Sex Ed Flashcards
1
Q
What bacteria is responsible in maintaining the pH of the vagina
A
Doderlein Lactobacilli
2
Q
How does Doderlein Lactobacilli maintain the pH of the vagina
A
Glucose -> lactic acid
3
Q
What is the normal pH of the vagina and why
A
4.5, prevents growth of bacteria
4
Q
Symptoms of vulvovaginitieg
A
- Change in colour/volume/smell of discharge
- Itching
- Burning
- Irritation
- Dyspareunia
- Dysuria
5
Q
Non-infectious causes of vulvovaginitieg
A
- Atrophic Vaginitis (post-menopause)
- Retained Foreign objects (condoms, tampons).
Needs to be examined by speculum
6
Q
Examination findings in atrophic vaginitis
A
- Smooth, Shiny Vaginal Epithelium and strpophy
7
Q
What causes atrophic vaginities
A
- Lack of oestrogen to maintain uterus wall causes thinning and inflammation
8
Q
RF for atrophic vaginitis
A
- Smoking
2. Breastfeeding
9
Q
Treatment of atrophic vaginitis
A
Local Oestorgen creams
Lubricants
10
Q
Three types of infectious vulvovagiitis
A
- Bacterial Vaginosis
- Candida Vulvovaginitis
^ imbalance in normal flora
- Trichomoniasis
^ STD
11
Q
What STDs cause cervicitis rather than vulvovaginitis
A
- Gonnorheoa
- Chlamidyia
- Mycoplasma
Vaginitis is rare
12
Q
What is bacteria vaginosis
A
When number of lactobacilli decrease = increase in pH
13
Q
What bacterial species will proliferate in when there is a lack of lactobacilli
A
- Gardnerella vaginalis
14
Q
RF for bacterial vaginosis
A
- New sex partenr
- Multiple partners
- Douches
- Antibiotics
- IUD
NOT A STD as it doesn’t colonise the male reproductive tract
15
Q
5 Characteristics of discharge in bacterial vaginosis
A
- Thin
- Homogenous
- Grey
- Foul Smell that gets WORST when having sex
- NO VULVAL INVOLVEMENTR
16
Q
Consequence of other symptoms of bacterial vaginosis that were not mentioned in the previous card
A
Signs of mixed infection
17
Q
Criteria for Bacterial Vaginosis
A
AMSEL CRITERIA
18
Q
What is the Amsel Criteria
A
3 of 4 must be met:
- Thin Grey Vaginal Discharge
- Vaginal pH> 4,5
- Positive WHIFF-AMINE TEST
- SALINE WET MOUNT FOR CLUE CELLS
19
Q
What is the WHIFF-AMINE TEST
A
- Discharge placed on slide and 10% KOH added
causes a fishy odour
20
Q
What are clue cells
A
- Vaginal epithelial cells with coccobacilli (stippled borders)
21
Q
Treatment of bacterial vaginosis
A
- Oral Metronidazole (500mg 2x daily for 7 days)
OR
Vaginal Creams (2% CLindamycin)
22
Q
What topical antiboitic should not be used with condoms
A
- CLINDAMYCIN (makes them less effective)
23
Q
What species of candida causes candida vulvovaginitis
A
Candida albicans (normally present in low numbers)
24
Q
RF for candidiasis
A
- Immunosuppressions (glucocorticoids)
- DM
- Antiboitics
- Increased oestrogen levels (pregnancy, contraception and COCP)
25
Symptoms of candidiasis
1. Intense itching
2. Thick, White 'cottage cheese', odourless vaginal discharge
3. Vulva is also flamed
26
Symptoms specific to vulva inflammation
1. Dyspareunia
| 2. Dysuria
27
Screening for candidiasis
1. Saline wet mount (10% KOH to destroy cellular elements)
| 2. Vaginal Culture if no pathogens seen on microscopy or recurrent symptoms or non-albicans species
28
What would be seen under a saline wet mount for candidiasis
1. Yeast or hyphae form
29
What is uncomplicated candidiasis
- Otherwise healthy, immunocompetent, non-pregnancy females
- <3 Episodes in the past year with MILD to MODERATE SYMPTOMS
- Confirmed albicans species
30
How is uncomplicated candidiasis treated
Single 150 mg ORAL FLUCONAZOLE
31
What is complicated candidiasis
1. Pregnant/DM/Immunosupressed
2. Severe Symptoms
3. History of >3 episodes in one year
4. Non-Albicans
32
Treatment of complicated candidiasis
1. 2/3 doses of 150mg Fluconazole (72 hours apart)
| 2. Intravaginal Boric Acid
33
Symptoms of Trichomoniasis infection 1
1. THIN, Purluent vaginal discharge
2. Burning and Itching
3. Dysuria
4. Urinary frequency
5. Lower abdomen pain
6. Dyspareunia
34
Diagnosis of trichomoniasis
1. Erythema of cultus and vaginal mucosa
2. MOTILE Trichomonads on saline wet mount
3. GOLD" nucleic Acid Amplification Test (NAAT) for DNA
35
Treatment of trichomoniasis
1. 2g oral Metronidazole (or Tinidazole but not for pregnancies)
