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MD1 Reproduction > Sexually Transmissible Infections > Flashcards

Sexually Transmissible Infections Flashcards

1
Q

What are sexually transmissible infections (STIs)?

A

Infections transmitted primary during sexual contact

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2
Q

What are the routes of transmission for STIs?

A

Oral-genital contact
Vaginal intercourse
Anal intercourse
Anilingus

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3
Q

How are STIs detected?

A

Microscopy
Culture
Serology
Nucleic acid amplification tests

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4
Q

What are the 5 P’s of a sexual history?

A 
Partners
- Male/female/both
- Number
Pregnancy prevention
Protection from STIs
Practices
Past history of STIs
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5
Q

What is the cellular morphology of Neisseria gonorrhoeae?

A

Intracellular Gram negative diplococci

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6
Q

What cells do N gonorrhoeae enter and how?

A

Adhere to columnar epithelial cells via pilli
Enter cells around cervix and urethra
Can also survive in neutrophils

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7
Q

What is the incubation period for N gonorrhoeae?

A

2-7 days

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8
Q

What proportion of infections ins asymptomatic?

A

80% in females

10% in males

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9
Q

What symptoms does N gonorrhoeae cause?

A

Pain

Discharge

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10
Q

What disseminated diseases can N gonorrhoeae cause?

A 
Arthritis
Maculopapular rash
Meningitis
Endocarditis
Epididymitis
Peri-hepatitis
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11
Q

When is risk of disseminated disease with N gonorrhoeae greater?

A

Post menses

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12
Q

When can pelvic inflammatory disease develop after an gonococcal infection?

A

1-2 weeks

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13
Q

What can pelvic inflammatory disease cause?

A

Tubal scarring

Infertility

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14
Q

What is neonatal gonococcal ophthalmia?

A

Gross purulent conjunctivitis

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15
Q

When does neonatal gonococcal ophthalmia develop?

A

Day 2-5 of life

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16
Q

What does neonatal gonoccocal ophthalmia cause?

A

Mild disease indistinguishable from other causes of conjunctivitis
Perforation of front of eye and blindness

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17
Q

What is the treatment for gonococcal ophthalmia?

A

IV cefotaxime, 7 days
Irrigate eyes regularly
Treat mother and sexual contacts

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18
Q

What specimens can be taken for the diagnosis of gonorrhoea?

A 
Cervical swab into charcoal transport
Male urethral swabs
Urine
Other specimens
- Conjunctiva
- Pharynx
- Skin lesions
- Anal
- CSF
- Blood
- Synovial fluid
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19
Q

What are the lab investigations for the diagnosis of gonorrhoea?

A

Non-selective: CHB in CO2
Selective: Thayer-Martin agar
Culture for antibiotic sensitivities

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20
Q

What antimicrobials are found in Thayer-Martin agar?

A

Colistin - kills Gram negative bacteria
Vancomycin - kills Gram positive bacteria
Nystatin - kills fungi

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21
Q

In what proportion of gonorrhoea cases is there a co-infection with chlamydia?

A

50%

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22
Q

What is the treatment for gonorrhoea?

A

Ceftriaxone

Azithryomycin - also kills chlamydia

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23
Q

How do you prevent gonorrhoea?

A

Barrier contraception

Contact tracing

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24
Q

Which organism causes chlamydia?

A

Chlamydia trachomatis

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25
Q

What are the signs and symptoms of cervicitis?

A 
Swollen
Red
Friable
Columnar epithelium exposed
Bleeds easily when touched
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26
Q

What is the cellular morphology of C trachomatis?

A

Obligate intracellular bacteria

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27
Q

What cell type does C trachomatis invade?

A

Columnar epithelium

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28
Q

What serovars of C trachomatis causes genital infection?

A

D-K

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29
Q

What serovars of C trachomatis cause lymphogranuloma venereum (LGV)?

A

L 1-3

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30
Q

What serovars of C trachomatis cause ocular infection (trachoma)?

