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Sexually Transmitted Infections Flashcards

1
Q

What are sexually transmitted infections (STIs)?

A

STIs are a group of infections caused by pathogens that are acquired and transmitted through sexual activity.

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2
Q

Why do healthcare providers play a critical role in STIs?

A

They help in prevention, early detection, treatment, and education to reduce transmission and complications.

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3
Q

Why are women more affected by STIs?

A

Women are:

  • More biologically susceptible
  • More likely to be infected and symptomatic
  • At risk of serious complications (e.g., infertility, adverse pregnancy outcomes)
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4
Q

What are the main types of STIs?

A
  1. Genital Ulcers (e.g., syphilis, herpes, chancroid)
  2. Urethral Discharge Syndromes (e.g., gonorrhea, chlamydia, trichomoniasis)
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5
Q

How do genital ulcers impact HIV transmission?

A

They facilitate HIV transmission and infection by breaking the mucosal barrier.

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6
Q

Which age group has the highest risk for STIs?

A

Young adults (18-28 years) are most affected.

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7
Q

What are the estimated new STI cases per year?

A

19 million new cases per year (CDC data).

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8
Q

How many people have incurable viral STIs?

A

Around 65 million people live with incurable viral STIs (e.g., herpes, HIV, HPV).

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9
Q

What percentage of sexually active individuals will acquire genital HPV?

A

50% of sexually active men and women will acquire HPV at some point in life

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10
Q

Why is syphilis increasing in men?

A

Increased due to homosexual transmission and high-risk sexual behavior.

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11
Q

Why is STI and HIV co-infection common?

A

Many STIs (e.g., syphilis, gonorrhea) increase susceptibility to HIV infection.

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12
Q

How does screening pregnant women help in STI prevention?

A

It reduces the prevalence of congenital syphilis, preventing transmission to newborns.

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13
Q

STI/ HIV Risk assessment: the 5Ps

A

5 P’s.
1. Partners.
2. Practices.
3. Prevention of pregnancy.
4. Protection from STIs
5. Past history of STIs.

  • Patients seeking treatment or evaluation for a particular STD should be screened for HIV.
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14
Q

Why is it important to ask about sexual partners?

A

To assess risk of exposure, including:

  • Number of partners
  • Gender of partners
  • Partner’s STI history
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15
Q

What does ‘Practices’ refer to in the 5 P’s?

A

It refers to sexual behaviors, including:

  • Type of intercourse (oral, vaginal, anal)
  • Condom use
  • High-risk activities (e.g., sex work, drug use)
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16
Q

Why is it important to discuss pregnancy prevention?

A

To assess contraceptive use and educate on dual protection (contraception + STI prevention).

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17
Q

How does protection from STIs factor into the assessment?

A

It evaluates:

  • Condom use (consistent vs. inconsistent)
  • Knowledge of STI prevention
  • Use of PrEP (for high-risk HIV exposure)
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18
Q

Why should a past history of STIs be assessed?

A

Previous STIs increase the risk of:

  • Reinfection
  • Complications (infertility, chronic pelvic pain)
  • HIV acquisition
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19
Q

Should patients being evaluated for an STI be tested for HIV?

A

Yes! All patients with suspected or confirmed STIs should be screened for HIV.

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20
Q

What are the two main types of STI prevention?

A

Primary prevention (prevents infection) and secondary prevention (early detection & treatment).

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21
Q

What vaccines help prevent STIs?

A

HPV vaccine (Bivalent for HPV 16 & 18; Quadrivalent for HPV 6, 11, 16 & 18).

HBV vaccine (Hepatitis B prevention).

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22
Q

At what age is the HPV vaccine recommended?

A

Boys & girls aged 11–12 years (can be given up to 26 years if unvaccinated).

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23
Q

How can behavioral changes reduce STI risk?

A

Abstinence or reducing the number of sexual partners lowers exposure risk.

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24
Q

What are effective barrier methods for STI prevention?

A

Male & female condoms (most effective against STIs).

