Sexually Transmitted Infections Flashcards by Sarah Adam

Women presents with post coital bleeding, lower abdominal pain and dyspareunia (painful sexual intercourse). What is she describing symptoms of?

Chlamydia infection

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A man presents with clear urethral discharge, dysuria and urethritis. What is he describing symptoms of?
What other symptoms could they experience?

Chlamydia infection

proctitis
epididymis-orchitis (inflammation of the epididymis +/- tescticle)

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What %’age of women develop PID after infection with chlamydia trachomatis?

~9%

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What are the complications of PID?

Increased risk of ectopic pregnancy
tubal damage/infertility
conjunctivitis
transmission to neonate (conjunctivitis 17%, pneumonia 20%)
Sexually acquired restive arthritis (SARA/reiter’s syndrome)
perihepatitis

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What is Fitz-Hugh-Curtis Syndrome?

perihepatitis

complication of PID involving the liver capsule inflammation that leads to the creation of adhesions

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What is the most commonly reported bacterial STI?

Chlamydia

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What %’age of women/men are infected with chlamydia but experience no symptoms?

70-80 women

50 men

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What is the incubation period of chlamydia trachomatis?

14 days

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How do we test for chlamydia?

women: vulvovaginal swab
men: first void urine
MSM: rectal swab if having receptive anal sex

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What is the 1st line tx for Chlamydia?

doxycycline 100mg BD for 1 week

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What is the 2nd line tx for Chlamydia?

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

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When is it safe to have sexual intercourse again?

After completion of doxycycline or 7 days after azithromycin

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Describe the structure of Chlamydia trachomatis

Gram negative intracellular coccus

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Describe the structure of Gonorrhoea

Gram negative intracellular diplococcus

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What are the primary sites of infection in Gonorrhoea?

Mucous membranes, i.e.
urethra 
endocervix 
rectum 
pharynx

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What is the incubation period of gonorrhoea?

2-5 days

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__% risk of a woman transferring to her male partner

__% risk of a male infecting his female partner (gonorrhoea)

20%

50-90%

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Describe the presentation of gonorrhoea in a male

10% asymptomatic
>80% have green tinged urethral discharge
dysuria

pharyngeal/rectal infections are usually asymptomatic

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Describe the presentation of gonorrhoea in a female

up to 50% asymptomatic
increased/altered vaginal discharge (~40%)
dysuria
pelvic pain <5%

again: pharyngeal/rectal infections are usually asymptomatic

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How do we make a diagnosis of gonorrhoea?

screening: NAAT test (96% sensitivity) done with swab
microscopy (symptomatic)
- urethral swab
- endocervical swab

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What is the 1st line tx for non-complicated gonorrhoea?

Ceftriaxone 500mg IM

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What is the 2nd line tx for non-complicated gonorrhoea?

Ceftixime 400mg orally + 2mg azithromycin

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Person diagnosed with gonorrhoea can have sexual intercourse again when?

After ceftriaxone injection or 7 days after ceftixime and azithromycin

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Patient presents with thick, cottage cheese like discharge with a yellowish colour. The discharge started 2 days ago, no Hx of blood in the discharge, but has dysuria. No pain on examination and no masses. What is the likely diagnosis?

Candida albicans

Tx: antifungal

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A 37 y/o woman of 35 weeks gestation presents at her GP clinic with a Hx of primary infection of genital herpes at 24 weeks (tx with acyclovir). She is wanting to discuss birth and management plans. What do you recommend

Aciclovir from 36 weeks (three times daily) and expectant delivery

16y/o presents with a fishy, green vaginal discharge. The symptoms have been present for 2 weeks and includes pruritus, dysuria and frequency. Vaginal swabs were taken and showed a motile flagellate on wet film microscopy. What is the likely diagnosis?

Trichomonas Vaginalis Tx: oral metronidazole 500mg twice daily for 7 days

A 26 year old lady attends the gynaecology clinic complaining of a yellowish vaginal discharge. A high vaginal swab is taken and submitted to the laboratory. The laboratory sees the organism shown moving about on microscopy. What is the likely diagnosis?

Trichomonas Vaginalis - Parasite (protozoa) Tx: oral metronidazole 500mg twice daily for 7 days or 2g as a single dose

A 23 y/o woman presents complaining of itchy vaginal discharge. She is in a stable relationship and is not on any OCP's. On examination you notice a red and oedematous labia with white spongy areas. What is the likely diagnosis?

