O&G: GU medicine Flashcards
1
Q
Bacterial Vaginosis
what is it
A
overgrowth of bacteria in the vagina, specifically anaerobic bac
not a STI but can increase the risk of developing one
2
Q
Bacterial Vaginosis
cause
A
a loss of lactobacilli (friendly bac) in the vagina
3
Q
Bacterial Vaginosis
why is lactobacilli healthy friendly bac
A
they produce lactic acid that keeps the vaginal pH low (<4.5)
the acidic environment prevents other bac from overgrowing
4
Q
Bacterial Vaginosis
what happens where there is a reduced number of lactobacilli
A
the pH rises in the vagina, which enable anaerobic bacteria to multiple in the more alkaline environment
5
Q
Bacterial Vaginosis
example of anaerobic bacteria associated with BV
A
- Gardnerella vaginalis (most common)
- Mycoplasma hominis
- Prevotella species
6
Q
Bacterial Vaginosis
can BV occur alongside other infections
A
yes. inc candidiasis, chlamydia and gonorrhoea
7
Q
Bacterial Vaginosis
RFs (5)
A
- multiple sexual partners (although not sexually transmitted)
- XS vaginal cleaning (douching, use of cleaning products and vaginal washes)
- recent abx
- smoking
- copper coil
8
Q
Bacterial Vaginosis
who does it occur less frequently in
A
- women taking COCP
- women using condoms effectively
9
Q
Bacterial Vaginosis
key presentation
A
fishy smelling discharge
watery grey/white discharge
10
Q
Bacterial Vaginosis
what symptoms may suggest an alternative cause or co-occurring infection
A
itching
irritation
pain
half of women with BV are asymptomatic
11
Q
Bacterial Vaginosis
examination
A
speculum can be performed to confirm the typical discharge
high vaginal swab to exclude other causes of symptoms
12
Q
Bacterial Vaginosis
inx
A
- Vaginal pH using a swab and pH paper
- standard charcoal vaginal swab for microscopy. Can be a high vaginal swab during speculum or self taken low vaginal swab
13
Q
Bacterial Vaginosis
BV occurs with a pH of?
A
above 4.5
14
Q
Bacterial Vaginosis
what is shown on microscopy
A
clue cells
15
Q
Bacterial Vaginosis
what are clue cells
A
epithelial cells from the cervix that have bacteria stuck inside them, usually Gardnerella vaginalis
16
Q
Bacterial Vaginosis
mnx of asymptomatic BV
A
none
17
Q
Bacterial Vaginosis
mnx
A
Metronidazole specifically targets anaerobic bac
PO or vaginal gel
18
Q
Bacterial Vaginosis
what is an alternative to metronidazole
A
clindamycin but less optimal
19
Q
Bacterial Vaginosis
what advice can you give
A
- avoid vaginal irrigation or cleaning with soaps that may disrupt the natural flora
20
Q
Bacterial Vaginosis
what advice to give when prescribing metronidazole
A
avoid alcohol as it can cause a ‘disulfiram-like reaction’ with N+V, flushing and sometimes severe sx of shock + angioedema
21
Q
Candidiasis
what is it
A
aka thrush
vaginal infection with a yeast of the Candida family
candida may colonise without causing sx. It then progresses to infection when the right environment occurs eg pregnancy or after trx with broad-spectrum abx that alters the vaginal flora
22
Q
Candidiasis
what is the most common yeast
A
Candida albicans
23
Q
Candidiasis
RFs (4)
A
- increased oestrogen (higher in pregnancy, lower pre-puberty + post-menopause)
- poorly controlled diabetes
- immunosuppression (eg using corticosteroids)
- broad spectrum abx
24
Q
Candidiasis
presentation
A
- odourless thick, white discharge
- vulval + vaginal itching, irritation or discomfort
25
Candidiasis
what can more severe infection lead to? (6)
- erythema
- fissures
- oedema
- dyspareunia
- dysuria
- excoriation
