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Trop Med > Sexually Transmitted Infections > Flashcards

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
Q

What is bacterial vaginosis and what is crucial?

A

Loss of normal lactobacilli with bacterial anaerobes
pH is greater than 4.7
Gardenerella and others

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26
Q

Appearance of vaginal candida? Appearance on KOH wet mount?

A

Thick, clumpy, white “cottage
cheese, surrounding erythema

Occurs in normal vaginal pH

Pseudohyphae or spores if
non-albicans species

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27
Q

Appearance of bacterial vaginosis? and on wet mount?

A

Homogenous, adherent, thin, milky white; malodorous “foul fishy”
Association with contraction of HIV

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28
Q

Amsel criteria for what and what are the criterion?

A

BV
Clinical findings (Amsel criteria): >3 of
– homogeneous discharge
– pH >4.5
– clue cells (>20%)
– amine odor on addition of KOH (+whiff test)

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29
Q

Other tests than Amsel criteria for BV?

A

Gram stain findings (Nugent score)
PCR for gardenerella

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30
Q

Rx of bacterial vaginosis?

A

metronidazole topically or PV 7/7, clindamycin is alternative

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31
Q

Symptoms of trichomonad vaginalis?

A

Abnormal genital discharge - yellow, dysuria, urinary frequency, itching, burning, dyspareunia, NGU in men

Strawberry cervix

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32
Q

What Is trichomonas associated with?

A

HIV

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33
Q

Tests for trich?

A

PCR
Microscopy -
▪ Motile trichomonads
▪ pH > 4.5

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34
Q

Treatment of trich?

A

1 week of metronidazole
Treat partner too
Males only need single dose of metronidazole

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35
Q

What constitutes uncomplicated vulvovaginal candidasis? Rx?

A

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

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36
Q

Rx of uncomplicated thrush during pregnancy?

A

Pregnancy: 7 days of vaginal imidazoles - NO fluconazole

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37
Q

Treatment of PID?

A

Ceftriaxone 250mg IM one dose stat
Doxycycline 100mg BID for 14 days
Metronidazole 400 TID for 14 days

38
Q

Treatment of chlamydia/gonorrhoea?

A

Ceftriaxone 250mg IM one dose stat
Doxycycline 100mg BID for 7 days

39
Q

Treatment of BV and trichomonas?

A

Metronidazole 400mg BID for 7 days

40
Q

Atrophic vaginitis - cause? key features?

A

Seen in estrogen deficiency
Vagina appears smooth, thin, dry, pH 6-7

41
Q

Recurrent vaginitis in older women? Purulent discharge?

A

Streptococcal Vaginitis
Strep pyogenes

42
Q

Purulent vaginitis in perimenopausal women - diagnosis and Rx?

A

Desquamative inflammatory vaginitis
Often related to high pH - lack of oestrogen - trial oestrogen Rx
Clindamycin and steroids locally

43
Q

Causes of genital ulcer disease?

A

Herpes
Syphilis
MPox
Chancroid
Lymphogranuloma venerum from chlamydia
Scabies
Do not forget non infective causes!

44
Q

Difference between chancre of syphylis and chancroid?

A

Painless- syphylis, indurated border, clean base, single
Painful - chancroid

45
Q

What are kissing lesions?

A

2 chancres close together
Chancroid
Painful and purulent

46
Q

What is the organism for chancroid?

A

Haemophilis ducreyi

47
Q

Beefy red lesions, aggressive, starting on penis?

A

Granuloma inguinale
Klebsiella granulomatis

48
Q

See an ulcer - what classic of herpes?

A

Vesicles (HSV2)

49
Q

Rx for chancroid?

A

Azithromycin or ciprofloxacin

50
Q

Rx of syphylis?

A

Benzylpenicillin

51
Q

Leading cause of genital ulcer disease?

A

Herpes (HSV 2)

52
Q

Rx of herpes?

A

Acyclovir

53
Q

Relationship between HSV and HIV?

A

HSV increases the risk of HIV-1 acquisition 2-3 fold

54
Q

Life cycle herpes?

A

Primary inoculation - direct contact, does not need to be symptoms in partner.
Replicates in sensory ganglion
Latency
Reactivates at times of stress

55
Q

Appearance of herpes?

