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Pathology (Guide) > Microbiology - STIs > Flashcards

Microbiology - STIs Flashcards

1
Q

What are some common presentations of man with an STI?

A
  • Asymptomatic
  • Urethral discharge
  • Dyrsuria
  • Scrotal pain/swelling
  • Rash/sores
  • Systemic Sx
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2
Q

What are some common presentation of a woman with an STI?

A
  • Asymptomatic
  • Vaginal discharge (+/- urethral, rectal)
  • Ulceration (painful/painless)
  • Itching/soreness (lumps/growths)
  • Abnormal bleeding (IMB, PCB)
  • Abdo pain, dyspareunia, dyrsuria
  • Systemic Sx
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3
Q

What are some common causes of discharge?

A
  • Gonorrhoea
  • Chlamydia
  • Trichomonas
  • Candida
  • Bacterial Vaginosis
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4
Q

What are some common causes of ulceration?

A
  • Syphilis (Painful)
  • HSV (painless)
  • LGV
  • Chancroid
  • Donovanosis
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5
Q

What are some common causes of rashes, lumps/growths?

A
  • Genital warts: HPV
  • Molluscum contagiosum
  • Scabies
  • Pubic lice
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6
Q

What is the causative organism of gonorrhoea?

A

Neisseria gonorrhoeae
- Obligate intracellular gram -ve diplococci

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7
Q

What are some common presentations of an uncomplicated gonorrhoeal infection (90%) in a man?

A

Gonococcal urethritis:
- Most common STI in europe
- Mucoid/mucopurulent discharge

Post-gonococcal urethritis:
- Following gonorrhoeal Tx
- Prevented by concomitant Tx with tertrcycline

Rectal prostitis:
- Mainly in MSM

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8
Q

What is the most common presentation of an uncomplicated gonorrhoeal infection (90%) in a woman?

A

Mucopurulent cervicits:
- Erythema + oedema
- Urethra (vaginal leakage)

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9
Q

What is a common presentation of a complicated gonorrhoeal infection (10%) in a man?

A

Prostatitis

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10
Q

What is a common presentation of a complicated gonorrhoeal infection (10%) in a woman?

A

PID (salpingitis)
- Ascending infection

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11
Q

What is Opthalmia neonatorum?

A

Neonatal conjunctivitis
- Develops if left untreated when transfer to child from birth canal
- Presents in 1/2 days with Gonorrhoea
- Presents in 1-2wks with Chlamydia

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12
Q

What is the gold standard investigation for diagnosing gonorrhoea?

A

Urethral (Sens: 95%) / Rectal (Sens: 20%) smears
- Produces a culture

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13
Q

What is the treatment for gonorrhoea?

A

IM Ceftriaxone (250mg) Single Dose

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14
Q

What is the causativ organism for chlamydia?

A

Chlamydia trachomatis
- Obligate intracellular gram -ve pathogen
- Can’t be cultured on agar

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15
Q

What is the epidemiology of chlamydia?

A
  • Common in young adults
  • 10% <25yrs infected in UK (Most common)
  • Asymptomatic (50% men, 80% women)
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16
Q

How is chlamydia classified?

A
  • Serovars A, B, C: Trachoma (infection of eyes which can cause blindness)
  • Serovars D-K: Genital chlamydia, opthalmia neonatorum
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17
Q

How is chlamydia diagnosed?

A

NAAT (nucleic acid amplification test) from genital swabs

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18
Q

What is the treatment for chlamydia?

A
  • Azithromycin 1g Stat
    OR
  • Doxycycline 100mg BD (7/7)
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19
Q

What are some complications of Chlamydia?

A
  • PID (tubal factor infertility, ectopic pregnancy, chronic pelvic pain)
  • Epididymitis
  • Reiter’s Syndrome
  • Adult conjunctivitis, opthalmia neonatorum
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20
Q

What is Lympho-granuloma venerum and its epidemiology?

A
  • Lymphatic infection with Chlamydia trachomatis: Serovars L1-3
  • Endemic in parts of developing world
  • MSM in developing world
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21
Q

What are some symptoms of Lympho-granuloma venerum?

