sexual health Flashcards
which organism causes syphilis
treponema pallidum
what are the tests for syphilis
- cardiolipin tests (e.g VDRL)
2. treponema antibody specific tests
what should the syphilis cardiolipin tests (VDRL) show after treatment
VDRL: negitive after treatment
what should the syphilis antibody tests show after treatment
remains positive after treatment
what can cause a falsely positive cardiolipin test
pregnancy
hiv
TB
malaria
what are the primary symptoms of syphilis
- chancre at site of contact
2. local painless lymphadenopathy
what are the secondary symptoms of syphilis
- rash: soles, palms, trunk
- systemic: rash, fevers, lymphadenopathy
- oral snail track ulcers
- condylomata lata - warts on genitals
what are the tertiary manifestations of syphilis
gummas ascending aortic aneurysm tabes dorsalis - neurosyphilis - locomotor ataxia syphilis dementia argyll robertson pupil
what is the first line management of syphilis
IM benzathine penicillin
name 3 signs of tertiary syphilis
argyll robertson pupil
gummas
tabes dorsalis
name complications of syphilis
aortic aneurysms
neurosyphilis
what is the incubation period of treponema pallidum
9-90 days
name a reaction that commonly occurs following treatment of syphilis
Jarisch-herxheimer
- condition that happens a couple of hours after 1st antibiotic dose that mimics anaphylaxis
presents with fever, tachycardia and rash
but no wheeze or hypotension
what organism causes chlamydia
chlamydia trachomatis
symptoms of chlamydia
female: cervicitis (bleeding, funny discharge), dysuria
male: dysuria, urethral discharge
or asymptomatic
females more likely to be asymptomatic
tests for chlamydia
nuclear acid amplification test
females: vaginal / cervical swab
males: first void urine sample
what does chlamydia trachomatis look like under the microscope
gram negative
intracellular
can be rods or cocci
what is the first line treatment of chlamydia
doxycycline 100mg bd for 7 days
how would you treat a pregnant lady with chlamydia
azithromycin / amoxicillin
must explain the risk and benefits of treating and let the woman decide herself
name complications of chlamydia for both males and females
F; PID, infertility, increased ectopic pregnancy risk, preihepatitis
M: epididymoorchitis, proctitis, infertility
both: reactive arthritis
how does chlamydia screening happen
opportunistic screening for asymptomatic young people aged 15-25
advised to screen once a year or even more if changes partners
what are the contact tracing rules for chlamydia / gonnorhoea
asymptomatic men and women: all sexual contacts from past 6 months
symptomatic man: all sexual contacts within the 4 weeks prior to symptom onset
what is fitz-hugh-curtis syndrome
a complication of a chlamydia infection that spreads to the liver from PID causing inflammation and swelling of the tissue surrounding the liver and stomach
when should chalmydia/gonnorhoea testing take place after sexual contact
2 weeks after sexual contact
what does gonorrhoea look like under microscope
gram negative diplococci
which organism causes gonorrhoea
neisseria gonorrhoae
1st line treatment of gonorrhoea
IM ceftriaxone
test for gonorrhoea
NAAT plus culture for sensitivities
complications of gonorrhoea
epididymitis urethral strictures PID infertility anal / oral disease salpingitis
what are the symptoms of disseminated gonorrhoea
tenosynovitis
migrating polyarthritis
dermatitis - usually vesicular or macuopapular
endocarditis
perihepatitis (fits-hugh-curtis syndrome)
septic arthritis (haematogenous spreading)
green frothy discharge from vagina, strawberry cervix, vulvovaginitis
trichomonas vaginalis
management of trichomonas
oral metronidazole
what is seen on microscopy in trichomonas
motile trophzoites
smelly, clear / white discharge
BV
what organism overgrows in BV
gardenella vaginalis
what is seen on testing for BV
- alkalotic pH >4.5
2. clue cells on microscopy
management of BV
oral metronidazole
complications of BV in pregnancy
preterm labour
low birth weight
late miscarriage
HIV pathophys
HIV-1 (most common) enters body –> infects T lymphocytes and other immune cells –> gets into cell –> viral RNA made into DNA by reverse transcriptase –> DNA goes into cell nucleus –> replicates –> releases more virus –> lots of mutations along the way so hard to get rid of –> travels to local lymph nodes and infects the immune cells there –> travels round body
HIV seroconversion symptoms
fever headache malaise flu like symptoms myalgia, rash, arthralgia, diarrhoea, mouth ulcers
what do you use to monitor HIV / response to treatment
cd4 cell count
what treatments are used in ART
2 x nuceloside reverse transcriptase inhibitors plus either 1 protease inhibitor or 1 non-nucleoside reverse transcriptase inhibitors
when should ART be started
as soon as diagnosis comes positive
how do you test / screen for HIV
HIV antibody testing
p24 antigen
both of the above should be used for screening
HIV viral load can also be used if confirmed
what methods are used to do the HIV antibody testing
enzyme linked immune sorbent assay and western blot assay
what are the expected results of HIV antibody testing within 1st 1-4 weeks
no antibodies found
when will HIV antibodies become present on testing
between 4 weeks to 3 months
when will p24 antigen become positive
when viral load raises between 1-4 weeks
when is repeat HIV testing recommended
if both positive it should be repeated to confirm diagnosis
if both come back neg they should be invited back in 12 weeks to double check they aren’t pos
how long after exposure to HIV are patients recommended to test
after 4 weeks
HIV positive patient presents to A+E with SOB, massive heamoptysi, hypotensive, tachycardic and multiple purple plaques on the skin he’s had for 4 weeks.
what is the likely diagnosis
kaposi sarcoma (purple plaques) - a HIV associated cancer
can have respiratory and GI tract involvement
resp involvement can cause massive haemoptysis and pleural effusion