A
  1. Vesicular first week
  2. Wet ulcer as they progress

Multiple lesions

56
Q

Diagnosis of genital herpes?

A

PCR HSV
Culture not widely available

57
Q

Serology in HSV?

A

Glycoprotein gG tests required
NOT IgM - get a lot of false positives

Western blot gold standard

58
Q

Rx of HSV2?

A

Acyclovir
Famciclovir
Valacyclovir
7-10 days
Treatment can be extended if healing is incomplete after 10 days of therapy.

59
Q

Genital HSV1 - how is this different?

A

Less frequent relapses
Cannot diagnose with serology - only PCR

60
Q

Organism for syphylis?

A

Treponema pallidum

61
Q

Difference between initial primary lesion of syphylis, herpes and chancroid?

A

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
Q

Monkey pox caused by? Mode of transmission?

A

Mpox virus
Direct contact

63
Q

How does monkey pox present?

A
64
Q

What is this?

A

M.pox
Genital lesions common

65
Q

What causes lymphogranuloma venereum?

A

Chlamydia species

66
Q

Diffuse rash differentials?

A

Syphylis
VZV
Herpes - disseminated
Molluscum
Disseminated gonococcoal

67
Q

Diagnosis of m.pox?

A

PCR. Aggressively scrub lesion

68
Q

Patient presenting with proctitis - common presenting STIs?

A

Gonorrhoea
Chlamydia
HSV

69
Q

Treatment for m.pox. Who should you rx?

A

Only high risk/Immunosuppressed
Vaccine for most

70
Q

Cause of chancroid?

A

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
Q

Diagnosis and Rx?

A

Chancroid
Azithromycin

Purulent base

72
Q

How does LGV present?

A

Primary infection: genital ulcer, heals within few days – Very rarely diagnosed

Secondary infection
– Inguinal lymph node swelling/ bubo

73
Q

LGV cause? Rx?

A

Serovars 1,2,3 of chlamydia trachomatis
Doxycycline

74
Q

What is this?

A

Groove sign
2 inguinal lymph nodes
LGV

75
Q

Beefy lesion on the penis, organism and Rx?

A

Donovanosis (Granuloma Inguinale)
Slow growing, non tender, bleeds easily
Klebsiella granulomatis
Rx: Azithromycin
Seen in Africa

76
Q

Where is Chancroid still prevalent?

A

Sub Saharan Africa

77
Q

What is this?

A

Syphilis
Treponema Pallidum

78
Q

Trichomonas vaginalis - affects who?

A

Females!
Vagina is reservoir

79
Q

Causes of non gonococcal urethrits?

A

chlamydia
Mycoplasma genitalium
Trichomonas
HSV

RARE RARE:
Coliforms (anal)
N.meningitidis
H.Influenza
EBV, adenovirus

80
Q

Mx of mycoplasma genitalium?

A

Doxycycline 7/7
Moxifloxacin 2nd line

81
Q

Transmission of monkey pox?

A

inoculation through broken skin, inhalation or via mucous membranes

82
Q

What is WHO diagnostic criteria for Mpox?

A

unexplained rash pls one of fever/headache/malaise/LN plus AND
MSM/travel/contact hx

83
Q

inc period for mpox?

A

5-21 days

84
Q

Skin rash in M.pox?which one is infectious?

A

All of them highly infectious
On palms and soles
More peripheral

85
Q

Difference in rash between respiratory or direct inoculation?

A

Respiratory - disseminated rash
Direct inoculation - can also be disseminated but can be local

86
Q

Diagnosis of M.Pox?

A

PCR

87
Q

Differentials of vesicular rash of mpox?

A

Chickenpox
Molluscum contangiosum
Disseminated gonococcal infection
Bacterial skin infections
Enterovirus
Measles
Syphilis

88
Q

Complications of mpox?

A

Sec bacterial infection, pneumonia, encephalitis, keratitis

89
Q

Two clades of mpox?

A

Clade 2 - west africa - low mortality
Clade 1 - central Africa - higher mortality

90
Q

Vaccine for mpox?

A

Smallpox vaccine
85% effective

91
Q

What type of viris is m.pox? What are the reservoir?

A

orthopox virus- large DNA genome
Rodents are reservoir

92
Q

Outcome in HIV patients for m.pox?

A

30% mortality

Trop Med (49 decks)

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