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Reproduction and Sexual Health > Sexually Transmitted Infection > Flashcards

Sexually Transmitted Infection Flashcards

1
Q

Commonest STI?

A

Chlamydia

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2
Q

Chlamydia trachomatis appearance on gram stain

A

Obligate intracellular organism

Doesn’t stain on gram stain

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3
Q

What is Chlamydia trachomatis divided into?

What is the clinical implication of this?

A

Serovars

Serovars A-C = eye infection

Serovars D-K = genital infection

Serovars L1-3 = lymphogranuloma venereum

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4
Q

Symptoms of chlamydia?

A

Pain

Dysuria/Dyspareunia

Vaginal bleeding (post-coital/intermenstrual)

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5
Q

How long does chlamydia take to show symptoms?

A

Might never show symptoms

Commonly asymptomatic

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6
Q

What microorganism is responsible for chlamydia infection?

A

chlamydia trachomatis

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7
Q

chlamydia is always sexually transmitted. true or false?

A

False

Mothers can transfer to neonates during childbirth

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8
Q

How does neonatal chlamydia present?

A

Conjunctivitis

Pneumonia

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9
Q

What is lymphogranuloma venereum?

What microoganism causes it?

A

Chlamydia infection of lymphatics

Occurs when microbe crosses anal mucous membrane and is taken up by lymphatics

chlamydia trachomatis L1,2,3

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10
Q

Man presents with dysuria 4 months after successful treatment of an STI.

Diagnosis?

What else would be expect to see?

What do you think the STI was?

A

Reactive arthritis

Arthritis, conjunctivitis, urethritis

Chlamydia

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11
Q

First and second line treatments for chlamydia.

A

1st: doxycycline (7 days)
2nd: azithromycin (3 days)

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12
Q

What organism causes gonorrhoea?

A

Neisseria gonorrhoeae

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13
Q

Neisseria gonorrhoeae appearance on gram stain.

A

Gram negative intracellular diplococcus

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14
Q

What organism can be cultured on chocolate agar?

A

Neisseria gonorrhoeae

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15
Q

Presentation of gonorrhoea.

A

Discharge (vaginal, urethral pus)
Pain
Dysuria

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16
Q

First and second line treatments for gonorrhoea.

A

1st: IM ceftriaxone
2nd: oral cefixime

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17
Q

What do these viruses cause?

HSV-1
HSV-2
HPV-6
HPV-11

A

HSV-1: genital herpes
HSV-2: genital herpes
HSV-6: genital warts
HSV-11: genital warts

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18
Q

What makes someone with HSV infectious?

A

Viral shedding

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19
Q

What HSV virus most commonly undergoes viral shedding?

What is the clinical implication of this?

A

HSV-2

In general, this means they are more contagious (particularly in first year of infection)

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20
Q

Why must a patient be symptomatic when they are viral shedding?

A

They don’t have to be
This isn’t true

Viral shedding can occur asymptomatically

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21
Q

How does primary genital herpes infection present?

A

Painful blistering

Pain, dysuria, discharge

Systemic symptoms

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22
Q

How do you diagnose genital herpes?

A

Swab re-roofed ulcer for PCR

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23
Q

Why can genital herpes be recurrent?

A

Migrates to dorsal root ganglion

24
Q

How do you treat primary genital herpes infection?

A

oral acyclovir (lignocaine for pain)

25
Q

How does a relapse of genital herpes infection present?

A

Small unilateral ulcers
Mild tingling
Few systemic symptoms

26
Q

How do you manage a patient with herpes in pregnancy?

A

Treat all herpes with acyclovir during pregnancy

If history of recurrent infection, treat prophylactically from 36 weeks gestation

27
Q

What microbe is responsible for syphilis infection?

A

Treponema pallidum

28
Q

How does treponema pallidum appear on gram stain?

A

Doesn’t stain on gram stain

Spirocheate organism

29
Q

Describe the stages of syphilis infection and when they occur.

