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Sexually Transmitted Infections Flashcards

1
Q

Rx of Gonorrhoea?

A

Ceftriaxone IM or IV

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2
Q

What are the common causes of cervicitis or urethritis?

A

C.trachomatis
N. gonorrhoeae
Mycoplasma genitalium

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3
Q

Symptoms of cervicitis?

A

Usually asymptomatic with C and G!!

Discharge
friable membrane -> abnormal bleeding
Pain on sex

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4
Q

Rarer causes of cervicitis?

A

HSV; adenovirus; CMV;
bacterial vaginosis;
retained foreign body

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5
Q

Definition of PID?

A

Any inflammatory process
that involves the upper
genital tract, including
* Endometritis
* Salpingitis
* Oophoritis
* Tubo-ovarian abscess
* Pelvic peritonitis
* Perihepatitis

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6
Q

Causes of PID

A

▪ C. trachomatis
▪ N. gonorrhoeae
▪ Anaerobes (Bacteroides,
Fusobacterium spp)
▪ Gram neg. facultative aerobes
▪ Streptococci (S. agalactiae)
▪ M. genitalium
▪ Less common but reported: S.
pneumoniae; Haemophilus spp.

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7
Q

What drugs will you use to Rx the common causes of cervicitis?

A

Gram negatives - gonorrhoea - cef
Gram positives - cef/doxy
Chlamydia - doxy

Plus metronidazole! For endometrial anaerobes and M. genitalium

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8
Q

Common causes of urethritis?

A

– Chlamydia trachomatis
– Neisseria gonorrhoeae

RARE:
- Herpes
- Coliforms
- Trichomoniasis
- Mycoplasma genitalium

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9
Q

What can we no longer use to Rx gonorrhoea due to resistance?

A

Azithromycin

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10
Q

Alternative to Rx gonorrhoea if ceftriaxone not available?

A

Gentamicin and Azithromycin

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11
Q

First line Rx for chlamydia?

A

Doxycycline 1 week

Alternatives: azithromycin or levofloxacin

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12
Q

Rx of mycoplasma genitalium?

A

Doxycycline for 7/7 followed by azithromycin (moxi if azithromycin resistant)

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13
Q

Causes of proctitis?

A
  • Gonorrhea
  • C. trachomatis (LGV & non-LGV strains) - Serovars L1/L2/L3
  • Herpes simplex virus
  • CMV - colitis (immunocompromised)
  • Ameobiasis - colitis
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14
Q

Rx of proctitis?

A

3 weeks of doxycycline

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15
Q

Symptoms of disseminated gonococcal infection?

A

Polyarthralgia, tenosynovitis, dermatitis, fever, GU symptoms

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16
Q

Single purulent vesicle with fever and painful knee. ∆?

A

Disseminated gonococcal infection

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17
Q

Pattern of arthritis in gonococcal disseminated infection?

A

Purulent arthritis - usually single joint, often knee, wrist, ankle

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18
Q

∆ of gonococcal infection?

A

Gram stain of skin lesion, urine, joint aspirate

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19
Q

Predominant bacteria in vagina?

A

Lactobacillus - produces lactic acid, pH 4.7
L. crispatus and L. jensenii

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20
Q

Common causes of vaginitis?

A

– Bacterial vaginosis (40%-45%)
– Vulvovaginal candidiasis (20%-25%)
– Trichomoniasis (15%-20%)

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21
Q

Vaginitis, Not responding to Rx, consider?

A

*Mucopurulent cervicitis
* Chemical irritation
* Herpes simplex virus
* Atrophic vaginitis
* Allergic reactions
* Lichen planus
* Desquamative inflammatory vaginitis
* Foreign bodies

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22
Q

Why give metronidazole for vaginal discharge?

A

Will treat trichomoniasis and bacterial vaginosis

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23
Q

When add in treatment for thrush in vaginal discharge?

A

vaginial itching

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24
Q

Yellow discharge likely diagnosis? Appearance on wet mount?