2. Screen all partners.
36
Characteristics of Treponema Pallidum
1. Gram-Negative, Spirochetes.
| 2. Obligate Parasite
37
What is an obligate parasite
Cannot survive outside the host
38
Adapation of a spirochete
1. Spiral shape contains endoflagella to move them about by spinning
39
Two ways syphilis can be transmitted
1. Acquired syphilis: enters through bodily fluid
| 2. Congenital Syphilis
40
Passages of acquired syphilis
1. Cuts/breaks in skin or mucous membranes of the external genitalia and mouth
2. Sexual Contact (oral, anal or vaginal)
3. Contaimated needles
4. direct contacts with skin lesions containing spirochetes
41
What is congenital syphilis
1. Mother has syphilis and t.pallidum infects baby during vaginal delivery.
42
Four stages of infection in acquired syphilis
1. Primary, early localised stage (week 1-3):
Spirochetes destroys the skin and soft tissue where they enter the body - painless CHANCRES that heal on their own
2. Secondary, dissemination stage (week 6-12)
Spirochetes invade the lymph nodes causing lymphadenopathy -> lymph -> blood
Spirochetes enter the blood (spriochetaemia), causing generalised lymphadenopathy.
Spirochetes attach to endothelial cells and capillaries on surface = non-itchy maculopapular rash
Either pustular or papulosquamous (scaly and hard).
Resolves in a few weeks
3. Latent phase
Disease enters a dormant phase, spirochetes found in capillaries of organs and tissues
Early sub-phase:
During the first year of infection, spirochetes re-enter the blood. Can still be found circulating in the blood, causing secondary stage symptoms
Late sub-phase:
After the first year of infection.
Tertiary Phase:
Overall, capitally infection causes a severe immune response.
Type IV hypersensitivity reaction:
T-cells recruit macrophages and release TNF and IL-1 and IL-6
Swelling, oedema, redness and warmth, fever.
Plasma cells produce antibodies against t/ pallidum antigens and stick to them to form Gumma
These gummy form organ damage:
Cardiovascular syphilis, neurosyphilis
43
Three characteristics of Chancres
1. Raised Border
2. Hard Base
3. Fluid Rich in Spirochetes that spread to other parts of the body and individuals
Look at where the primary chancre originated from to see how it was transmitted.
44
When might a primary chancre not be seen in syphilis
1. BLOOD TRANSFUSION
45
How does the maculopapular rash in stage 2 of acquired syphilis spread
Trunks -> arms and legs, genitalia -> palms and soles
46
Three types of rashes found in stage 2 syphilis
1. Pustular
2. Papulosquamous
3. Condyloma Lata (white painless rash found in moist regions)
47
Most infectious stage of syphilis
1. Stage 2, secondary.
48
Three main antigens of t. palladium
1. Group specific antigen
Species specific antigen
Cardiolipin
Plasma cells produce antibodies against these antigens
49
Structure of a gamma
1. Immune cell complex, surrounded by fibroblasts.
Inside is coagulative necrotic
50
What is cardiovascular syphilis
1. Endarteritis (vaso vasorum inflammation which supplies the blood vessels)
Can cause aortic aneurysms
51
What is neurosyphilis
1. Spirochetes sit in the capillaries supplyingg the posterior spinal cord = Tabes Dorsalis
2. Destroys protective sheath of spinal cord nerves: Loss of vibration sense and proprioception.
Sometimes, they invade the anterior spinal cord: General Paresis (loss of sensation and weakness).
