PATHOLOGY- Sexually transmitted infections Flashcards
Name the 8 most common STIs
- Syphilis
- Gonorrhea
- Chlamydia
- Trichomoniasis
- Hepatitis B
- Herpes Simplex
- HIV
- Human papilloma virus (HPC)
Name the 4 STIs that are curable
- Syphilis
- Gonorrhea
- Chlamydia
- Trichomoniasis
Name the 4 STIs that are incurable (at present)
- Hepatitis B
- Herpes Simplex
- HIV
- Human papilloma virus (HPC)
How do we treat bacterial (chlamydia, gonorrhoea and syphilis) and parasitic (trichomoniasis) STIs
Single dose antibiotics
Which STIs are caused by bacteria?
Chlamydia
Gonorrhoea
Syphilis
Which STIs are caused by parasites?
Trichomoniasis
How do we treat Herpes/ HIV?
Antivirals can modulate the disease but cannot cure it
How do we treat hepatitis B?
Antivirals can modulate the virus and slow the liver damage but can’t cure it
which STI especially has a rapid increasing rate of antimicrobial resistance
gonorrhoea
Have the cases of genital warts increased or decreased since 2018?
decreased (because of the HPV vaccine)
How do we classify STIs?
In two categories:
- Bacterial (or parasitic) origin
- Viral
Describe STIs that are bacterial (or parasitic) in origin
- Often asymptomatic
- Damage usually occurs prompt to treatment
- Treated with antibiotics
Describe STIs that are viral in origin
- Cannot be cured
- We treat the symptoms
- Remains in the body and can reoccur
List the STIS that are of a viral origin
- Herpes
- HPV
- Hep B
- HIV
What are the risk factors of STIs
- Unprotected sex
- Oral sex
- Multiple partners
- Previous STIs
- Alcohol and recreational drug misuse
- injecting drugs
- Meds for erectile dysfunction
- Being young
- Holiday sex
Is syphilis chronic or acute?
Chronic
Name the bacteria that causes syphilis
Treponema pallidum
why is syphilis spirochete
corkscrew shaped
How is syphiliss spread?
Almost exclusively transmitted sexually
But in some cases can be mother to child (vertical)
Very rarely can be transmitted haematogenously
How many stages does syphilis have and what are they?
- Primary
- Secondary
- Latent
- Tertiary
When does primary syphilis develop?
Usually 2-3 weeks after primary infection
Describe the clinical presentation and symptoms of primary syphilis
- Theres usually a lesion (known as a chancre) at the site of infection
- Progresses to an ulcer over 7 days
- Is painless, solitary, indurates and has a clean base
- Can be found on the glans, corona, labia, fourchette or perineum
- Can be extra genital (EG oral cavity)
- Localused painless lymph nose enlargement (lymphadenopathy)
Does the chancre caused by primary syphilis heal?
Yes it can heal naturally with or without treatment
How does syphilis spread around the body?
By haematological and lymphatic dissemination
When does secondary syphilis develop?
2weeks - 6 months post exposure
Concurrent or up to 8 weeks after chance
Describe the clinical presentation and symptoms of secondary syphilis
- Painless superficial lesion of skin / mucosa
- Can show up on the palms and soles of feet
- rash diffuses and is often symmetric
- In moist areas of the skin you can find opercular lesions called condylomata lata
- Enlarged lymph nodes
- Mild neurosyphilis
How long does secondary syphilis last?
Several weeks and then the person enters the latent stage
Are the symptoms and effects of neurosyphilis at any stage of syphilis the same?
NO
Neurosyphilis of secondary syphilis is mild and not the same as neurosyphilis of tertiary syphilis
Describes what happens in the latent syphilis phase
- It is asymptomatic
- The disease goes ‘quiet’
- Secondary reinfection occurs 25% of the time
Define latent
UK defines it as less than a year post infection
Name the 3 main clinical manifestations of tertiary syphilis
- Neurosyphilis
- Cardiovascular
- Benign tertiary/ gummatous
Is tertiary syphilis more common in treated or untreated patients
Untreated
who does tertairy syphilis affect
1/3 untreated patients, usually after a latent period of 5 years or more.
Name the 3 components of neurosyphilis
- Meningovascular syphilis
- General paresis
- Tapes dorsalis
What is effected if someone has Meningovascular syphilis?
