenital warts caused by?

A

HPV 6 & 11

these types have low oncogenicity

56
Q

How is HPV spread?

A

by skin to skin contact (penetrate sex not a prerequisite) or indirect e.g. sex toys

57
Q

Where is HPV present?

A

on genitals

groin region

anus

58
Q

prevalence of HPV?

A

30-50% of the population

59
Q

Transmission rates of anogenital warts?

A

Male to female 55%

female to male 70%

@ 3 months

60
Q

Incubation period of HPV?

A

months to years

61
Q

What vaccine is HPV included in?

A

the quadrivalent cervix vaccine gardicyl

62
Q

Treatment of anogenital warts?

A

restricted to external visible warts

63
Q

Treatment if <4cm skin surface involved?

A

podophyllotoxin

64
Q

Treatment cycles of anogenital warts?

A

four treatment cycles consist of BD application for 3 days then followed by 4 days rest (highly irritave)

65
Q

Response rate of treatment of anogenital warts?

A

30-70% response rate at 4-6 weeks but recurrence is common

66
Q

What is used for refractory cases?

A

imiquimod 3x a week for up to 16 weeks

recurrence is less common

67
Q

What does imiquimod do?

A

stimulates the immune system to increase uptake of interferine alpha 2 which has potent antiviral activities

68
Q

Treatment for large surface areas?

A

cryotherapy or electrocautery to the skin area

cryotherapy is preferred as it has a lower tendency to leave any scarring

69
Q

What causes anogenital herpes?

A

HSV 1 or 2

70
Q

Transmission of HSV?

A

skin to skin contact (penetrative sex not required) or indirect e.g. sex toys

71
Q

What % of people infected with HSV will have mild/no symptoms?

A

80%

72
Q

What % of the population have HSV 1?

A

50% by age 30

73
Q

What % of the population have HSV 2?

A

3-10% (up to 25% of sexually active persons)

74
Q

Incubation period of HSV?

A

4-14 days or even longer

75
Q

Characterisation of primary infection of HSV?

A

flu-like symptoms and small blisters that burst to leave red open sores (up to 20 days duration)

76
Q

Where can these blisters affect?

A

genitals, rectum, cervix, buttocks or thighs

urination can be painful

77
Q

Diagnosis of HSV?

A

by sampling blister (PCR)

78
Q

Treatment of HSV 1&2?

A

400mg aciclovir for 5 days

79
Q

Recurrence of HSV1 ?

A

50% chance of at least one recurrence

80
Q

Recurrence of HSV2?

A

80% chance of at least once recurrence

81
Q

What diminishes with time of HSV?

A

frequency and severity

Management of Infection (36 decks)

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