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Y4 reproductive health > Sexually transmitted disease > Flashcards

Sexually transmitted disease Flashcards

1
Q

HIV

A

Single stranded RNA retrovirus that infects and replicates within the human immune system using host CD4 cells

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2
Q

HIV pathophysiology

A

Single stranded RNA retrovirus that infects and replicates with CD4 cells

Penetrates the host CD4 cell & empties its contents

Infected cell divides, viral DNA is read, creating viral protein chains & immature viruses pushes out of the cell, retaining some cell membrane

Host cell destroyed in process

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3
Q

HIV CD4 levels

A

Upon seroconversion (the process of producing anti-HIv antibodies during primary infection), flu-like sx experienced

CD4 levels fall → person is extremely infectious

Over next months to years → infection can enter a latent phase → more susceptible to infections

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4
Q

HIV transmission

A

Unprotected sexual contact

Sharing of injecting equipment

Medical procedures

Vertical transmission

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5
Q

HIV risk factors

A

MSM

IV drug users

High prevalence areas

Unprotected sex with a partner who has lived/travelled in Africa

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6
Q

HIV clinical features

A

Seroconversion illness - non-specific, flu-like illness → fever, muscle aches, malaise, lymphadenopathy, maculopapular rash, pharyngitis

Symptomatic HIV - weight loss, high temperatures, diarrhoea, frequent minor opportunistic infections e.g. HZV or candidiasis

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7
Q

HIV ix

A

4th generation combo essay (EIA) - detect anti-HIV antibodies

Confirmatory tests in lab if positive - immunoblot

RNA detection by PCR for ‘viral load’ → better in earlier disease

Second sample to confirm patient ID

HIV+ = CD4 count, HIV viral load, HIV resistance testing, baseline bloods, screening for other relevant infections

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8
Q

HIV mx

A

HAART: highly active antiretroviral therapy

2 NRTI + 3rd agent

  • integrase inhibitor
  • protease inhibitor

Compliance key and patient must keep taking the drugs for the rest of their lives

Most patients stable & monitored 6-12 monthly

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9
Q

HIV monitoring

A

Regular tests:

  • CD4 count
  • HIV viral load
  • FBC
  • U&Es
  • Urinalysis
  • ALT, AST & bilirubin

Pregnancy testing & in treatment failure → resistance testing

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10
Q

HIV prevention

A

Safe sex, condom use

Screening & regular testing

Treatment as prevention

Post-exposure prophylaxis → within 72 hours of high-risk exposure, available via A+E/sexual health service, truvada + raltegravir

Pre-exposure prophylaxis → at risk patients eligible, truvada/descovy daily or ‘event-based’

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11
Q

Hep B transmission

A

Parenteral

Vertical

Sexual - multiple partners, condom less AI, rimming

Sporadic - prisons, LD institutions

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12
Q

Hep B prevention

A

Testing - high risk groups

Vaccinations - high risk groups

Advice to patient living with HBV - inform GP/dentist, don’t donate, cover wounds

Pregnancy & HBV - vaccinate neonate

Sexual contacts - vaccination, condoms/dental dams

Household contacts - vaccination

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13
Q

Hep B investigations

A

Surface antigen - does pt have hep B? → active hep B

Core antibody - has pt ever been exposed?

Surface antibody - is pt immune to hep B?

Hep B viral load

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14
Q

Hep B mx

A

Notifiable

Hepatology referral

Screen for other infections

Treatment options inc. peg interferon alpha 2a, antivirals (entecavir, tenofovir)

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15
Q

Post-exposure prophylaxis in BBI

A

HIV PEP - starter packs of ARVs, duration of 28 days

Hep B - booster, HBIG

Hep C - no prophylaxis available

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16
Q

Hep B needlestick injury

A

Source patient - not affected staff member

Recipient - blood samples, further testing at 6, 12 & 24 weeks

While waiting - safe sex, good infection control, avoid blood donation

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17
Q

Hep B complications

A

Acute liver failure

Mortality

Increased risk of pregnancy cx

Chronic hep B

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18
Q

Hep C transmission

A

Parenteral - needlestick, transfusion, haemodialysis

Vertical

Sexual transmission - low

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19
Q

Hep C clinical features

A

Asymptomatic

Acute icteric hepatitis, chronic hepatitis picture

Incubation period ~6 weeks

70% untreated progress to chronic infection → cirrhosis & HCC

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20
Q

Hep C testing

A

Anti-HCV (total) for initial screening - current or past infection

  • positive 4-10 weeks after exposure
  • antibody provides incomplete protection - reinfection possible

