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Genitourinary > Sexually Transmitted Infections - Chlamydia, Gonorrhoea + Syphilis > Flashcards

Sexually Transmitted Infections - Chlamydia, Gonorrhoea + Syphilis Flashcards

1
Q

What is the most common STI?

A

Chlamydia

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2
Q

Is chlamydia more common in males or females?

A

Females - 15-25 YO

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3
Q

Is gonorrhoea more common in males or females?

A

Males

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4
Q

What is the bacteria causing chlamydia?

A

Chlamydia trachomatis:
- Gram-NEGATIVE bacterium

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5
Q

What is the bacteria causing gonorrhoea?

A

Neisseria gonorrhoea:
- Gram-NEGATIVE diplococcus bacterium

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6
Q

What are site of occurrence of chlamydia & gonorrhoea in adults?

A
  • Urethra
  • Endocervical canal
  • Rectum
  • Pharynx
  • Conjunctiva
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7
Q

What are site of occurrence of chlamydia & gonorrhoea in neonates?

A
  • Conjunctiva
  • Atypical pneumonia also in neonatal Chlamydia
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8
Q

Does chlamydia infect the vagina?

A

No.

Chlamydia and gonorrhoea cannot infect squamous epithelium.

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9
Q

What is the incubation period for chlamydia and gonorrhoea?

A

Chlamydia = 1-3 weeks

Gonorrhoea = 10 days for women; 1-5 days in men

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10
Q

What does gonorrhoea look like on a gram stain?

A

Gram negative.
Diplococci.
In the cytoplasm of polymorphs.

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11
Q

What is the primary site of infection for chlamydia + gonorrhoea in males?

A

Urethra

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12
Q

What is the primary site of infection for chlamydia + gonorrhoea in females?

A

Cervix

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13
Q

Describe the clinical presentation of chlamydia + gonorrhoea in females.

A

Asymptomatic.
Change in vaginal discharge.
Menstrual irregularity.
Dysuria.

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14
Q

What are the 2 complications of chlamydia in males?

A

Epididymo-orchitis and reactive arthritis

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15
Q

Give 3 complications of chlamydia + gonorrhoea in females.

A
  1. Pelvic inflammatory disease (PID)
  2. Neonatal transmission
  3. Fitz-Hugh-Curtis Syndrome
    - Peri-hepatitis but no decline in liver function
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16
Q

Diagnosis of chlamydia.

A

Nucleic Acid Amplification Tests (NAATs):
- High specificity and sensitivity - but negative test DOES NOT EQUAL not infected

  • Females:
  • Self collected vaginal swab - better since more material collected
  • Endocervical swab
  • First void urine - lower sensitivity
  • Male - first void urine
17
Q

Diagnosis of gonorrhoea.

A
  1. Nucleic acid amplification testing (NAAT):
    - Used to detect the RNA or DNA of gonorrhoea.
  2. Near patient tests:
    - Microscopy of gram stained smears of genital secretions - looking for GRAM-NEGATIVE DIPLOCOCCI
    - Male: sample from urethra
    - Female: sample from endocervix
  3. Culture on selective medium to confirm
  4. Antibiotic sensitivity testing:
    - A standard charcoal endocervical swab should be taken for microscopy, culture and antibiotic sensitivities before initiating antibiotics.
    - This is particularly important, given the high rates of antibiotic resistance.
18
Q

Management of chlamydia.

A
  1. Partner management
  2. Test for other STIs
  3. ORAL AZITHROMYCIN STAT (convenient - just 1 dose) or ORAL
    DOXYCYCLINE for 7 days (less convenient, but more effective)
  • Pregnant:
  • ERYTHROMYCIN for 14 days or AZITHROMYCIN STAT
19
Q

Management for gonorrhoea.

A
  1. Partner notification!
  2. Test for other STIs
  3. Continuous surveillance of antibiotic sensitivity
  4. Single dose treatment is preferred:
    * IM CEFTRIAXONE with AZITHROMYCIN STAT
20
Q

What organism causes syphilis?

A

Treponema pallidum

21
Q

What are the features of primary syphilis?

A

Chancre (painless ulcer)
Macule - papule - non tender solitary ulcer

22
Q

What are the features of secondary syphilis?

A

Maculopapular rash
Condylomata lata (grey wart-like lesions around the genitals and anus)
Low-grade fever
Lymphadenopathy
Alopecia (localised hair loss)
Oral lesions

23
Q

What are the features of tertiary syphilis?

A

Key features to be aware of are:

Gummatous lesions (gummas are granulomatous lesions that can affect the skin, organs and bones)
Aortic aneurysms
Neurosyphilis

24
Q

What are the features of neurosyphilis?

A

Neurosyphilis can occur at any stage if the infection reaches the central nervous system, and present with symptoms of:

Headache
Altered behaviour
Dementia
Tabes dorsalis (demyelination affecting the spinal cord posterior columns)
Ocular syphilis (affecting the eyes)
Paralysis
Sensory impairment

25
Q

What is a Argyll-Robertson pupil?

A

Argyll-Robertson pupil is a specific finding in neurosyphilis.

It is a constricted pupil that accommodates when focusing on a near object but does not react to light.

They are often irregularly shaped.

It is commonly called a “prostitutes pupil” due to the relation to neurosyphilis and because “it accommodates but does not react“.

26
Q

Management of syphilis.

A
  1. Full screening for other STIs
  2. Advice about avoiding sexual activity until treated
  3. Contact tracing
  4. Prevention of future infections
  5. A single deep IM dose of benzathine benzylpenicillin (penicillin)
27
Q

What is the most common cause of epidydimitis?

A
  1. Gonorrhoea in young
  2. E coli over 35

Genitourinary (17 decks)

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