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Reproduction & Sexual Health > Sexually Transmitted Infections > Flashcards

Sexually Transmitted Infections Flashcards

1
Q

What are the standard STIs tested for?

A

Chlamydia
Gonorrhoea
HIV
Syphillis

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2
Q

How do you test for chlamydia and gonorrhoea?

A

NAAT

Increased sensitivity over culture

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3
Q

Where are NAAT samples taken?

A

Vulvovaginal swab or endocervical swab
Throat swab
Rectal swab
Urine - first void sample in males

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4
Q

What is a problem with NAAT?

A

It can detect dead organisms - wait 5 weeks to do cure test

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5
Q

How do you test for HIV/Syphilis?

A

Blood test

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6
Q

When a patient presents with discharge what tests can be done?

A

Cervical microscopy (gram stain)
Vaginal microscopy and pH (>4.5 in pathology)
Urethral microscopy (gram stain)
Amies swab

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7
Q

When should a amies swab be done?

A

High vaginal swab in HSV, unknown cause of discharge, pregnant, postpartum, post gynae, PID

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8
Q

What is the commonest STI in the UK?

A

Chlamydia

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9
Q

Where does chlamydia infect?

A

Columnar epithelium at mucosal site - urethra, rectum, throat, eyes, endocervix

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10
Q

How is chlamydia transmitted?

A

Vaginal, oral or anal sex

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11
Q

What percentage of patients with chlamydia are asymptomatic?

A

70-80% of women

50% of men

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12
Q

What are the symptoms of chlamydia?

A 
Milky Discharge (men)
Irregular bleeding (women) 
Abdominal pain (both)
Dysuria (men)
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13
Q

What are the signs of chlamydia?

A

Urethritis
Cervicitis
Epididymo-orchitis
Proctitis (LGV)

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14
Q

Name the three serological groups of chlamydia

A

Serovars A-C - trachoma
Serovars D-K - genital infection
Servers L1-L3 - lymphogranuloma venereum

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15
Q

Describe lymphogranuloma venereum

A

Mainly in MSM, rectal pain, discharge and bleeding

67% also have HIV

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16
Q

Describe the bacteria chlamydia trachomatis

A

Obligate intracellular bacteria with biphasic life cycle, does not stain with gram stain - no peptidoglycan in cell wall. Cannot reproduce outside of host.

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17
Q

What is the treatment of chlamydia?

A

1st - doxycycline 100mg BD 7 days

2nd - azithromycin 1g stat followed by 500mg daily for 2 days

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18
Q

What is the treatment in PID?

A

Inpatient - ceftrixone, metronidazole, doxycycline

Outpatient - ofloxacin & metronidazole

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19
Q

State the complications of chlamydia

A

PID, tubal damage, conjunctivitis, pneumonia, reactive arthritis (righters), Fitz Huge Curtis

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20
Q

Describe Fitz Huge Curtis

A

Perihepatitis - piano string adhesions from liver

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21
Q

What is the testing advice for chlamydia?

A

14 days following exposure, >25 years old with discharge rarely chlamydia - high re-infection rate

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22
Q

Describe the action of bacteria neisseria gonorrhoea

A

Gram negative intracellular diplococcus - attaches to host epithelial cells and endocytose into the cell to replicate

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23
Q

Why does GC appear intracellularly on gram film?

A

Easily phagocytose by polymorphs

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24
Q

How does gonorrhoea present?

A

Mucopurulent urethral discharge, dysuria, endocervical - discharge, irregular bleeding, external dysuria, pharyngeal/rectal is usually asymptomatic

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25
Q

How is gonorrhoea investigated?

A

NAATs - urethral/endocervical swab
Microscopy if symptomatic
Culture is positive microscopy or GC contact - endocervical, rectal, throat swab

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26
Q

Why are cultures only done in the clinic?

A

GP were false negatives as the organism would die on the way to lab

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27
Q

How is gonorrhoea treated?

A

1st Ceftriaxone 1g IM

2nd Cefixime 400mg + azithromycin 2g

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28
Q

What is the incubation period for gonorrhoea?

A

2-5 days

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29
Q

What are the lower genital tract complications of gonorrhoea?

A 
Bartholinitis 
Tysonitis 
Periurethral abscess 
Rectal abscess 
Epidiymitis 
Urethral stricture
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30
Q

What are the upper genital tract complications of gonorrhoea?

A 
Endometritis
PID
Hydrosalpinx 
Infertility 
Ectopic pregnancy 
Prostatis
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31
Q

What is the new emerging STI?

A

Mycoplasma genitalium

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32
Q

How is mycoplasma genitalium managed?

A

NAAT test - high levels of macrolide resistance

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33
Q

What bacteria causes syphilis?

A

Treponema Pallidum Palldium subtype

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34
Q

How is syphilis transmitted?

A

Sex
During birth
Trans-placental

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35
Q

Describe primary syphilis

A

Organism multiples at inoculation site to form a chancre (90% genital) and then gets into the blood stream

36
Q

What is the incubation period of primary syphilis?

A

9-90 days

37
Q

Other than chancre what else can be present in primary syphilis?

A

Non-tender local lymphadenopathy

38
Q

Describe secondary syphilis

A

Large number of bacteria circulating in blood with multiple manifestations at different sites

39
Q

What is the incubation period for secondary syphilis?

A

6 weeks to 6 months

40
Q

Describe the signs and symptoms of secondary syphilis

A 
Snail track mouth ulcers 
Generalised rash (hands and feet)
Malaise
Anterior uveitis 
Cranial nerve lesion
Condylomata lata
41
Q

Describe condylomata lata

A

Highly infectious lesion exudes a serum teeming with treponemes

42
Q

Describe latent syphilis

A

No symptoms but low level multiplication of spirochaete in intima of blood vessels

43
Q

What happens in late syphilis?

