Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Sexual Health + Obs & Gynae > Sexually transmitted infections (STI) > Flashcards

Sexually transmitted infections (STI) Flashcards

1
Q

What is chlamydia?

A

A sexually transmitted infection (STI) caused by Chlamydia Trachomatis, which is a Gram-negative bacteria.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How is chlamydia transmitted? Infection sites?

A

Transmission via contacted with infected secretions or fluids.

Infection sites:
- urethral
- endocervix
- less frequently pharynx, rectum and conjunctiva

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Risk factors of chlamydia?

A

Age <25
New sexual partner
More than one sexual partner in past 12 months
Inconsistent condum use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Complications of chlamydia?

A

Pelvic inflammatory disease (increases risk of infertility, ectopic pregnancy chronic pelvic pain)

Epididymo-orchitis

Lymphogranuloma venereum (LGV)

Sexually acquired reactive arthritis (SARA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Presentation of chlamydia in urethral/cervical site?

A

Urethral/cervical infection
- 70% asymptomatic
- abnormal/purulent vaginal discharge
- dysuria
- post-coital or intermenstrual bleeding
- +/- deep dyspareunia

  • mucopurulent cervical discharge
  • +/- pelvic pain/tenderness
  • inflamed, friable cervix
  • +/- cervical motion tenderness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Presentation of chlamydia in anorectal site?

A

Anorectal infection
- frequently asymptomatic
- anal discharge
- anorectal discomfort
- tenderness on DRE exam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Presentation of chlamydia in penile urethral site?

A

Penile urethral infection:
- 50% asymptomatic
- dysuria
- urethral discharge
- urethral discomfort -pruritus
- painful ejaculation
- +/- testicular pain, swelling

  • mucopurulent urethral discharge
  • +/- testicular pain, swelling, and tenderness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Presentation of chlamydia in pharyngeal site?

A
  • 90% asymptomatic
  • sore throat
  • tonsillar exudates, hypertrophy, erythema
  • pharyngeal erythema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How is chlamydia diagnosed?

A

Nucleic acid amplification tests (NAATs)
Cervical symptoms
- vaginal swab or first-catch urine (FCU)

Penile symptoms
- first-catch urine (FCU)

Rectal symptoms:
- self-administered rectal swab

Pharyngeal symptoms
- pharyngeal swab

Screen for other STIs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How is chlamydia managed?

A

If they have strongly suggestive signs/symptoms, start the tx, don’t wait for lab results.

Doxycycline 100mg BD for 7 days
If pregnant or breastfeeding, prescribe azithromycin.

Avoid all types of sexual intercourse until the person and their sex partner(s) have completed tx.
- avoid re-infection
- avoid infecting other people

Screen for other STIs.

Refer all pts with confirmed chlamydia to GUM for partner notification.

Offer repeat testing to people <25 years old 3-6 months after completing tx.
- checks for re-infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

When do you screen for chlamydia?

A

Asymptomatic screening via NAAT
- sexual partners of those with proven or suspected chlamydial infection

  • all sexually active people under 25 screened annually or more frequently if they have new sex partner
  • all people with concerns about a sexual exposure (e.g. they’re worried if the condom broke) [if exposure within last 2 wks, carry out the test. Repeat in 2 wks after exposure if the first test is negative.]
  • people with 2 or more sexual partners in the last 12 months
  • people under age 25 treated for chlamydia in the last 3 months
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How is gonorrhoea transmitted? Infection sites?

A

Transmission via contact with infected secretions or fluids.

Infection sites:
- urethra
- endocervix
- rectum
- pharynx
- conjunctiva

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is gonorrhoea?

A

A sexually transmitted infection (STI) caused by the bacterium Neisseria gonorrhoeae.

There are two subtypes:
- uncomplicated (localised infection of urethra, endocervix, rectum, pharynx, or conjunctiva)
- disseminated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Complications of gonorrhoea?

A

Pelvic inflammatory disease
Epididymo-orchitis
Prostatitis
Male infertility
Penile urethral stricture
Perihepatic abscess
Miscarriage, foetal loss and congenital infections during pregnancy
Reactive arthritis
Disseminated gonorrhoea (septic arthritis, tenosynovitis, pustural skin lesions, rarely meningitis or endocarditis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Presentation of gonorrhoea in penile urethral site?

A

Penile urethral infection:
- dysuria
- urethral discharge
- painful ejaculation
- +/- testicular pain, swelling

  • mucopurulent or purulent urethral discharge
  • +/- testicular pain, oedema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Presentation of gonorrhoea in anorectal site?

A

Anorectal infection:
- anal discharge
- perianal or anal pain
- tenesmus (the feeling that you need to pass stools, even though your bowels are already empty)
- rectal bleeding

  • rectal pain on DRE exam
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Presentation of gonorrhoea in pharyngeal site?

A

Pharyngeal infection:
- 90% asymptomatic
- sore throat

  • tonsillar exudates, hypertrophy, erythema
  • pharyngeal erythema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Presentation of gonorrhoea in cervical site:

A

Cervical infection
- 50% asymptomatic
- abnormal vaginal discharge
- dysuria
- intermenstrual bleeding
- +/- dyspareunia
- +/- lower abdominal pain

  • mucopurulent endocervical discharge
  • +/- pelvic or abdominal tenderness
  • friable cervix
  • +/- cervical motion tenderness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How is gonorrhoea diagnosed?

