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MD3002 Pathology > Sexually Transmitted Infections > Flashcards

Sexually Transmitted Infections Flashcards

1
Q

What are the most common STIs in the UK?

A
  • Chlamydia
  • Human papilloma virus
  • Neisseria gonorrhoeae
  • HErpes simplex virus
  • Treponema pallidum (syphilis)
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2
Q

What is the average number of new sexual partners over a 5 year period for men and women?

A
  • Men: 3.8

- Women 2.4

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3
Q

What are the risk factors for STIs?

A
  • Young age
  • FAilure to use barrier contraceptives
  • Non-regular sexual relationships
  • Men who have sex with men
  • IV drug use
  • African origin
  • Social deprivation
  • Sex workers
  • Poor access to advice and treatment of STIs
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4
Q

What are the determinants of risky sexy behaviour?

A
  • Individual factors: low self-esteem, lack of skills, lack of knowledge of the risks of unsafe sex
  • External influences: peer pressure, attitudes and predjudices of society
  • Service provision: accessibility of sexual health services and/or lack or resources such as condoms
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5
Q

What are the 3 basic ways we can test for STIs?

A
  • NAATs (chlamydia, gonnorhoea, herpes)
  • Microscopy, culture and sensitivity (gonnorhoea, candida, Bacterial vaginosis, trichomonas vaginalis)
  • Blood tests (syphilis, HIV, Hepatitis)
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6
Q

What are the features of chlamydia trachomatis?

A
  • Obligate
  • Intracelluar
  • Gram -ve
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7
Q

What are the different chlamydia serotypes?

A
  • A, B, C - trachoma
  • D-K - genital infection
    L1, L2, L3 - lymphogranuloma venereum cancer
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8
Q

What are the chlamydia symptoms in men?

A
  • Urethral/anal discharge
  • Epididymal tenderness
  • Prostatitis
  • Reiter’s syndrome
  • Procitis
  • Pharyngitis
  • Perihepatitis - upper abdominal pain
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9
Q

What are the chlamydia symptoms in women?

A
  • Vaginal/anal discharge
  • Post-coital bleeding
  • Abdominal tenderness
  • Pelvic tenderness
  • Infertility
  • Reiter’s syndrome
  • Procitis
  • Pharyngitis
  • Perihepatits - upper abdo pain
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10
Q

What are some complications with chlamydia?

A 
Pelvic inflammatory disease (1-30%)
- Tubal infertility (1-20%)
Sexually acquired reactive arthritis (+ Reiter's)
Epididymo-orchitis 
Peri-hepatitis
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11
Q

What is associated with Reiter’s?

A
  • Urethritis
  • Conjunctivitis
  • Arthritis
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12
Q

Where can chlamydia and gonorrhoea investigations be taken from?

A 
Women 
- Vulvo-vaginal swab (VVS) self taken 
Men 
- First catch urine (FCU)
Extra genital sites:
- Rectal/pharyngeal
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13
Q

What is the treatment of chlamydia?

A
  • Doxycycline 100mg twice daily 7 days
  • Avoid sexual contact
  • Partner notification
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14
Q

What is Lymphogranuloma venerum (LGV)?

A
  • Caused by one of 3 invasive serovars (L1-3) of chylamydia trachomatis
  • Presents with solitary genital lesion, proctitis, lympadanpothay
  • Treated with doxycycline
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15
Q

What are the main feaatures of neisseria gonorrhoeae?

A
  • Gram negative

- Intracellular diplococcus

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16
Q

What do the neisseria gonorrhoeae cells infect?

A
  • Epithelial cells of mucous membrane of GU tract or rectum

- Development of localised infection with production of pus

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17
Q

What percentage of men have symptoms of gonorrhoea compared with chlamydia?

A
  • Gonorrhoea - 90%

- Chlamydia - 10%

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18
Q

What percentage of women will be asymptomatic with gonorrhoea?

A

50%

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19
Q

What does female urethral infection involve?

A

Dysuria +/- frequency

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20
Q

What does endocervical gonorrhoea infection involve?

A
  • 50% increased/altered vaginal discharge
  • 25% lower abdo pain
  • Occasionally inter-menstraul bleeding (IMB)
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21
Q

What can rectal and pharyngeal gonorrhoea present with?

A

Rectal
- Mostly asymptomatic but can present with anal d/c/pain/discomfort
Pharyngeal
- Mostly asymptomatic but can present with sore throat

22
Q

What is the difference between gonorrheal and chlamydia discharge?

A

Gonorrhea thicker, chlamydia more watery

23
Q

How is confirmed uncompliccated gonorrhoea treated?