A

Cardiovascular and neuromuscular complications

44
Q

How is primary syphilis diagnosed?

A

Dark field microscopy
PCR
IgM

45
Q

How is secondary and tertiary syphilis diagnosed?

A

Serology to detect antibodies

  • non-treponemal (RPR - disease activity)
  • treponemal
46
Q

Describe the treatment of syphilis

A

Early - 2.4MU benzathine penicillin stat

Late - 2.4MU benzathine penicillin weekly x 3 weeks

47
Q

What follow up should be done in syphilis?

A

Serology - RPR is negative, decrease by four fold by 3-6 months post treatment

48
Q

What causes genital herpes?

A

HSV1 and HSV2

49
Q

Describe the herpes virus

A

Enveloped virus containing double-stranded DNA transmitted by close contact with someone shedding the virus

50
Q

Which virus is shed more easily?

A

HSV2

51
Q

Describe the pathogenesis of herpes

A
  1. Virus duplicates in dermis and epidermis
  2. Gets into nerve endings of sensory and autonomic nerves
  3. Inflammation causes painful small vesicles which are easily reroofed
  4. Virus migrates to sacral root ganglion and hides from immune system
  5. Reactivation leads to genital herpes
52
Q

What is the duration and incubation of primary herpes?

A

Incubation 3-6 days

Duration 14-21 days

53
Q

How can primary herpes present?

A

Blistering, ulceration, pain, dysuria, discharge, lymphadenopathy, fever, malaise

54
Q

Describe recurrent herpes

A

Usually HSV2 unilateral small blisters and ulcers, minimal systemic involvement - resolves in 5-7 days

55
Q

How is herpes diagnosed?

A

Swab in virus transport medium of reroofed blister for PCR

56
Q

How is herpes treated?

A

Aciclovir 400mg TDS 5 days
Topical lidocaine 5% ointment if painful
Saline bathing
Analgesia

57
Q

What is the special circumstance for herpes treatment?

A

First episode in 3rd trimester within 6 weeks of delivery dates, ask if first episode - HSV NAAT and type specific serology for antibodies
Risk of neonatal herpes

58
Q

State the differential diagnosis of genital lumps

A
  • skin tags
  • molluscum contagiosum (pox virus)
  • spots of fordyce (blockage of sebaceous gland)
  • pearly penile papules (normal)
59
Q

What is the most common viral STI in UK?

A

HPV

60
Q

What is the most oncogenic type of HPV?

A

Type 16

61
Q

Which types of HPV cause warts and are low risk?

A

Type 6 and 11

62
Q

Name the different features of HPV depending on type

A
  • latent infection
  • anogenital warts
  • palmar and plantar warts (11 and 6)
  • cellular dysplasia/intra-epithelial neoplasia (16 and 18)
63
Q

What is the incubation period of HPV?

A

3 weeks to 9 months

64
Q

Describe anogenital warts

A

Cauliflower lesions at sites of friction - HPV 6 and 11

65
Q

What are the treatment options for HPV?

A

Podophyillotoxin - cytotoxic liquid
Imiquimod - immune modifier better for peri-anal disease and supports immune and superficial clearance
Cryotherapy - requires multiple treatments
Electrocautery

66
Q

Who is given the HPV vaccination?

A

Girls 11-13
MSM
S1 boys

67
Q

Describe pubic lice

A

Close genital skin contact, they bite and feed on blood causing itch
Female lay eggs and can survive unto 17 days
Males can survive for 22 days

68
Q

How are pubic lice treated?

A

Malathion lotion

69
Q

What bacteria are naturally present in the vagina?

A

Lactobacillus
Group B Strep
Candida
Strep viridian’s

70
Q

Why is lactobacillus significant?

A

Produces lactic acid+/- hydrogen peroxide to create an acidic pH

71
Q

What is the characteristic appearance of candida?

A

Budding yeast and hyphae

72
Q

State the predisposing factors to candida?

A

Recent antibiotics
High oestrogen (pregnancy/contraception)
Poorly controlled diabetes
Immune-compromised patients

73
Q

How does candida present?

A

Itchy cottage cheese white discharge

74
Q

How is candida diagnosed?

A

Examination and high vaginal swab

75
Q

How is candida treated?

A

Clotrimazole Pessary or cream

Oral fluconazole

76
Q

What does candida look like in males?

A

Spotty rash of balanitis

77
Q

Name a sexually transmitted parasite

A

Trichomonas vaginalis

78
Q

How does Trichomonas vaginalis present?

A

Vaginal discharge and irritation in females

79
Q

What is the diagnosis and treatment of Trichomonas vaginalis ?

A

Diagnosed with high vaginal swab for microscopy

Treatment with oral metronidazole

80
Q

What is bacterial vaginosis?

A

Overgrowth of anaerobic bacteria - homogenous discharge may contain bubbles

81
Q

Describe the microscopic appearance of bacterial vaginosis

A

Bacilli replaced with coccobacilli and few leukocytes

82
Q

How does bacterial vaginosis present?

A

Asymptomatic, vaginal discharge, fishy odour particularly worse after sex/menstruation

83
Q

What does bacterial vaginosis increase your risk of?

A

Upper tract infection, premature rupture of membranes and preterm delivery, increased risk of acquiring HIV

84
Q

How is bacterial vaginosis treated?

A

Metronidazole 7 days

85
Q

What is the relapse rate of bacterial vaginosis?

A

30%

Reproduction & Sexual Health (36 decks)

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