Candidiasis tx: clotrimazol pessaries

18y/o woman presents complaining of feeling wet all the time. She is on the COCP. What is the likely diagnosis?

Ectropion a common condition caused when cells from inside the cervical canal, (columnar epithelium - secretory), are present on the transformation zone, outside the cervix

A 22y/o male presents to the GUM clinic complaining of a flu-like illness with fever, headache and backache. He also noticed a few small, fluid filled itchy blisters on his genital area. He also complains of severe burning on micturition. What is the likely diagnosis

Genital herpes | Herpes simplex

A 36y/o homosexual male presents to the GUM clinic complaining of white plaques on his mouth. While examining the patient you notice bluish-brown nodules on his arm. What is the likely diagnosis

oral candidiasis - an oppotunistic infection found in immunosuppressed HIV patients Karposi's sarcoma is a cutaneous manifestation of AIDS, initially caused by proliferation of small blood vessels in the dermis. Later nodules are formed.

A 22y/o presents to the emergency department feeling unwell and with a high fever. She has vaginal discharge, dysuria and painful intercourse. while examining the patient you notice a large lump in the vulval area, which her GP diagnosed to be a Bartholis access. What is the likely diagnosis?

Gonorrhoea PID - the finding of a bartholian's access is diagnostic in the past 50% of women in the reproductive age group with a BA tested positive for gonorrhoea

38 y/o IV drug user brough to the ED in a comatose state. On examination you identify signs suggestive of chronic liver disease with jaundice and ascites. When the results of the tests for viral markers are back later, you notice he is positive for HBsAg and anti-HBE. What is the likely diagnosis?

chronic hepatitis B (anti-HBe)

A woman complains of vulval pruritus and a creamy white vaginal discharge. What is the likely diagnosis?

Candida albicans (thrush)

A man complains of a 2 week Hx of thin urethral discharge and pain on passing urine. What is the likely diagnosis?

Chlamydia trachomatis

Man complains of painless warts on his glans penis. What is the likely diagnosis?

HPV

A woman complains of vulval discomfort and a profuse yellow-green discharge with a strong unpleasant odour. What is the likely diagnosis?

Trichomonas vaginalis classical fishy odour

A man complains of severe pruritus in the perineal and pubic areas. He is found to have lice in his pubic hair. What is the likely diagnosis?

Phthirus pubis

A woman had severe pain on intercourse and micturition. Sh e is now in acute urinary retention. On examination, there are clusters of small, painful vesicles on her labiae and vulva. What is the likely diagnosis?

Herpes simplex virus (type 2)

What specimen would you take to confirm the diagnosis of HSV?

Swab a deroofed blister for PCR test (HSV)

Name the antiviral therapy available for the treatment of genital herpes.

Aciclovir

A 35 year old man has developed these lesions over a period of about 18 months. The lesions are not particularly painful or tender unless he wears tight underpants and the skin becomes chafed. His girlfriend insisted he see a doctor because she "won't have sex with a cauliflower". What are the lesions?

genital warts

What virus causes genital warts?

HPV

What are the commonest causes of genital ulceration in the UK?

Syphillis | HSV

A 30 year old man attends your surgery with an ulcerated lesion on his penis. The lesion is not particularly tender to touch. You feel enlarged lymph nodes in both groins. The patient has been working in Thailand for the last 6 months where he had unprotected sex with a girl in a bar on several occasions. What are the causes of genital ulceration?

Syphilis - treponema pallidum or Genital herpes most likely syphilis

What specimen(s) would you send to the microbiology laboratory in order to confirm the diagnosis of syphilis?

PCR - VDRL - RPR

What is the treatment of syphilis?

early syphilis: 2.4MU benzathine penicillin (long acting penicillin) late syphilis: 2.4MU benzathine penicillin x3

What is the incubation period for genital herpes?

3-6 days

How long does a flare of genital herpes last?

