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3rd yr- IWB- Pathology > Sexually transmitted infections > Flashcards

Sexually transmitted infections Flashcards

1
Q

Name the 8 most common STIs

A
  1. Syphilis
  2. Gonorrhea
  3. Chlamydia
  4. Trichomoniasis
  5. Hepatitis B
  6. Herpes Simplex
  7. HIV
  8. Human papilloma virus (HPC)
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2
Q

Name the 4 STIs that are curable

A
  1. Syphilis
  2. Gonorrhea
  3. Chlamydia
  4. Trichomoniasis
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3
Q

Name the 4 STIs that are incurable (at present)

A
  1. Hepatitis B
  2. Herpes Simplex
  3. HIV
  4. Human papilloma virus (HPC)
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4
Q

How many people in the world have genital herpes?

A

500 million

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5
Q

How many women in the world have HPV?

A

290 million

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6
Q

How many STIs were reported in England?

A

447,694

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7
Q

How do we treat bacterial and parasitic STIs

A

Single dose antibiotics

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8
Q

Which STIs are caused by bacteria?

A

Chlamydia
Gonorrhoea
Syphilis

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9
Q

Which STIs are caused by parasites?

A

Trichomoniasis

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10
Q

How do we treat Herpes/ HIV?

A

Antivirals can modulate the disease but cannot cure it

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11
Q

How do we treat hepatitis B?

A

Antivirals can modulate th virus and slow the liver damage but can’t cure it

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12
Q

Have the cases of Syphilis increased or decreased since 2018?

A

Increased

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13
Q

Have the cases of Gonorrhoea increased or decreased since 2018?

A

Increased

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14
Q

Have the cases of herpes increased or decreased since 2018?

A

Increased

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15
Q

Have the cases of genital warts increased or decreased since 2018?

A

decreased (because of the HPV vaccine)

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16
Q

How do we classify STIs?

A

In two categories:

  1. Bacterial (or parasitic) origin
  2. Viral
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17
Q

Describe STIs that are bacterial (or parasitic) in origin

A
  1. Often asymptomatic
  2. Damage usually occurs prompt to treatment
  3. Treated with antibiotics
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18
Q

Describe STIs that are viral in origin

A
  1. Cannot be cured
  2. We treat the symptoms
  3. Remains in the body and can reoccur
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19
Q

List the STIS that are of a viral origin

A
  1. Herpes
  2. HPV
  3. Hep B
  4. HIV
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20
Q

What are the risk factors of STIs

A
  1. Unprotected sex
  2. Oral sex
  3. Multiple partners
  4. Previous STIs
  5. Alcohol and recreational drug misuse
  6. injecting drugs
  7. Meds for erectile dysfunction
  8. Being young
  9. Holiday sex
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21
Q

Is syphilis chronic or acute?

A

Chronic

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22
Q

Name the bacteria that causes syphilis

A

Treponema pallidum

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23
Q

How is syphiliss spread?

A

Almost exclusively transmitted sexually
But in some cases can be mother to child (vertical)
Very rarely can be transmitted haematogenously

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24
Q

How many stages does syphilis have and what are they?

A
  1. Primary
  2. Secondary
  3. Latent
  4. Tertiary
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25
Q

When does primary syphilis develop?

A

Usually 2-3 weeks after primary infection

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26
Q

Describe the clinical presentation and symptoms of primary syphilis

A
  1. Theres usually a lesion (chancre) at the site of infection
  2. Progresses to an ulcer over 7 days
  3. Is painless, solitary, indurates and has a clean base
  4. Can be found on the glans, corona, labia, fourchette or perineum
  5. Can be extra genital (EG oral cavity)
  6. Localused painless lymph nose enlargement (lymphadenopathy)
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27
Q

Does the chancre caused by primary syphilis heal?

A

Yes it can heal naturally with or without treatment

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28
Q

How does syphilis spread around the body?

A

By haematological and lymphatic dissemination

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29
Q

How can we treat syphilis?

