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Obstetrics + Gynaecology > Sexually Transmitted Infections > Flashcards

Sexually Transmitted Infections Flashcards

1
Q

What is PID?

A

Infective inflammation of endometrium, uterus, fallopian tubes (salpingitis), ovaries + peritoneum

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2
Q

What are the clinical features of PID?

A 
May be asymptomatic
Deep dyspareunia
Menstrual abnormalities
Post-coital bleeding
Dysuria
Abnormal discharge - purulent/smelly

If severe:

  • fever
  • nausea + vomiting
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3
Q

How is PID diagnosed?

Which additional investigations should be done?

A 
Endocervical swabs (for chlamydia + gonorrhoea)
High vaginal swab (for trichomonas vaginalis + bacterial vaginosis)

Additional:

  • full STI screen
  • urine dipstick +/- MSU (exclude UTI)
  • pregnancy test
  • transvaginal USS
  • laparoscopy (if very severe + diagnostic uncertainty)
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4
Q

What is the treatment for PID?

A

Broad spectrum antibiotics:

  • doxycycline, ceftriaxone + metronidazole
  • OR ofloxacin + metronidazole
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5
Q

When might a patient require admission for PID?

A

If pregnant, especially if risk of ectopic
Severe symptoms: N&V, fever
Signs of pelvic peritonitis
Unresponsive to antibiotics, need for IV therapy

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6
Q

What are the complications of PID?

A 
Ectopic pregnancy (scarring)
Infertility
Tubo-ovarian abscess
Chronic pelvic pain
Fitz-Hugh Curtis syndrome (perihepatitis --> RUQ pain)
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7
Q

What are the different subtypes of chlamydia?

A

Chlamydia trachomatis:

  • types A-C –> ocular infection
  • types D-k –> genitourinary infection
  • types L1-L3 –> lymphogranuloma venereum (LGV)
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8
Q

What is LGV?

A

Chlamydia infection in men who have sex with men –> proctitis
- rectal pain, discharge + bleeding

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9
Q

What are the symptoms and signs of chlamydia in women?

A 
Many asymptomatic
Dysuria
Abnormal discharge
Intermenstrual or post-coital bleeding
Deep dyspareunia 
Lower abdominal pain

Signs:

  • cervicitis +/- contact bleeding
  • mucopurulent discharge
  • pelvic tenderness
  • cervical excitation
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10
Q

What are the features of chlamydia in men?

A

Urethritis –> dysuria + urethral discharge

Epididymo-orchitis –> testicular pain

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11
Q

How is chlamydia diagnosed?

A

NAAT –> nucleic acid amplification test, 14 days post-exposure
- women: vulvo-vaginal swab
- men: first catch urine sample
If indicated - swabs from rectum, eye + throat

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12
Q

What is the treatment for chlamydia?

A

Doxycycline 100mg twice daily for 7 days

or Azithromycin 1g stat followed by 500mg daily for 2 days

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13
Q

What advice should be given regarding sexual intercourse following chlamydia diagnosis?

A

Avoid sex (including oral) until they and/or their partner have completed treatment

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14
Q

What are the complications of chlamydia infection?

A 
PID
Ectopic
Infertility
Conjunctivitis
Sexually acquired reactive arthritis/Reiter's syndrome
Transmission to neonate
Fitz-Hugh Curtis syndrome
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15
Q

What causes gonorrhoea?

A

Neisseria gonorrhoea - gram negative diplococcus

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16
Q

How does gonorrhoea present and how is it diagnosed?

A

Very similar to chlamydia
NAAT - screening test
Microscopy if symptomatic
Culture if micro +ve

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17
Q

How is gonorrhoea treated?

A

Single dose IM cefriaxone 1g
- if symptoms suggestive, treat without waiting for test result
Usually treat for chlamydia at same time
TEST OF CURE FOR ALL PATIENTS

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18
Q

What are the complications of gonorrhoea?

A 
PID
Epididymo-orchitis
Prostatitis
Disseminated gonococcal infection --> joint pain + skin lesions
Gonococcal meningitis
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19
Q

What causes syphilis?

A

Treponema pallidum - spirochete gram negative bacteria

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20
Q

What happens in primary syphilis?

A

Chancre - painless ulcer on genital site

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21
Q

What happens in secondary syphilis?

A

3 months post infection:

  • rash on hands and soles
  • fever
  • malaise
  • arthralgia
  • weight loss
  • headaches
  • condylomata lata (warts in moist areas)
  • painless lymphadenopathy
  • silvery grey mucous membrane lesions
22
Q

What happens after secondary syphilis?

