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DipGUM > MSM sexual health > Flashcards

MSM sexual health Flashcards

1
Q

Which subtype HPV is cause of anogenital warts?

A

6 and 11

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2
Q

Which subtype HPV is associated with anal neoplasia?

A

16, 18, 31 and 33

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3
Q

Where else might high risk HPV persist in MSM and what consequence may occur?

A

Oropharynx

Oropharyngeal squamous cell carcinoma

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4
Q

What is the clinical significance of high risk HPV in MSM with HIV?

A 
higher frequency of hrHPV
persistence of hrHPV
increased incidence anal dysplasia
increased progression to AIN and anal cancer
increased relapse of AIN and anal cancer
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5
Q

What additional risk factor increases risk of AIN and anal cancer in hr HPV MSM?

A

Smoking

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6
Q

Which group might regular digital anorectal examination be effective as screening for anal cancer?

A

HIV +ve MSM >50 yrs old

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7
Q

When performing HPV vaccination what is the minimum interval between vaccination dose 0, 1 and 2?

A

0-1 = 1 month
1-2 = 3 month
typical 0, 2 and 6 months

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8
Q

When performing HPV vaccination when should the vaccination course be completed?

A

aim within 1 year

within 2 year clinically acceptable

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9
Q

What is the prevalence of hrHPV in MSM strongly associated with?

A

numbers of sexual partners

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10
Q

In MSM 16-20 yr olds reporting no prior receptive anal sex, what proportion have HPV infection?

A

10%

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11
Q

In MSM 16-20 yr olds reporting greater than 4 receptive anal partners, what proportion have HPV infection?

A

47%

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12
Q

London study - MSM 18-40 - proportion with ONE q-vaccine HPV type?

A

25%

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13
Q

London study - MSM 18-40 - proportion with TWO q-vaccine HPV typeS?

A

7% (hence rationale for vaccination)

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14
Q

Efficacy of qHPV vaccine in 16–26-year-old MSM against AIN?

A

50%

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15
Q

efficacy of qHPV vaccine - reduction of warts - in 16–26-year-old MSM?

A

70%

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16
Q

What specific substance-use are a marker of increased STI risk?

A

Binge EToH
inhaled nitrates
methamphetamine
grade 1A

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17
Q

What tests should be offered for MSM at all services?

A 
NAAT for GC/CT
HIV
Syphilis
Hepatitis B
if indicated Hepatitis C
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18
Q

What proportion of gonorrhoea diagnoses in men are in MSM?

A

70%

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19
Q

What non-penile intercourse practices are related to extra-genital infection?

A

Rimming
Fingering
Fisting
Sex toy use

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20
Q

What proportion of rectal and pharyngeal infection are asymptomatic?

A

Rectal 70-90%

Throat 95-100%

21
Q

Which pharyngeal STI is most likely to spontaneously resolve?

A

Gonorrhoea high incidence:prevalence ratio

22
Q

Which STI is most associated with oral sex?

A

Urethral Gonorrhoea
and
primary syphilis

23
Q

Which STI is most associated with anal sex?

A

Urethral chlamydia

24
Q

Which group of MSM have a higher rate of mgen compared to CT or GC infection?

A

HIV +ve MSM

25
Q

HSV-2 is a significant risk factor for HIV acquisition among MSM, does suppressive therapy with aciclovir reduce this risk?

A

No

26
Q

Should MSM be vaccinated for hepatitis A?

A

No

Only during outbreaks to higher risk groups or if co-infection HIV, HBV, HCV

27
Q

The presence of which other STIs is associated with hepatitis C infection in MSM?

A

Syphilis and LGV

28
Q

When should hepatitis C testing be offered to MSM?

A 
Routinely if
- sex associated with injury or IVDU
Annually if
- eligible for 3 monthly HIV test
-on PrEP
- HIV +ve
29
Q

What proportion of syphilis diagnoses in men are in MSM?

A

84%

30
Q

What are localised MSM syphilis outbreaks often linked to?

A

Geospatial social networking apps

31
Q

Which MSM should be offered 3 monthly STI testing?

A

UAI with unknown/serodiscordant HIV status past 12 months
>10 sexual partners past 12 months
Drug use past 6 months
multiple or anonymous partners
any unprotected sexual contact since last test
treatment for STI past 12 months

32
Q

How effective is text message prompt at increasing STI testing?

A

Significantly increased re-attendance for testing

33
Q

Which bacterial organisms are implicated in sexually transmitted enteric infections?

A 
Shigella flexneri 3a, 2a and sonnei
Campylobacter
Ecoli
Salmonella
Yersinia enterocolitica
34
Q

What other causes of enteric infections in MSM?

A

Hepatitis A

Parasites

35
Q

Describe the symptoms of proctitis

A

Rectal pain
Discharge
Bleeding
+/- tenesmus

36
Q

Which pathogens are implicated in proctitis?

A

Chlamydia + LGV
Gonorrhoea
T pallidum
HSV

37
Q

Describe the symptoms of enteritis

A

Diarrhoea
Abdominal pain
Dysentry (severe diarrhoea with blood and mucous)

38
Q

Describe microscopy findings in proctitis

A

> 10 PMNLs/high power field

39
Q

If a person with proctitis tests positive for rectal chlamydia what else needs to be checked?

A

Test for LGV serovar

40
Q

What risk factors are associated with enteric infection?

A

Multiple partners
Group sex
Chemsex
Using and sharing sex toys including oral contact
Oro-anal contact including oro-penile sex after anal sex

41
Q

General advice on how to avoid enteric infection?

A

Wash hands, genitals, perineum before sex
Use condoms, latex gloves, dental dams
Avoid sharing sex toys or douching equipment

42
Q

What is the technique ‘hot spotting’ in partner notification used for?

A

To identify/treat an index case that is anonymous

Health promotion takes place at likely venues

43
Q

Which UK PrEP study looked at daily dosing PrEP?

A

PROUD study

44
Q

Which PrEP study looked at on demand dosing PrEP?

A

IPERGAY

45
Q

What proportion of people experience GI side effects on PrEP ?

A

<10%

46
Q

How long do side effects from PrEP take to resolve?

A

<1 month

47
Q

What percentage reduction in bone density is associated with PrEP?

A

1%

48
Q

Condomless anal sex rates - PrEP and no PrEP?

A

PrEP 21%

no PrEP 12%

49
Q

What proportion of HIV transmission is from undiagnosed men?

A

82%

DipGUM (39 decks)

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