A

With benzathine penicillin, doxycycline

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30
Q

When dos secondary syphilis develop?

A

2weeks - 6 months post exposure

Concurrent or up to 8 weeks after chance

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31
Q

Describe the clinical presentation and symptoms of secondary syphilis

A
  1. Painless superficial lesion of skin / mucosa
  2. Can show up on the palms and soles of feet
  3. rash diffuses and is often symmetric
  4. In moist areas of the skin you can find opercular lesions called condylomata lata
  5. Enlarged lymph nodes
  6. Neuro syphilis
  7. Milk meningeal signs may be present (40% of patients)
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32
Q

Describe the symptoms of secondary neurosyphilis

A
  1. Visual changes (Retinal necrosis)
  2. CN nerve palsies
  3. Aspetic meningitis syndrome (head aches / Meningismus)
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33
Q

How long does secondary syphilis last?

A

Several weeks and then the person enters the latent stage

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34
Q

Are the symptoms and effects of neurosyphilis at any stage of syphilis the same?

A

NO

Neurosyphilis of secondary syphilis is mild and not the same as neurosyphilis of tertiary syphilis

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35
Q

Describes what happens in the latent syphilis phase

A
  1. It is asymptomatic
  2. The disease goes ‘quiet’
  3. Secondary reinfection occurs 25% of the time
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36
Q

Define latent

A

UK defines it as less than a year post infection

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37
Q

Name the 3 main clinical manifestations of tertiary syphilis

A
  1. Neurosyphilis
  2. Cardiovascular
  3. Benign tertiary/ gummatous
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38
Q

When does tertiary syphilis develop?

A

in 1/3 UNTREATED patient this will usually develop after a latent period of 5 years or more

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39
Q

Is tertiary syphilis more common in treated or untreated patients

A

Untreated

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40
Q

Name the 3 components of neurosyphilis

A
  1. Meningovascular syphilis
  2. General paresis
  3. Tapes dorsalis
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41
Q

What is effected if someone has Meningovascular syphilis?

A

The meninges around the brain are affected (base of the brain, cerebral convexities and spinal leptomeninges)

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42
Q

Describe what happens to a person who has meningovascular neurosyphilis

A
  1. Obliterative vascular inflammation occurs in the brain (Heubner arteries)
  2. Inflammation of small/ medium CNS arteries which can lead to stroke or stroke like symptoms
  3. Cerebral gummas in the meninges and can extend into the parenchyma
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43
Q

What are cerebral gummas?

A

Plasma rich mass lesions

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44
Q

What happens in general paresis?

A

Invasion of the brain by T. palladium

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45
Q

Give some symptoms are clinical presentations of general paresis

A
  1. Memory loss
  2. Personality change
  3. Depression, mania and psychosis
  4. Dysarthria
  5. Hypotonia, tremor
  6. Insidious progressive cognitive impairment associated with mood alterations
  7. Ends with severe dementia
46
Q

What does general paresis usually end with?

A

Severe Dementia

47
Q

What happens in tabes dorsalis?

A

Affects the nerves final column/ peripheral nerves

48
Q

Give some symptoms and clinical presentations of tabes dorsalis

A
  1. Lighting pains (severe unprovoked pain)
  2. Ataxia
  3. Argyll Robinson pupil
  4. Loss of pain sensation leading to skin and joint damage (Charcot joints)
49
Q

What is ataxia?

A

Loss of proprioception

50
Q

What is the Argyll Robinson pupil?

A

It is a strong specific sign for syphilis and effects the pupils

51
Q

What are the symptoms of Argyll Robinson pupil?

A

Bilateral small pupils that react to near objects

52
Q

What don’t Argyll Robinson pupils react to

A

DONT react to light only to close objects

53
Q

How common is neurosyphilis?

A

Very rare (less than 0.5% of all syphilis case)

54
Q

What can happen if you develop cardiovascular tertiary syphilis?