26
Candidiasis
how can candidiasis be differentiated from BV and trichomonas
BV + trichomonas have a pH >4.5
candidiasis has a pH <4.5
27
Candidiasis
what confirms the dx
a charcoal swab with microscopy
28
Candidiasis
mnx
antifungal medication eg clotrimazole
29
Candidiasis
how can antifungal medication be delivered
cream (clotrimazole) inserted into vagina with an applicator
pessary (clotrimazole)
tablet (fluconazole)
30
Candidiasis
what options do NICE recommend for initial uncomplicated cases
- single dose of intravaginal clotrimazole cream (5g of 10% cream) at night
- single dose of clotrimazole pessary (500mg) at night
- 3 doses of clotrimazole pessaries (200mg) over 3 nights
- single dose of fluconazole (150mg)
31
Candidiasis
what is a standard over the counter treatment
Canesten Duo
contains a single fluconazole tablet and clotrimazole cream
32
Candidiasis
trx for recurrent infections (>4/yr)
induction + maintenance regime over 6m with PO or vaginal antifungal medications
this is off label use
33
Candidiasis
warning to give regarding antifungal creams and pessaries
they can damage latex condoms and prevent spermicides from working
so alternative contraceptive is required for at least 5d after use
34
Chlamydia
what kind of bacteria is Chlamydia trachomatis
gram -ve
35
Chlamydia
it's an intracellular organism. What does this mean
it enters and replicate within cells before rupturing the cell and spreading to others
36
what is the most common STI in the UK and a significant cause of infertility
Chlamydia
37
Chlamydia
RFs
- young
- sexually active
- multiple sexual partners
38
Chlamydia
what % of men and women are asymptomatic
50% in men
75% in women
can still pass it on!
39
Chlamydia
what is the NCSP
National Chlamydia Screening Programme set out by PHE
aims to screen every sexually active person under 25yrs for chlamydia annually or when they change their sexual partner
40
Chlamydia
if tested +ve in the NCSP. when should they have a re-test
3m after trx to ensure they have not contracted it again, rather than to check the trx has worked
41
Chlamydia
what is the minimum a pt is tested for when attending GUM clinic for STI screening
- Chlamydia
- Gonorrhoea
- Syphilis (blood test)
- HIV (blood test)
42
what are the 2 types of swabs involved in sexual health testing?
- Charcoal swabs
| - Nucleic acid amplification test (NAAT) swabs
43
what are Charcoal swabs for
microscopy
culture
sensitivities
44
what is the transport medium for charcoal swabs (the liq at the bottom of the tube)
Amies transport medium - contains chemical solution for keeping micro organisms alive during transport
45
charcoal swabs can be used for ___ and ____
endocervical swabs and high vaginal swabs
46
what bacteria can charcoal swabs confirm
- Bacterial vaginosis
- Candidiasis
- Gonorrhoea (specifically endocervical swab)
- Trichomonas vaginalis (specifically a swab from the posterior fornix)
- other bac eg group B streptococcus
47
what does NAAT check for
the DNA or RNA of the organism
used to test specifically for chlamydia and gonorrhoea
48
on a women a NAAT test can be performed on what
- vulvovaginal swab (self-taken lower vaginal swab)
- endocervical swab
- first-catch urine sample
49
on a man a NAAT test can be performed on what?
- first-catch urine sample
| - urethral swab
50
Chlamydia
what can be taken to diagnose chlamydia in the rectum and throat (considered where anal or oral sex has occurred)
rectal and pharyngeal NAAT swabs
51
gonorrhoea is suspected, what next?
