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Reproduction Pathology > Sexually Transmitted Infections > Flashcards

Sexually Transmitted Infections Flashcards

1
Q

Definition of a sexually transmitted infection

A

An infection which is predominately sexually transmitted

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2
Q

STI vs STD

A

STI is the infection e.g. HPV

STD is the disease it causes e.g. warts

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3
Q

What is the activity of identification and informing sexual contacts of someone with an STI called?

A

‘partner notification’ or

‘contact tracing’

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4
Q

What is gonnorhoea caused by?

A

Neisseria Gonnorhoea

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5
Q

Which is more common, chlamydia or gonnorhoea?

A

Chlamydia

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6
Q

What gender is gonnorhoea more common in?

A

Men, often MSM

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7
Q

What does MSM mean?

A

Men who have sex with men

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8
Q

Incubation period of gonorrhoea

A

Average 5-6 days

Range 2 days - 2 weeks (if get symptoms at all)

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9
Q

Male symptoms of gonnorhoea

A

Thick, profuse yellow discharge
Dysuria
Rectal and pharyngeal infection often asymptomatic
10% with no symptoms

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10
Q

What % of males have no gonorrhoea symptoms?

A

10%

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11
Q

What % of women have no gonorrhoea symptoms?

A

> 50%

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12
Q

Women symptoms of gonnorhoea

A 
>50% asymptomatic
Vaginal discharge 
Dysuria
Intermenstrual bleeding
Post coital bleeding
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13
Q

Investigations for gonnorhoea

A

NAAT from urine or swab from exposed site (vagina, rectum, throat)
gram stain smear from urethra/cervix/rectum in symptomatic people
To confirm antibiotic sensitivity -> culture of swab obtained specimen from exposed site using highly selective lysed blood agar

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14
Q

NAAT means….

A

Nucleic acid amplification test

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15
Q

Treatment of gonnorhoea

A

Blind treatment with
- ceftriaxone 500mg IM once
PLUS
- Azithromycin 1g

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16
Q

Follow up after treatment for gonnorhoea infection

A

Test of cure at 2 weeks

Test of re infection at 3 months

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17
Q

Male complications of gonorrhoea

A

Epididymitis
Acute monoarthritis usually elbow or shoulder
Disseminated gonococcal infection; skin lesions - pustular with halo

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18
Q

Women complications of gonorrhoea

A

PID
Bartholin’s Abscess (gonococcal opthalmia neonatorum)
Acute monoarthritis (especially eblow or shoulder)
Disseminated gonococcal infection; skin lesions - pustular with halo

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19
Q

Causative organisms of chlamydia

A

Chlamydia trachomatis serovars D to K

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20
Q

Which type of causative organism of chlamydia is rare and causes lymphogranuloma and symptoms of severe proctitis?

A

Serovar Lb2

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21
Q

Who is chlamydia most commonly seen in?

A

mostly < 25 y/os

Especially in sexually active teenage women

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22
Q

Male symptoms of chlamydia

A

> 70% asymptomatic
Slightly watery discharge
Dysuria
Conjunctivitis

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23
Q

What % of males have asymptomatic chlamydia?

A

> 70%

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24
Q

What % of females have asymptomatic chlamydia?

A

> 80%

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25
Q

Female Symptoms of chlamydia

A 
>80% asymptomatic
Vaginal discharge 
Dysuria
Intermenstrual bleeding
Post coital bleeding
Conjunctivitis
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26
Q

Investigations of chlamydia

A

First void urine in men
Self taken or clincial taken swab from cervix, urethra, rectum as appropriate
All tested using NAAT

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27
Q

Treatment of chlamydia

A

Azithromycin 1g po once OR

Doxycycline 7 days

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28
Q

Follow up after chlamydia treatment

A

Test for reinfection 3-12 months

Earlier test of cure not needed unless symptoms present

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29
Q

Male complications of chlamydia

A

Epididymitis
Reactive arthritis
Reiter’s syndrome - urethritis/cervicitis + conjunctivitis + arthritis

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30
Q

Women complications of chlamydia

A

PID ->hence ectopic pregnancy, pelvic pain and infertility
Reactive arthritis
Reiter’s syndrome - urethritis/cervicitis + conjunctivis + arthritis

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31
Q

What % of women who get chlamydia will develop a problem with their fertility?

A

1%

32
Q

What is herpes caused by?

A

Herpes simplex virus types 1 and 2

33
Q

What is HSV2 an important co factor for?

A

HIV transmission

34
Q

Approx. what % of the UK population has herpes?

A

15-20% - very common

35
Q

Which strain of herpes is more common in genital infection?

A

Both strains equally common

36
Q

Which gender is herpes most common in?

A

Roughly equal in both sexes

37
Q

Incubation period of herpes

A

5 days to months

38
Q

what % of people have no symptoms of herpes?

