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Yr4 - O&G > Sexually Transmitted Diseases > Flashcards

Sexually Transmitted Diseases Flashcards

1
Q

Cause of chlamydia

A

Caused by bacterium Chlamydia trachomatis

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2
Q

Types of chlamydia

A

Serotypes A-C - causes ocular infection
Serotypes D-K - responsible for GI infection
Serotypes L1-L3 - causes lymphogranuloma venereum

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3
Q

Pathophysiology of chlamydia

A

Transmission via unprotected vaginal, anal or oral sex
Enters host cell as an elementary body - infectious form
- becomes reticular body - non-infectious
- mature back to elementary body

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4
Q

Risk factors for chlamydia

A 
Age <25
Sexual partner positive for chlamydia
Recent change in sexual partner
Co-infection with another STI
Non-barrier contraception or lack of consistent use of barrier contraception
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5
Q

Clinical features of chlamydia in women

A 
Symptoms
- Dysuria
- Abnormal vaginal discharge
- Intermenstrual or postcoital bleeding
- Deep dyspareunia
- Lower abdominal pain
Signs
- cervicitis +/- contact bleeding
- Mucopurulent endocervical discharge
- Pelvic tenderness
- Cervical excitation
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6
Q

Chlamydia clinical features in men

A 
Symptoms
- urethritis
     - dysuria
     - urethral discharge
- epididymo-orchitis
     - testicular pain
Signs
- epididymal tenderness
-mucopurulent discharge
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7
Q

Investigations for chlamydia

A

Tests available at sexual health clinics, GUM clinics and GPs
National screening programme for under 25s
Nucleic acid amplification test
- women = vulvovaginal swab
- men = first catch urine sample

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8
Q

Management of chlamydia

A

Doxycycline 100mg twice daily for 7 days or
Azithromycin 1g single dose
Avoid sexual intercourse/oral sex until completed treatment/7days following azithromycin

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9
Q

Complications of chlamydia

A

Reactive arthritis
Women
- salpingitis/endometritis -> PID
-> perihepatitis, ectopic pregnancy and infertility
Men
- epididymitis/epididymo-orchitis -> infertility

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10
Q

Complications of chlamydia in pregnancy

A

Increase risk of premature delivery with low birth weight
Increased risk of miscarriage/stillbirth
Neonatal chlamydial conjunctivitis and pneumonia
Treat with erythromycin

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11
Q

Causes of genital herpes

A

Herpes simplex virus

Transmitted via skin-to-skin contact

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12
Q

Types of genital herpes

A

HSV-1
- genital herpes
- affects areas around mouth and nose causing cold sores
HSV-2
- genital and anal areas causing genital herpes

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13
Q

Pathophysiology of genital herpes

A

HSV enters body through small cracks in skin or mucous membranes
Virus travels to nearest nerve ganglion and remains there
During reactivation virus travels back down nerve into surface of genitals causing symptomatic outbreak

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14
Q

Risk factors of genital herpes

A

Having multiple sexual partners

Oral sex with partner suffering from cold sores

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15
Q

Clinical features of primary infection of genital herpes

A

Small red blisters around the genitals that are very painful and can form open sores
- In males - on the penis, anus, buttocks and thigh
- In females - on the vulva, clitoris, buttocks and anus
Vaginal or penile discharge
Flu-like symptoms, fever, muscle aches
Itchy genitals
Lesions crust and heal after about 20 days

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16
Q

Clinical features of secondary infection of genital herpes

A

Often shorter and less severe
Burning and itching around the genitals
Painful red blisters around the genitals

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17
Q

Clinical features of cold sores

A

Painful lesions around the mouth and nose

- last 7-10 days

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18
Q

Investigations for genital herpes

A

History - sexual partners, cold sores, STIs
Swab from open sore
- tested for presence of HSV
- PCR can differentiate between 1 and 2

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19
Q

Management of genital herpes

A 
Primary infection
- aciclovir
Recurrent outbreaks
- painkillers
- petroleum jelly
- ice packs
- episodic treatment with aciclovir
- daily aciclovir if severe to supress
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20
Q

Herpes during pregnancy

A 
If contracted before pregnancy
- will have antibodies so baby safe
- vaginal or C-section
If contracted during last trimester
- no antibodies so baby at greater risk
- C-section recommended
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21
Q

Define genital warts

A

Benign epithelial or mucosal outgrowths cause by DNA human papilloma virus (HPV)

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22
Q

Pathophysiology of genital warts

A

Most commonly HPV6 and HPV11
Spread through skin-to-skin contact
Virus penetrates epithelial barrier and infects basal keratinocytes
- virus replicates -> multiplication of keratinocyte

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23
Q

Types of oncogenic HPV

A

HPV16 and HPV 18

- lead to cancer of vulva, vagina, cervix and anus

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24
Q

Risk factors for genital warts

A 
Early age at first sexual intercourse
Multiple sexual partners
Immunosuppression
Smoking
Diabetes associated with persistence of warts
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25
Q

