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Sexually transmitted infections Flashcards

1
Q

Describe the routes of transmission for STIs?

A

Oral-genital contact

Vaginal intercourse

Anal intercourse

Anilingus

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2
Q

Describe the agent of gonorrhea?

A

Nesisseria gonorrheae

Gram negative diplococci

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3
Q

What does neisseria gonorrhoeae adhere to in the body to cause infection?

A

Columnar epithelial cells (line urethra and cervix)

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4
Q

Describe the incubation period for gonorrhea?

A

2-7 days

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5
Q

Describe the presentation of gonorrhea?

A

Asymptomatic common in females (80%)

Urethritis and thick urethral discharge in males

Infection in throat (difficult to distinguish from other causes of pharyngitis)

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6
Q

Describe the antibiotic resistance levels of neisseria gonorrhoeae?

Why does this occur?

A

Increasing levels of antibiotic resistance

Able to exchange antibiotic resistance genes with other neisseria (eg. meningitidis) that colonise mouth

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7
Q

Describe the possible consequences of dissemination of gonorrhoea?

In how many cases does this occur?

A

Dissemination occurs in 0.5-3% if untreated

Arthritis
Maculopapular rash
Meningitis
Endocarditis
Epididymitis
Peri-hepatitis (Fitz-Hugh-Curtis syndrome)

Pelvic Inflammatory Disease (> tubal scarring, infertility)

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8
Q

Describe the symptoms of Pelvic Inflammatory Disease?

A

Fever

Pelvic tenderness

Discharge

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9
Q

Describe the pathology of Fitz-Hugh-Curtis syndrome?

A

Gonorrhoea > ascends up Fallopian tubes > enters abdominal cavity > liver adhesions > hepatitis> derangement in LFTs

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10
Q

Describe the possible consequences of a mother with gonorrhoea delivering a baby naturally?

A

Neonatal gonococcal opthalmia

Gross purulent conjunctivitis

If untreated > perforation and blindess

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11
Q

Describe the treatment of neonatal gonococcal opthalmia?

A

IV cefotaxime for 7 days

Irrigate eyes regularly

No topical treatment

Also treat mother and sexual contacts

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12
Q

Why is it important to distinguish neonatal gonococcal opthalmia from other causes of conjuntivitis?

A

Different treatments

Other conjunctivitis only requires topical treatments, whereas NGO requires systemic treatment

NGO can lead to blindness if untreated

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13
Q

Describe the major diagnostic specimens that can be collected for investigation of gonorrhoea?

A

Cervical swab in charocal transport medium (female)

Urethral swab (male)

First void urine

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14
Q

Describe the laboratory investigations that can be performed for investigation of gonorrhoea?

A

CULTURE

Non-selective: CBA in CO2

Selective: Thayer-Martin agar (inhibits growth of normal)

Culture for antibiotic sensitivities

NUCLEIC ACID AMPLIFICATION TESTS

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15
Q

Describe the treatment for gonorrhoea?

Explain?

A

Ceftriaxone 500mg IV/IM and Azithromycin 1g oral

Combination used to delay emergence of resitance

Azithromycin also treats chlamydia (coinfection common)

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16
Q

How can gonorrhoea be prevented?

A

Barrier contraception

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17
Q

Describe the agent that causes chlamydia?

A

Chlamydia trachomatis

Obligate intracellular parasite

Serovars D-K cause genital infection

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18
Q

Describe the different stages of chlamydia trachomatis?

A

Elementary bodies: infectious, non-replicating, hardy

Reticulate bodies: metabolically active, replicate

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19
Q

Describe the life cycle of chlamydia?

A

Elementary body infects columnar epithelium of target > reticulate body froms in cell > replication > reticulate bodies reorganise into elementary bodies > elementary bodies released

48-72 hours

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20
Q

What is the most common STI?

A

Chlamydia

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21
Q

Describe the presentation of chlamydia?

A

Females: cervicitis

Males: urethritis

Frequently asymptomatic

22
Q

Describe the possible clinical findings for chlamydia?

A

MALES
Dysuria
Meatal erythema
Clear urethral discharge
Testicular pain
Prostatitis

FEMALES
Cervicitis, endometritis, vaginal discharge
Urethritis/dysuria
Irregular bleeding
Pelvic pain and dyspareunia
PID

23
Q

What is LGV?