A

80%

39
Q

Herpes symptoms

A

80% asymptomatic
Rest have recurring symptoms (monthly/annually)
Burning/itching then blistering then tender ulceration
flu like symptoms
dysuria
neuralgic pain in back, pelvis and legs

40
Q

Investigations of herpes

A

Clinical impression

Swab from lesion tested using PCR

41
Q

Treatment of herpes

A 
Primary outbreak 
- aciclovir e.g. for 5 days, 400mg td 
- Lidocaine ointment 
Infrequent recurrences
- Lidocaine ointment 
- aciclovir 1.2 g once daily until symptoms gone (1-3 days)
Frequent recurrences 
- acyclovir 400bd long term suppression
42
Q

Complications of herpes

A

Autonomic neuropathy (urine retention)
neonatal infection
secondary infection

43
Q

What does trichomonas vaginalis cause?

A

Trichomoniasis

44
Q

Who usually gets trichomoniasis?

A

Middle aged women

45
Q

Male symptoms of trichomoniasis

A

Usually asymptomatic

46
Q

Female symptoms of trichomoniasis

A

10-30% asymptomatic
Profuse thin vaginal discharge
- greenish, frothy and foul smelling. vulvitis

47
Q

What % of women are asymptomatic for trichomoniasis?

A

10-30%

48
Q

Investigations for trichomoniasis

A

PCR on vaginal swab
Not on urine so no test for men
Microscopy of wet preparation of vaginal discharge

49
Q

Treatment of trichomoniasis

A

Metronidazole 400mg po bd for 5 days or 2g single dose

50
Q

Complications of trichomoniasis

A

Miscarriage and preterm labour

51
Q

Causative organisms of anogenital warts

A

Human papilloma virus types 6 and 11 (occasionally type 1)

52
Q

What % of the population has a HPV infection and warts

A

> 90% of UK population have a genital HPV infection at somepoint in their life
only 20% of those infected with a wart causing strain of HPV get warts

53
Q

Symptoms of anogenital warts

A

Lumps with a surface texture of a small cauliflower

Occasionally itching or bleeding especially if perianal or intraurethral

54
Q

Investigations of anogenital warts

A

Appearance

Biopsy unusual

55
Q

When is a biopsy used to investigate anogenital warts?

A

To exclude intraepithelial neoplasia but this is rarely needed

56
Q

Treatment of anogenital warts

A 
Hormonal 
- podophyllotoxin 
- Imiquimod
Cryotherapy 
Diathermy, scissor removal for bulky warts
57
Q

Complications of anogenital warts

A

None common

Neonatal laryngeal papillomatosis

58
Q

What is syphilis caused by?

A

Treponema pallidum subspecies pallidum

59
Q

Common risk factor for syphilis

A

MSM

60
Q

Incubation period of syphilis

A

9 to 90 until appearance of chancre but can be asymptomatic

61
Q

Symptoms in the stages of syphilis

A 
Often asymptomatic or mild symptoms
Primary 
- local ulcer (chancre)
Secondary 
- rash 
- mucosal ulceration 
- neuro symptoms
- patchy alopecia 
- other symptoms
Tertiary (all very rare) 
- neurological
- Cardiovascular 
- gummatous 
- Skin lesions
62
Q

Definition of early latent syphilis

A

No symptoms but < 2 years since caught

63
Q

Definition of late latent syphilis

A

No symptoms but > 2 years since caught

64
Q

Investigations for syphilis

A

Clincial signs
Serology for TP IgGEIA, TPPA, RPR
PCR sample from an ulcer

65
Q

Treatment for syphilis

A

early (<2 years) and no neurological involvement
- Benzathine penicillin 2.4 MU IM once OR
- doxycycline 100mg bd po 2 weeks
Late (> 2 years) and no neurological involvement
- benzathine penicillin 2.4 MU IM weekly for 3 doses
- doxycycline 100mg bd po 28 days

66
Q

Complications of syphilis

A

Neurosyphilis (cranial nerve palsies common)
Cardiac or aortal involvement
Congenital syphilis

67
Q

What is the equation to do with STIs?

A

B x C x D
B = the probability of transmission
C = contact (number of sexual contacts in a year)
D = Duration

68
Q

How can we reduce STIs?

A 
Condoms/barrier methods
Vaccines (HPV, HBV)
PrEP (pre exposure prophylaxis) /ARVs (HIV)
PEP (post exposure prophylaxis)
Types of sex; education
69
Q

How can we reduce the number of sexual contacts in a certain period of time?

A

Education
Cultural influences/role models/advertising
Alcohol

70
Q

How can we reduce the duration of STIs?

A 
Education of symptoms
Accessibility of testing (stigma, appeal)
Screening programmes 
- Cervical - HPV
- Antenatal - HIV, Hep B, syphilis 
Resistance
71
Q

Which STIs have a resistance problem?

A

HIV

Gonnorhoea

72
Q

Investigation specifics for gonorrhoea

A

Due to resistance every swab has to be tested for drug resistance

73
Q

If having gonnorhoea Tx, what must be done?

A

Abstain from sex for 2 weeks

74
Q

Most common cause of PID

A

Chlamydia

75
Q

Management of the baby if the mum is Hep B +ve

A

Hep B vaccine

0.5ml of HBIG within 12 hours of birth with a further vaccine at 1 - 2 months then another at 6 months

Reproduction Pathology (28 decks)

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