Clinical features of genital warts

A

Warts appear after initial infection

- painless, fleshy growths

26
Q

Investigations for genital warts

A

Diagnosis by examination

Biopsy for atypical lesions and suspected intraepithelial neoplastic lesions

27
Q

Management of genital warts

A

Lesions most likely resolve spontaneously
Topical treatments
- podophyllotoxin - small clusters, non-keratinised lesions
- imiquimod - larger keratinised warts
Physical ablation
- excision - pedunculated/large warts or accessible small hard warts
- cryotherapy - multiple small warts
- electrosurgery - large warts that have failed to respond to topical treatments
- laser surgery - difficult to access warts eg in anus

28
Q

Features of HPV vaccination

A

Protects mainly against HPV16 and HPV18
- since 2012 protected against HPV 6 and 11
Offered to girls aged 12-13 in UK

29
Q

Features of HPBV in pregnancy

A

Due to hormonal changes genital warts may multiply or enlarge
Treatment aims to reduce lesions so neonate’s exposure reduced

30
Q

Define HIV

A

Human Immunodeficiency Virus
- single stranded RNA retrovirus that infects and replicates within human immune system using CD4 host cells
Leads to AIDS (Acquired Immune Deficiency Syndrome)

31
Q

Pathophysiology of HIV

A

Infects and replicates within CD4 cells
- single stranded RNA converted to DNA by reverse transcriptase
- combined with host DNA by integrase
When infected cell divides viral DNA read creating viral protein chains
- immature virus pushes out of cell retaining some cell membrane
- virus matures when protease cuts viral protein chains

32
Q

CD4 levels in HIV infection

A

Seroconversion - production of anti-HIV antibodies during primary infection
- flu-like symptoms
- CD4 levels fall
Latent phase
- initially asymptomatic
- CD4 levels fall and viral load increases

33
Q

Transmission of HIV

A

Unprotected sexual contact
Sharing of injecting equipment
Medical procedure - blood products, skin graft, organ donor, artificial insemination
Vertical transmission - mother to child in utero, during childbirth or breastfeeding

34
Q

At risk groups in UK for HIV

A

Men who have sex with men
Intravenous drug users
Those in high prevalence areas
Those who have had unprotected sex with a partner who has lived or travelled in Africa

35
Q

Define PID

A

Infection of upper genital tract in females

- affects uterus, fallopian tubes and ovaries

36
Q

Pathophysiology of PID

A

Infective inflammation

  • spread of bacterial infection from vagina or cervix to upper genital tract
  • Chlamydia trachomatis
  • Neisseria gonorrhoea
37
Q

Risk factors for PID

A

Sexually active
Aged under 15-24
Recent partner change
Intercourse without barrier contraceptive protection
History of STIs
Personal history of pelvic inflammatory disease
Instrumentation of cervix
- inadvertently introduces bacteria
- gynae surgery, TOP, insertion of IUD/IUS

38
Q

Clinical features of PID

A

Can be asymptomatic
Lower abdominal pain
Deep dyspareunia (painful sexual intercourse)
Menstrual abnormalities (e.g menorrhagia, dysmenorrhoea or intermenstrual bleeding)
Post-coital bleeding
Dysuria (painful urination)
Abnormal vaginal discharge (especially if purulent or with an unpleasant odour)

39
Q

Differential discharge of PID

A 
Ectopic pregnancy (a pregnancy test is mandatory to exclude this).
Ruptured ovarian cyst
Endometriosis
Urinary tract infection
40
Q

Investigations for PID

A

Endocervical swabs
- for gonorrhoea and chlamydia
Full STI screen – HIV, syphilis, gonorrhoea and Chlamydia
Urine dipstick +/- MSU – to exclude UTI
Pregnancy test - exclude pregnancy
TV USS – if there is severe disease or diagnostic uncertainty
Laparoscopy - severe cases of diagnostic uncertainty for biopsy

41
Q

Management of PID

A 
14 day broad spectrum abx
- ceftriaxone
- doxycycline
- metronidazole
Avoid sexual intercourse
All sexual partners from last 6 months should be tested
42
Q

Reasons for admittance to hospital for PID

A

f pregnant and especially if there is a risk of ectopic pregnancy
Severe symptoms: nausea, vomiting, high fever
Signs of pelvic peritonitis
Unresponsive to oral antibiotics, need for IV therapy
Need for emergency surgery or suspicion of alternative diagnosis

43
Q

Complications of PID

A

Ectopic pregnancy – due to narrowing and scarring of the fallopian tubes
Infertility – affects 1 in 10 women with PID
Tubo-ovarian abscess
Chronic pelvic pain
Fitz-Hugh Curtis syndrome – perihepatitis that typically causes right upper quadrant pain

44
Q

Define syphilis

A

STI caused by spirochete gram negative bacteria

- Treponema pallidum subspecies pallidum

45
Q

Pathophysiology of syphilis

A

Contracted by sexual intercourse, mother to foetus via placenta and through infected blood products
Treponema pallidum enters, divides and infectious hard ulcer forms at site of contact after incubation period = primary syphilis
If untreated can cause systemic damage by obliterating arteritis
- endothelial cells excessively proliferate

