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Reproductive & Sexual Health > Sexually Transmitted Infections > Flashcards

Sexually Transmitted Infections Flashcards

1
Q

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

A

Chlamydia

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2
Q

What percentage of women and men with chlamydia are asymptomatic?

A

70-80% of women, 50% of men

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3
Q

Chlamydia is a gram ____ ______ ______ bacterium

A

Chlamydia is a gram negative obligate intracellular bacterium

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4
Q

How is chlamydia transmitted?

A

Vaginal, oral or anal sex

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5
Q

Which age group have the highest incidence of chlamydia?

A

20-24 years

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6
Q

Chlamydia is very small, stain _____ with gram stain have a typical ___ wall of gram ___ bacteria

Cell wall lacks ________

A

Chlamydia is very small, stain poorly with gram stain have a typical LPS wall of gram negative bacteria

Cell wall lacks peptidoglycan

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7
Q

The percentage of women with chlamydia who develop PID is estimated at _%

A

The percentage of women with chlamydia who develop PID is estimated at 9%

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8
Q

An episode of PID increases the risk of ectopic pregnancy ___ fold and carries a risk of tubal factor infertility of __-__%

A

An episode of PID increases the risk of ectopic pregnancy ten fold and carries a risk of tubal factor infertility of 15-20%

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9
Q

What is the primary target of chlamydia?

A

Mucosal epithelial cells, replicates within vacuole in cytoplasm of host cell

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10
Q

How can some people clear chlamydia infection?

A

Good TH1 and gamma interferon response, some have abnormal immune response which confers damage

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11
Q

How does chlamydia present in females?

A
  • post coital or intermenstrual bleeding
  • lower abdominal pain
  • dyspareunia
  • mucopurulent cervicitis
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12
Q

How does chlamydia present in males?

A
  • Urethral discharge
  • Dysuria
  • Urethritis
  • Epididymo-orchitis
  • Proctitis (LGV)
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13
Q

What are the complications of CT?

A
  • PID 50%
  • tubal damage
  • chromic pelvic pain
  • transmission to neonate
    • conjunctivitis
    • pneumonia
  • SARA- sexually acquired reactive arthritis
  • reiters syndrome (commoner in men)
  • hugh-curtis syndrome
    • perihepatitis
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14
Q

Who should be tested for chlamydia?

A

Women who have had chlamydia trachomatis in the past year

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15
Q

1 in 5 women who are diagnosed and treated for chlamydia are estimated to become infected within __ months after initial treatment

A

1 in 5 women who are diagnosed and treated for chlamydia are estimated to become infected within 10 months after initial treatment

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16
Q

What is LGV?

A

Serovars of chlamydia trachomatis (L1-L3)

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17
Q

How does LGV present?

A

in MSM

Rectal pain, discharge and bleeding

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18
Q

Describe the testing for CT?

A

Test 14 days following exposure

NAAT (nucleic acid amplification test)- females (vulvovaginal swab), males (first void urine)

MSM (add rectal swab if has receptive anal intercourse)

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19
Q

What is the treatment for chlamydia trachomatis?

A

Doxycycline 100mg BD x 1 week

Azithromycin 1G stat followed by 500mg daily for two days

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20
Q

What is associated with mycoplasma genitalium?

A

Non gonococcal urethritis (15-25%) and PID

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21
Q

How is mycoplasma genitalium tested for?

A

NAAT test (same sample sites as GC/CT

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22
Q

Why is mycoplasma genitalium so easily spread?

A

It has asymptomatic carriage

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23
Q

Gonorrhoea is a gram _____ _________ _______
The primary sites of infection are; (4)

A

Gonorrhoea is a gram negative intracellular diplococcus
The primary sites of infection are;

  1. Mucous membranes of urethra
  2. endocervix
  3. rectum
  4. pharynx
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24
Q

What is the incubation period of gonorrhoeal urethral infection?