A

Lymphogranuloma venereum

Invasive lymphatic infection caused by chlamydia

24
Q

How commonly is chlamydia transferred to neonates?

A

50% transmission

25
Describe the consequences of neonatal chlamydia?
25% conjunctivitis: thin, haemorrhagic 10% pneumonia: 3-4 months incubation, staccato cough
26
Describe the laboratory investigation of chlamydia?
Sample: cervical/urethral/anal swab or first void urine Tests: NA detection (not culture) TEST OF CURE REQUIRED (post procedure and pregnancy)
27
When and why is test of cure required in chlamydia?
Post procedure and in pregnancy Chance of reinfection or lack of response to initial treatment
28
Describe the treatment for chlamydia?
Azithromycin 1g oral, 2 doses 1 week apart OR Doxycycline 100mg oral twice daily, 10-14 days Severe chlamydia PID: azithromycin 500mg IV daily, 14 days (step down to oral when well) Treat sexual contacts Test of cure Retest
29
Describe trichomonas vaginalis?
Sexually transmitted Flagellated protozoan \> motile
30
Describe the presentation of infection with trichomonas vaginalis?
Frequently asymptomatic Frothy, green-yellow vaginal discharge Pruritis, odour, dysuria, abdominal pain
31
Describe the possible appearance of the cervix after infection with trichomoas vaginalis?
Cervical erythema and friability
32
Describe the effect of trichomonas vaginalis on the pH of the vagina?
pH \> 5 Becomes more alkaline
33
What is infection with trichomonas vaginalis a marker for?
High risk sexual activity
34
Describe the prevalence of trichomonas vaginalis infection?
Underestimated About 5% sexually active women
35
Describe a possible consequence of trichomonas vaginalis infection? How does this occur?
Genital inflammation \> doubled risk HIV acquisition
36
Which groups of people is trichomonas vaginalis infection associated with?
Non-steady partners Older partners Marijuana users Indigenous community
37
Describe the laboratory testing for trichomonas vaginalis?
High vaginal swab \> microscopy, culture Urine \> PCR (expensive for this infection) Sometimes seen on Pap smear
38
Describe the treatment for infection with trichomonas vaginalis?
Metronidazole 2gm orally singly Tinidazole 2 gm orally singly Or smaller doses for better SE tolerance Treat partners Follow up testing (may have resistance)
39
Why is follow up testing required after treatment of trichomonas vaginalis infection?
May have antibiotic resistance
40
Describe the agent that causes syphilis?
Treponema pallidum Spirochaete bacterium
41
Describe the stages of syphilis?
Primary: ulcer (Chancre) on genitals, 2-3 weeks after exposure Secondary: ulcer heals \> rash, lymphadenopathy, abdominal pain, alopecia Early latency Late latency Tertiary: can lead to neurosyphilis
42
Describe the laboratory testing for syphilis?
Microscopy: difficult to see, don't Gram stain Serology: non-treponemal and treponemal tests
43
Describe the non-treponemal tests that are used for investiagting syphilis/t.pallidum?
Ab to cellular lipids and lecithin Positive 4-8 weeks post-infection useful for screening and monitoring therapy
44
Describe the treponemal tests that are used to investigate syphilis/t.pallidum?
Detect antigens on organism itself Positive slighlty earlier and for life
45
Describe mycoplasma genitalium?
Smallest genome Newly emerging No cell wall Flask shaped (protusion for attachment to columnar mucosa) Sexually transmitted Antibiotic resitant
46
Describe the prevalence of mycoplasma genitalium?
3-5%
47
What is the main diagnostic tool for mycoplasma genitalium? Why?
Nucelic acid detection Difficult to culture No cell wall \> no Gram stain
48
Describe the presentation of infection with mycoplasma genitalium?
Urethritis (men) Cervicitis (women) Acute endometritis PID May predispose to HIV transmission
49
Describe the treatment for mycoplasma genitalium?
Azithromycin 1gm (15-30% failure) or Moxifloxacin 400mg daily, 7-10 days (expensive, failures described)
50
List the indications for STI testing?
Symptomatic patient investigation Screening for asymptomatic infection Pre-pregnancy Antenatal screening Blood and organ donation Contact tracing Epidemiological surveillance

Reproductive (21 decks)

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