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402 - Infectious diseases > Sexually transmitted infections > Flashcards

Sexually transmitted infections Flashcards

1
Q

Risk factors for ↑ STI acquisition

A
  • Higher levels of sexual activity
  • Unsafe sex (w/o condom)
  • Higher no. of sexual partners
  • Anonymous sexual partners
  • Concurrent sexual partners
  • Sexual contact in high prevalence countries
    • Sub Saharan Africa
    • South + SE Asia
    • Caribbean
  • Reduced access to health services

HIV is also an STI - many of the RF for acquiring STI same for acquiring HIV

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2
Q

Chlamydia trachomatis

  • species
  • presentation - men + women
  • Diagnosis
  • tx
A
  • Species
    • Chlamydia trachomatis = intracellular bacteria
  • Presentation
    • most asymptomatic
    • Men → urethritis – dysuria (pain passing urine), urethral discharge
    • Women → vaginal discharge – cervicitis, lower abdominal pain
  • Diagnosis
    • = molecular testing - NAAT- nucleic acid amplification test
    • Women – vaginal swab
    • Men – first void urine
    • Extra-genital – throat swab + rectal swab
  • Tx
    • uncomplicated - Doxycycline 100mg bd 7 days
    • except PID chlamydia - ofoxacin 400mg BD 2 weeks
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3
Q

PID - pelvic inflammatory disease

  • =
  • presents
    • sign - Fitzhugh Curtis syndrome
  • causes (organisms)
  • diagnosis by
A
  • = infection of the female reproductive organs from ascending infection
  • Presents w/:
    • Abdo/pelvic pain,
    • vaginal discharge,
    • dyspareunia (painful intercourse)
    • Peri-hepatitis
      • Fitzhugh Curtis syndrome - PID spread to liver → RUQ pain
  • Causes
    • Chlamydia/gonorrhoea
    • Mycoplasma
    • BV organisms
  • Diagnosed by
    • Clinical symptoms + signs
    • Laparoscopy
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4
Q

LGV - Lympho-granuloma Venerum

  • caused by
  • features/presentation
A
  • caused by L type of chlamydia
  • Features
    • proctitis (rectal inflammation
  • Presents
    • Anal pain, rectal discharge, tenesmus (cramping rectal pain)
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5
Q

causes of proctitis in MSM

A
  • Gonorrhoea
  • Chlamydia (D-K) types
  • LGV ( Lympho-granuloma Venerum) – chlamydia type L
  • Herpes simplex
  • Syphillis
  • Non STIs – e.g. IBD
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6
Q

Chlamydia → Sexually acquired reactive arthritis (SARA)

  • causes
  • symptoms
    • (mnemonic)
  • Other organism causes
A
  • Causes molecular mimicry
  • Symptoms – cant see, cant pee, cant climb a tree
    • Urethritis
    • Joint pain
    • Conjunctivitis
  • Other causes
    • Chlamydia
    • Shigella
    • HIV
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7
Q

Chlamydia complications (4)

A
  • PID (women)
  • Lympho-granuloma Venerum → Proctitis
  • Sexually acquired reactive arthritis (SARA)
  • Sexually acquired reactive arthritis (SARA)
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8
Q

Management of bacterial STIs (principles)

A
  1. Partner notification + tx
  2. Education, health promotion
  3. Abstinence
  4. Abx tx
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9
Q

Gonorrhoea

  • =
  • Clinical presentation
  • Diagnosis
  • Tx
  • Complications
A
  • = Gram negative, Bacteria STI
    • Important anti-microbial resistance
  • Clinical presentation
    • Men
      • Urethritis – inflammation of urethra → dysuria
      • Milky purulent discharge
    • Conjunctivitis – uncommon
  • Diagnosis
    • Microscopy – identify organism
    • Culture – quite difficult
    • NAAT – amplification testing – highly sensitivity
      • No antimicrobial resistance data
  • Tx
    • 2 antimicrobials – Azithromycin, Ceftriaxone
      • however some have resistance to azith
  • Complications
    • ​Men + women
      • Conjunctivitis
      • Disseminated gonorrhoea → septicaemia (rash + arthritis)
    • Men
      • Epididimo-orchitis
    • Women
      • PID
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10
Q

Causes of vaginal discharge

  • 4 categories + examples
  • STIs
  • Non STI
  • Inflammatory
  • Other
A
  • STI
    • TV
    • Chlamydia
    • Gonorrhea
  • Non-STI
    • BV
    • candida
  • Inflammatory
    • foreign body
    • chemical irritant
    • dermatological
  • Other
    • normal physiological - age, hormones, pregnancy, sexual activity
    • neoplasia

Important to ask about CHANGES in discharge

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11
Q

Normal microbiology of the vagina

A
  • Normal vaginal flora = mainly lactobacilli species
  • Housekeeping role
  • Produce natural antimicrobials à
    • prevent overgrowth of other bacteria
    • create low pH environments
    • Bacteriocin like substances
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12
Q