3. Invade into brain: Slurred speech, beavhiour, memory loss, difficulty coordinating and paralysis
4. Invade into the eyes
52
Sign of eye invasion of syphilis
1. Argyll Robertson Pupil
53
What is Argyll Robertson Pupil
1. Pupil loses light reflex but has accommodation reflex, which means it constricts with a nearby object but no response to light
54
Two ways a baby can be infected with syphilis
1. Placenta
| 2. Childbirth
55
Symptoms of early disease of syphilis in babies
1. Snuffles
2. Maculopapular rash
3. Hepatosplenomegaly from organ damage
4. Optic neuritis
56
Symptoms of late disease of syphilis in babies
1. Saddle Nose
2. Saber Shins
3. Hutchinson Teeth
4. Hearing Loss
57
Diagnosis of syphilis
1. Non-Treponemal Tests:
Rapid Plasma Reagin test
2. Venereal Disease Research Lab Test
to detect anti-cardiolipin (REAGIN)
2. Trependemal Tests:
T.pallidum particle agglutination
2. Fluorescent treponema antibody absorbed. Detect antibodies specifically targeting t pallidum.
58
Diagnosing congenital syphilis
1. If baby has four times higher the non-treponema serological titer
2. CSF fluid: VDRL, cell count and protein
3. Long Bone X-rAYS
4. Eye exam
5. Hearing test s
59
Treatment of syphilis
1. IM Penecillin G Benzathine
IV in neurosyphilis
2. Doxycyclin
60
What is the Jarisch-Herxheimer Reaction
1. Spirochetes die and release lots of antigens together.
Causes severe IMMUNE REACTION.
Lasts for a few days.
61
Types of hypersensitivity reactions
I: IgE mediated (exposure to external antigens/allergies)
II: Antibody-mediated cytotoxic reaction (IgG or IgM) (antibodies binding to antigens in host tissues)
III: Immune complex-mediated (SLE, glomerulonephritis, RA)
IV: Cell-mediated, delayed.
62
Type 1 vs Type 2 herpes simplex virus
Type 1: NO ANTIBODIES to HSV
Painful vesicles on erythematous base
Pruritus
Dysuria
Inguinal Lymphadenopathy
Systemic Symptoms
Type 2: Antiboidies
NON-PRIMARY INFECTION
Less severe
GENERALLY, HSV-1 is above the waist infection, while HSV-2 is below the waist
63
Two characteristics of HSV-1 strains
Envelope, double stranded DNA
64
How can Herpes spread
1. Most contagious when virus-filled lesions are present 2. Spread by asymptomatic shedding (ie., Saliva and Genital secretions)
Usually moves into the body through small cracks in the skin or mucosa. Binds to epithelial cells receptors and get abosrbed
65
What is the lytic cycle
1. Where the viral DNA is transcribed and Translate by cells, forming new viral proteins = new herpes viruses that invade neighbouring epithelial cells.
66
Where do HSV strains remain dormant in the body
HSV-1: Trigeminal Ganglia
HSV-2: Sacral Ganglia (genitalia neurons)
FOR LIFE
67
When HSV re-activates in the neurones, how do symptoms present
Trigeminal and Sacral ganglions serve only one side of the face and body:
Ulcers form on the ipsilateral side as the ganglion ove
68
Triggers for HSV
1. Stress
2. Skin Damage
3. Viral Illness
Recurrent episodes are less severe
69
Symptoms of HSV
1. Prodrome: Tingling or Burning before ipsilateral blisters appear.
Primary Infection is asymptomatic except in children: Gums, palate, tongue, lips
Fever and Enlarged Lymph Nodes.
Pharyngitis
2. GENITALS:
Form at the lbaia majora, mons pubis, vaginal mucosa and cervix in women
Shaft of penis in men.