endocervical charcoal swab is required MC&S
52
Chlamydia
presentation in women
majority are asymptomatic
- abnormal vaginal discharge
- pelvic pain
- abnormal vaginal bleeding (intermenstrual or postcoital)
- dyspareunia
- dysuria
53
Chlamydia
presentation in men
- urethral discharge or discomfort
- dysuria
- epididymo-orchitis
- reactive arthritis
54
Chlamydia
rectal chlamydia and lymphogranuloma venereum presentation
anorectal sx:
- discomfort
- discharge
- bleeding
- change in bowel habits
55
Chlamydia
examination findings
- pelvic or abdo tenderness
- cervical motion tenderness (cervical excitation)
- inflamed cervix (cervicitis)
- purulent discharge
56
Chlamydia
dx
NAAT
57
Chlamydia
1st line mnx for uncomplicated chlamydia infection
doxycycline 100mg BD for 7d
58
Chlamydia
why has the recommendation of azithromycin been removed as mnx
Due to Mycoplasma genitalium resistance to azythromycin
and it being less effective for rectal chlamydia infection
59
Chlamydia
whom is doxycycline CI'd in
pregnant and breastfeeding women
60
Chlamydia
what alternative options should be given to treat pregnant or breastfeeding women
- Azithromycin 1g stat then 500mg OD for 2d
- Erythromycin 500mg QDS for 7d
- Erythromycin 500mg BD for 14d
- Amoxicillin 500mg TDS for 7d
61
Chlamydia
when should a test of cure be used
for rectal cases
in pregnancy
where sx persist
62
Chlamydia
how long should sex be abstained for and why
for 7d of trx of all partners to reduce the risk of re-infection
63
Chlamydia
who should you refer the pt to
refer all pts to genitourinary medicine (GUM) for contact tracing and notification of sexual partners
64
Chlamydia
complications (8)
- PID
- chronic pelvic pain
- infertility
- ectopic pregnancy
- epididymo-orchitis
- conjunctivitis
- lymphogranuloma venereum
- reactive arthritis
65
Chlamydia
pregnancy related complications (5)
- preterm delivery
- PROM
- low birth weight
- postpartum endometritis
- neonatal infection (conjunctivitis + pneumonia)
66
Chlamydia
what is lymphogranuloma venereum (LGV)
a condition affecting the lymphoid tissue around the site of infection with chlamydia
67
Chlamydia
whom does lymphogranuloma venereum most commonly occur in
men who have sex with men (MSM)
68
Chlamydia
how many stages does lymphogranuloma venereum have
3
primary stage
secondary stage
tertiary stage
69
Chlamydia
LGV: what does the primary stage involve
a painless ulcer (primary lesion)
70
Chlamydia
LGV: where does the primary lesions occur in men and women
men: penis
women: vaginal wall
rectum after anal
71
Chlamydia
LGV: what does the secondary stage involve
lymphadenitis: swelling, inflammation + pain in the lymph nodes infected with the bacteria
72
Chlamydia
LGV: which lymph nodes may be affected in the secondary stage
inguinal or femoral
73
Chlamydia
LGV: what does the tertiary stage involve?
inflammation of the rectum (proctitis) and anus
74
Chlamydia
LGV: what does proctocolitis lead to in the tertiary stage
- anal pain
- change in bowel habit
- tenesmus (feeling of needing to empty the bowel)
- discharge
75
Chlamydia
1st line treatment for Lymphgranuloma Venereum
Doxycycline 100mg BD for 21d
erythromycin, azithromycin and ofloxacin are alternatives
76
Chlamydia
how does Chlamydial Conjunctivitis occur
genital fluid comes in contact with the eye eg hand-to-eye spread
77
Chlamydia
chlamydia conjunctivitis presentation
- chronic erythema
- irritation
- discharge >2w
- most cases are unilateral
78
Chlamydia
Ddx for chlamydia conjunctivitis
Gonococcal conjunctivitis
79
Chlamydia
whom does chamydial conjunctivitis commonly affect
- young adults
| - neonates with mothers infected with chlamydia
80
Gonorrhoea
what kind of bacteria is
Neisseria gonorrhoeae
gram -ve diplococcus
81
Gonorrhoea
what membranes does it infect
mucous membranes with a columnar epithelium
eg endocervix in women
urethra, rectum, conjunctiva and pharynx
82
Gonorrhoea
how does it spread
via contact with mucous secretions from infected areas
83
Gonorrhoea
what increases the risk of infection
- young
- sexually active
- having multiple partners
- having other STIs
84
Gonorrhoea
why is ciprofloaxin or azithromycin no longer used to treat gonorrhoea
high levels of resistance to these antibiotics