46
Q

Risk factors for syphilis

A

Engaging in unprotected sex – especially with high risk partners
Multiple sexual partners
Men who have sex with men (MSM)
HIV infection

47
Q

Clinical features of primary syphilis

A

Papule appears before ulcerating into a chancre

  • painless ulcer
  • singular, hard and non-itch
  • heals within 3-10 weeks
48
Q

Clinical features of secondary syphilis

A

Usually develops 3 months post-infection
- Skin rash – hands and soles of the feet (not usually itchy or painful)
- Fever
- Malaise
- Arthralgia
- Weight loss
- Headaches
- Condylomata lata - elevated plaques like warts at moist areas of skin
- Painless lymphadenopathy
- Silvery-grey mucous membrane lesions – oral, pharyngeal, genital
Disease then enters asymptomatic latent phase

49
Q

Clinical features of tertiary syphilis

A

Presents may years after initial infection
Gummatous syphilis
- form in bone, skin, mucous membranes of the upper respiratory tract, mouth and viscera or connective tissue
- patients non-infectious
Neurosyphilis
- Tabes dorsalis – ataxia, numb legs, absence of deep tendon reflexes, lightning pains, loss of pain and temperature sensation, skin and joint damage
- Dementia – cognitive impairment, mood alterations, psychosis
- Meningovascular complications – cranial nerve palsies, stroke, cerebral gummas
- Argyll Robertson pupil – pupil is constricted and unreactive to light, but reacts to accommodation
Cardiovascular syphilis
- Aortic regurgitation due to aortic valvulitis (diastolic murmur), also aortic root dilatation
- Angina due to stenosis of the coronary ostia
- Dilation and calcification of the ascending aorta

50
Q

Investigations for syphilis

A

Dark ground microscopy of chancre fluid - detects spirochaete in primary syphilis
PCR testing of swab from active lesion
Serology:
- Treponemal tests – assess for exposure to treponemes
- Treponemal ELISA (IgG/IgM) – remains positive for life
- TPPA or TPHA – remain positive for life
- Non-treponemal tests:
- RPR/VDRL: rises in early disease; falling titres indicate successful treatment or progression to late disease - False positives can occur in inflammatory conditions or during pregnancy
Lumbar puncture: CSF antibody tests in neurosyphilis

51
Q

Management of syphilis

A

Penicillin
Advising patients to avoid sexual contact of any kind, or exposure of other people to active lesions until the condition has been successfully treated
Screening for other STIs
Patient education
Contact tracing
Follow-up serology to determine response to treatment

52
Q

Syphilis in pregnancy

A

Screening offered as part of antenatal screening
T. pallidum has potential to cross placenta or infect baby during delivery
If left untreated, syphilis during pregnancy may result in miscarriage, stillbirth, pre-term labour or congenital syphilis
- severe and debilitating
- saddle nose, rashes, fever and failure to gain weight

53
Q

Define trichomoniasis

A

Curable STI caused by protozoan trichomonas vaginalis

54
Q

Pathophysiology of trichomoniasis

A

Transmitted through unprotected vaginal intercourse
Affects the female urethra, vagina and paraurethral glands and the male urethra and underneath the foreskin
Replicates via binary fission destroys epithelial cells through direct cell contact and by the release of cytotoxins

55
Q

Risk factors for trichomoniasis

A

Multiple sexual partners
Unprotected sexual intercourse
A history of other STIs
Older women are more at risk of TV

56
Q

Female features of trichomoniasis

A

Symptoms
- Offensive vaginal odour
- Abnormal vaginal discharge – thick/thin/frothy and yellow-green
- Itchiness or soreness of the vulva
- Dyspareunia
- Dysuria
Signs
- Abnormal vaginal discharge – thick/thin/frothy and yellow-green
- Vulvitis
- Vaginitis
- Strawberry cervix – punctate and papilliform appearance

57
Q

Male features of trichomoniasis

A 
Symptoms
- Urethral discharge
- Dysuria
- Urinary frequency 
- Pain or itching around the foreskin
Signs
- Urethral discharge
- Balanoposthitis – inflammation of the glans penis (rare)
58
Q

Investigations for trichomoniasis

A 
Female:
- High vaginal swab is taken from the posterior fornix during examination 
- Self-administered vaginal swab
Males
- Urethral swab 
- First void urine sample
59
Q

Management of trichomoniasis

A

Metronidazole
Contact tracing - patient’s current partner(s) and any sexual partners of the preceding four weeks should also be tested and treated simultaneously
Abstain from sexual intercourse whilst being treated

60
Q

Trichomonas vaginalis in pregnancy

A

May carry risk of premature labour and low-birth weight

Infection at delivery may predispose to maternal postpartum sepsis

Yr4 - O&G (19 decks)

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