Dental dams (reduce oral STI transmission).

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25
How does male circumcision help in STI prevention?
Reduces risk of HIV, HPV, and other STIs in heterosexual men.
26
What is post-exposure prophylaxis (PEP)?
PEP for HIV: A 28-day course of antiretroviral therapy given within 72 hours of exposure. PEP for STIs: Antibiotic treatment after high-risk exposure.
27
What is the goal of secondary STI prevention?
Early detection & treatment to prevent complications and transmission.
28
What are partner services in STI prevention?
Expedited Partner Therapy (EPT) – providing treatment to partners without requiring a clinic visit.
29
What type of lesions are seen in herpes simplex virus (HSV) infections?
Painful, multiple vesicles on an erythematous base.
30
Are HSV lesions deep or shallow?
Shallow ulcers that do not follow a neural distribution.
31
What type of lymphadenopathy is associated with HSV?
Bilateral painful inguinal adenopathy.
32
What is the gold standard test for diagnosing HSV?
Viral culture.
33
Which test is more sensitive than viral culture for HSV diagnosis?
PCR testing (1.5–4 times more sensitive than viral culture).
34
What type of lesion is seen in chancroid?
A painful ulcer on the penis or vulvovaginal area.
35
What type of lymphadenopathy is associated with chancroid?
Unilateral tender adenopathy.
36
What is the most sensitive and specific test for detecting Haemophilus ducreyi?
PCR testing.
37
What is the characteristic lesion of primary syphilis (treponema pallidum) ?
A single, painless, indurated ulcer at the site of inoculation.
38
What are the common screening tests for syphilis?
RPR (Rapid Plasma Reagin) & VDRL (Venereal Disease Research Laboratory) tests.
39
How are positive syphilis screening tests confirmed?
With Treponema pallidum particle agglutination (TP-PA) or fluorescent treponemal antibody absorbed (FTA-ABS) testing.
40
What type of lesion is seen in Lymphogranuloma Venereum (LGV) Chlamydia trachomatis (L1, L2, L3)?
A painless ulcer on the penis, anus, or vulvovaginal area.
41
What type of lymphadenopathy is associated with LGV?
Painful unilateral suppurative inguinal adenopathy.
42
What are the complications of untreated LGV?
Significant tissue destruction & scarring, leading to elephantiasis of the penis, scrotum, or labia.
43
What diagnostic test is used for LGV?
A complement fixation titre greater than 64 is diagnostic of infection.
44
What are the symptoms of Chlamydia trachomatis infection in men?
Urethritis with clear or white discharge, epididymitis, and prostatitis.
45
How can Chlamydia trachomatis be transmitted to newborns?
It can be transmitted during normal vaginal delivery (NVD).
46
What is the preferred diagnostic test for Chlamydia trachomatis?
Nucleic acid amplification tests (NAATs) using urine or vaginal specimens.
47
What are the symptoms of Neisseria gonorrhoeae infection in men?
Urethritis with mucopurulent urethral discharge, epididymitis, and prostatitis.
48
Are women with Neisseria gonorrhoeae infections typically symptomatic?
No, women are frequently asymptomatic.
49
What areas of the body can Trichomonas vaginalis infect?
Vagina, urethra, Bartholin glands, and prostate.
50
What are the symptoms of Trichomonas vaginalis infection in men?
Urethral discharge, dysuria, and urinary urgency.
51
What are the symptoms of Trichomonas vaginalis infection in women?
Frothy white or green, foul-smelling vaginal discharge, pruritus, and erythema.
52
What percentage of women with Trichomonas vaginalis are asymptomatic?
50% of women are asymptomatic.
53
What is the most sensitive diagnostic test for Trichomonas vaginalis in men?
NAAT (Nucleic Acid Amplification Test).
54
What approach is used in South Africa for managing urethral discharge?
The syndromic approach.
55
Why is the syndromic approach used for managing STIs in South Africa?
It allows for immediate treatment based on symptoms without waiting for lab results, reducing transmission and complications.
56