85
Gonorrhoea
what % of men and women are symptomatic
90% men
50% women
86
Gonorrhoea
what may females present with
- odourless purulent discharge, possibly green or yellow
- dysuria
- pelvic pain
87
Gonorrhoea
what may males present with
- odourless purulent discharge, possibly green or yellow
- dysuria
- testicular pain or swelling (epididymo-orchitis)
88
Gonorrhoea
presentation of rectal infection
may cause anal or rectal discomfort and discharge
but often asymptomatic
89
Gonorrhoea
presentation of pharyngeal infection
- sore throat
but often asymptomatic
90
Gonorrhoea
symptoms of prostatitis
- perineal pain
- urinary sx
- prostate tenderness on ex
91
Gonorrhoea
symptoms of conjucntivitis
- erythema
| - purulent discharge
92
Gonorrhoea
dx
NAAT to detect the RNA or DNA of gonorrhoea
then charcoal endocervical swab for MC&S
93
Gonorrhoea
what swabs to use in genital infection
- endocervical
- vulvovaginal
- urethral
- 1st catch urine
94
Gonorrhoea
trx for uncomplicated gonococcal infection
if the sensitivities are NOT known:
- single does of IM ceftriaxone 1g
if the sensitivities ARE known:
- single dose of PO ciprofloaxin 500mg
95
Gonorrhoea
when should a test of cure be done after trx for culture
72hrs after trx
96
Gonorrhoea
when should a test of cure be done after trx for RNA NATT
7d after trx
97
Gonorrhoea
when should a test of cure be done after trx for DNA NATT
14d after trx
98
Gonorrhoea
how long should you abstain from sex
7d of treatment of all partners to reduce risk of re-infection
99
Gonorrhoea
complications
- Pelvic inflammatory disease
- Chronic pelvic pain
- Infertility
- Epididymo-orchitis (men)
- Prostatitis (men)
- Conjunctivitis
- Urethral strictures
- Disseminated gonococcal infection
- Skin lesions
- Fitz-Hugh-Curtis syndrome
- Septic arthritis
- Endocarditis
100
Gonorrhoea
what is a key complication in a neonate
gonococcal conjunctivitis
medical emergency
101
Gonorrhoea
what is neonatal conjunctivitis called
ophthalmia neonatorum
102
Gonorrhoea
what is Disseminated Gonococcal Infection (GDI)
a complication of gonococcal infection
where the bacteria spreads to the skin and joints
103
Gonorrhoea
what does Disseminated Gonococcal Infection cause
- various non-specific skin lesions
- polyarthralgia (joint aches + pains)
- Migratory polyarthritis (arthritis that moves between joints)
- Tenosynovitis
- Systemic symptoms such as fever + fatigue
104
Mycoplasma Genitalium
what is it
a bacteria that causes non-gonococcal urethritis
an STI
105
Mycoplasma Genitalium
what presentation is MG similar to
chlamydia
106
Mycoplasma Genitalium
what is the key feature
urethritis
107
Mycoplasma Genitalium
what may infection lead to
```
Urethritis
Epididymitis
Cervicitis
Endometritis
Pelvic inflammatory disease
Reactive arthritis
Preterm delivery in pregnancy
Tubal infertility
```
108
Mycoplasma Genitalium
inx
NAAT to look specifically for the DNA or RNA of the bacteria
109
Mycoplasma Genitalium
why are traditional cultures not helpful in isolating MG
it is a very slow growing organism
110
Mycoplasma Genitalium
what samples are recommended to be taken for men and women
men: 1st urine sample in morning
women: self taken vaginal swabs
111
Mycoplasma Genitalium
what do the guidelines recommend after trx in every +ve pt
- check sample for macrolide resistance
| - perform a test of cure
112
Mycoplasma Genitalium
mnx
- doxycycline 100mg BD for 7d
- then Azithromycin 1g stat
- then 500mg OD for 2d
unless known to be resistant to macrolides
113
Mycoplasma Genitalium
what can be used as an alternative to doxycycline and azithromycin or in complicated infections
Moxifloxacin
114
Mycoplasma Genitalium
trx in pregnant and breastfeeding women
azithromycin alone because doxycycline is CI'd
115
Pelvic Inflammatory Disease
what is it
inflammation and infection of the organs of the pelvis , caused by infection spreading up through the cervix
116
what is significant cause of tubular infertility and chronic pelvic pain
Pelvic Inflammatory Disease
117
Salpingitis
inflammation of the fallopian tubes
118
Oophoritis
inflammation of the ovaries
119
Parametritis
inflammation of the parametrium, which is the connective tissue around the uterus
120
Peritonitis
