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Sexually transmitted infections Flashcards

1
Q

Most commonly reported bacterial STI in sexual health clinics?

A

Chlamydia (CT)

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2
Q

Gram stain of Chlamydia ?

A

Gram negative obligate intracellular bacterium

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3
Q

How is Chlamydia transmitted?

A

Vaginal, oral or anal

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4
Q

An episode of PID increases the risk of?

A

Ectopic pregnancy ten fold and carries a risk of tubal factor infertility of 15-20%.

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5
Q

Presentation of chlamydia in female?

A

Post coital or intermenstrual bleeding
Lower abdominal pain
Dyspareunia
Mucopurulent cervicitis

NOTE: 70-80% of women

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6
Q

Presentation of chlamydia in male?

A 
Urethral discharge
Dysuria
Urethritis
Epididymo-orchitis
Proctitis (LGV)
NOTE: 50% of men are asymptomatic
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7
Q

Complications of chlamydia?

A

PID (CT accounts for 50% of cases)
Tubal damage (infertility, ectopic pregnancy)
Chronic pelvic pain
Transmission to the neonate (17% conjunctivitis, 20% pneumonia)
Adult conjunctivitis
Sexually acquired reactive arthritis (SARA) /Reiter’s syndrome (commoner in men)
Fitz-Hugh-Curtis Syndrome (Perihepatitis)

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8
Q

Testing advice for chlamydia?

A

Stop testing for CT in women >25 with vaginal discharge

Do test women who have had CT in past year

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9
Q

What is LGV?

A

LGV stands for lymphogranuloma venereum. It’s a type of chlamydia bacteria that attacks the lymph nodes, which are an important part of your body’s defence against infections

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10
Q

Symptoms of LGV?

A

Rectal pain, discharge and bleeding

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11
Q

What group of people is LGV common in ?

A

MSM

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12
Q

Diagnosis of chlamydia?

A 
Test 14 days following exposure
NAAT
females (vulvovaginal swab)
males (first void urine)
MSM (add rectal swab if has receptive anal intercourse)
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13
Q

Chlamydia treatment?

A

Doxycycline 100mg BD x 1 week
or (if contraindicated)
Azithromycin 1G stat followed by 500 mg daily for 2 days

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14
Q

Associated with Non Gonococcal Urethritis (15-25%) and PID?

A

Mycoplasma Genitalium

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15
Q

Test for Mycoplasma Genitalium?

A

NAAT test

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16
Q

Associated with high levels of macrolide?

A

Mycoplasma Genitalium

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17
Q

Gram statin for Gonorrhoea?

A

Gram negative intracellular diplococcus

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18
Q

Primary sites of infection for Gonorrhoea?

A

mucous membranes of the urethra, endocervix, rectum, and pharynx

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19
Q

Presentation of Gonorrhoea in males ?

A

Asymptomatic - ≤10%
Urethral discharge – >80%
Dysuria
Pharyngeal/rectal infections – mostly asymptomatic

20
Q

Presentation of Gonorrhoea in females ?

A

Asymptomatic (up to 50%)
Increased/altered vaginal discharge (40%)
Dysuria
Pelvic pain (<5%)
Pharyngeal and rectal infection are usually asymptomatic.

21
Q

Complications of gonorrhoea in the lower genital tract?

A 
Bartholinitis
Tysonitis
Periurethral abscess
Rectal abscess
Epididymitis
Urethral stricture
22
Q

Complications of gonorrhoea in the upper genital tract?

A 
Endometritis
PID
Hydrosalpinx
Infertility
Ectopic pregnancy
Prostatitis
23
Q

Diagnosis of gonorrhoea?

A

NAATs (screening test) >96% sensitivity

Microscopy (Symptomatic)
Urethral 90-95% sensitivity
Endocervical 37-50% sensitivity

Culture (if Micro +ve or contact of GC)
Urethral or Endocervical

24
Q

Treatment of gonorrhoea?

A

First-line: Ceftriaxone 500 mg IM
Second-line: Cefixime 400 mg oral (only if IM injection is contra-indicated or refused by patient)
Test of cure in all patients

25
Q

Symptoms of genital Herpes (primary infection)?

A 
Blistering and ulceration of the external genitalia
Pain
External dysuria
Vaginal or urethral discharge
Local lymphadenopathy
Fever and myalgia (prodrome)
26
Q

Which virus are recurrent episodes of genital herpes associated with?

A

HSV-2

Note: often overlooked/misdiagnosed as “thrush“ (mild, localised anogenital tingling, burning or soreness)

Minimal systemic symptoms, resolves within 5-7 days

27
Q

Investigations for genital herpes?

A

Swab base of ulcer for HSV PCR

28
Q

Management of genital herpes?

A

Give oral antiviral Treatment (Aciclovir 400mg TDS x 5/7)
Consider topical Lidocaine 5% ointment if very painful
Saline bathing
Analgesia

29
Q

Special circumstances for herpes?

A

Pregnancy due to risk of neonatal herpes

Inform O+G (review birth plan)

30
Q

Most common viral STI in UK?

A

HPV

31
Q

High risk HPV genotypes?

A

16 & 18

32
Q

HPV genotypes associated with anogenital warts?

A

6 & 11

33
Q

HPV genotypes associated with palmoplantar warts?

A

1 & 2

34
Q

HPV genotypes associated with cellular dysplasia?

A

16

35
Q

HPV genotypes associated with vast majority of cervical, anal, penile, vulval and oropharyngeal?

A

18

36
Q

How is HPV transmitted?

A

Likely to have acquired HPV from asymptomatic partner

37
Q

Treatment for HPV?

A

Podophyllotoxin (Warticon)
Cytotoxic
Not licensed for extra genital warts (but widely used)

Imiquimod (Aldara)
immune modifier
can be used on all Anogenital warts

Cryotherapy
Cytolytic can require repeat treatments

Electrocautery

38
Q

Bacterium associated with syphilis?

A

TREPONEMA PALLIDUM

39
Q

How is syphilis transmitted?

A

Sexual contact
Trans-placental/during birth
Blood transfusions
Non-sexual contact – healthcare workers

40
Q

Signs and symptoms associated with primary syphilis?

A 
primary chancre (painless)
Non-tender local lymphadenopathy
41
Q

Signs and symptoms of secondary syphilis?

A

Skin (macular, follicular or pustular rash on palms + soles)
Lesions of mucous membranes
Generalized Lymphadenopathy
Patchy Alopecia
Condylomata Lata (most highly infectious lesion in syphilis, exudes a serum teeming with treponemes)

42
Q

Diagnosis of syphilis?

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

43
Q

Serological tests for syphilis?

A

NON-TREPONEMAL
VDRL (Venereal Disease Research Laboratory)
RPR (Rapid Plasma Reagin)

TREPONEMAL
TPPA (Treponemal Pallidum Particle Agglutination)
ELISA/EIA (Enzyme Immunoassay) - SCREENING TEST
INNO-LIA (Line immunoassay)
FTA abs (Fluorescent Treponemal Antibody absorbed)

44
Q

Treatment for syphilis?

A

Early Syphilis
2.4 MU Benzathine penicillin x 1

Late Syphilis
2.4 MU Benzathine penicillin x 3

45
Q

Serological follow up for syphilis?

A

Until RPR 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 (6 decks)

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