A

Leads to syphilitic aortitis

  1. Aneurysm proximal aorta
  2. Aortic valve insufficiency
  3. Coronary artery disease
55
Q

Describe how the aorta is affected in a patient with cardiovascular syphilis

A
  1. Inflammation of proximal aorta
    This leads to the occlusion of the vasa vasorum which causes scarring of proximal aortic ultimately leading to loss of elasticity
  2. Progressive dilation of aortic arch/ root which leads to aortic valve insufficiency and aneurysms of the proximal aorta
56
Q

Describe how the coronary arteries are affected in a patient with cardiovascular syphilis

A

Narrowing coronary artery ostia occurs which can lead to myocardial ischemia

57
Q

What happens in a patient with benign tertiary gummatous syphilis?

A

They form gummas in their bones, skin and mucous membranes of their upper airway and mouth

58
Q

How can we detect syphilis

A
  1. Direct detection using microscopy or PCR

2. Serology (Blood tests)

59
Q

Which 2 blood tests can we carry out to investigate syphilis

A
  1. VDRL: Non specific IgG/ IgM (quantative-corresponds to stage of disease and can change with therapy)
  2. TPPA: specific anti Tp. Palidum antibodies (qualitative - is raised for life)
60
Q

Which of the 2 blood tests when investigating syphilis is used to check therapy response?

A

VDRL

61
Q

How can we diagnose neurosyphilis?

A
  1. Spinal tap
  2. CSF testing
  3. CT scan for gummas
62
Q

What is the treatment for syphilis?

A

Penicillin

63
Q

Name the most common STI in the uk

A

Chlamydia trachomatis

64
Q

Why is chlamydia so prevalent in the UK?

A

As more than 50% of patients are asymptomatic so the diseases goes undetected and is passed on

65
Q

What part of the body is affected by chlamydia in women

A

Cervix and or urethra

They can get vaginal discharge or dysuria

66
Q

What part of the body is affected by chlamydia in men

A

Urethra

They can get dysuria and epididymitis

67
Q

How is chlamydia diagnosed?

A

By checking urine or taking a swab

68
Q

Why is chlamydia dangerous

A

It can put you at risk of getting secondary (more dangerous) diseases:

  1. PID
  2. Endometriosis
  3. Premature births / infertility
  4. Reactive arthritis of the joins, urethra and the eyes
69
Q

What should you look out for in the oral cavity if you suspect a patient has chlamydia?

A

Theres no specific oral manifestation but look out for a sore throat, pharyngitis/ tonsillitis

70
Q

How is chlamydia treated?

A

Antibiotic therapy: Azithromycin or doxycycline

71
Q

Name the second most common STI in the uk

A

Gonorrhoea

72
Q

What is gonorrhoea caused by?

A

Gram negative aerobic bacteria called neisseria gonorrhoeae

73
Q

How is gonorrhoea usually transmitted?

A

Almost exclusively transmitted sexually

Rare cases of vertical transmission

74
Q

How are women affected by gonorrhoea?

A 
50% are asymptomatic 
Those who aren't can suffer from:
1. Urethral or vaginal discharge
2. Dysuria 
3. PID
75
Q

How are men affected gonorrhoea

A

Dysuria, urethral discharge, epididymitis

76
Q

What does PID stand for?

A

Pelvic inflammatory disease

77
Q

How is gonorrhoea treated?

A 
Intermuscular Ceftriaxone (125g)
Oral cefixime (400g)
Oral azithromycin (1g)
78
Q

What is drug resistant gonorrhoea resistant to?

A

Injectable gentamicin combined with oral azithromycin or oral gemifloxacin

79
Q

What are some of the oral manifestations of gonorrhoea?