The meninges around the brain are affected (base of the brain, cerebral convexities and spinal leptomeninges)
Describe what happens to a person who has meningovascular neurosyphilis
- Chronic meningitis (base of the brain, cerebral convexities and spinal leptomeninges)
- . Obliterative vascular inflammation occurs in the brain (Heubner arteries)
- Inflammation of small/ medium CNS arteries which can lead to stroke or stroke like symptoms
- Cerebral gummas in the meninges and can extend into the parenchyma
What are cerebral gummas?
Plasma rich mass lesions
What happens in general paresis?
Invasion of the brain by T. palladium
Give some symptoms are clinical presentations of general paresis
- Memory loss
- Personality change
- Depression, mania and psychosis
- Dysarthria
- Hypotonia, tremor
- Insidious progressive cognitive impairment associated with mood alterations
- Ends with severe dementia
What does general paresis usually end with?
Severe Dementia
What happens in tabes dorsalis?
Affects the nerves final column/ peripheral nerves
Give some symptoms and clinical presentations of tabes dorsalis
- Lighting pains (severe unprovoked pain)
- Ataxia
- Argyll Robinson pupil
- Loss of pain sensation leading to skin and joint damage (Charcot joints)
What is ataxia?
Loss of proprioception
What is the Argyll Robinson pupil?
It is a strong specific sign for syphilis and effects the pupils
What are the symptoms of Argyll Robinson pupil?
Bilateral small pupils that react to near objects
What don’t Argyll Robinson pupils react to
DONT react to light only to close objects
How common is neurosyphilis?
Very rare (less than 0.5% of all syphilis case)
What can happen if you develop cardiovascular tertiary syphilis?
Leads to syphilitic aortitis
- Aneurysm proximal aorta
- Aortic valve insufficiency
- Coronary artery disease
Describe how the aorta is affected in a patient with cardiovascular syphilis
- Inflammation of proximal aorta
This leads to the occlusion of the vasa vasorum which causes scarring of proximal aortic ultimately leading to loss of elasticity - Progressive dilation of aortic arch/ root which leads to aortic valve insufficiency and aneurysms of the proximal aorta
Describe how the coronary arteries are affected in a patient with cardiovascular syphilis
Narrowing coronary artery ostia occurs which can lead to myocardial ischemia
What happens in a patient with benign tertiary gummatous syphilis?
- They form gummas in their bones, skin and mucous membranes of their upper airway and mouth
- Nodular lesions ? Hypersensitivity / chronic inflammatory reaction
- Pathologic fractures
- Skin and mucous membranes - nodular lesions or, rarely, destructive, ulcerative lesions.
rare due to effective antibiotics
How can we detect syphilis
- Direct detection using microscopy or PCR
- Serology (Blood tests)
Which 2 blood tests can we carry out to investigate syphilis
- VDRL: Non specific IgG/ IgM (quantative-corresponds to stage of disease and can change with therapy)
- TPPA: specific anti Tp. Palidum antibodies (qualitative - is raised for life)
Which of the 2 blood tests when investigating syphilis is used to check therapy response?
VDRL
How can we diagnose neurosyphilis?
- Spinal tap
- CSF testing
- CT scan for gummas
What is the treatment for syphilis?
antibiotics- Penicillin
Name the most common STI in the uk
Chlamydia trachomatis
Why is chlamydia so prevalent in the UK?
As more than 50% of patients are asymptomatic so the diseases goes undetected and is passed on
What part of the body is affected by chlamydia in women
Cervix and or urethra
They can get vaginal discharge or dysuria
What part of the body is affected by chlamydia in men
Urethra
They can get dysuria and epididymitis
How is chlamydia diagnosed?
By checking urine or taking a swab
Why is chlamydia dangerous
It can put you at risk of getting secondary (more dangerous) diseases:
- PID
- Endometriosis
- Premature births / infertility
- Reactive arthritis of the joins, urethra and the eyes
What should you look out for in the oral cavity if you suspect a patient has chlamydia?
Theres no specific oral manifestation but look out for a sore throat, pharyngitis/ tonsillitis
How is chlamydia treated?
Antibiotic therapy
Name the second most common STI in the uk
Gonorrhoea
What is gonorrhoea caused by?
Gram negative aerobic bacteria called neisseria gonorrhoeae
How is gonorrhoea usually transmitted?