HCV RNA - distinguish current from past infection

Hep C genotype - guide treatment

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21
Q

Hep C prevention

A

Risk modification

No vaccine

No immunoglobulin

No PEP

Testing can reduce the risk of transmission to others

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22
Q

Hep C advice

A

Curable

Check for other hepatitis infections

Do not donate blood, semen or organs

Screen for STIs

Acute hepatitis is notifiable

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23
Q

Hep C mx

A

Refer to hepatology

Direct acting antivirals - 8-12 weeks

  • often used in combination
  • prevent virus from completing life-cycle
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24
Q

Genital sores aetiology

A

Infectious

  • viral - HSV, varicella, CMV, EBV, mpox
  • bacterial - syph, strep, staph
  • fungal

Inflammatory/immune

Drug related

Malignancy

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25
Q

Genital sores hx

A

Hx of PC

Associated symptoms - genital, systemic, rashes, eyes, mouth, joints

Happened before?

DHx, PMHx, DHx, allergies

Sexual hx, contraception, pregnancy risk

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26
Q

Mpox

A

Zoonotic viral infection → mostly west and central Africa

  • SymptomsSystemic features precede rashRash 1-5 days later → widespread/local, contagious until scabs fall over with healed skin below

Vaccination for high risk groups in future

Mx - self-limiting, tecovirimat for severe presentations

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27
Q

Genital sores differentials

A

LGV (MSM) - invasive chlamydia, primary lesion = ulcer

  • untreated → secondary disease (LN, lymphadenitis) , tertiary disease (chronic inflammation & destruction)

Tropical ulcer disease

Non sexually acquired genital ulceration - often adolescents, supportive treatment, associated with EBV

Behcet’s

Fixed drug eruption

Erosive lichen planus

Malignancy - chronic, non-healing ulceration

  • RFs = smoking, previous HPV linked malignancy, lichen sclerosus
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28
Q

Genital HSV presentations

A

Primary - first infection with no pre-existing antibodies

Non-primary - first infection with pre-existing antibodies

Recurrent episodes - recurrence of clinical symptoms due to reactivation of pre-existent infection

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29
Q

Genital HSV ix

A

Immediate - HSV PCR from base of lesion

Delayed - full STI screen, syphilis serology, HIV antibody test

HSV serology (helpful only in specific situations) - serum samples weeks apart can show seroconversion, pregnancy

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30
Q

Genital HSV mx

A

Course of oral antiviral

5% lidocaine - pain relief

Rest and analgesia

Salt water bathing

Vaseline

Avoid sexual contact whilst symptomatic, disclose to partner

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31
Q

Genital HSV complications

A

Superinfection

Urinary retention

Proctitis

Emotional distress

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32
Q

HSV in pregnancy

A

Recurrent episode - low rise

Primary infection in last trimester - risky for newborn

  • neonatal HSV has high rates of morbidity
33
Q

Syphilis aetiology

A

Treponema pallidum

34
Q

Syphilis transmission route

A

Sexually - including OI

Vertical

35
Q

Syphilis stages

A

Primary (chancre) - ulcer around genitals, anus, oral mucosa

Secondary - maculopapular rash all over body, mucous patches in mouth, early neurological involvement

Latent - no symptoms after period of primary & secondary stages

Tertiary - late neuro, CVS complications

36
Q

Syphilis ix

A

Lesion - treponemal PCR

Bloods - Treponemal enzyme immunoassay

If initial test is positive - TPPA, RPR

Full STI screen inc. HIV testing

37
Q

Syphilis mx

A

Depends on the stage

First line - IM benzathine penicillin

Alternatives - doxy, ceftriaxone

38
Q

Genital warts

A

HPV 6 & 11 (16 + 18 → high risk types for neoplastic change)

