Sexual Health Flashcards
What are the types of HIV test?
POCT: window period of 6-12wks, fingerprint test that allows results within minutes.
Antibody/antigen test: blood test with window period of 4-6wks, results in 1 wk
What are some of the high HIV prevalence countries?
Sub-Saharan Africa, South America, South East Asia.
Describe Lymphogranuloma Venereum (LGV), its symptoms, tests, and treatment.
Due to infection with chlamydia trachomatis serovars L1, L2, L3 that infect mononuclear phagocytes. Largely occurs in MSM presenting with proctitis.
Symptoms: usually present with painless papule or shallow ulcer, tender inguinal lymphadenopathy. Secondary disease progresses to systemic upset (fever, headache, nausea, lethargy) and gross swelling of inguinal lymph nodes
Tests: full STI screening, PCR for definitive diagnosis
Treatment: Doxycycline 100mg BD for 21days
-buboes may be drained percutaneously to relieve symptoms.
Describe Syphillis, its symptoms, tests, and management.
A sexually transmitted disease caused by the spirochaete Treponema Pallidum. Higher risk in MSM.
Primary features: Chancre (painless ulcerations the site of sexual contact, entry point for spirochaete), local non-tender lymphadenopathy.
Secondary features: 6-10wks after primary infection, scaly rash on trunk, palm and soles, malaise, lymphadenopathy, fevers, tonsillitis, buccal ‘snail track’ ulcers, condylomata lata (flat papules around/beyond genitals)
Tertiary features: follows after 2yrs of latency. Gummas (granulomatous lesions of the skin and bones), ascending aortic aneurysm, general paresis of insane (dementia psychoses), tabes dorsalis (ataxia, numb legs chest and bridge of nose, lighting pains, argyll-Robertson pupil) neurosyphillis.
Congenital features: blunted upper incisors teeth, Rhagades (linear scars at angle of mouth) keratitis, saddle nose, Saber shins, deafness. Hutchinsons triad = keratitis, deafness and pointed teeth.
Tests: Treponeme specific e.g. EIA (+ve 12-21days), TPPA (+ve 21-28days). Non-treponemal tests e.g. RPR (Tests for cardiolipin antibodies +ve after 28days)
Management:
- Benzylpenicllin + probenecid, or doxycycline
- beware Jarisch-herxheimer reaction is sometimes seen following treatment, fever rash, tachycardia after first does of antiobiotics it is thought to be due to the release of endotoxins following bacterial, consider steroids but do not stop treatment.
Describe Gonorrhoea, its symptoms, and management.
An sexually transmitted disease that can lead to urethral structure and infertility.
Symptoms:
- Men resent with urethral pus +/- dysuria, tenesmus, proctitis +/- discharge PR e.g. If homosexual
- Women often asymptomatic, or present with van giant discharge, dysuria, proctitis.
Management:
- encourage safe sex and trace contacts
- ceftriaxone + management for chlamydia (azithromycin stat or doxycycline for 7 days)
Describe Chlamydia, It’s symptoms, investigations, and management
Chlamydia is a small intracellular gram-negative bacteria that can cause, ocular infection (trachoma), genitourinary infection, and Lymphogranuloma Venereum). Most commonly diagnosed bacterial sexually transmitted STI in UK.
Symptoms:
- Female include vaginal discharge, dysuria, lower abdominal pain, fever, intermenstrual or postcoital bleeding, dyspareunia, cervical excitation.
- Male include urethritis, dysuria, urethral discharge, epididymis-orchitis presenting at unilateral testicular pain +/- swelling. Fever.
Investigations: Urine sample and Nucleic acid amplification test (NAAT)
Management:
- Doxycycline 100mg BD for 7days (CI in pregnancy)
- Single dose of 1g of azithromycin
- contact tracing
- test for other STIs
What are the main groups of Anti-retrovirals and give some examples.
Nucleoside Reverse Transcriptase Inhibitors (NRTIs):
- Zidovudine (AZT) first HIV drug. SEs include anaemia, low WCC, GI disturbance, fever, rash, myalgia, stop if deranged LFT, heptatomegaly, lactic acidosis.
- Didanosine SEs pancreatitis, Hyperuricaemia, GI disturbance, Liver failure, optic nerve changes.
- Lamivudane is well tolerated. Similar but less common SEs as AZT.
- Emtricitabine is like Lamivudane but active against Hep B.
- Stavudine stop if neuropathy or deranged liver function
- tenofavir SEs as AZT
- Abacavir SE hepatitis, lactic acidosis, hypersensitivity syndrome, rash, fever, vomiting.
Protease Inhibitors:
-Saquinavir SEs oral ulcers paraesthesiae, myalgia, beaches, dizziness, pruritis, rash, pancreatitis.
Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs):
- Nevirapine SEs Steven-johnsons, toxic epidermal necrolysis, hepatitis
- efavirenz SEs rash, insomnia, dizziness, avoid in pregnancy
- Rilpivirine new
Intergrase Strand Transfer Inhibitors (InSTIs):
-Raltegravr, elvitegravir, dolutegravir, SEs GI upset, insomnia
Once-a-day tablets (combination regimens):
-Atripla, Eviplera, Stribild, Kivexa/Epzicom
What are some common AIDs defining illnesses?
- Candidiasis (Oral or Oeosphageal)
- Cervical carcinoma (invasive)
- Candidiasis of bronchi, trachea or lungs.
- Lymphoma
- Coccidioidomycosis, disseminated or extrapulmonary.
- Mycobacterium avium complex (MAC) or M. kansasii, disseminated or extrapulmonary.
- Cryptococcosis, extrapulmonary.
- Mycobacterium tuberculosis, any site (pulmonary or extrapulmonary).
- Cryptosporidiosis, chronic intestinal (>1 month’s duration).
- Cytomegalovirus (CMV) disease (other than liver, spleen or nodes).
- Pneumocystis jirovecii pneumonia.
- CMV retinitis (with loss of vision).
- Pneumonia, recurrent or bacterial.
- Encephalopathy e.g. CMV, Toxoplasmosis
- Progressive multifocal leukoencephalopathy.
- Herpes simplex: chronic ulcer(s) (>1 month’s duration); or bronchitis, pneumonitis or oesophagitis.
- Salmonella septicaemia, recurrent.
- Histoplasmosis, disseminated or extrapulmonary.
- Toxoplasmosis of brain.
- Wasting syndrome due to HIV.
- Kaposi’s sarcoma.
Describe Progressive multifocal Leukoencephalopathy (PML), its symptoms and investigations
Widespread demyelination due to infection of olifodendrocytes by JC virus (a polyoma DNA virus).
Symptoms: Subacute onset, behavioural changes, speech/motor/visual impairment.
Investigations: CT shows Single or mutiple brain lesions, no mass effect usually non-enhancing. MRI is better high-signal demyelinating White matter lesions are seen.