A
  • Ceftriaxone - 1 g IM (most strain respond to this)

- Ciprofloxacin 500mg orally (when antimicrobial susceptibility is known)

24
Q

What percentage of gonorrhoea is resistant to ciprofloxacin?

25
Q

What should be done if someone is exposed to gonorrhoea after 14 days (e.g parnter of someone who tested positive)?

A

Test then treat if positive (if less than 14 days organism may not have developed could treat or could wait 14 days)

26
Q

What organism causes thrush?

A

Candida albicans

27
Q

What is thrush?

A

Acute dermatitis of vulva/vagina caused by invasion of commensal yeasts - usually candida albicans (80-90%)

28
Q

What does thrush present with?

A
  • Itch
  • Vulval pain
  • Superfcial dyspareunia
  • Curd like white vaginal discharge
29
Q

How is thrush treated?

A

Topical clotrimazole

30
Q

What does primary syphilis present with?

A

Hard genital or oral ulcer at site of infection after about 3 weeks (asymptomatic for up to 24 weeks)

31
Q

What does secondary syphilis present with?

A
  • Red maculopapular rash anywhere plus pale moist papules in urogenital region and mouth *condyloma lata)
    (can be latent for 3-30 years)
32
Q

What does tertiary syphilis involve?

A

Degeneration of nervous system, aneurysms and granulomatous lesions in liver, skin and bones (gummas) in about 40% of patients

33
Q

How can syphilis be diagnosed?

A
  • From lesions or infected lymph nodes
  • Dark field microscopy
  • Direct fluoresccent antibody (DFA) test
  • NAAT
  • EIA - can be for immunoglobulin M for early infection or IgG (the latter becomes positive at 5 weeks) or both
34
Q

How is early syphilis treated (primary, secondary or early latent)?

A

Benzathine penicillin G 2.4 MU IM single dose

35
Q

How is late latent, CV and gummatous syphilis treated?

A

Benzathine penicillin 2.4 MU IM weekly for 3 weeks (3 doses)

36
Q

How is neurosyphilis including neurological/opthalmic involvement in early syphilis treated?

A
  • Procain penicillin 1.8 - 2.4 MU IM OD plus probenecid 500mg PO QDS for 14 days: 1C
  • Benzylpenicillin 10.8-14.4g daily, given as 1.8-2.4g IV every 4h for 14 days
37
Q

What HPV types cause genital warts?

38
Q

What does HPV cause?

A

Induces hyperplastic epithelial lesions, types exhibit tissue/cell specificity

39
Q

How long can the incubation period be for HPV?

A

3 weeks - 8 months

40
Q

What percentage of the population is infected with HPV?

41
Q

How can HPV be treated?

A
  • Podophyllum
  • Cryo
  • Laser
  • Surgery
42
Q

What can HSV be subdivided into?

A
  • HSV type 1 - usually affects the oral region and causes cold sores
  • HSV type 2 - associated with genital infection (penis, anus, vagina)
    Both can infect mouth and/or genitals due to oral sex or autoinoculation
43
Q

What dos the primary infection of genital herpes involve?

A
  • Febrile flu-like prodrome (5-7 days)
  • Tingling neuropathic pain in genital area/buttocks/legs
  • Extensive bilateral crops of painful blisters/ulcers in the genital area including the vagina and cervix in women
  • Tender lymph nodes 9inguinal)
  • Local oedema
  • Dysuria
  • Vaginal/urethral discharge
44
Q

How is the primary infection of genital herpes treated?

A
  • Saline bathing
  • Local anesthetics
  • Aciclovir - if within 5 days of the start of the episode
45
Q

Where does herpes become latent?

A

Local sensory ganglia

46
Q

What is the recurrence of herpes like?

A
  • Periodic reactivation which can cause symptomatic lesions or asymptomatic but stil infectious
  • Episodes udually shorter (<10days)
  • Attacks become less frequent over time
  • ~ HSV-1 - 1 attack in subsequent 12 months
  • HSV-2 - 4 attacks in the subsequent 12 moths
47
Q

How long after primary infection can HSV become antibody positive?

48
Q

What can serology of HSV identify?

A
  • Those with an asymptomatic infection

- Can distinguish between the 2 types of HSV

49
Q

How is HSV diagnosed?

A
  • Clinical appearence
  • Viral culture
  • DNA detection using NAAT of a swab from the base of the ulcer / vesicle fluid
  • Serology
50
Q

What is PrEP?

A
  • Pre-exposure prophylaxis for HIV

- Free in NHS scotland

51
Q

What bacteria causes syphilis?

A

Treponema pallidum

MD3002 Pathology (19 decks)

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