A
  1. Gonococcal pharyngitis following oral genital contact
  2. Sore throat with redness exudates
  3. N. gonorrhoeae cultured with 70% oropharyngeal gonorrhoea
80
Q

What is pelvic inflammatory disease (PID)

A

Ascending infection of vulva/ vagina with spread to other areas of female genital system

81
Q

What symptoms are associated with initial pelvic inflammatory disease(PID)

A
  1. Pelvic pain
  2. Adnexal (lower abdomen) tenderness
  3. Fever
  4. Vaginal discharge
82
Q

Other than STIs how else may a patient develop PID

A

Puerperal infections:

Post spontaneous abortion, normal or abnormal deliveries

83
Q

What are the main causes of PID?

A
  1. Gonorrhoea

2. Chlamydia

84
Q

Why is scarring in the Fallopian tubes dangerous?

A

Can lead to infertility

85
Q

List some of the acute complications of PID?

A

Peritonitis and bacteremia

May cause endocarditis, meningitis and supportive arthritis

86
Q

List some of the chronic complications of PID

A
  1. Infertility and tubal obstruction
  2. Pelvic pain
  3. Intestinal obstruction due to adhesion between the bowel and pelvic organs
  4. ECTOPIC PREGNANCY
87
Q

How do we treat PID?

A

Antibiotics

88
Q

What is ectopic pregnancy?

A

When a fertilised egg sits in the wrong place in the Fallopian tube due to inflammation and the embryo can start growing in the fallopian tube and can cause it to rupture

89
Q

Why is HPV dangerous?

A

It can cause cancer

90
Q

How can HPV spread?

A

Orogenital contact

Entry via basal epithelia layer through micro abrasion in genital skin during sexual contact

91
Q

Name the lesions that can form in a patient with HPV

A
  1. Sq. papiloma
  2. Verruca vulgaris
  3. Condyloma acuminatum
92
Q

How many types of HPV are there?

A

40

93
Q

What are HPV type 6 and 11 describes as and why

A

Low risk as they down cause cancer

94
Q

Why are HPV types 16 and 18 important

A

As they are high risk and can cause cancer (cervical, head and neck)

95
Q

What is the average incubation period for HPV type 6 and 11?

A

3 months but can Be anywhere between 3 weeks to 2+ years

96
Q

When are you most infectious to others if you have hpv?

A

When you have visible warts

97
Q

How do the warts associated with HPV get treated

A

Majority of patients clear the infection by themselves but if they don’t:

  1. Abiative therapies like cryotherapy, electrocautery
  2. Immune modulation
  3. Surgical removal of warts
98
Q

Are condoms useful in minimising the spread of HPV?

A

NO they do not eliminate viral transmission

99
Q

Which types of HPV dont cause warts?

A

Types 16, 18 (high risk)

100
Q

Name the 2 types of herpes simplex

A
  1. Herpes simplex virus type 1 (HSV-1)

2. Herpes simplex virus type 2 (HSV-2)

101
Q

How is HSV-1 transmitted?

A

Through oral to oral contact and can cause cold sores or oral herpes

102
Q

How is HSV-2 transmitted?

A

Sexually transmitted and can cause genital herpes

103
Q

What do both HSV1 and HSV2 have in common?

A

They are both life long infections

104
Q

What are some of the symptoms of herpes

A

Painless blister or ulcers at the site of infection

105
Q

When is herpes simplex most contagious?

A

Most contagious when symptoms are present but can still be transmitted in the absence of symptoms (but can be transmitted without symptoms)

106
Q

What is the relationship between HSV and HIV?

A

Infection with HSV2 increases the risk of acquiring an transmitting HIV

107
Q

Des rice the clinical manifestations and symptoms of HSV1

A

Cold sores
Genital infection
Cervical lymphadenopathy
Malise, fever and irritability

108
Q

What are cold sores?

A

Vesicles that coalesce and form larger vesicles
Found many on the junction of lip and skin
They can rupture to release live viral particles that can infect others

109
Q

Is there a cure for HSV?

A

No anti virals can attenuate the symptoms but can’t cure

110
Q

What are the differences in the oral manifesto of HSV1 and HSV2

A

Oral lesions are clinically indistinguishable from each other

3rd yr- IWB- Pathology (11 decks)

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