Almost exclusively transmitted sexually
Rare cases of vertical transmission
How are women affected by gonorrhoea?
50% are asymptomatic Those who aren't can suffer from: 1. Urethral or vaginal discharge 2. Dysuria 3. PID
How are men affected gonorrhoea
Dysuria, urethral discharge, epididymitis
What does PID stand for?
Pelvic inflammatory disease
How is gonorrhoea treated?
Intermuscular Ceftriaxone (125g)
Oral cefixime (400g)
Oral azithromycin (1g)
What is drug resistant gonorrhoea resistant to?
Injectable gentamicin combined with oral azithromycin or oral gemifloxacin
What are some of the oral manifestations of gonorrhoea?
- Gonococcal pharyngitis following oral genital contact
- Sore throat with redness exudates
- N. gonorrhoeae cultured with 70% oropharyngeal gonorrhoea
What is pelvic inflammatory disease (PID)
Ascending infection of vulva/ vagina with spread to other areas of female genital system
What symptoms are associated with initial pelvic inflammatory disease(PID)
- Pelvic pain
- Adnexal (lower abdomen) tenderness
- Fever
- Vaginal discharge
What are the main causes of PID?
- Gonorrhoea
- Chlamydia
Why is scarring in the Fallopian tubes dangerous?
Can lead to infertility
List some of the chronic complications of PID
- Infertility and tubal obstruction
- Pelvic pain
- Intestinal obstruction due to adhesion between the bowel and pelvic organs
- ECTOPIC PREGNANCY
How do we treat PID?
Antibiotics
What is ectopic pregnancy?
When a fertilised egg sits in the wrong place in the Fallopian tube due to inflammation and the embryo can start growing in the fallopian tube and can cause it to rupture
Why is HPV dangerous?
It can cause cancer
How can HPV spread?
Orogenital contact
Entry via basal epithelia layer through micro abrasion in genital skin during sexual contact
Name the lesions that can form in a patient with HPV
- Sq. papiloma
- Verruca vulgaris
- Condyloma acuminatum
How many types of HPV are there?
40
What are HPV type 6 and 11 describes as and why
Low risk as they don’t cause cancer
Why are HPV types 16 and 18 important
As they are high risk and can cause cancer (cervical, head and neck)
but unlikely to cause visible warts
When are you most infectious to others if you have hpv?
When you have visible warts
How do the warts associated with HPV get treated
Majority of patients clear the infection by themselves but if they don’t:
- Abiative therapies like cryotherapy, electrocautery
- Immune modulation
- Surgical removal of warts
Are condoms useful in minimising the spread of HPV?
NO they do not eliminate viral transmission, only reduce
Which types of HPV dont cause warts?
Types 16, 18 (high risk)
HPV infection is
transient
asymptomatic/sub-clinical
Name the 2 types of herpes simplex
- Herpes simplex virus type 1 (HSV-1)
- Herpes simplex virus type 2 (HSV-2)
How is HSV-1 transmitted?
Through oral to oral contact and can cause cold sores/oral herpes and also gential herpes
How is HSV-2 transmitted?
Sexually transmitted and causes genital herpes
What do both HSV1 and HSV2 have in common?
They are both life long infections
What are some of the symptoms of herpes
Painful blister or ulcers at the site of infection
can be asymptomatic
When is herpes simplex most contagious?
Most contagious when symptoms are present but can still be transmitted in the absence of symptoms (but can be transmitted without symptoms)
What is the relationship between HSV and HIV?
Infection with HSV2 increases the risk of acquiring an transmitting HIV
Describe the clinical manifestations and symptoms of HSV1
Cold sores
Genital infection
Cervical lymphadenopathy
Malise, fever and irritability
What are cold sores?
Vesicles that coalesce and form larger vesicles
Found many on the junction of lip and skin
They can rupture to release live viral particles that can infect others
Is there a cure for HSV?
No anti virals can attenuate the symptoms but can’t cure
What are the differences in the oral manifesto of HSV1 and HSV2
Oral lesions are clinically indistinguishable from each other
which type of herpes causes most cases of gential herpes
hepres simplex 2
how are genital hepres transmitted
gential-genital
oral-genital
how are antiviral useful for cases of genital herpes
control duration, freq and severity
no cure