14-21 days

Primary episode of genital herpes may present with what?

``` inability to pee vaginal or urethral discharge local lymphadenopathy fever and myalgia multiple shadow blisters and swollen labia ```

A recurrent episode of genital herpes may present with what?

usually unilateral, small blisters/ulcers minimal systemic symptoms resolves within 5-7 days

What is the difference in episodes of genital herpes with T1 and T2?

Type 1: 12/18 months between attacks | Type 2: 4-6 attacks a year

What is the treatment for genital herpes?

Oral acyclovir (400mg TDSx5/7) consider topical lidocaine 5% ointment is painful saline bathing analgesia

With regards to HSV1 vs HSV2 which has a higher rate of viral shedding?

HSV2

What is the most common viral STI ini the UK?

HPV | lifetime risk 80%

There are >200 genotypes of HPV, what does the 11-13 vaccine cover against?

6, 11, 16, 18

Anogenital HPV is most commonly caused by what type of virus?

6/11

Palmoplantar HPV is most commonly caused by what type of virus?

1/2

Cellular dysplasia caused by HPV is most commonly caused by what type of virus?

16/18 responsible for most of cervical, anal, penile, vulval and oropharyngeal dysplasia

What is the incubation period of HPV?

3 weeks to 9 months

What %'age of HPV warts clear without treatment?

20-34%

What %'age of HPV warts clear with treatment?

60%

What %'age of HPV warts persist despite treatment?

20%

Anogenital warts are caused by HPV 6/11 and occur at _______.

sites of friction 'cauliflower like lesions'

Regarding treatment of HPV warts there are 4 choices - name them.

Podophyllotoxin (warticon) - clearance rate 45-83% Imiquimod 5% cream (Aldara) cryotherapy electrocautery

What is the difference between Podophyllotoxin and Imiquimod?

Podophyllotoxin is not licences for extra-genital warts but is widely used Imiquimod can be used on all anogenital warts (keratinised and non-keratinised)

How is syphillis spread?

sexual contact trans-placental/during birth blood transfusions non-sexual contact (Healthcare workers)

What group of people are more likely to have syphilis?

MSM | men who have sex with men

Incubation period for primary syphilis is how long?

9-90 days

In primary syphilis the lesion seen is known as what?

Primary chancre (painless) 90% genital 10% extra-genital

Incubation period for secondary syphilis is how long?

6weeks - 6 months

In secondary syphilis what symptoms are present?

``` skin rash lesions of mucous membranes generalised lymphadenopathy patchy alopecia condylomata lata (wart like lesion) ```

What is important to do following treatment of penicillin for syphillis?

Follow up serology until the RPR is negative or serofast (no change) titres should decrease fourfold by 3-6months in early syphilis if they don't it is likely the patient has been reinfected

HIV is what type of virus?

retrovirus | HIV-2 is responsible for the global pandemic

What cells does HIV target?

CD4 Th lymphocytes

A woman presents with itching on her pubic area. You suspect pubic lice. How long do male lice live, on average?

22 days

A non-sexually active woman presents with a vaginal discharge which contains bubbles and has an offensive smell. What is the most likely infection?

Bacterial vaginosis

A 48-year old previously well man is admitted to ITU with Type 1 respiratory failure. He is unconscious and ventilated. PCR of a broncho-alveolar lavage has confirmed Pneumocistis jiiroveci. His parents and his wife visit him daily. Which is the most appropriate way to obtain an HIV test?

Obtain venous blood from the patient and request HIV antibody/antigen

A 28-year old MSM (man who has sex with men) presents to the sexual health clinic with a 2 week history of sore throat, fever and a rash on his chest. He last had sex 1 week ago with a regular male partner of 4 months with whom he has condomless receptive and insertive anal sex. He last had sex with a different person 1 year previously. On examination his BP and pulse are normal, his temperature is 37.9, he has small shotty neck nodes bilaterally, erythematous but not enlarged tonsils with no pus and a fine maculopapular rash to his chest. The patient is worried he may have HIV. A near-patient rapid 4th generation HIV Antibody/antigen test is non-reactive. How do you explain the result and further management to the patient?

His symptoms may be due to Primary HIV infection and venous blood should be obtained and sent to the laboratory for HIV antibody/antigen testing.

A patient presents with fishy malodorous discharge. It is grey and whitish in colour. She is very bothered with the discharge. You have taken a swab. What is the most likely diagnosis?

Bacterial Vaginosis

A 16 year old girl is seen by her GP with some vaginal discharge. Her observations are normal. A swab test shows presence of Chlamydia. What is the best antibiotic treatment for her?

doxycycline

A 12 year old patient attends to discuss the HPV vaccine. She would like to know when she will receive it. What will you advise?

Between 1st and 3rd year of secondary school