Sexually Transmitted infections and HIV

Question 1

What are issues in STIs

Answer 1

Always more than one patient- always have to talk to the person in front of you about someone else such as the sexual partners and their children

Vertical transmission

Partner notification

Confidentiality

High rates of re-infection - every time you get infected with chylamdia and every time you get infected you have an enhanced inflammatory reaction therefore this can effect fertility

May be life-long infection

Stigma and psychological morbidity

Question 2

what are the risks of STIs

Answer 2

Age - depends on age, anyone can get one but shift towards younger ages

Sexual partner - male will depend on whether they have exclusively male or female parterres, sex between men has a higher risk of STIs

Sexual practice - type of sex that you have, certain sort of sex have a higher risk - anal and vaginal sex has a higher transmission than oral sex

Condom usage - present STIs

Ethnicity

Area of residence

Question 3

what is the impact of STI the highest in

Answer 3

Heterosexuals under age 25
MSM
Black ethnic minorities

Question 4

what is the most common STI

Answer 4

Chlamydia

Question 5

what has a large increase in STI diagnosis in male and male sex

Answer 5

Syphilis 20% increase

Gonorrhoea 22% increase with increasing drug resistance

Question 6

what is the full name for chylamydia

Answer 6

Chlamydia trachomatis

Question 7

what has caused the reduction in chlamydia

Answer 7

• chlamydia screening has decreases the diagnosis rate

Question 8

What STIs are common in women

Answer 8

• warts heights
• herpes
• gonorrhoea
• syphilis

Question 9

what are the common STIs in mean

Answer 9

• Warts
• Gonorrhoea - increasing rate
• herpes
• syphilis

Question 10

What type of pathogen in chylamydia trachoma’s

Answer 10

Obligate intracellular pathogen

Question 11

what symptoms cause show in chlamydia trachomatis

Answer 11

• asymptomatic infection common

Question 12

What is a serorvars

Answer 12

distinct variation within a species of bacteria/ virus or in immune cells of different individuals

Question 13

what symptoms can serovars D-K

Answer 13

Males - Urethritis - clear watery discharge, epipdidymitis, prostatitis

Females - Cervicitis(increase in vaginal discharge, spotting after sexual intercourse), Pelvic Inflammatory Disease, Fitz-Hugh Curtis - intra-abdominal syndrome

Neonate - conjunctivitis and pneumonia

Question 14

what symptoms can serovars L1-3 cause

Answer 14

Lymphogranuloma venereum (lymphatic issues)
-   Buboes, proctitis

• usually rectally acquired, can cause abdominal pain and change in bowel habits

Question 15

what are the complications of chlamydia trachomatis

Answer 15

• reactive arthritis - due to reaction inflammatory processes that has been triggered by the presence of chlamydia in the genital tract
• infertility - more often you have chlamydia the more your infertility can go up - can cause tubule damage and lead to ectopic pregnancy

Question 16

what are the types chlamydia trachomatis

Answer 16

serovars D-K

serovars L1-3 cause

Question 17

What is the treatment of chlamydia trachomatis

Answer 17

Azithromycin, Doxycycline

Question 18

what are the features of chlamydia in the neonate

Answer 18

Neonate - conjunctivitis and pneumonia

Question 19

What are the symptoms of Neisseria gonorrhoea

• males
• females
• neonates

Answer 19

Males – Urethritis, proctitis (rectally acquired), sore throat, epididymitis, prostatitis

Females – Cervicitis, PID, Peri-hepatitis, septic abortion

Neonates – Conjunctivitis

Question 20

what are the complications of neisseria gonorrhoea

Answer 20

Septic arthritis,
blindness,
infertility
septicaemia

Question 21

How do you treat neisseria gonorrhoea

Answer 21

– Ceftriaxone

Drug resistance increasing

Question 22

what causes genital warts

Answer 22

Human Papilloma Virus (DNA)

6 and 11

Question 23

what HPV is associated with carcinoma

Answer 23

Some associated with carcinoma (16, 18, 31,33)

Question 24

what are the symptoms of HPV

Answer 24

90% asymptomatic

Question 25

How do you manage genital warts

Answer 25

Vaccination

Management

• Topical podophyllotoxon, imiquimod
• Cryotherapy - freeze them of

Question 26

what HSV is oral and what HSV is genital

Answer 26

HSV-1 oral
HSV-2 genital
- can have both - can have either infection or both in either site

Question 27

How does HSV behave

Answer 27

Primary infection - can be severe and people can get sick or it can be asymptomatic, can go on for a long period of time

Latency - once you are infection they stay there forever, integrate into the host DNA and viruses

Reactivation -

Question 28

What is the treatment of HSV

Answer 28

Aciclovir
Famciclovir - prodrugs
Valaciclovir - prodrugs

Question 29

what is another word for syphilis

Answer 29

Treponema pallidum

Question 30

what are the types of syphilis

Answer 30

Primary - genital ulcer at site of infection - painless so not noticed by the individual

Secondary - rash, lymphadenopathy

Latent - may not know that you have it but it stays present in the body for a long period of time and causes damage

Tertiary - effect the cardiovascular symptom, music-skeletal system and brain as it is a cause of dementia,

Congenital

Question 31

what are the symptoms of symphilis

Answer 31

Often asymptomatic in early stages

Question 32

What is the treatment of syphlis

Answer 32

Penicillin - injections

Doxycycline - for allergic to penicillin, slightly less efficous

Question 33

Describe primary syphilis

Answer 33

Chancre usually single, painless

Dark ground positive - see organisms under the microscope

Lymphadenopathy

Serology may be negative

Infectious++

Question 34

How do you diagnose syphilis

Answer 34

• serology

- in the early stages of syphilis may be negative therefore need to repeat the blood tests

Question 35

Describe secondary syphilis

Answer 35

Rash, fever, lymphadenopathy

Condyloma lata

Serology positive

Infectious++

• effects soles of hand and feet can cause redness

Question 36

what does untreated HIV cause

Answer 36

AIDS

Question 37

what is untreated HIV associated with

Answer 37

• decreased CD4 lymphocytes associated in the blood

Question 38

how is HIV treated

Answer 38

• Use of retrovirus
• viral suppression
• allows immune recovery/preservation
• normal life expectancy
• other morbidities is related to inflammation
• • U=U - undetectable means untransmissable

Question 39

when can you not pass on HIV

Answer 39

• when they have undetectable viral load they are untransmissable

Question 40

what are complications related to HIV related to

Answer 40

• chronic inflammation high rates that are driven by HIV

Question 41

late diagnosis of HIV has a

Answer 41

high mortality rate

Question 42

Who gets HIV

Answer 42

• heterosexual

- men who have sex with men

Question 43

HIV treatment as prevention

Answer 43

- Vertical transmission 
Partner studies U=U 
- individual couples 
- population effect 
- test and treat

• post exposure prophylaxis
• pre-exposure prophylaxis is used - PREP

Question 44

what makes up HAART treatment

Answer 44

• protease inhibitors
• integrase inhibitors
• nucleoside reverse transcriptase inhibiters
• fusion inhibitors
• Non-Nucleoside RT inhibitor

Question 45

what are the short term and long term side effects of HAART

Answer 45

Short-term
Nausea / vomiting / headache
Sleep disturbance (efavirenz)

Long-term
Lipodystrophy (NRTIs and PIs) 
Renal dysfunction (tenofovir)
Peripheral neuropathy (d4T, AZT, DDI)
Lactic acidosis – may be fatal (d4T, DDI)