inflammation of the peritoneal membrane
121
Pelvic Inflammatory Disease
STI causes (3)
- Neisseria gonorrhoea (more severe)
- Chlamydia trachomatis
- Mycoplasma genitalium
122
Pelvic Inflammatory Disease
non STI causes (3)
- Gardnerella vaginalis (assc w/ BV)
- Haemophilus influenzae (assc resp infection)
- Escherichia coli (assc w/ UTIs)
123
Pelvic Inflammatory Disease
RFs ((6)
- not using barrier contraception
- multiple sexual partners
- younger age
- existing STIs
- previous PID
- intrauterine device (eg copper coil)
124
Pelvic Inflammatory Disease
presentation
- pelvic or lower abdo pain
- abnormal discharge
- abnormal bleeding (intermenstrual or postcoital)
- dyspareunia
- fever
- dysuria
125
Pelvic Inflammatory Disease
examination findings (4)
- pelvic tenderness
- cervical excitation
- cervicitis
- purulent discharge
- may have fever and other signs of sepsis
126
Pelvic Inflammatory Disease
inx
testing for causative organisms and other STIs:
- NAAT swabs for gonorrhoea + chlamydia
- NAAT swabs for Mycoplasma genitalium
- HIV test
- Syphilis test
- high vaginal swab: BV, candidiasis, trichomoniasis
- pregnancy test
- pus cells under microscopy
- inflammatory markers (CRP, ESR)
127
Pelvic Inflammatory Disease
how can you exclude PID
the absence of pus cells under microscopy from vagina or endocervix swabs
128
Pelvic Inflammatory Disease
mnx
- refer to GUM
- signs of sepsis or pregnant: admit
one suggested outpatient regime:
- single dose of IM ceftriaxone 1g (to cover gonorrheoa)
- Doxycycline (to cover chlamydia + Mycoplasma genitalium)
- Metronidazole (to cover anaerobes such as Gardnerella vaginalis)
129
Pelvic Inflammatory Disease
mnx of pelvic abscess
may need drainage by interventional radiology or surgery
130
Pelvic Inflammatory Disease
complications (6)
- sepsis
- abscess
- infertility
- chronic pelvic pain
- ectopic pregnancy
- Fitz-Hugh-Curtis syndrome
131
Pelvic Inflammatory Disease
what is Fitz-Hugh-Curtis Syndrome
a complication of PID
caused by inflammation and infection of the liver capsule (Glisson's capsule) leading to adhesions between the liver and peritoneum
132
Pelvic Inflammatory Disease
how may bacteria spread from the pelvis in Fitz-Hugh-Curtis Syndrome
via the peritoneal cavity, lymphatic system or blood.
133
Pelvic Inflammatory Disease
Fitz-Hugh-Curtis Syndrome presentation
RUQ pain
that can be referred to the right shoulder tip if there is diaphragmatic irritation
134
Pelvic Inflammatory Disease
Fitz-Hugh-Curtis Syndrome inx and trx
Laparoscopy to visualise and also treat the adhesions by adhesiolysis
135
Trichomoniasis
what is Trichomonas vaginalis
a type of parasite spread through sex
136
Trichomoniasis
what kind of organism is Trichomonas
classed as a protozoan
single-celled organism with flagella
137
Trichomoniasis
how many flagella do trichomonas have
4 flagella at the front
| 1 at the back
138
Trichomoniasis
what can Trichomoniasis increase the risk of
- contracting HIV (by damaging the vaginal mucosa)
- BV
- cervical cancer
- PID
- pregnancy-related complications such as preterm delivery
139
Trichomoniasis
symptoms (5)
50% are asymptomatic
- vaginal discharge
- itching
- dysuria
- dyspareunia
- balanitis (inflammation of the glans penis)
140
Trichomoniasis
what is the typical description of the vaginal discharge
frothy and yellow-green
but can vary significantly. May have a fishy smell
141
Trichomoniasis
what will examination of the cervix show
'strawberry cervix' aka colpitis macularis
142
Trichomoniasis
why is it called a strawberry cervix
inflammation of the cervix
tiny haemorrhages across the surface of the cervix giving the appearance of a strawberry
143
Trichomoniasis
what will the vaginal pH show
raised pH >4.5 (similar to BV)
144
Trichomoniasis
dx
charcoal swab with microscopy
145
Trichomoniasis
where should swabs be taken in a woman
from the posterior fornix of the vagina (behind the cervix)
self-taken low vaginal swab may be used as an alternative
146
Trichomoniasis
where should swabs be taken in a man
urethral swab
or first catch urine
147
Trichomoniasis
mnx
refer to GUM
metronidazole
148
Genital Herpes
which organism is responsible for both cold sores (herpes labialis) and genital herpes
