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Microbiology and STIs Flashcards

1
Q

Give examples of bacterial STIs

A

Chlamydia

Gonorrhoea

Syphilis

Mycoplasma genitalium

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2
Q

Give examples of viral STIs

A

Human papilloma virus

Herpes simplex virus

Hepatitis

HIV

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3
Q

Describe normal vaginal flora

A

Acidic environment

Lactobacillus predominates

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4
Q

Why are full STI screens done?

A

Co-infections are common, if a patient is ar risk of an STI, they are at risk of all STIs

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5
Q

Is candida an STI?

A

NO

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6
Q

What is the most common cause of candida?

A

Candida Albicans

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7
Q

Non-albicans candida is more common in which group of patients?

A

Immunosuppressed

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8
Q

What are some of the predisposing factors to getting candida?

A

Recent antibiotic treatment

Pregnancy

High oestrogen levels

Poorly controlled diabetes

Immunosuppression

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9
Q

How does candida present?

A

Intensely itchy

White vaginal discharge

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10
Q

How is candida diagnosed?

A

Self taken vulvovaginal swab

or clinician takes endocervical swab

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11
Q

What is the treatment for candida?

A

Clotrimazole

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12
Q

Is bacterial vaginosis an STI?

A

No - but it is more common in people who are sexually active

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13
Q

What is bacterial vaginosis?

A

Imbalance of bacteria in the vagina - anaerobes take over, turning the normally acidic environment alkaline

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14
Q

How does bacterial vaginosis present?

A

Foul smelling discharge

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15
Q

What are some of the possible consequences of bacterial vaginosis?

A

Increased rates of endometriosis

Increased risk of preterm delivery and infections in pregnancy

Increased risk of acquiring HIV

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16
Q

What is the treatment for bacterial vaginosis?

A

Oral metronidazole

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17
Q

Do you need to treat the partners of patients with bacterial vaginosis?

A

No

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18
Q

What is the organism which causes chlamydia?

A

Chlamydia trachomatis

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19
Q

Which sex is chlamydia more common in?

A

More common in women than men

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20
Q

What is the most common STI in the UK?

A

Chlamydia

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21
Q

Which STI is caused by an obligate intracellular bacteria which doesn’t stain with gram stain?

A

Chlamydia trachomatis

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22
Q

Which of the serological groupings of chlamydia is responsible for causing genital infection?

A

Serovars D-K

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23
Q

Lymphogranuloma venereum is a serovar of chlamydia. How does it present?

A

Diagnosed in MSM

Rectal pain, discharge and bleeding

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24
Q

Irregular bleeding is the red flag for which STI?