A

Early LGV (primary stage):
- 3-12 days
- Painless genital ulcer
- Proctitis
- Balanitis
- Cervicitis

Early LGV (secondary stage):
- 2wks-6mths
- Painful inguinal buboes
- Fever
- Malaise
- Rare: hepatitis, meningo-encephalitis, pneumonitis

Late LGV:
- INGUINAL LYMPHADENOPATHY
- GENITAL ELEPHANTIASIS
- Genital + perianal ulcers/abscesses
- Frozen pelvis

Current LGV outbreak:
- Rectal Sx/proctitis (pain, tenesmus, bleeding)

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22
Q

How is lympho-granuloma venerum diagnosed?

A
  • NAAT
  • Genotypic identification of L1-3 Serovar
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23
Q

What is the treatment for lympho-granuloma venerum?

A

Doxycycline 100mg BD for 3wks

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24
Q

What is the causative organism of syphilis?

A

Treponema pallidum
- Obligate gram -ve spirochaete

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25
Q

What are the symptoms of primary syphilis?

A

Macule to papule to PAINLESS SOLITARY GENITAL ULCER
- Appears 1-12wks folloeing transmission
- May persist 4-6wks

Regional adenopathy

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26
Q

What are the symptoms of secondary syphilis?

A
  • Systemic bacteraemia 1-6mths after infection (fever, malaise, lymphadenopathy)
  • MACULOPAPULAR RASH ON PALMS + SOLES (+ back, trunk, limbs)
  • Condyloma acuminate (genital warts)
  • Mucosal lesions
  • Uveitis
  • Neurological involvement
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27
Q

What are the symptoms of latent syphilis?

A
  • No obvious signs
  • Serological infection
  • Asymptomatic
28
Q

What are the symptoms of tertiary syphilis?

A

2-30yrs later

GUMMATOUS:
- Skin/bone/mucosa granulomas
- Spirochaetes scanty

CARDIOVASCULAR:
- Mimics any cardiac disease
- Especially: Aortic Root Dilatation/Aortitis
- +++ Spirochaetes
- +++ Inflammation

NEUROSYPHILIS:
- Dementia
- Tabes dorsalis
- Argyll-Robertson pupil
- Spirochaetes in CSF

29
Q

How is syphilis diagnosed?

A
  • DARK GROUND MICROSCOPY: Treponemes seen in primary lesions
  • Ab tests (Treponemal + non-treponemal)
30
Q

How does a non-treponemal test work for syphilis detection?

A
  • Detects Abs against non-specific antigen
  • VDRL Slide test: detects lipoidal Ab on host + treponemal cells
  • Can get false +ves (need to confirm with treponemal test)
  • RPR = modified VDRL test
  • Useful in primary syphilis
  • Titre falls in response to treatment (4-fold reduction suggestst response to Tx)
31
Q

How does a treponemal test work for syphilis detection?

A
  • Detects Abs against specific antigens from T. pallidum
  • More specific than non-treponemal test
  • Remains positive for years (despite effective Tx)
32
Q

What are some examples of treponemal tests for syphilis?

A
  • Enzyme Immunoassay (EIA)
  • Fluorescent Treponemal Antibody (FTA)
  • T. pallidum Haemagglutination Test (TPHA)
  • T. pallidum Particle Agglutination Test (TP-PA)
33
Q

What is the treatment for syphilis?

A

Single Dose IM Benzathine Penicillin
- Doxycycline if allergic

34
Q

What is Jarisch-Herxheimer Reaction, its symptoms and treatment?

A

Common reaction to Abx given for syphilis Tx
- Develops within hours of Abx
- Clears within 24hrs

Sx:
- Flu-like Sx
- ?Exacerbation of syphilitic Sx

Tx:
- Paracetamol/analgesia

35
Q

What is congenital syphilis and its symptoms?

A

Syphilis occuring during pregnancy/birth
- Develops over first couple years

Sx:
- Hepatosplenomegaly
- Rash
- Fever
- Neurosyphilis
- Pneumonitis

Late congenital syphilis can occur in 40%

36
Q

What is the causative organism for Chancroid?

A

Haemophilus ducreyi
- Gram -ve coccobacillus (like Hib)

37
Q

What are the features of Chancroid?