A 
Enter asymptomatic latent phase
Tertiary syphilis can present may years after initial infection:
- gummatous syphilis (granulomas)
- neurosyphilis
- cardiovascular syphilis
23
Q

How is syphilis diagnosed?

A 
Demonstration of bacteria from lesions or infected lymph nodes:
- Dark Field Microscopy
- PCR
Serological testing:
- antibody to pathogenic treponemes
24
Q

What is the treatment for syphilis?

A

Benzathine penicillin IM

25
Q

What causes genital warts?

A

HPV 6 + 11

26
Q

How are genital warts managed?

A 
Often resolve spontaneously over time
Topical treatments:
- Podophyllotoxin
- Imiquimod
Physical ablation:
- excision
- cryotherapy
- electrosurgery
- laser surgery
27
Q

What causes genital herpes?

A

HSV-1 and HSV-2

Spread from sexual contact or oral sex with someone who has a cold sore

28
Q

How is herpes diagnosed?

A

Swab from open sore –> PCR

29
Q

What is the management for genital herpes?

A

Oral Aciclovir
Topical lidocaine 5% ointment if very painful
Saline bathing
Analgesia

30
Q

What causes trichomonas vaginalis (TV)?

A

Anaerobic flagellated protozoa

vaginal UPSI, not through oral or anal sex

31
Q

What are the symptoms of TV?

A

Offensive vaginal odour
Abnormal discharge - thick/thin/frothy and yellow-green
Itchiness or sore vulva
Dyspareunia
Dysuria
Strawberry cervix (punctate and papilliform appearance)

32
Q

How is TV diagnosed?

A

High vaginal swab (female) or urethral swab/first void urine (male) for culture

33
Q

How is TV treated?

A

Metronidazole

34
Q

What is bacterial vaginosis (BV)?

A

NON sexually transmitted infection of lower genital tract in females
Due to disturbance in normal vaginal flora –> increase in vaginal pH

35
Q

What are the risk factors for BV?

A 
Sexual activity
IUD
Receptive oral sex
Presence of STI
Vaginal douching, scented soaps
Recent antibiotic use
Ethnicity (black)
Smoking
36
Q

What are the features of BV?

A

Offensive, fishy vaginal discharge

Thin, white/grey discharge

37
Q

How is BV diagnosed?

A

High vaginal smear –> microscopy

  • presence of CLUE CELLS
  • reduced numbers of lactobacilli
  • absence of pus cells
38
Q

What is the treatment for BV?

A

Metronidazole

39
Q

What are the risk factors for vulvo-vaginal candidiasis (thrush)?

A 
Pregnancy
Diabetes
Use of antibiotics
Use of steroids
Immunosuppression
40
Q

What are the features of vaginal thrush?

A

ITCH
White, curd like, non-offensive discharge
Dysuria
Erythema + swelling of vulva
Satellite lesions: red, pustular lesions with superficial white/creamy plaques that can be scraped off

41
Q

What is the treatment for vaginal thrush?

A

Intravaginal antifungal e.g. clotrimazole
Oral antifungal

If not resolved in 7-14 days:

  • consider alternative diagnosis
  • consider predisposing risk factors and address
42
Q

How is the treatment of vaginal thrush different in pregnancy?

A

DO NOT give oral antifungals

- use vaginal antifungals only

43
Q

What kind of virus is HIV?

A

Single stranded RNA retrovirus that infects and replicated within CD4 cells (T helper cells)

44
Q

What happens during the seroconversion stage of HIV?

A

2-6 weeks after exposure - flu-like illness:

  • fever
  • muscle aches
  • malaise
  • lymphadenopathy
  • maculopapular rash
  • pharyngitis
45
Q

What happens after the seroconversion stage of HIV?

A

Latent asymptomatic phase

Then symptomatic phase

46
Q

What happens during the symptomatic phase of HIV?

A

Weight loss
High temperatures
Diarrhoea
Frequency minor opportunistic infections e.g. herpes zoster or candidiasis

If left untreated –> AIDS

47
Q

How is the development of AIDS characterised?

A

AIDS defining illnesses (infections + malignancies):

  • pneumocystis jiroveci
  • non-Hodgkins lymphoma
  • TB
48
Q

How is HIV diagnosed?

A

Fourth generation tests

–> test for serum or salivary HIV antibodies and p24 antigen

49
Q

How is HIV monitored?

A 
CD4 count
HIV viral load
FBC
U&Es
Urinalysis
ALT, AST and bilirubin
50
Q

How is HIV transmission to the baby avoided in pregnancy?

A

Antenatal antiretroviral therapy during pregnancy and delivery
Avoidance of breastfeeding
Neonatal post-exposure prophylaxis

Obstetrics + Gynaecology (22 decks)

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