A

Chlamydia

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25
How does chlamydia present in female patients?
Dyspareunia Lower abdominal pain Oozing vaginal discharge Intermenstrual or postcoital bleeding
26
How does chlamydia present in male patients?
Milky urethral discharge Dysuria Urethritis Epididymo-orchitis Proctitis
27
What are some of the possible complications of chlamydia?
Tubal infertility Reiter's syndrome Conjunctivitis Fitz-Hugh-Curtis Syndrome (Perihepatitis) Chronic pelvic pain Ectopic pregnancy
28
What STI might be the cause of red eye in an infant?
Chlamydia
29
Transmission of chlamydia to neonates can cause what?
Conjunctivitis Pneumonia
30
Which STI accounts for 50% of pelvic inflammatory disease?
Chlamydia
31
How is chlamydia diagnosed?
Test 14 days following exposure NAAT or PCR - Vulvovaginal swab (women), first void urine (men)
32
What is the treatment for chlamydia?
Doxycycline PO 7 days
33
Which STI is more common in men than women?
Gonorrhoea
34
What is the organism which causes gonorrhoea?
Neisseria gonorrhoea
35
Which STI is caused by a gram negative intracellular diplococcus?
Gonorrhoea
36
How does gonorrhoea present in female patients?
Pelvic pain Vaginal discharge Intermenstrual or postcoital bleeding
37
How does gonorrhoea present in males?
Urethral discharge Dysuria
38
What are some of the possible complications of gonorrhoea?
Tubal infertility PID Ectopic pregnancy Bartholinitis Tysonitis
39
How is gonorrhoea diagnosed?
Swabs for culture or NAAT
40
What is the first line treatment for gonorrhoea?
IM ceftriaxone
41
What is the second line treatment for gonorrhoea?
Cefixime PO
42
Which STI is particularly associated with rising incidence of antibiotic resistance?
Gonorrhoea
43
What is the name of the emerging sexually transmitted bacterial infection which involves asymptomatic carriage and is associated with non-gonococcal urethritis and PID?
Mycoplasma genitalium
44
What causes genital herpes?
Herpes simplex virus type 1 and type 2
45
How is genital herpes transmitted?
Genital to genital contact or oropharyngeal to genital contact
46
What are the symptoms of genital herpes?
Very painful blistering and ulceration of the external genitalia Dysuria Vaginal/ urethral discharge and discharge from the lesions themselves Local lymphadenopathy Fever and myalgia
47
What is the risk if someone presents in the 3rd trimester of pregnancy with genital herpes?
Neonatal herpes
48
How do you diagnose genital herpes?
Swabs of the deroofed blisters for PCR
49
What is the treatment for genital herpes?
Aciclovir PO Analgesia or topical lidocaine Saline bathing
50
What causes genital warts?
Human papilloma virus (HPV)
51
What is the most common viral STI in the UK?
HPV
52
Which STI has the typical 'cauliflower appearance'?
Genital warts
53
Which types of HPV are associated with anogenital warts?
HPV 6 and 11
54
Which types of HPV are associated with cancer?
HPV 16 and 18
55
How is HPV managed?
May clear spontaneously Topical podophylin (wart icon) Cryotherapy with liquid nitrogen
56
Who gets the HPV vaccine?
Girls aged 11-13 MSM
57
What bacteria causes syphilis?
Treponema pallidum
58
How can syphilis be transmitted?
Sexual contact Trans-placental/ during birth Blood transfusions
59
How does primary syphilis present?
Chancre (painless ulcer) at the site of inoculation Non tender local lymphadenopathy
60
How might secondary syphilis present?
Snail track ulcers in the mouth Pustular rash on the palms and soles Patchy alopecia Condylomata lata Generalised lymphadenopathy
61
How might late stage syphilis present?
Cardiovascular or neurovascular complications e.g aortic aneurysms
62
How is syphilis diagnosed?
PCR (swabs) Specific and non-specific serological tests
63
What are the specific serological screening tests for syphilis?
EIA, TPHA and TPPA
64
What are the non-specific serological screening tests for syphilis?
CDRL RPR
65
How is syphilis treated?
Long-acting IM penicillin
66
What is trichomonas vaginalis and how is it treated?
Parasite causing STI Oral metronidazole
67
What is the treatment for pubic lice?
Malathion lotion
68
How may proctitis present? | which may occur with STIs in MSM
Bloody diarrhoea Feeling of fullness in the rectum
69
What is the treatment for acute bacterial prostatitis?
Ciprofloxacin
70
What are the benefits of using NAATs?
Highly sensitive and specific Can test for both gonorrhoea and chlamydia at the same time
71
HIV is a retrovirus, what does this mean?
It uses the reverse transcriptase enzyme rather than the transcriptase enzyme
72
What is the normal range of CD4 count?
>500
73
With what CD4 count is there risk of opportunistic infections?
<200
74
What is the target site for HIV?
CD4 receptors
75
How might primary HIV infection present?
Symptoms can be very vague; Fever Maculopapular rash Myalgia Pharyngitis Headache
76
What is the most common opportunistic infection in patients with HIV?
Pneumocystis pneumonia | caused by pneumocystis jiroveci
77
What antibiotic is used to treat pneumocystis pneumonia, an opportunistic infection occurring in patients with HIV?
Co-trimoxazole
78
What is immune reconstitution syndrome?
When HIV is treated and the immune system starts to recover, it can reveal an underlying infection such as TB which then becomes active
79
What organism causes cerebral toxoplasmosis, an opportunistic infection which can occur in patients with HIV?
Toxoplasma gondii
80
Multidermatomal or recurrent herpes zoster infections should make you consider what diagnosis?
HIV
81
What is 'slim's disease'?
Cachexia due to HIV
82
Name 3 AIDS related cancers
Kaposi's sarcoma Non-hodgkins lymphoma Cervical cancer
83
How can HIV affect the disease progression of psoriasis and rheumatoid arthritis?
Psoriasis is a CD8 mediated disease – in HIV there are high levels of CD8 – so psoriasis can get worse with HIV Rheumatoid arthritis is a CD4 mediated disease – in HIV there are low levels of CD4 – so RA can get better with HIV
84
Why are patients more likely to acquire HIV through anoreceptive sex?
The wall of the rectum is thinner than the vagina and anal penetration involves more trauma to tissues
85
What factors can increase the risk of transmission of HIV?
Trauma Genital ulceration Concurrent STIs
86
Which group of people are most likely to go undiagnosed with HIV?
Heterosexual men Don't have the typical risk factors and are less likely to present for care
87
What tests can be done to detect HIV?
Viral load p24 antigen Antibody testing Rapid HIV test (POCT) Recent infection testing algorithm (RITA)
88
What tests are done as the *mainstay of diagnosis for HIV?
Antibody testing and P24
89
What is the highly active anti-retroviral therapy for HIV?
Combination of 3 drugs from at least 2 classes to which the virus is susceptible
90
What secondary prevention methods should be offered to people with HIV?
Vaccines - Hep A/B, flu and HPV Smoking cessation
91
What are the rules/ guidance in terms of partner notification for patients with HIV?
Partner notification is VOLUNTARY Doctors have a duty of care to their patient - they can advice PN but can't force it Exposing someone to the risk of transmission can be illegal in some circumstances in Scotland
92
How can onward HIV transmission be prevented?
Condom use HIV treatment STI treatment PN Pre and post exposure prophylaxis Change of sexual behaviours - e.g not receiving rectally
93
When can a vaginal Vs a caesarean delivery be done in mothers with HIV?
Vaginal delivery if undetected viral load Caesarean section if detected viral load
94
What are the rules with breastfeeding in HIV +ve mothers?
Exclusive formula feeding for all babies born to HIV +ve mothers
95
What is the whiff test and which condition is it used to identify?
10% potassium hydroxide is added to the vaginal discharge to produce a fish odour Used to identify bacterial vaginosis

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