A

A-C

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31
Q

How long is the life cycle of C trachomatis?

A

48-72 hrs

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32
Q

What are the two forms of C trachomatis during its life cycle?

A 
Elementary bodies
- Infectious
- Non-replicating
- Hardy
Reticulate bodies
- Metabolically active
- Replicate
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33
Q

What is the life cycle of C trachomatis?

A
  1. Attachment and entry of elementary body to target cell
  2. Formation of reticulate body
  3. Binary fission of reticulate bodies
  4. Reorganisation of reticulate bodies into elementary bodies
  5. Multiplication ceases
  6. Release of elementary bodies
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34
Q

What is the most common STI?

A

Chlamydia

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35
Q

What does chlamydia cause in males and females?

A

Males: urethritis
Females: cervicitis

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36
Q

Is chlamydia always symptomatic?

A

No, frequently asymptomatic

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37
Q

What are the clinical findings of chlamydia in males?

A 
Dysuria
Meatal erythema
Clear urethral discharge
- Not as purulent as gonorrhoea
Testicular pain
Prostatitis
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38
Q

What are the clinical findings of chlamydia in females?

A 
Cervicitis, endometritis/vaginal discharge
Urethritis/dysuria
Irregular bleeding
Pelvic pain and dyspareunia
Pelvic inflammatory disease
- Acute
- Chronic
39
Q

What is LGV?

A

Invasive lymphatic infection

40
Q

What are the clinical features of GLV?

A

Ulcerative genital lesion, similar to chancre of syphilis
Suppurative inguinal lymphadenopathy
Systemic symptoms
Men who have sex with men: proctocolitis

41
Q

What is proctocolitis?

A

Inflammation of rectum and colon

42
Q

Where is LGV endemic?

A

Africa
India
Southeast Asia
South America

43
Q

What is the rate of vertical transmission of chlamydia?

A

50%

44
Q

What does neonatal chlamydia present as?

A

Conjunctivitis

Pneumonia

45
Q

When does conjunctivitis caused by neonatal chlamydia appear?

A

2-28 days

46
Q

When does penuomonia caused by neonatal chlamydia appear?

A

2-8 weeks

47
Q

What are the lab investigations for the diagnosis of chlamydia?

A 
Cervical/urethral/anal swab
Urine
Nucleic acid detection
Test of cure needed
- Post-procedure; eg: IUD insertion
- Pregnancy
48
Q

What is the mainstay of chlamydia identification?

A

Nucleic acid detection

49
Q

Why is chlamydia culture not routine?

A

Needs cell culture techniques

50
Q

What is the treatment for chlamydia?

A 
Azithromycin, oral
OR
Doxycycline, oral
- Less well tolerated
Contact trace partners
Notifiable disease
Test of cure in 4-6 weeks
Advise retest in 3 months
51
Q

What is the treatment for severe chlamydia causing pelvic inflammatory disease?

A

Azithromycin, IV > step down to oral when well

52
Q

What can repeated episodes of chlamydia cause?

A

Scarring

53
Q

What is the cellular morphology of Trichomonas vaginalis?

A

Flagellated protozoan

54
Q

Can you get female to female transmission of T vaginalis?

A

Yes

55
Q

Can you get male to male transmission of T vaginalis?

A

Very rare

56
Q

Can T vaginalis be asymptomatic?

A

Yes, frequently

57
Q

How is T vaginalis transmitted?

A

Sexually

58
Q

What are the clinical features of a T vaginalis infection?

A 
Vaginal discharge
- Frothy
- Green-yellow
- Smelly, fishy odour
Cervical erythema and friability
Pruritis
Dysuria
Abdominal pain
59
Q

What is the presence of T vaginalis a marker for?

A

High risk sexual activity
Possibility of other STIs
- Chlamydia
- Gonorrhoea

60
Q

What does the genital inflammation caused by T vaginalis increase the risk of acquiring?