3. Keratoconjuctivitis
Pain, Redness, Tearing, Light sensitivity
Corneal involvement:
Blurry Vision, Branching Dendritic Lesions (CLASSIC)
4. NEuro:
Meningiitis or Encephalitis from Temporal lobe infection
Commonly happens during reactivation
Requirews a lumbar puncture
70
Characteristics of HSV lesions
Small, painful fluid filled blisters that ulcerate and heal in a few weeks.
71
Where do HSV blisters form
The Vermilion border (border of the lip).
72
What is Herpetic Whitlow
Infection of HSV at the finger tips
Easy to get carrie to to other parts of the body (auto inoculation)
73
What is Herpes Gladiatorum
1. Infection of trunk, extremities and head from skin to skin contacts (common among wrestlers).
74
What is Eczema Herpeticum
HSV infection from Atopic Dermatitis
75
What does a lumbar puncture show for HSV
1. Increased RBC, EBCs and protein levels
76
Symptoms of Neonatal HSV
1. Skin, Eye and Mucous membrane infection (at site of damaged skin)
2. CNS infection (lethargy, irritability, seizures)
Requires lumbar puncture, CT, MRI and EEG
2-3 weeks after delivery
3. Disseminated infection: Sepsis and organ failure.
77
Diagnosis of HSV
2. PCVR
2. Antibody responses
3. Viral culture
78
Treatment of HSV
1. Often resolves its own
| 2. Acyclovir at start of prodrome
79
Symptoms of Acutec PID
1. Lower abode pain that WORSENS during sexual intercourse or sudden movement
2. Post-coital bleeding
3. Intermenstrual bleeding
80
Symptoms of Chronic PID
1. Weight loss, abdominal pain
| 2. Fever gradually increases
81
Investigations for STDs
1. First-Void Urine
2. Nucleic Acid Amplification Test
3. Urethral and endocervical swabs
4. HIV testing
82
First line treatment for Chlamidyia
1. Doxycycline (100mg twice daily for 7 days)
| 2. Azithromycin if not tolerated
83
Symptoms of Chlamidyia
1. Increased Vaginal Discharge
2. Post coital bleeding
3. Prupulent vaginal dischagre
4. Dysuria
5. Pelvic pain
Remember, asymptomatic in 70% of women
84
What other parts of the body may chlamidyia present
1. Lymphogranuloma centrum: tenesmus, anorectal discharge, diarrhoea
2. Rectal chalmidyia (anal discharge)
3. Adult conjunctivitis
4. Oropharyngeal infection
85
What is Reactive Arthritis
Triad:
1. Conjunctivitis
2. Nongonoccoccal urethritis
3. ASYMETRIC OLIGOARTHRITIS
Can't see, can't pee, can't climb a tree
Also keratoderma blennorhagica, achilles tenditis.
86
What STD causes reactive arthritis
Chlamidyia
87
RF for reactive arthritis
1. Male
2. 20-40 years olf
3. White (as they more likely carry HLA-B27 gene)
88
Diagnosis of Syphilis
1. Dark-field microscopy
2. PCR
3. TPPA
4. VDRL
89
Hep A: Chronic or Acute
Acute
90
Where is Hep A contracted
Food and Water
91
How does the Immune system tackle Hep A
Anti- HAV IgM is raised over 6 weejs
Anti- HAV IgG rises slowly during this time and after (persist for life)
So if someone has IgG but no IgM, they were vaccinated but not infected or had a prior infection
92
Treatment of Hep A
Fluids
93
Hep E, acute or chronic
Acute mainly but can be chronic in immunocompromised
94
Hep E transmission
Food and water
Pregnancy (vertical transmission) - can cause acute liver failure
95
Diagnosis of Hep E
Stool culture and blood tests to check for HEV RNA
96
Treatment of Hep E
1. Liver transplant
| 2. Ribavirin
97
Transmission of Hep B
1. Acute AND Chronic
| 2. Blood, body fluids and vertical transmission
98
Serology of Hep B
1. HesAg and Anti-Hbs
If one is positive, the other is negative
99
What is the exception to having no HBsAG or Anti-Hbs
1. Cleared infection (anti-has has not rise enough to be detected)
2. Never exposed
100
Hep B infection serology in chronic or acute infection vs vaccinated or recovered