A

Short in men (3-5 days)

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25
Q

__% risk of gonorrhoea transmission from infected woman to male partner

__-__% risk from infected man to female partner

A

20% risk of gonorrhoea transmission from infected woman to male partner

50-90% risk from infected man to female partner

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26
Q

How does gonorrhoea present in males?

A

Asymptomatic (<10%)

Urethral discharge >80%

Dysuria

Pharyngeal/rectal infections- mostly asymptomatic

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27
Q

How does gonorrhoea present in females?

A

Asymptomatic (up to 50%)

Increased/altered vaginal discharge (40%)

Dysuria

Pelvic pain (<5%)

Pharyngeal and rectal infection are usually asymptomatic

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28
Q

Complications of gonorrhoea favour _____:______

_% females: <_% males

A

Complications of gonorrhoea favour females:males

3% females: <1 % males

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29
Q

What are the lower genital tract complications of gonorrhoea?

A

Bartholinitis

Tysonitis

Periurethral abscess

Rectal Abscess

Epiididymitis

Urethral stricture

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30
Q

What are the upper genital tract complications of gonorrhoea?

A

Endometritis

PID

Hydrosalpinx

Infertility

Ectopic pregnancy

Prostatitis

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31
Q

What is tysonitis

A

inflammation of Tyson’s glands (preputial glands).

32
Q

How is gonorrhoea diagnosed?

A

NAATs (screening test) >96% sensitivity

33
Q

How is gonorrhoea tested for if symptomatic

A

Microscopy

Urethral (90-95% sensitivity)

Endocervical 37-50% sensitivity

34
Q

What are the advantages of gonorrhoea testing via

  • microscopy
  • culture
  • NAAT
A

Microscopy

  • Near Pt diagnosis*
  • Timely treatment*

Culture

Always allows antibiotic sensitivity and monitoring

NAAT

  • Non invasive*
  • Less problems with transport, media and storage*
35
Q

What are the disadvantages of gonorrhoea testing via

  • Microscopy
  • Culture
  • NAAT
A

Microscopy

  • Invasive test*
  • Low sensitivity*
  • Requires confirmation*

Culture

  • Invasive test*
  • Requires specific media and incubation*

NAAT

  • Risk of false positive*
  • Positive result should be confirmed by NAAT with different targer*
36
Q

What is the first line treatment for Gonorrhoea?

A

Ceftriaxone 500mg IM

37
Q

What is the second line treatment for Gonorrhoea?

A

Cefixime 400mg oral (only if IM injection is contraindicated or refused by patient )

38
Q

What is the most important aspect of gonorrhoea testing in all patients

A

Test of a cure

39
Q

What are the three variations of genital herpes?

A

Primary infection

Non-primary first episode

Recurrent infection

40
Q

Genital herpes (primary infection)

Incubation- _- _ days

Duration- __-__ days

A

Genital herpes (primary infection)

Incubation- 3- 6 days

Duration- 14-21 days

41
Q

What are the symptoms of genital herpes primary infection?

A
  • Blistering and ulceration of the external genitalia
  • pain
  • external dysuria
  • vaginal or urethral discharge
  • local lymphadenopathy
  • fevel and myalgia (prodrome)
42
Q

Recurrent episodes of herpes symptoms are common with which HSV?

A

HSV 2

43
Q

Describe recurrent episodes of HSV2

A

Often overlooked/misdiagnosed

Usually unilateral, small blisters and ulcers

minimal systemic symptoms, resolves within 5-7 days

44
Q

How should herpes be investigated and managed?

A
  • Swab base of ulcer for HSV PCR
  • Give oral antiviral treatment (aciclovir 400mg TDS x5/7)
  • Consider topical lidocaine 5% ointment if very painful
  • saline bathing
  • analgesia
45
Q

Viral shedding following HSV _ is consistently higher than for HSV _

A

Viral shedding following HSV 2 is consistently higher than for HSV 1

46
Q

How can viral shedding be reduced?

A

By supressive therapy

47
Q

What should be done if herpes is diagnosed within 5 weeks of EDD

A

Inform O+G

48
Q

What is the mose common viral STI in the UK

A

HPV

49
Q

How many hpv genotypes are there?