A

HIV

61
Q

How does a T vaginalis infection increase the risk of HIV acquisition?

A

In females: shed more HIV virions

If males HIV positive, females more susceptible

62
Q

What is a T vaginalis infection associated with?

A

Non steady partner
Older partner
Marijuana use

63
Q

In which demographic does T vaginalis have an increased prevalence?

A

Indigenous community

64
Q

What are the lab investigations for T vaginalis?

A 
High vaginal swab
- Wet prep microscopy to detect motility
- Culture
Urine
- PCR
Sometimes seen on Pap smear
65
Q

What is the treatment for T vaginalis?

A 
Metronidazole, oral
Tinidazole, oral
Clindamycin cream
Treat partners
Follow up testing
66
Q

Why is follow up testing required after treatment for a T vaginalis infection?

A

May have resistance

67
Q

What is the causative organism of syphilis?

A

Treponema pallidum

68
Q

What are the clinical features of primary syphilis?

A

Lesions at site of inoculation on mucous membranes
5 weeks after inoculation
Chancres = painless ulcers

69
Q

What are the clinical features of secondary syphilis?

A 
3-6 months after primary lesions healed
Fever
Rash
Alopecia
Some hepatitis
70
Q

What are the stages of syphilis?

A 
Primary
Secondary
Early latent
Late latent
Tertiary
71
Q

How is T pallidum detected in the lab?

A 
Microscopy
- Hard to see on light microscopy
- Can use dark field microscopy
Serology
- Non-treponemal tests
- Treponemal tests
72
Q

What non-treponemal test is used regularly?

A

RPR

73
Q

Describe non-treponemal tests

A

Abs to cellular lipids and lecithin
Positive 4-8 weeks post infection
70% positive within 2 weeks of chancre
100% positive fr secondary and latent

74
Q

What are non-treponemal tests useful for?

A

Diagnosis

Monitoring therapy

75
Q

What can cause false positive reactions in non-treponemal tests?

A

Connective tissue disorders
Viral infections
IV drug use
Pregnancy

76
Q

What can cause false negative reactions in non-treponemal tests?

A

Prozone effect

- Excess Abs can give negative results

77
Q

What are treponemal tests used for?

A

Screening

78
Q

What is the most regularly used treponemal test?

A

EIA

79
Q

What doesn’t Mycoplasma genitalium have which other bacteria doo?

A

Cell wall

80
Q

Can M genitalium be cultured?

A

Not easily

  • Fastidious
  • Difficult to culture > takes 1-2 months to grow
81
Q

What is the mainstay of diagnosis of M genitalium?

A

NAAT

82
Q

What samples are used for the diagnosis of M genitalium?

A

Ist void urine

Vaginal swab

83
Q

How is M genitalium transmitted?

A

Sexually

84
Q

What is the antibiotic susceptibility of M genitalium?

A

Antibiotic resistant

85
Q

What is the clinical presentation of M genitalium?

A 
Males: urethritis
- 50% asymptomatic
Females
- Cervicitis
- Acute endometritis
- Pelvic inflammatory disease, especially post termination of pregnancy
86
Q

How long can an M genitalium infection persist for?

A

3-6 months

87
Q

What may an M genitalium infection predispose you to?

A

HIV transmission

88
Q

How can azithromycin resistance be tested for in M genitalium?

A

Whilst doing NAAT

89
Q

What is the treatment for an M genitalium infection?

A

Azithromycin

90
Q

What is the failure rate of azithromycin as a treatment for an M genitalium infection?

A

15%

91
Q

What can be used in treatment if M genitalium is resistant?

A

Moxifloxacin

92
Q

What are the limitations of the use of moxifloxacin?

A

Expensive
Failures described
Not safe in pregnancy

93
Q

What are the indications for STI testing?

A 
Symptomatic patient
Screening for asymptomatic infection
Pre-pregnancy
Antenatal screening
Blood and organ donation
Contact tracing
Epidemiological surveillance

MD1 Reproduction (11 decks)

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