the herpes simplex virus (HSV)
149
Genital Herpes
what are the 2 main strains of HSV
HSV-1 and 2
150
Genital Herpes
after infection, where does the virus become latent (in cold sores)
trigeminal nerve ganglion
151
Genital Herpes
after infection, where does the virus become latent (in genital herpes)
sacral nerve ganglia
152
Genital Herpes
what can HSV cause
- cold sores (herpes labialis
- genital herpes
- aphthous ulcers
- herpes keratitis
- herpes whitlow
153
Genital Herpes
what is aphthous herpes
small painful oral sores in the mouth
154
Genital Herpes
what is herpes keratitis
inflammation of the cornea in the eye
155
Genital Herpes
what is herpetic whitlow
a painful skin lesion on a finger or thumb
156
Genital Herpes
how is HSV spread
through direct contact with affected mucous membranes
or viral shedding in mucous secretions
157
Genital Herpes
what does it mean when the virus can be shed even when no symptoms are present
it can be contracted from asymptomatic individuals
158
Genital Herpes
when is asymptomatic shedding more common
in the first 12m of infection and where recurrent sx are present
159
Genital Herpes
which strain is most associated with cold sores
HSV-1
160
Genital Herpes
what happens to HSV-1 contracted in childhood <5yrs usually
remains dormant in the trigeminal nerve ganglion
and reactivates as cold sores, particularly in times of stress
161
Genital Herpes
how is genital herpes caused by HSV-1 usually contracted
through oro-genital sex, where the virus spreads from a person with an oral infection to the person that develops a genital infection
162
Genital Herpes
what does HSV-2 typically cause
genital herpes
163
Genital Herpes
how is HSV-2 mostly spread
STI
164
Genital Herpes
when do symptoms of an initial infection with genital herpes usually appear
within 2w
but may display no symptoms or develop them months/years later
165
Genital Herpes
presentation of genital herpes (5)
- ulcers or blistering lesions affecting the genital area
- neuropathic type pain (tingling, burning, shooting)
- flu-like sx (fatigue, headaches)
- dysuria (painful urination)
- inguinal lymphadenopathy
166
Genital Herpes
how long can symptoms last in a primary infection
3w
recurrent episodes are usually milder and resolve more quickly
167
Genital Herpes
dx
clinically based on hx and exam
viral PCR swab from a lesion can confirm dx and causative organism
168
Genital Herpes
mnx
refer to GUM
Aciclovir
169
Genital Herpes
additional measures as mnx
- paracetamol
- topical lidocaine (instillagel)
- cleaning with warm salt water
- topical vaseline
- additional oral fluids
- wear loose clothing
- avoid intercourse with sx
170
Genital Herpes
what is the main issue with genital herpes during pregnancy
risk of neonatal herpes simplex infection contracted during labour and delivery
it has a high morbidity and mortality
171
Genital Herpes
how does the fetus gain passive immunity to the virus
after initial infection, the woman develops antibodies
during pregnancy, these antibodies can cross the placenta into the fetus
172
Genital Herpes
how is primary genital herpes contracted before 28w gestation treated?
with aciclovir during initial infection
followed by regular prophylactic aciclovir starting from 36w gestation
173
Genital Herpes
what mode of delivery is recommended in women with primary genital herpes contracted before 28w
asymptomatic: vaginal delivery (provided it is is >6w after initial infection)
symptomatic: caesarean
174
Genital Herpes
how is primary genital herpes contracted after 28w gestation treated?
aciclovir during the initial infection
followed immediately by regular prophylactic aciclovir.
Caesarean section is recommended in all cases
175
Genital Herpes
what is recurrent genital herpes in pregnancy
where the woman is known to have genital herpes before the pregnancy
176
Genital Herpes
what is the risk of neonatal infection in women with recurrent genital herpes
low risk of neonatal infection (0-3%), even if the lesions are present during delivery
177
Genital Herpes
what is the mnx if the pregnant woman has recurrent genital herpes
Regular prophylactic aciclovir is considered from 36 weeks gestation to reduce the risk of symptoms at the time of delivery.
