Sexually-transmitted Infections Flashcards by Kerry Hendrie

What is the most common bacterial STI? What kind of organism is it?

Chlamydia

Gram negative bacterium

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How is chlamydia transmitted?

Vaginal
Anal
Oral

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In what age group is the highest incidence of chlamydia?

20-24 year olds

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How does chlamydia typically present in a female?

Asymptomatic (70-80%)
Post-coital or intermenstrual bleeding
Lower abdo pain
Dyspareunia
Mucopurulent cervicitis

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How does chlamydia typically present in a male?

Asymptomatic (50%)
Urethral discharge
Dysuria
Urethritis
Epididymo-orchitis
Proctitis (LGV)

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What is the treatment for chlamydia?

Doxycycline 100mg BD x 1 week

Azithromycin 1g stat followed by 500mg daily for 2 days

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What kind of organism is N. gonnorrhoea? How does it appear on gram stain?

Gram negative intracellular diplococcus

Polymorphs, kidney bean shaped diplococci

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How does gonnorrhoea typically present in males?

Urethral discharge >80%
Dysuria
Asymptomatic <10%
Pharyngeal/rectal infections mostly asymptomatic

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How does gonorrhoea typically present in a female?

Dysuria
Pelvic pain (<5%)
Increased/ altered vaginal discharge
Asymptomatic in up to 50%
Pharyngeal/rectal infections mostly asymptomatic

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List diagnostic tests for gonorrhoea

NAATs (screening test)
Microscopy if symptomatic
Culture if microscopy positive

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What is the treatment for gonorrhoea?

Ceftriaxone 500mg IM

Test of cure in all patients (2 weeks)

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If ceftriaxone is contraindicated, what is the 2nd line treatment for gonorrhoea?

Cefixime 400mg oral

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How long does genital herpes usually last?

14-21 days following incubation of 3-6 days

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How does a primary infection of genital herpes typically present?

Blistering/ulceration
Pain
Extreme dysuria
Discharge
Lymphadenopathy
Fever and myalgia (prodrome)

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Is it more common to get recurrent genital herpes via HSV1 or HSV2?

HSV2

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How is genital herpes treated?

Oral aciclovir 400mg TDS
Topical lidocaine 5% if painful
Saline bathing
Analgesia

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Viral shedding for HSV1 is higher than HSV2. True/False?

False

HSV2 viral shedding higher than HSV1

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What is the most common viral STI in the UK?

HPV (causing genital warts)

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What is the incubation period of HPV?

3 weeks to 9 months

Which strain of HPV is the most common cause of anogenital warts? How do they appear?

Low risk - 6 and 11

Cauliflower appearance

How are genital warts caused by HPV treated?

Podophyllotoxin (Warticon) - 1st line
Imiquimod (Aldara) - 2nd line (1st if perianal warts or immunocompromised) 
Cryotherapy - 1st line in pregnancy
Electrocautery
HPV vaccination

Which organism causes syphillis?

Treponema pallidum (spirochaete)

What are the main modes of transmission of syphilis?

Sexual contact
Trans-placental
Blood transfusion
Non-sexual contact - healthcare workers

What are the 5 stages of syphilis?

EARLY INFECTIOUS
Primary
Secondary
Early latent
LATE NON-INFECTIOUS
Late latent
Tertiary

What are the features of primary syphilis?

Chancre (painless lesions) Lesions at site of innocculation (genital or extragenital) Non-tender lymphadenopathy

What are the features of secondary syphilis?

``` Maculopapular rash Palms and soles affected Lesions of mucous membranes Generalised lymphadenopathy Alopecia Condylomata lata ```

What are the 2 groups of tests that are down to diagnose syphilis?

Microscopy + PCR to detect organism | Serological testing to detect antibody

What are the non-specific serological tests for syphilis?

VDRL | RPR

What are the specific serological tests for syphilis? Which is used for screening?

TPPA ELISA (used for screening) FT antibody absorption INNO-LIA

How is early and late syphilis treated respectively?

LONG ACTING PENICILLIN | 2.4MU benzathine penicillin once or three times a day

What is partner notification? List the main methods

VOLUNTARY process of informing people who have been in contact with an STI Patient referral Provider referral Provisional referral

Partner notification is not needed for...

Warts, herpes (no benefit in asymptomatic finding) | Vaginal thrush, bacterial vaginosis (not STIs)

List vaccinations that can be given to prevent STIs

Hepatitis B Hepatitis A HPV

What is PreP therapy?

Medicine taken before exposure to reduce risk of infection, particularly HIV

What is PEPSE?

Medicine taken after exposure to reduce risk of infection, particularly HIV and Hepatitis B

List complications of chlamydia

PID Tubal damage (infertility, ectopic pregnancy) Chronic pelvic pain Transmission to neonate Adult conjunctivitis Reiter's syndrome Fitz-Hugh-Curtis syndrome (perihepatitis)

What is the triad of symptoms present in Reiter's syndrome?

Conjunctivitis Urethritis Arthritis

What is LGV? What are the clinical signs?

Serovars of chlamydia trachomatis (L1-3), common in MSM | Rectal pain, discharge, bleeding, concurrent STIs

What is the diagnostic tests for chlamydia?

Test 14 days following exposure NAAT - females (vulvovaginal swab), males (first void urine) Rectal swab in MSM who have had receptive UPAI

List lower genital tract complications of gonorrhoea

``` Bartholinitis (inflam of Barth glands next to vagina) Tysonitis (inflam of Tyson glands) Periurethral abscess Rectal abscess Epididymitis Urethral stricture ```

List upper genital tract complications of gonorrhoea

``` Endometritis PID Hydrosalpinx Infertility Ectopic pregnancy Prostatitis ```

How is genital herpes diagnosed?

Swab base of ulcer for HSV PCR

Which group of people are there special circumstances for the management of genital herpes?

Pregnant women

What are the two main classifications of syphillus?

Congenital | Acquired

What is the most highly infectious lesion in syphillus, and it exudes serum?

Condylomata lata

Syphillus is followed up until...

RPR is negative or serofast

What is the interval period for testing for chlamydia or gonorrhoea?

14 days