A

Trichomoniasis
Motile flagellated protozoa

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25
What is bacterial vaginosis and what is crucial?
Loss of normal lactobacilli with bacterial anaerobes pH is greater than 4.7 Gardenerella and others
26
Appearance of vaginal candida? Appearance on KOH wet mount?
Thick, clumpy, white “cottage cheese, surrounding erythema Occurs in normal vaginal pH Pseudohyphae or spores if non-albicans species
27
Appearance of bacterial vaginosis? and on wet mount?
Homogenous, adherent, thin, milky white; malodorous “foul fishy” Association with contraction of HIV
28
Amsel criteria for what and what are the criterion?
BV Clinical findings (Amsel criteria): >3 of – homogeneous discharge – pH >4.5 – clue cells (>20%) – amine odor on addition of KOH (+whiff test)
29
Other tests than Amsel criteria for BV?
Gram stain findings (Nugent score) PCR for gardenerella
30
Rx of bacterial vaginosis?
metronidazole topically or PV 7/7, clindamycin is alternative
31
Symptoms of trichomonad vaginalis?
Abnormal genital discharge - yellow, dysuria, urinary frequency, itching, burning, dyspareunia, NGU in men Strawberry cervix
32
What Is trichomonas associated with?
HIV
33
Tests for trich?
PCR Microscopy - ▪ Motile trichomonads ▪ pH > 4.5
34
Treatment of trich?
1 week of metronidazole Treat partner too Males only need single dose of metronidazole
35
What constitutes uncomplicated vulvovaginal candidasis? Rx?
Mild - mod symptoms Not immunocompromised Non-recurrent Likely to be C. albicans Fluconazole 150 mg PO, single dose Any 3-7 day vaginal imidazole regimens
36
Rx of uncomplicated thrush during pregnancy?
Pregnancy: 7 days of vaginal imidazoles - NO fluconazole
37
Treatment of PID?
Ceftriaxone 250mg IM one dose stat Doxycycline 100mg BID for 14 days Metronidazole 400 TID for 14 days
38
Treatment of chlamydia/gonorrhoea?
Ceftriaxone 250mg IM one dose stat Doxycycline 100mg BID for 7 days
39
Treatment of BV and trichomonas?
Metronidazole 400mg BID for 7 days
40
Atrophic vaginitis - cause? key features?
Seen in estrogen deficiency Vagina appears smooth, thin, dry, pH 6-7
41
Recurrent vaginitis in older women? Purulent discharge?
Streptococcal Vaginitis Strep pyogenes
42
Purulent vaginitis in perimenopausal women - diagnosis and Rx?
Desquamative inflammatory vaginitis Often related to high pH - lack of oestrogen - trial oestrogen Rx Clindamycin and steroids locally
43
Causes of genital ulcer disease?
Herpes Syphilis MPox Chancroid Lymphogranuloma venerum from chlamydia Scabies Do not forget non infective causes!
44
Difference between chancre of syphylis and chancroid?
Painless- syphylis, indurated border, clean base, single Painful - chancroid
45
What are kissing lesions?
2 chancres close together Chancroid Painful and purulent
46
What is the organism for chancroid?
Haemophilis ducreyi
47
Beefy red lesions, aggressive, starting on penis?
Granuloma inguinale Klebsiella granulomatis
48
See an ulcer - what classic of herpes?
Vesicles (HSV2)
49
Rx for chancroid?
Azithromycin or ciprofloxacin
50
Rx of syphylis?
Benzylpenicillin
51
Leading cause of genital ulcer disease?
Herpes (HSV 2)
52
Rx of herpes?
Acyclovir
53
Relationship between HSV and HIV?
HSV increases the risk of HIV-1 acquisition 2-3 fold
54
Life cycle herpes?
Primary inoculation - direct contact, does not need to be symptoms in partner. Replicates in sensory ganglion Latency Reactivates at times of stress
55
Appearance of herpes?
1. Vesicular first week 2. Wet ulcer as they progress Multiple lesions
56
Diagnosis of genital herpes?
PCR HSV Culture not widely available
57
