Sexual Health Flashcards
How does Primary syphilis present? How long does it last?
Chancre: round with indurated base lesion located at the site of inoculation by the bacterial spirochete, this usually heals 3-8 weeks later.
How does secondary syphilis present?
4-10 weeks after primary, non-itchy symmetrical maculopapular rash appears (palms, soles, face) appears alongside mucosal ulcers, lymphadenopathy, malaise, fevers, hepatitis sx, glomerulonephritis, neurological complications.
What are the features of Tertiary Syphilis?
20-40 years after primary infection in untreated pts:
- gummatous disease
- cardiovascular complications (aortitis, arteritis, aortic valve regurg)
- neurological complications (menigovascular syphilis, paresis, dementia, tabes dorsalis, argyll-roberstson pupil)
What are the three components of serological syphilis testing?
EIA, RPR, TP-PA.
What does the syphilis serology show for an active syphilis infection?
EIA, RPR, and TP-PA reactive.
What does syphilis serology indicate if the EIA and RPR are reactive but TP-PA is not? Or if the EIA is the only reactive?
Tests do not agree which indicates:
- Early infection
- Prior syphilis
- False +ve EIA
What does syphilis serology indicate if the EIA and TP-PA are reactive but the RPR is not?
- Previously treated syphilis
- Early syphilis
What does a higher RPR value (>1:64) mean on Syphilis serology testing?
Higher = worse disease
>1:64 = secondary syphilis
Once TPPA is +ve in syphilis serology does it ever change?
Once +ve = always +ve = current infection or previous infection.
What is the 1st line management for syphilis?
IM Benpen
What is the Jarisch-Herxeimer Reaction?
Acute febrile reaction when commencing syphilis treatment due to sudden release of toxins from the killed bacteria.
How long does it take for a chlamydia test to turn +ve?
2 weeks
What are the sx of chlamydia?
Men: Dysuria, urethral discharge
Women: dysuria, intermenstrual bleeding, urethral discharge, pelvic pain
BOTH CAN BE ASYMPTOMATIC
How do we test for chlamydia?
NAAT: vulvovaginal swab, endocervical swab or 1st catch urine (men)
How do we manage chlamydia?
Doxycycline 100mg BD for 1 week
What are the complications of untreated chlamydia?
Tubal factor infertility, PID, epididymitis, proctitis
What is the presentation of LGV (lymphogranuloma venereum)?
Painless ulcer which progresses to inguinal buboes (tender groyne swellings) which elicit the ‘groove’ sign (depression along the superficial veins).
Who is at a higher risk of LGV (lymphogranuloma venereum)?
MSM
What is the most common cause of proctitis in homosexual males?
LGV
How does Trichomonas Vaginalis present?
- Frothy yellow discharge with associated fishy odour.
- Dyspareunia and vulvar irritation in women.
- Strawberry cervix (punctate bleeding and papilliform appearance)
- Urethritis in men.
What does Trichomonas vaginalis look like under microscopy?
Flagellated and unicellular protozoa
How is Trichomonas Vaginalis managed?
Metronidazole PO:
- 400-500mg BD for 5-7 days
OR
- Single dose 2g
What type of organism is Neisseria Gonorrhoea?
Gram negative intracellular diplococci (bacteria)
How long can it take for a Gonorrhoea test to be +ve after infection?
72 hour incubation period
What are some symptoms of Gonorrhoea?
Urethral discharge, dysuria, tenderness of inguinal node tenderness, abnormal bleeding (women).
Can be asymptomatic (more commonly in women).
What part of the genital tract does Gonorrhoea infect women?
Endocervix - columnar epithelium
Gonorrhoea can cause proctitis - what are the symptoms of this?
Rectal pain, bleeding discharge.
What is a complication of Gonorrhoea for women?
PID
What is the presentation of disseminated a Gonorrhoea infection? What are the RFs?
Small and large joint polyarthritis/swelling, dermatitis, and tenosynovitis.
Recent menstruation, complement deficiency, SLE.
What is the management of Gonorrhoea?
Single dose IM ceftriaxone (gent if penicillin allergic).
Do C+S as they have massive antibiotic resistance.
Re-do test 1 week later to ensure it has gone.
How long after gonorrhoea treatment should the pt avoid sexual activity?
1 week post treatment.
How does chancroid present?
Erythematous papule becomes pustular, and then ulcerates (soft, irregular border with a friable base and a grey-yellow exudate).
Alongside inguinal lymphadenopathy.
What organism is responsible for Chancroid? How does it appear on microscopy?
Haemophilus ducreyi bacteri (gram -ve anaerobic rod).
‘School of fish’ appearance of microscopy.
How do you manage Chancroid?
- Ceftriaxone, azithromycin, or ciprofloxacin
- Symptomatic relief ( e.g., drainage of buobes)
What are the signs of Mycoplasma Genetalium? How can we test for and treat it?
Dysuria, abnormal discharge, abdo pain, dyspareunia, intermenstrual bleeding, bleeding during sex.
CANNOT TEST FOR IT.
Treated alongside gonorrhoea with the 400mg IM ceftriaxone
Which HPV strain most commonly causes genital warts?
HPV 6+11
How are non-keratinised HPV genital warts managed?
Podophyllotoxin
What are the two categories of HSV infections?
Primary (1st exposure = worse sx), non-primary
How does HSV present?
HSV1: cold sores
HSV 2: Viral prodrome followed by a genital warts.
But can differ.
How do you manage genital warts caused by HSV?
Acyclovir 400mg TD for 5 days (10 days if sever) OR Valaciclovir 500mg BD for 5 days.
May need some topical lidocaine for pain relief.
How long after HSV genital warts can sexual activity be resumed?
After wart have gone.
How long does HSV stay in your system for?
