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Sexually Transmitted Infections Flashcards

1
Q

what is the most commonly reported bacterial STI in sexual health clinics?

A

chlamydia (CT)

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2
Q

what % of those with chlamydia are asymptomatic?

A

70-80% of women

50% of men

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3
Q

what type of bacteria is chlamydia?

A

gram negative obligate intracellular bacterium

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4
Q

what are the methods of transmission of chlamydia?

A

vaginal
oral
anal

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5
Q

in what age does the highest incidence of chlamydia occur?

A

20-40 years

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6
Q

what is a complication of chlamydia which increases the risk of ectopic pregnancy and tubal factor infertility?

A

pelvic inflammatory disease

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7
Q

how does chlamydia present in females if symptomatic?

A

post coital or intermenstrual bleeding
lower abdominal pain
dyspareunia
mucopurulent cervicitis

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8
Q

how does chlamydia present in males if symptomatic?

A 
urethral discharge 
dysuria 
urethritis 
epididymo-orchitis 
proctitis (LGV)
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9
Q

other than PID, what are another 2 complications of chlamydia (CT)?

A

conjunctivitis

reactive arthritis

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10
Q

what testing advice has been offered for CT?

A

stop testing for CT in women >25 with vaginal discharge

do test women who have had CT in past year
*one in five women with diagnosed and treated chlamydia are estimated to become reinfected within 10 months of initial treatment

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11
Q

what is LGV?

A

serovar of chlamydia trachomatis (L1-3)

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12
Q

who does LGV present in and what are the symptoms?

A

men who have sex with men (MSM)

rectal pain, discharge and bleeding

*high risk of concurrent STIs (67% HIV)

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13
Q

how is CT diagnosed?

A

test 14 days following exposure

NAAT - females (vulvovaginal swab), males (first void urine)

for MSM, add rectal swab if receptive anal intercourse

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14
Q

how is CT treated?

A

doxycycline 100mg BD x 1 week

or azithromycin 1G stat followed by 500mg daily for 2 days

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15
Q

what is mycoplasma genitalium?

A

emerging sexually transmitted pathogen which is associated with non gonococcal urethritis and PID

*1-2% population

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16
Q

mycoplasmic genitalium is asymptomatic - true or false?

A

true

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17
Q

how is mycoplasma genitalium diagnosed?

A

NAAT test (same sample sites as CT)

*test if first line treatment for PID and NGU failed

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18
Q

mycoplasma genitalium is associated with what resistance?

A

macrolide (estimated at 40%)

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19
Q

what type of bacteria is gonorrhoea?

A

gram negative intracellular diplococcus

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20
Q

what are the primary sites of infection of gonorrhoea?

A

mucous membranes of urethra, endocervix, rectum and pharynx

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21
Q

what is the incubation time of gonorrhoea?

A

very short in men (2-5 days)

*20% risk from infection women to male, 50% from male to female

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22
Q

in what age is the prevalence of gonorrhoea higher?

A

men - 20-24

women = <20

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23
Q

how does gonorrhoea present in men?

A

purulent urethral discharge
dysuria
pharyngeal / rectal infection (these are mostly asymptomatic)

*less than 10% asymptomatic

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24
Q

how does gonorrhoea present in females?

A

increased/altered vaginal discharge
dysuria
pelvic pain
pharyngeal and rectal infection usually asymptomatic