178
HIV
what is it
an RNA retrovirus
179
HIV
what is the most common type
HIV-1
HIV-2 is rare outside West Africa
180
HIV
how is it transmitted
- unprotected anal, vaginal or oral sexual activity
- vertical transmission (mother to child)
- mucous membrane, blood or open wound exposure to infected blood or bodily fluids
181
HIV
when does AIDs occur
when the CD4 count is under 200 cells/mm3
182
HIV
name some AIDS-defining illnesses
- Kaposi's sarcoma
- Pneumocystis jirovecii pneumonia
- Cytomegalovirus infection
- Candidiasis (oesophageal or bronchial)
- Lymphomas
- TB
183
HIV
why can HIV antibody tests be negative for 3m following exposure
it can take up to 3m to develop antibodies to the virus after infection
repeat testing is necessary
184
HIV
whom should you test in hospital and do you need consent
everyone admitted to hospital with an infectious disease for HIV
patients with any RFs
needs verbal consent but don't need counselling
185
HIV
types of testing (3)
- antibody testing
- testing for the p24 antigen
- PCR testing for the HIV RNA
186
HIV
facts about antibody testing
- the typical screening test for HIV
- simple blood test
- pts can self sample at home and order online
187
HIV
facts about testing for the p24 antigen
- checks directly for this specific HIV antigen
| - can give a +ve result earlier in the infection compared with the antibody test
188
HIV
how do you calculate the viral load
PCR testing for the HIV RNA levels tests directly for the number of viral copies in the blood
189
HIV
how do you monitor it
- CD4 count
| - Viral load (VL)
190
HIV
what is the CD4 count
the number of CD4 cells in the blood
these are the cells destroyed by the virus
the lower the count the higher the risk of opportunistic infection
191
HIV
what is the normal CD4 count range
500-1200 cells/mm3
192
HIV
what is the CD4 count in AIDS
<200 cell/mm3
193
HIV
what is the viral load
the number of copies of HIV RNA per ml of blood
194
HIV
what does 'undetectable' mean
the viral load below the lab's recordable range (usually 50-100 copies/ml)
195
HIV
what is offered to everyone with a diagnosis irrespective of viral load or CD4 count
antiretroviral therapy (ART)
196
HIV
what do the BHIVA guidelines recommend starting a regime of
2 NRTIs
+
3rd agent
197
HIV
what is HARRT
Highly Active Anti-Retrovirus Therapy
198
HIV
name some classes of HAART medications that work slightly differently on the virus
- Protease inhibitors (PIs)
- Integrase inhibitors (IIs)
- Nucleoside reverse transcriptase inhibitors (NRTIs)
- Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
- Entry inhibitors (EIs)
199
HIV
what is additionally given to patients with a CD4 <200/mm3 and why
Prophylactic co-trimoxazole (Septrin)
to protect against pneumocystis jirovecii pneumonia (PCP)
200
HIV
what does HIV increase the risk of developing and what is done to help
CV disease
close monitoring of CV RFs and blood lipids
statins may be required
201
HIV
what additional mnx is done for women with HIV and why
yearly cervical smears because HIV predisposes to developing HPV and cervical cancer
202
HIV
which vaccines should be up to date and which should they avoid
influenza, pneumococcal, hepatitis A and B, tetanus, diphtheria and polio vaccines
avoid live vaccines
203
HIV
advice for reproductive health
- condoms for vaginal and anal sex
- dams for oral sex
even if both partners are HIV +ve
- partners should have regular HIV tests
- if viral load is undetectable = untransmissionable
204
HIV
how to conceive safely
sperm washing
IVF
205
HIV
when is normal vaginal delivery recommended
for women with a viral load <50 copies/ml
206
HIV
when is Caesarean section considered
in patients with >50 copies/ml
207
HIV
when is Caesarean section recommended
>400 copies/ml
208
HIV
when should IV zidovudine be given during the caesarean section
if the viral load is unknown or there are >10,000 copies/ml
209
HIV
what prophylactic trx is given to low risk babies (mother's viral load <50)
zidovudine for 4w
210
HIV
what prophylactic trx is given to high risk babies (mother's viral load >50)
zidovudine, lamivudine and nevirapine for 4w
211
HIV
is breastfeeding okay even if the mother's viral load is undetectable
no , it can be transmitted
212
HIV
what is PEP
Post-exposure prophylaxis
used after exposure to HIV to reduce the risk of transmission
combination of ART therapy
213
HIV
what is the current PEP regime
Truvada (emtricitabine and tenofovir)
and raltegravir for 28 days.