A

Primary: painless chancre at site of contact (~2 weeks post infection)

Secondary: erythematous palmoplantar rash, snail track ulcers and flu (~4 months post infection and pass over a few weeks)

Latent: asymptomatic (can last decades)

Late: life threatening cardiovascular and neurological damage (long time after initial infection)

30
Q

What is the simplest test to do in suspected syphilis?

A

Swab chancre for PCR

31
Q

What blood tests can you order for suspected syphilis?

What do they tell you?

A

IgM/IgG ELISA test
- screening test

TPPA/TPHA
(treponema pallidum particule/haem-agglutination assay)
- positive result confirms infection
- may be positive for life after infection

VDRL/RPR
(venereal disease research laboratory test / rapid plasma reagin)
- non specific test
- used to monitor treatment response

32
Q

Dark ground microscopy can be used to see which type of organism?

A

Treponema pallidum

33
Q

Management of syphilis.

A

IM benzathine benzylpenicillin

long acting

34
Q

5% of people with HPV ___ infection go onto develop genital warts. True/false?

A

False

1%

____ = 6/11

35
Q

How do you manage genital warts?

A

Topical podophyllotoxin

Screen for other STIs

36
Q

Viruses causing

  • genital warts
  • genital herpes
A

warts: HPV 6/11
herpes: HSV 1/2

37
Q

Increased sexual partners increases risk of bacterial vaginosis. True/false?

A

True

Not a sexually transmitted infection but lots of partners increases risk

38
Q

What are the normal vaginal flora?

A

Lactobacilli

Produce lactic acid

39
Q

What do the normal vaginal flora produce and what does this do?

A

Lactobacilli produce lactic acid to suppress growth of other microbes

40
Q

What can be seen on microscopy in bacterial vaginosis?

A

Lactobacilli replaces by clumps of coccobacilli

Clue cells - clumps obscure edges of vaginal epithelial cells

41
Q

How do you treat bacterial vaginosis?

A

Metronidazole

42
Q

In what infection would you consider the whiff test?

What does it involve and show?

A

Bacterial vaginosis

Adding potassium hydroxide to vaginal discharge produces fishy odour

43
Q

How does bacterial vaginosis present?

A

Vaginal discharge

44
Q

What microorganism causes trichomoniasis?

A

Trichomonas vaginalis

Single celles protozoa

45
Q

In what condition might you see an alkaline vagina?

What is the normal pH?

A

Trichomoniasis
(pH>5)

3.5-4.5

46
Q

How might trichomoniasis present?

A

Vaginal discharge (thin, frothy, fishy)

Itchy vagina

47
Q

How do you treat trichomoniasis?

A

Metronidazole

48
Q

What is the name of the emerging sexually transmitted pathogen which may be a big problem in the future?

A

Mycoplasma Genitalium

49
Q

What is PID and what causes it?

A

• Ascending infection of the female reproductive tract

Chlamydia, gonorrhoea (bacterial vaginosis)

50
Q

How does PID present?

A

In a very varied way (from asymptomatic to severe)

Pelvic pain, abnormal discharge, fever, N+V

51
Q

How do you treat PID?

A

Metronidazole + ofloxacin

52
Q

What is the nucleic acid amplification test (NAAT)?

What does it test for?

A

Sensitive PCR test

Both chlamydia/gonorrhoea in one test

53
Q

Where would you take the sample from in NAAT from

  • male?
  • female?

Where else might you swab and why?

A

M: first pass urine
F: vuvlovaginal swab

Rectum, pharynx (MSM)

Although asympomatic, pharngeal gonococcal infection sustains gonorrhoea infection in general population

54
Q

“2 kidney beans” on microscopy?

A

Gonorrhoea

55
Q

Benefits/disadvantages of NAAT v culture?

A

Benefts

  • NAAT is more sensitive
  • culture can test for antimicrobial resistance

Disadvantages
- difficult to grow on culture

56
Q

What infection requires a test of cure?

A

Gonorrhoea

Reproduction and Sexual Health (5 decks)

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