*up to 50% asymptomatic

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25
what % of those with gonorrhoea get complications?
``` females = 3% males = <1% ```
26
what are the lower genital tract complications of gonorrhoea?
``` bartholinitis tysonitis periurethral abscess rectal abscess epididymitis urethral stricture ```
27
what are the upper genital tract complications of gonorrhoea?
``` endometritis PID hydrosalpinx infertility ectopic pregnancy prostatitis ```
28
how is gonorrhoea diagnosed?
NAATs (screening) microscopy (if symptomatic) culture (if micro +ve or contract of GC) *this will give antibiotic options
29
how is gonorrhoea treated?
first line = ceftriaxone 1G IM second line = cefixime 400mg oral (only if IM injection is contra-indicated or refused by patient) *always get them back to do test of cure (at 2 weeks)
30
what are the three types of genital herpes infection?
primary infection non-primary first episode recurrent infection
31
what is the incubation and duration of primary genital herpes infection?
``` incubation = 3-6 days duration = 14-21 ```
32
what are the symptoms of primary genital herpes infection?
``` blistering and ulceration of external genitalia pain external dysuria vaginal or urethral discharge local lymphadenopathy fever or myalgia (prodrome) ```
33
recurrent episodes of HSV are more common in type 1 - true or false?
false - HSV-2 has more common recurrence
34
what are the symptoms of a recurrent episode of HSV?
unilateral, small blisters and ulcers minimal systemic symptoms (resolves within 5-7 days) *often overlooked / misdiagnosed
35
how are genital herpes diagnosed?
swab base of ulcer for HSV PCR
36
how are genital herpes treated?
give oral antiviral treatment (aciclovir 400mg TDS x 5/7) consider topical lidocaine 5% ointment if very painful saline bathing analgesia
37
viral shedding is more common in what type of HSV?
viral shedding following HSV 2 is consistently higher than for HSV 1 * more frequent in first year of infection * more in individuals with frequent recurrences * reduced by suppressive therapy (if more than 6 in a year - 400mg aciclovir and assess again after a year) * type 1 - less attacks also
38
what should you do if genital herpes presents in pregnancy?
inform O+G (review birth plan) * if first episode in 3rd trimester within 6 weeks of EDD * if not a primary episode this is good as will have passed antibodies onto baby
39
what is the most common viral STI in the UK?
HPV
40
what is the lifetime risk of acquiring HPV?
80%
41
how many types of HPV are described and how many of these infect anogenital epithelium?
>200 HPV described | >40 HPV types infect anogenital epithelium
42
what are the low and high risk types of HPV?
low = 6,11, 42, 43, 44 high = 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68
43
what are the different clinical sequelae of HPV which are associated with different genotypes?
latent infection anogenital warts (6 and 11) palmar and plantar warts (1 and 2) cellular dysplasia / intraepithelial neoplasia (16 and 18)
44
what strains of HPV are covered in HPV vaccines?
6, 11 (genital warts) | 16 and 18 (cancer)
45
what % of population is exposed to HPV and what % develop anogenital warts?
80% exposed 10% probably harbour infection 1% develop anogenital warts
46
what is the incubation period of HPV transmission?
3 weeks to 9 months *likely to have got it from asymptomatic partner
47
you can only transfer one type of HPV at a time - true?
FALSE | transmission of more than one HPV type is common
48
what are the success rates of treatment of HPV?
spontaneous clearance = 20-34% clearance with treatment = 60% persistence despite treatment = 20% *smoking makes it harder to clear
49
what are the four treatment options for HPV?
podophyllotoxin (warticon) * cytotoxic * not licensed for extra genital warts (but widely used) imiquimod (aldara) * immune modifier * can be used on all anogenital warts (1st line when anogenital) cryotherapy * cytolytic, can require repeat treatments * tend to use in combo with one of above or if warts tiny electrocautery
50
what groups of people are now included in HPV vaccine?
MSM | adolescent boys
51
what bacterium causes syphilis?
treponema pallium
52
how can syphilis be transmitted?
sexual contact trans-placental / during birth blood transfusions non-sexual contact (healthcare workers)
53
what are the two classifications of syphilis?
congenital | acquired
54
what types of acquired syphilis causes early infectious syphilis (within first 2 years)?
primary secondary early latent
55
what types of acquires syphilis causes late non-infectious syphilis?
late latent | tertiary
56
what is the incubation period of primary syphilis?
9-90 days (mean of 21 days)
57
what is the lesion of primary syphilis normally known as?
chancre (painless), appears at site of inoculation * genital (90%) or extra genital (10%) * also get non-tender local lymphadenopathy
58
what is the incubation period of secondary syphilis?
6 weeks to 6 months
59
what are the symptoms of secondary syphilis (known as great imitator)?
skin (macular, follicular or pustular rash on palms + soles) lesions of mucous membranes generalised lymphadenopathy patchy alopecia condylomata lata (most highly infectious lesion in syphilis, exudates a serum teeming with treponemes)
60
how is syphilis diagnosed?
demonstration of treponema pallidum (from lesions or infected lymph nodes) * dark field microscopy * PCR serological testing = detects antibody to pathogenic treponemes
61
what is the screening serological test for syphillis?
ELISA / EIA (enzyme immunoassay) when this is positive, then do definitive test
62
how is syphilis treated?
early = 2.4 MU benzathine penicillin x1 late = 2.4 MU benzathine penicillin x3
63
how is syphilis followed up?
followed up until PCR is negative or serofast * titres should decrease fourfold by 3-6 months in early syphilis * there is serological relapse / reinfection if titres increase by fourfold

Reproduction (45 decks)

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