214
HIV
disadvantages of PEP
not 100% effective
must be commenced within 72h
215
Syphilis
what bacteria causes it and what kind is it
Treponema pallidum
spirochete, a type of spiral shaped bacteria
216
Syphilis
what is the incubation period
21d
217
Syphilis
how may it be contracted
oral, vaginal or anal sex involving direct contact with an infected area
vertical transmission
IV drug use
blood transfusions and other transplants
218
Syphilis
what are the stages
- primary
- secondary
- latent
- tertiary
219
Syphilis
how does primary syphilis present
painless ulcer (chancre) at the original site of infection (usually on genitals). resolved over 3-8w
local lymphadenopathy
220
Syphilis
how does secondary syphilis present
- systemic symptoms can resolve after 3-12w
- condylomata lata
- maculopapular rash
- low grade fever
- lymphadenopathy
- alopecia
- oral lesions
221
what is latent syphilis
occurs after the secondary stage, where symptoms disappear despite still being infected
222
when does early latent syphilis occur
within 2 years of the initial infection
223
when does late latent syphilis occur
from 2 years after the initial infection onwards
224
what is tertiary syphiliis
can occur many year after the initial infection
affects many organs
development of gummas and CV + neuro complications
225
what is neurosyphilis
occurs if the infection involves the CNS
presents with neuro sx
226
syphilis
what is condylomata lata
grey wart like lesion around the genitals and anus which presents at the secondary stage
227
syphilis
what are gummas
granulomatous lesions that can affect the skin, organs and bones
228
syphilis
how may tertiary syphilis present
- gummas
- aortic aneurysms
- neurosyphilis
229
what may neurosyphilis present with
- Argyll-Robertson pupil
- Headache
- Altered behaviour
- Dementia
- Tabes dorsalis (demyelination affecting the spinal cord posterior columns)
- Ocular syphilis (affecting the eyes)
- Paralysis
- Sensory impairment
230
Neurosyphilis
what is Argyll-Robertson pupil
a specific finding for neurosyphilis
a constricted pupil that accommodates when focusing on a near object but does not react to light
aka prostitutes pupil: it accommodates but does not react
231
Neurosyphilis
what is Tabes dorsalis
demyelination affecting the spinal cord posterior columns
232
Neurosyphilis
what is ocular syphilis
affecting the eyes
233
Syphilis
screening
antibody testing for antibodies to T.pallidum bacteria
234
Syphilis
inx for pts with suspected syphilis or +ve antibodies
refer to GUM
samples from sites of infection can be tested to confirm presence of T.pallidum with:
- Dark field microscopy
- PCR
235
Syphilis
what are 2 non-specific but sensitive tests used to assess for active syphilis infection
- rapid plasma reagin (RPR)
| - venereal disease research lab (VDRL)
236
what does non-specific mean
they often produce false positive results
237
syphilis
mnx
single deep IM dose of benzathine benzylpenicillin (penicillin)
238
Recurrent candidiasis indicates the need to test for what?
diabetes mellitus with Glycated haemoglobin
239
painful lesion on his penis. He has recently returned from a holiday in the Gambia
what is it and how to treat
Chancroid
ciprofloxacin and Ceftriaxone
240
bilateral bihilar interstitial infiltrates on CXR and uncompliant with cART therapy. What is it and what trx
Pneumocystis Pneumonia (PCP)
trx: Co-Trimoxazole
241
engaged in receptive anal sex. Do you prescribe PEP
yes, prescribe PEP to anyone who has engaged in receptive anal sex, regardless of whether the HIV status of the partner is known
242
18y with multiple uniform smooth lesions present around the coronal margin of the glans.
what is it
pearly penile papules
reassure and discharge
243
numerous lesions on the glans penis
painless, irregular in shape
soft and moist to the touch
what is it
genital warts
244
mnx of genital warts if not concerned about appearance
a conservative approach can be adopted. If there is concern, keratinised lesions can be removed using cryotherapy whilst non keratinised lesions can be removed using podophyllotoxin, imiquimod or sinecatechin
245
mnx of genital warts if concerned about appearance
keratinised lesions: removed using cryotherapy
| non keratinised lesions: podophyllotoxin, imiquimod or sinecatechin
246
what is the most likely diagnosis in a HIV positive patient with a raised opening pressure on lumbar puncture.
cryptococcal meningitis