Nearly always transmitted via sexual contact, spread through skin to skin contact

39
Q

Genital warts clinical features

A

Usually asymptomatic & painless

Itching or feeling sore

Psychological distress

Consider internal lesions → bleeding, distortion of urine flow

Peri-anal lesions

Hx of suddenly noticing them/only noticing them once sexual contact

40
Q

Genital warts differentials

A

Fordyce spots, pearly papules, skin tags, follicles, sebaceous cysts

Syphilis

Vulval intraepithelial neoplasia, prostatic intraepithelial neoplasia

Molluscum contagiosum

41
Q

Genital warts mx

A

Screen for other STIs

Aimed at getting rid of the appearance of the warts but will not clear the virus → body clears over time

No treatment - spontaneously resolve

Destruction - cryoRx, hyfrecation

Anti-mitotic agents

Immune modifiers - imiquimod cream

Surgery

42
Q

Genital warts referral

A

Suspicious/uncertain/internal lesions

Recalcitrant lesions

Cervical lesions

Meatal warts

Immunosuppressed, pregnancy, children & young people, elderly patients, high-risk

43
Q

HPV immunisation

A

Quadrivalent vaccine protects against subtypes 16&18

Given in school age 12-13 years

44
Q

Genital warts pregnancy

A

Common for warts to present in the first time in pregnancy → linked to altered immunological response

Risk of vertical transmission very low

W&W approach, cyro, surgical removal

Vaginal delivery is fine

45
Q

Genital discharge aetiology

A

Physiology - pregnancy, sexual arousal

Vaginal - candidiasis, BV, TV

Cervical - gonorrhoea, chlamydia

46
Q

Genital discharge ix

A

Examination + pH testing

Vulvovaginal swab - NAAT for G+C, PCR for T, vaginalis

High vaginal swab - culture (T. vaginalis, candida), microscopy (wet mount - TV, gram stain)

Endocervical swab (where relevant) - gonorrhoea

Other tests - culture, HSV PCR, mycoplasma genitalium (VVS PCR)

47
Q

Anogenital candidiasis

A

Fungal infection caused by candida yeast

48
Q

Anogenital candidiasis risk factors

A

Immunosuppression

Oestrogens

Recent abx

DM

Mucosal breakdown

Recurrent candidiasis ? associated with atopy

49
Q

Anogenital candidiasis clinical features

A

Pruritus vulvae - itchiness of the vulva

Vaginal discharge - white, curd-like

Dysuria

O/E - erythema & swelling of the vulva, satellite lesions (red, pustular lesions with superficial white/creamy pseudomembranous plaques that can be scraped off)

Curd-like discharge in vagina

50
Q

Anogenital candidiasis ix

A

None are necessary if acute uncomplicated vulvovaginal candidiasis

pH normal (< 4.5)

High vaginal/vaginal wall swab

51
Q

Anogenital candidiasis mx

A

Initial course of an intravaginal antifungal - clotrimazole or fenticonazole

Oral antifungal - fluconazole or itraconazole → prescribed as an alternative to the intravaginal mx

Topical imidazole - for vulval sx

52
Q

Management of candidiasis in pregnancy

A

Intravaginal antifungal

Do NOT give oral antifungals eg. fluconazole & itraconazole

Treat vulval sx with topical antifungal

Return if sx have not resolved within 7-14 days

53
Q

Recurrent candidiasis

A

4 symptomatic episodes/year

Consider alternative diagnosis & concordance

Induction followed by maintenance therapy

Consider host factors → iron deficiency, diabetes

54
Q

Bacterial vaginosis

A

Imbalance in vaginal flora

Loss of lactobacilli, elevated pH

Gardnerella, prevotella, M. Hominis

55
Q

Bacterial vaginosis risk factors

A

Douching/perfumed products

Cunnilingus

Black race

Recent change in partner

Smoking

Presence of an STI

56
Q

Bacterial vaginosis clinical features

A

Offensive fishy smelling vaginal discharge → not usually associated with soreness, itching or irritation

O/E - thin, white/grey, homogenous vaginal discharge

57
Q

Bacterial vaginosis ix

A

Clue cells, reduced numbers of lactobacilli, absence of pus cells

pH > 4.5 & KOH whiff test

High vaginal swab

58
Q

Bacterial vaginosis mx

A

Metronidazole PO (no alcohol)