A
  • Tropical ulcer disease
  • Mainly in Africa (rare in UK)
  • Multiple painless ulcers +/- lymphadenopathy
38
Q

How is Chancroid diagnsed?

A
  • Culture: CHOCOLATE AGAR
  • PCR
39
Q

What is the causative organism for Donovanosis (granuloma inguinale)?

A

Klebsiella granulomatis
- Gram -ve bacillus

40
Q

What are the feature of Donovanosis (granuloma inguinale)?

A
  • Present in tropical regions (Africa, India, PNG, Australian aboriginal communities)
  • Large, beefy, painless, red ulcers
41
Q

How is donovanosis diagnosed?

A
  • Giemsa stain of biopsy/tissue crush
  • DONOVAN BODIES
42
Q

How is donovanosis treated?

A

Azithromycin

43
Q

What are some common enteric pathogens that are spread through oro-anal contact?

A
  • Shigella
  • Salmonella
  • Giardia (protozoa)
44
Q

What is the causative organism for Trichomoniasis?

A

Flagellated protozoan - T. vaginalis

45
Q

How does Trichomoniasis present in men + women?

A

Men:
- Usually asymptomatic
- Sometimes urethritis

Women:
- Discharge (yellow-green)
- STRAWBERRY CERVIX

46
Q

How is trchomoniasis diagnosed?

A
  • Wet prep microscopy (flagellated organisms seen)
  • PCR
47
Q

What is the treatment for trichomoniasis?

A

Metronidazole

48
Q

What is trichomoniasis associated with?

A

Increased risk of HIV infection (due to mucosal damage)

49
Q

What is the causative organism for bacterial vaginosis?

A
  • Abnormal vaginal flora
  • Polymicrobial
  • Decreased lactobacilli
50
Q

What are the symptoms associated with bacterial vaginosis?

A
  • Watery discharge
  • Odour
51
Q

What is the cause of bacterial vaginosis?

A
  • Sexually associated not transmitted
  • A/w hygiene practices (soaps)
52
Q

How is bacterial vaginosis diagnosed?

A
  • Microscopy of gram stain
  • Raised pH
  • Whiff test
  • CLUE CELLS
53
Q

What is the treatment for bacterial vaginosis?

A
  • Lifestyle: just use water for washing (no soaps)
  • Metronidazole PO/topical
54
Q

What is the causative organism for Candidiasis?

A
  • Candida albicans (years)
55
Q

What is the presentation of candidiasis in men + women?

A

General:
- Thick, white discharge (cottage cheese)
- Itching
- Soreness
- Redness

Women:
- Vulvovaginitis

Men:
- Balanitis

56
Q

What is candidiasis associated with?

A
  • NOT STD (can be part of normal flora)
  • Immunodeficiency (e.g. pregnancy, DM0
  • Hygiene practices
57
Q

How is candidiasis treated?

A
  • PO/topical antifungals (e.g. clotrimazole/fluconazole)
58
Q

What is the causative oragnism of Molluscum contagiosum?

A
  • Pox virus, dsDNA
59
Q

How does molluscum contagiosum present and how does it spread?

A

General:
- Small papules with central punctum

Children:
- Hands + faces
- Spread = skin-to-skin contact

Adults:
- Genital lesions
- Spread = sexual contact

Immunocompromised:
- Widespread lesions

60
Q

What is the treatment for molluscum contagiosum?

A
  • Usually no Tx
  • If persistent/severe: Cryotherapy
61
Q

What is the causative organism for genital warts?

A
  • dsDNA Human Papillomavirus
  • HPV 6 / HPV 11
62
Q

How is genital warts diagnosed?

A

Clinical Dx:
- Papular
- Planar
- Pedunculated
- Carpet
- Keratinised
- Pigmented

63
Q

How are genital warts treated?

A

Home:
- Podophyllotoxin solution/cream (not suitable for pregnant women)

Clinic:
1. Cryotherapy
2. Imiquimod

64
Q

What are some viral STIs?

A

Hepatitis
- HAV: (Oro-anal sex)
- HBV
- HCV (Mainly HIV +ve MSM)

Herpes
HIV

65
Q

How does HSV present?

A
  • Painful ulcers
  • No lymphadenopathy

Pathology (Guide) (84 decks)

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