Type 1: less extreme sx, stays in system for 20 years ish.
Type 2: more aggressive, stays in system for 3-5 years.
What is the incubation period for Hepatitis B?
60-90 days
How is Hepatitis B transmitted?
Infected blood/bodily fluids: sex, vertical transmission, transfusions, IVDU
Where is Hepatitis B endemic too?
Sub-Saharan Africa, Asia, pacific islands
How might Hepatitis B present in adults and children?
Adults: jaundice, fever, malaise, dark urine, light coloured stools.
Children: only 5% have symptoms so often don’t present in acute phase and therefore 90% progress to chronic.
At what point does Hepatitis B become chronic?
The body is unable to clear is after 6 months.
What are the complications of chronic hepatitis B?
Cirrhosis, decompensated liver failure, increased risk of hepatocellular carcinoma.
What is seen on liver biopsy of chronic hepatitis B?
Ground-glass hepatocytes on light microscopy.
In serology of Hepatitis B, what does HBcAB represent?
Hepatitis core antibody:
- IgM is +ve in acute infections, IgG is +ve in chronic infections
In serology of Hepatitis B, what does Anti-HBc represent?
Core antibody is +ve in those who have had an infection at some point.
In serology of Hepatitis B, what does HBsAG represent?
Surface antigen +ve in active infection, persists >6 months
In serology of Hepatitis B, what does Anti-HBs represent?
Anti surface antibody is +ve in those who have cleared an infection or had a vaccine.
In serology of Hepatitis B, what does HBeAg represent?
hepatitis B e antigen indicates viral replication, these are the most infective pts.
In serology of Hepatitis B, what does Anti-HBe represent?
Low viral viral load/replication.
How can we manage Hepatitis B?
1st Line: Pegylated interferon alfa 2a.
2nd Line: Tenofovir or Entecavir.
These reduce liver disease: ALT normalisation and improved histology.
What type of virus is Hepatitis C? What is the incubation period?
RNA virus.
6-9 weeks.
How is hepatitis C transmitted?
Mostly blood, rarely other bodily fluids.
IVDU, blood transfusion, needlestick injury, sexual transmission (rare but higher rate if also HIV +ve).
How do you know if a HepC infection is cleared?
Pt will be +ve for Anti-HCV but -ve for HCV RNA
How does Hepatitis C present? What % become chronic? What % develop cirrhosis?
Mostly asymptomatic and therefore 75% go on to develop chronic disease: persistently high LFTs and 25-30% get cirrhosis.
How do you test for Hepatitis C? When do you manage it?
Test antibody levels, they can remain +ve for months after cleared so if still +e after 2 months then treat.
What is the management for Hepatitis C?
Nucleoside analogues such as Sofosbuvir and daclatsavir.
How does Molloscum contagiosum present?
Pink, waxy, umbilicated lumps caused by close contact.
If there are >100 Molloscum Contagiosum what should you test for?
HIV - may be immunocompromised
How is Molloscum Contagiosum managed?
Supportively, or can use imiquimod/cryotherapy in immunocompromised pts.
What type of virus is HIV? How do they replicate?
Double-stranded RNA virus.
1) Virus uses reverse transcriptase to convert RNA to pro-viral DNA
2) They then use host cell machinery to reproduce using this DNA (targets CD4).
What is the incubation period for HIV?
Up to 4 weeks.
What is the acute retroviral syndrome of HIV?
Period following exposure, presents with maculopapular rash, sore throat, lymphadenopathy, fever, mouth ulcers, flu-like illness.
How would you manage someone presenting with the acute retroviral syndrome of HIV?
- Investigations: including CD4 count
- Commence ART
- Track and trace
What are the CDC categories for HIV?
CDCA: asymptomatic period
CDC B: some sx/disease (oral candida, peripheral neuropathy, etc)
CDC C: ‘aids defining illness’ (CDC4 usually <250)
What causes Kaposi’s Sarcoma? What is it composed of?
HHV8, composed of vascular endothelium.
Primary CNS Lymphoma and Toxoplasmosis present very similarly in HIV pts, what is this presentation in CT?
Ring defining lesions with mass effect and cerebral oedema.
How can you diagnose Cryptococcal meningitis?
LP: increased opening pressure (6-25 cmH2O).
India Ink Stain: encapsulated yeast organisms.
How can you diagnose Toxoplasma? Mx?
Ring defining lesions on CT head.
Mx: Pyrimethamine and Sulfadiazine (alongside folate).
What causes Progressive Multifocal Leukoencephalopathy (PML) in HIV pts?
Human polyomavirus JC
Which cancers are AIDs defining illnesses?
Cervical, NHL, KS
What type of organism causes Trichomonas Vaginalis infection? How does it present?
Protozoa.
Copious quantities of discharge - may be asymptomatic (especially in men).
What are the symptoms of genital candidiasis?
Itching, white curdy discharge. sour milk odour, dysuria, superficial dyspareunia.
What are risks for genital candidiasis?
Pregnancy, antibiotics, immunosuppression.
How can we manage vaginal candidiasis?
Oral fluconazole, or vaginal clotrimazole.
How is PID managed?
Ceftriaxone IM stat, doxycycline , metronidazole
Bilateral adnexal tenderness and cervical motion tenderness in a female who is sexually active is likely what?
PID
What is the triad of Reactive arthritis? Which STI is it most commonly associated with?
Can’t see (conjunctivitis), can’t pee (dysuria), can’t climb a tree (arthritis).
Chlamydia.
Clue cells are often seen on gram stain of someone with BV, what are clue cells?
Vaginal epithelial cells surrounded with a layer of bacteria.
At what CD4 count do we treat HIV pts prophylactically for PCP? With what do we treat them?
CD4 <200,
Co-trimoxazole.