Alternative - clindamycin/metronidazole gel

Washing advice

59
Q

Trichomonas vaginalis

A

Curable STI caused by the protozoan trichomonas vaginalis

60
Q

Trichomonas vaginalis clinical features

A

Female - offensive vaginal odour, abnormal vaginal discharge, itchiness/soreness of the vulva, dyspareunia, dysuria, strawberry cervix

Male - urethral discharge, dysuria, urinary frequency, urethral discharge

61
Q

Trichomonas vaginalis risk factors

A

Multiple sexual partners

Unprotected sexual intercourse

Hx of other STIs

Older women

62
Q

Trichomonas vaginalis investigations

A

Female - high vaginal swab from posterior fornix

Male - urethral swab or first void urine sample

63
Q

Trichomonas vaginalis mx

A

Metronidazole PO

Current partner & any other sexual partners in preceding four weeks should be tested & treated

Abstain from sexual intercourse

64
Q

Trichomonas vaginalis pregnancy

A

May carry a risk of premature labour & baby having a low birth-weight

At delivery → may predispose to maternal postpartum sepsis

Metronidazole can also affect taste of breast milk → high dose is avoided

65
Q

Neisseria gonorrhoea

A

Gram negative intracellular diplococci

Transmitted through direct inoculation of infected secretions

66
Q

Neisseria gonorrhoea clinical features

A

Urethral - mucopurulent discharge, +/- dysuria

Endocervical - altered discharge, dysuria, dyspareunia, lower abdo pain

Rectal - asymptomatic, anal discharge, pain

Phayngeal - asymptomatic, sore throat

67
Q

Neisseria gonorrhoea risk factors

A

Aged < 25 years

Men who have sex with men

Living in high density urban areas

Previous gonorrhoea infection

Multiple sexual partners

68
Q

Neisseria gonorrhoea ix

A

Gonorrhoea culture - taken in all cases prior to treatment for AMR

NAAT

Microscopy

69
Q

Neisseria gonorrhoea mx

A

Ceftriaxone IM - 1st line

If antimicrobial susceptibility known - ciprofloxacin 500mgms stat dose

Screening for other STIs, further safe sex practices

70
Q

Neisseria gonorrhoea complications

A

Disseminated infection - pustular lesions, joints, tendon involvement

Transluminal spread - PID, prostatitis, epididymo-orchitis

71
Q

Neisseria gonorrhoea pregnancy

A

May be associated with complications such as perinatal mortality, spontaneous abortion, premature labour & early fetal membrane rupture

Vertically transmitted during delivery → neonatal conjunctivitis → prophylactic abx can be given to prevent this

72
Q

Chlamydia trachomatis clinical features

A

Asymptomatic

Female genital tract - discharge, PCB, IMB, dysuria, LAP, deep dyspareunia

Penile urethra - urethral discharge, dysuria

Rectal infection - asymptomatic, anal discharge, anorectal discomfort

Pharyngeal - no sx

Conjunctiva - low grade, unilateral irritation

73
Q

Chlamydia trachomatis ix

A

Women - vulvovaginal swab, endocervical swab or first catch urine

Men - first catch urine sample or urethral swab

NAAT

74
Q

Chlamydia trachomatis mx

A

Doxycycline PO or azithromycin single dose

Avoid sex until they and/or their partner have completed treatment

75
Q

Chlamydia trachomatis complications

A

PID

Epididymitis or epididymo-orchitis

Reactive arthritis

76
Q

Non-specific urethritis

A

Describe the presence of urethritis when a gonococcal bacteria are not identifiable or the initial swab

77
Q

Non-specific urethritis aetiology

A

Chlamydia trachomatis

Mycoplasma genitalium

Less common - ureaplasma urealyticum, tichomonas vaginalis, e. coli

78
Q

Non-specific urethritis ix

A

NAAT

Urine

HSV

79
Q

Non-specific urethritis mx

A

Contact tracing

Doxycycline PO

Azithromycin - mycoplasma genitalium

Y4 reproductive health (11 decks)

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