Serology in HSV?
Glycoprotein gG tests required NOT IgM - get a lot of false positives Western blot gold standard
58
Rx of HSV2?
Acyclovir Famciclovir Valacyclovir 7-10 days Treatment can be extended if healing is incomplete after 10 days of therapy.
59
Genital HSV1 - how is this different?
Less frequent relapses Cannot diagnose with serology - only PCR
60
Organism for syphylis?
Treponema pallidum
61
Difference between initial primary lesion of syphylis, herpes and chancroid?
Syphylis - inc period 9-90 days, single papule HSV - inc period 2-7 days, multiple vesicles Chrancroid - inc period 1-10 days, multiple pustule
62
Monkey pox caused by? Mode of transmission?
Mpox virus Direct contact
63
How does monkey pox present?
64
What is this?
M.pox Genital lesions common
65
What causes lymphogranuloma venereum?
Chlamydia species
66
Diffuse rash differentials?
Syphylis VZV Herpes - disseminated Molluscum Disseminated gonococcoal
67
Diagnosis of m.pox?
PCR. Aggressively scrub lesion
68
Patient presenting with proctitis - common presenting STIs?
Gonorrhoea Chlamydia HSV
69
Treatment for m.pox. Who should you rx?
Only high risk/Immunosuppressed Vaccine for most
70
Cause of chancroid?
Hemophilus ducreyi --small fastidious gram-negative rod Erythematous papule evolves into ulcer Often more than one ulcer present Typically 1-2 cm, but can be larger, generally with erythematous base and clear margins (often undermined), purulent base Inguinal lymphadenitis present ~50% of time
71
Diagnosis and Rx?
Chancroid Azithromycin Purulent base
72
How does LGV present?
Primary infection: genital ulcer, heals within few days – Very rarely diagnosed Secondary infection – Inguinal lymph node swelling/ bubo
73
LGV cause? Rx?
Serovars 1,2,3 of chlamydia trachomatis Doxycycline
74
What is this?
Groove sign 2 inguinal lymph nodes LGV
75
Beefy lesion on the penis, organism and Rx?
Donovanosis (Granuloma Inguinale) Slow growing, non tender, bleeds easily Klebsiella granulomatis Rx: Azithromycin Seen in Africa
76
Where is Chancroid still prevalent?
Sub Saharan Africa
77
What is this?
Syphilis Treponema Pallidum
78
Trichomonas vaginalis - affects who?
Females! Vagina is reservoir
79
Causes of non gonococcal urethrits?
chlamydia Mycoplasma genitalium Trichomonas HSV RARE RARE: Coliforms (anal) N.meningitidis H.Influenza EBV, adenovirus
80
Mx of mycoplasma genitalium?
Doxycycline 7/7 Moxifloxacin 2nd line
81
Transmission of monkey pox?
inoculation through broken skin, inhalation or via mucous membranes
82
What is WHO diagnostic criteria for Mpox?
unexplained rash pls one of fever/headache/malaise/LN plus AND MSM/travel/contact hx
83
inc period for mpox?
5-21 days
84
Skin rash in M.pox?which one is infectious?
All of them highly infectious On palms and soles More peripheral
85
Difference in rash between respiratory or direct inoculation?
Respiratory - disseminated rash Direct inoculation - can also be disseminated but can be local
86
Diagnosis of M.Pox?
PCR
87
Differentials of vesicular rash of mpox?
Chickenpox Molluscum contangiosum Disseminated gonococcal infection Bacterial skin infections Enterovirus Measles Syphilis
88
Complications of mpox?
Sec bacterial infection, pneumonia, encephalitis, keratitis
89
Two clades of mpox?
Clade 2 - west africa - low mortality Clade 1 - central Africa - higher mortality
90
Vaccine for mpox?
Smallpox vaccine 85% effective
91
What type of viris is m.pox? What are the reservoir?
orthopox virus- large DNA genome Rodents are reservoir
92
Outcome in HIV patients for m.pox?
30% mortality

Trop Med (49 decks)

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