1. HbsAg positive, but Anti-HBs negative
| 2. HBsAg negative, but Anti-HBs positive
101
Antibodies found in Hep B
1. Antibodies AGAINST HBcAg
IgM-anti-HBc and total anti-HBc
Total Anti-HBc remains high but the former decreases
HBeAg: positive = highly infectious
Sign of replication
HBV DNA PCR: Mirrors HBeAg
Shows virus is replicating
102
Complication of Hep B
Cirrhorsis - Hepatocellular carcinoma
103
Treatment of chronic Hep B
1. Pegylated Interferron SC
| 2. Tenofovir
104
Transmission of Hep D
Body fluids and Blood
105
What's interesting about Hep D
Has a HBsAg outer envelope (HBV), so requires prior HBV virus to infect: CO-INFECTION
They infect each other at the same time or during a chronic Hep B infection
106
Testing for Hep D
1. Hep B confirmation test
2. HDV IgM
2. Total HDV antibodies
3. HDV RNA
4. HDag
107
Treatment of Hep D
1. Peg-INF alpha-2a (HDV RNA elevated) or 2b (AST and ALT elevated)
108
Transmission of Hep C
1. Blood or body fluids
109
Extrahepatic manifestations of hep c
1. Cryoglobulinemia
2. Membranoproliferative glomerulonephritis
3. Prophyria Cutanea Tarda (blisters)
110
Microscopic findings for gonnorhoea
Gram negative, diplococci
111
Prevalence of symptoms in gonorrhoea vs chlamidyia
G - 90%
C - 10%
112
Treatment of Chlamidyia
Doxycycline
113
Treatment of Gonnorheoa
IM Ceftriaxone - GOLD STANDARD
114
What causes Lymphogranuloma centrum
C. Trachematis
115
LGV vs Syphilis
Syphilis is a indurated lesion with one swollen inguinal ligament.
This is Groove Sign
116
What is a main cause for a painful genital lesion that bleeds on contact
Chancroids (haemophilus Ducreyi infection)
117
Treatment of Chancroids
Ciprofloxacin and Ceftriaxone
118
What is the GODL standard diagnostic for HIV
HIV antibody AND HIV antigen testing
119
What forms part of post-exposure prophylaxis in HIV
Raltegrivir and Truvada
120
When is cART indicated for HIV
CD4 + < 200
AIDS diagnosis
Or if HIV is already diagnosed and CD4 starts to fall below 350
121
VDRL vs TPPA as markers for syphilis
VDRL is released immediately after infection and then go away
TPPA are present for the rest of your life, as a marker for a previous syphilis infection
122
Appearance of non-malicious penile ulcers
Smooth lesions around the coronal margin of the glans
Re-assure and discharge
123
First Line treatment for pneumocystis pneumonia
Co-Trimoxazole
124
What is the first line contraceptive in under 18s for controlling painful, heavy periods
COCP
125
Appearance of trichomoniasis
Motile PROTOZOA
126
What is the most effective treatment for Kaposi's sarcoma
Starting cART
127
Most common cause of epididymis-orchitis in older guys
E.COli
128
What long-term contraception can be given to women with fibroids
IUS! Controls heavy bleeding from fibroids
129
What is the initial screening tool for Syphilis
EIA
130
What serum levels are monitored for Syphilis treatment
RPR
131
What condition can result in increased CA-125
PID
132
After prescribing antibiotics to a pregnant woman for UTIs, what should be the next management step
Urine Culture
133
Main treatment of cellulitis
Clarithromycin
134
Most common cause for viral meningitis in adults
Coxsackie B
135
Management of necrotising Fasciitis
Surgical Debridement
136
How long should someone with infectious mononucleosis avoid contact sports for
8 weeks after having glandular fever
137
What does lymphogranuloma venerum associate with that isn't seen in Syphillis
Proctocollitis and rectal bleeding
138
What is diagnostic for HIV in the early stages of infection (3-12 weeks)
HIV p24 antigen testing
139
How often should valaciclovir be used to treat herpes
Twice daily for 10 days
140
How often is Metronidazole given to women for
5-7 days