BV - bacterial vaginosis

  • cause
  • Clinical features
  • Complications
  • Risk factors
  • Diagnosis
  • Tx
A
  • Natual balance of microbes disturbed
    • ↓ lactobacilli in flora, overgrowth of catalase -ve organisms → byproducts that give rise to symptoms
  • Clinical features
    • asymptomatic
    • Musty/fishy odour
    • Thin, grey-white discharge
    • Raised pH
    • Pruritus + inflammation typically absent
      • Although can cause irritation + soreness after sex
  • Complications
    • Post-surgical infection
    • risk w/ pregnancy - PROM
  • Risk factors
    • Multiple or new partners
    • Douching, washing practices
    • Smoking
    • IUCD/IUS
  • Diagnosis
    • vaginal slide gram stain - look for presence of epithelial cells
  • Tx
    • only for symptomatic women
    • Antibiotics
      • 1st line – Metronidazole
      • 2nd line – metronidazole or clindamycin intravaginal gel
    • Lifestyle advice
      • Washing advice
      • Resolves spontaneously
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13
Q

Trichomonas vaginalis (TV)

  • causative agent
  • Symptoms
  • signs
  • diagnosis
  • tx
A
  • Causative agent
    • Flagellate Protozoon
    • Trichomonas Vaginalis
  • Symptoms
    • asymptomatic
    • vaginal discharge - thin, offensive
    • Vulval itchy, soreness, external dysuria
  • Signs
    • vaginal discharge - thin, frothy, yellow
    • vulval + vaginal inflamation
    • cervical inflammation (strawberry cervix)
  • Diagnosis
    • micrscopy
    • cervical cytology
    • PCR
  • tx
    • Metronidazole 400mg BD PO 5 days
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14
Q

Vulvo-vaginal candidiasis (Thrush)

  • cause / causative agent
  • symptoms
  • signs
  • diagnosis
  • tx
A
  • cause / causative agent
    • overgrowth of candida albicans species → inflammation
    • Candida albicans (80-92%)
    • Candida glabrata
    • Other species
  • symptoms
    • vulval itching, soreness
    • vaginal discharge - thick, curd-like
    • Superficial dyspareunia
  • signs
    • vulval/vaginal erythema
    • fissuring
    • vulval oedema
    • thick, adherent, non-offensive discharge
    • normal PH
  • diagnosis
    • Gram stain vaginal smear → spores + pseudo-hypae
    • culture
  • tx
    • General measure - avoid local irritants (saops)
    • topical antifungals - clotrimazole
    • oral antifungals - gluconazole
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15
Q

BV vs candidiasis (thrush)

  • compare discharge
  • compare vulval/vaginal inflammation
  • compare pH
A
  • Dishcharge
    • BV - thin, grey, fishy
    • Thrush - thick, white, not smelly
  • Vulval/vaginal irritation
    • BV - no inflammation, not itchy
    • Thrush - inflammation, irritation, pruritis
  • pH
    • BV - ↑
    • Thrush - normal
  • but can get both together
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16
Q

HSV

  • HSV types 1 + 2 → causes
  • Ulcers features
  • Diagnosis
  • Complications
    • Fingers, eyes, brain
  • Management
    *
A
  • HSV 1+2→ oro-genital ulcers
  • Ulcer features
    • shallow, red ring
    • very tender
    • in women → dysuria + genital oedema
  • Diagnosis
    • PCR testing
  • Complications
    • Fingers →Herpetic Whitlow
      • Recurrent painful HSV ulcers on fingers
    • Eyes → Dendritic ulcers
    • Brain → HSV encephalitis (HSV-1)
      • Temporal encephalitis
  • Management
    • _​_oral antiviral - acyclovir
    • lidocaine gel - pain relief
    • salt bathing
    • abstinence
      *
17
Q

HIV

  • CD4 count for = early, late + advance
  • Consequences of late diagnosis (6)
  • Risk factors
A
  • CD4 count
    • Early >350
    • Late 200-350
    • Advanced <200
  • Consequences of late diagnosis
    • Opportunistic infection
      • Toxoplasma gondii – brain parasite
      • Pneumocystis jirovecii – pneumonia
    • Cancers
      • Hodgkin’s lymphoma
      • Kaposi’s sarcoma
    • Drug-drug interactions
      • Polypharmacy
    • Side effects - e.g.
      • Chemo
      • Anti-microbial
      • Severe rashes
    • Ongoing HIV transmission
      • Late presenters have a higher viral load → more likely to pass on HIV through sexual contact/vertical transmission
    • Higher mortality rate
  • Risk factors
    • MSM
    • IVDU + their partners
    • High prevalence areas – sub-Saharan Africa
    • Sexual partners of people living with HIV
    • People who received blood transfusions overseas
      • Or in UK prior to 1985
    • Needle stick injury or other occupational injury
18
Q

HIV

  • Types of test
    *
A
  • How to test
    • blood sample
    • POCT - point of care test (small drop of blood)
    • HIV home testing - saliva

402 - Infectious diseases (1 decks)

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