A

>200

50
Q

What are the high risk HPV types

A

16, 18

31, 33, 25, 52, 58

51
Q

Which HPV genotype presents with;

  • anogenital warts
  • palmar and plantar warts
  • cellular dysplasia/intraepithelial neoplasia
A

Which HPV genotype presents with;

  • anogenital warts= 6/11
  • palmar and plantar warts= 1/2
  • cellular dysplasia/intraepithelial neoplasia = 16/18
52
Q

Who are you most liekly to have acquired HPV from?

A

Asymptomatic partner

53
Q

What is the incubation period of HPV?

A

3 weeks to 9 months

54
Q

Where is subclinical HPV common?

A

On all anogenital sites

55
Q

HPV immunology

Spontaenous clearance of warts: __-__%

Clearance with treatment: __%

Persistence despite treatment: __%

A

HPV immunology

Spontaenous clearance of warts: 20-34%

Clearance with treatment: 60%

Persistence despite treatment: 20%

56
Q

What is the treatment for HPV

A

Podophyllotoxin (Warticon)

  • cytotoxic*
  • Not licensed for extragenital warts- but widely used*

Imiquimod (aldara)

  • Immune modifier*
  • Can be used on all anogenital warts*

Cryotherapy

cytolytic can require repeat treatments

Electrocautery

57
Q

Who gets HPV vaccine?

A

MSM

Women

Adolescent boys

58
Q

What causes syphilis?

A

Treponema pallidum (spirochete)

59
Q

How is syphillis transmitted?

A

Sexual contact

Trans-placental/during birth

Blood transfusions

Non-sexual contact- healthcare workers

60
Q

What are the classifications of syphilis?

A

Congenital

Acquired

61
Q

What are the phases of early infectious acquired sphilis?

A

Primary

Secondary

Early latent

62
Q

What are the phases of late non-infectious acquired sphilis?

A

Late latent

tertiary

63
Q

What is the incubation period of primary syphilis?

A

From 9-90 days (mean of 21 days)

64
Q

What is the primary syphilis lesion known as?

A

Chancre (painless)

65
Q

Where to chancres appear?

A

At the site of inoculation

66
Q

What percentage of chancres are genital?

A

90%

67
Q

Primary syphilis presents with a chancre and what else?

A

Non-tender local luymphadenopathy

68
Q

What is the incubation period for secondary syphillis?

A

6 weeks to 6 months

69
Q

Describe the presentation of secondary syphillis?

A
  • Skin (macular, follicular or pustular rash on palms + soles)
  • Lesions of mucous membranes
  • Generalised lymphadenopathy
  • Patchy alopecia
  • Condylomata lata
70
Q

What are condylomata lata?

A

Most highly infectious lesion in syphilis, exudes a serum teeming with treponemes

71
Q

How is syphillis diagnosed?

A

Demonstration of treponema pallidum

From lesions or infected lymph nodes

Techniques;

  • Dark field microscopy
    • PCR (Polymerase Chain Reaction)*

Serological testing

- detects antibody to pathogenic treponemes

72
Q

What are the non-treponemal serological tests for syphillis?

A

VDRL (venereal disease research laboratory)

RPR (rapid plasma reagin)

73
Q

What are the treponemal serological tests for syphillis?

A

TPPA (treponemal pallidum partical agglutination)

ELISA/EIA (enzyme immunoassay) Screening test

INNO-LIA (line immunoassay)

FTA abs (fluorescent treponemal antibody absorbed)

74
Q

What is the treatment for early and late syphilis?

A

Early

  • 2.4 MU Benzathine penicillin x 1

Late

  • 2.4 MU Benthatine penicillin x 3
75
Q

What is the serological follow up for early/late syphillis?

A

Until RPR is negative or serofast

  • titres should decrease fourfold by 3-6 months in early syphillis
  • there is serological reslapse/reinfection if titres increase fourfold

Reproductive & Sexual Health (54 decks)

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