What trend has been observed in Neisseria gonorrhoeae resistance in South Africa?
There has been a significant increase in quinolone-resistant N. gonorrhoeae.
57
How does access to healthcare help in STI prevention?
It prevents further transmission, including mother-to-child transmission.
58
Why is it important to decrease the risk of STI-related complications?
To prevent long-term issues such as infertility, chronic pelvic pain, and increased HIV susceptibility.
59
How does routine STI screening benefit patients?
It provides an opportunity to promote prevention, education, and early treatment.
60
What additional service should be promoted during STI screening?
HIV counselling and testing.
61
What are the initial steps in assessing a patient with urethral discharge or dysuria?
- Take a comprehensive history, including sexual orientation - Examine the patient - If no visible discharge, ask the patient to milk the urethra - Emphasize HIV testing and partner tracing
62
What is the primary treatment for MUS (Male Urethritis Syndrome) ?
Ceftriaxone, IM, 250 mg single dose Azithromycin, oral, 1 g as a single dose If the sexual partner has vaginal discharge (VDS), additionally: Metronidazole, oral, 2 g as a single dose
63
What is the treatment if urethral discharge persists after 7 days?
Suspected ceftriaxone 250 mg treatment failure: - Ceftriaxone, IM, 1 g single dose - Azithromycin, oral, 2 g as a single dose - Metronidazole, oral, 2 g as a single dose (if not already given) Refer all ceftriaxone treatment failures within 7 days for: - Gentamicin, IM, 240 mg as a single dose
64
What is the protocol for patients with severe penicillin allergy?
- DO NOT give ceftriaxone - Increase azithromycin dose to 2 g as a single dose - Refer for: * Gentamicin, IM, 240 mg as a single dose * Azithromycin, oral, 2 g as a single dose
65
How is ceftriaxone IM injection prepared?
Dissolve 250 mg in 0.9 mL lidocaine 1% without epinephrine Dissolve 1 g in 3.6 mL lidocaine 1% without epinephrine
66
What are the initial steps in assessing a patient with genital ulcers?
- Take a history - Examine for ulcers and buboes (if present) - Emphasize HIV testing
67
How does sexual activity affect the diagnosis of genital ulcers?
Not sexually active in the last 3 months → Consider genital herpes Sexually active in the last 3 months → Follow treatment protocol
68
What is the primary treatment for genital ulcer syndrome?
Benzathine benzylpenicillin, IM, 2.4 MU single dose If HIV-positive or unknown status, add: - Acyclovir, oral, 400 mg 8-hourly for 7 days Review all cases in 1 week
69
What is the next step if ulcers are not healing or not clearly improving?
Emphasize HIV testing If no improvement: Azithromycin, oral, 1 g as a single dose If no response after 48 hours: Refer
70
How should penicillin-allergic men and non-pregnant women be treated?
Perform baseline RPR Replace benzathine penicillin with: Doxycycline, oral, 100 mg 12-hourly for 14 days Follow-up RPR in 6 months
71
What is the protocol for penicillin-allergic pregnant or breastfeeding women?
Refer for confirmation of syphilis infection Consider penicillin desensitization
72
How is benzathine benzylpenicillin IM injection prepared?
Dissolve 2.4 MU in 6 mL lidocaine 1% without epinephrine
73
What are some urological manifestations in men?
- Epididymitis - Prostatitis - Infertility (due to poor sperm quality) - Urethral stricture disease
74
What should always be considered in patients with genital ulcers?
Malignancies should always be considered.
75
What are some female urological manifestations related to pelvic pain and reproductive health?
- Pelvic Inflammatory Disease (PID) - Chronic pelvic pain syndrome - Ectopic pregnancies
76
What is HPV associated with in terms of urological manifestations?
HPV is associated with Squamous Intraepithelial Lesions (SIL).
77
What does the isolation of Chlamydia, Gonorrhoea, or Syphilis in children indicate?
It indicates sexual contact and requires close contact with child protection authorities.

Urulogy (15 decks)

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