A

Nucleic acid amplification tests (NAATs)
Cervical symptoms
- vaginal swab (reliable compared to FCU)

Penile symptoms
- first-catch urine (FCU)

Rectal symptoms:
- self-administered rectal swab

Pharyngeal symptoms
- pharyngeal swab

Send these samples for culture and sensitivity because of resistant gonorrhoea cases.

Screen for other STIs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How is gonorrhoea managed?

A

If they have strongly suggestive signs/symptoms, start the tx, don’t wait for lab results.

Ceftriaxone 1g 1M injection (if susceptibility is unknown)

Ciprofloxacin 500mg oral (if susceptibility is known)

Avoid all types of sexual intercourse for 7 days until the person and their sex partner(s) have completed tx.
- avoid re-infection
- avoid infecting other people

Test of cure after 1 week after tx.

Partner notification.

Consider empirical tx (broad spectrum) of recent sexual partners.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is Human Papillomavirus (HPV) and its prognosis? How is it transmitted?

A

A virus that causes warts, including anogenital warts (Condylomata acuminata).

If left untreated, warts can resolve itself within 6 months. 95% people have undetectable HPV within 2 years.

Transmission via skin-to-skin contact or contact with gential secretions. Usually via sexual contact, and may transmit via auto-inoculation (touching the wart).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Complications of Human Papillomavirus (HPV)?

A

Anogenital cancer
- cervical cancer (type 16/18)
- penile, rectal, vulvovaginal, oropharyngeal cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Presentation of Human Papillomavirus (HPV)?

A

Asymptomatic
Skin growths of anogenital or oral region
- single or multiple warts
- +/- irritation, pruritus, bleeding

  • verruca (usually <10mm; broad-based or pedunculated; pigmented or skin colour)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How is Human Papillomavirus (HPV) diagnosed?

A

Clinical diagnosis
Biopsy if atypical lesion
Screen for other STIs

24
Q

How is Human Papillomavirus (HPV) managed?

A

Refer to sexual health specialist for tx otherwise treat in primary care.

Advice:
- no change to cervical cytology screening intervals
- use condom
- smoking cessation
- current partner may not be responsible for transmitting HPV (long latency period of 3 wks to 8 months)
- partner screen for STIs

Cryotherapy (use liquid nitrogen to freeze the cells, which kills off the virus), excision, or electrocautery (electrical device to burn the wart away).

Pharmacotherapy:
- podophyllotoxin 0.5% solution, imiquimod 5% cream, sinecatechins 10% ointment
- change tx if <50% response after 4-5 wks.

25
Q

HPV immunisation

A

Gardasil 9 is a HPV vaccine that targets high-risk HPV genotypes 6, 11, 16, 18, 31, 33, 45, 52, and 58.

A single dose is given to both males and females at the age of 12 or 13.

May obtain HPV immunisation until age 25.
Men who have sex with men can get it up to age 45 -two doses.

Types 16 and 18 causes >80% cervical cancers.

Types 6 and 11 causes ~90% genital warts.

HPV vaccine protects against the development of genital warts, cervical, oropharyngeal, and other anogenital cancers.

26
Q

What is Herpes Simplex Virus (HSV) (genital herpes)

A

HSV is a genital infection caused by HSV-1 or HSV-2.

HSV-1 is the most common cause or oro-labial and genital HSV in UK.

HSV-2 causes genital infection.

27
Q

How does Herpes Simplex Virus (HSV) transmit?

A

Transmission by direct contact of mucosal surfaces or breaks in skin with infected secretions or mucosal surfaces. Asymptomatic shedding.

HSV-1: transmitted via oral or genital contact

HSV-2: transmitted via genital contact only

28
Q

Risk factors of Herpes Simplex Virus (HSV)?

A

Age 15-24 years
Female sex
Previous STIs
High number of sexual partners
Unprotected sexual intercourse
Men who have sex with men
Immunosuppression

29
Q

What can reactivate latent Herpes Simplex Virus (HSV)?

A

Local trauma (e.g. you have oral herpes and you accidentally bite your lip)
UV light
Illness
Immunosuppression
Stress

30
Q

How does Herpes Simplex Virus (HSV) present in primary infection?

A
  • clustered, painful erythematous vesicles (develops 4-7 days after exposure)
  • fever
  • malaise
  • headache
  • dysuria
  • tender inguinal lymphadenopathy
  • vaginal or urethral discharge
  • tingling/neuropathic pain in genital area
  • can last up to 3 wks
31
Q

How does Herpes Simplex Virus (HSV) present in recurrent infection?

A
  • clustered, painful erythematous vesicles within same dermatome as primary outbreak
  • potential prodromal (before other symptoms occur) tingling/burning up to 48 hours before vesicles appear
  • less severe than primary infection
  • systemic symptoms less common
  • lasts up to 6-12 days
32
Q

How is Herpes Simplex Virus (HSV) is diagnosed?

A

Swab lesions for HSV
- viral PCR
- if necessary, rupture vesicle to obtain secretions

Screen for other STIs

33
Q

How is Herpes Simplex Virus (HSV) managed?

A

No cure

Transmission possible with close skin contact or contact with infected secretions, so hygiene is important.

Avoid all sex if lesions are present.
Consistently use condoms with all partners, especially is the person has a hx of herpes because it can be asymptomatic

First infection:
- refer to sexual health service
- commence tx within 5 days of onset or while new lesions are forming.
- oral antiviral therapy: Aciclovir or Valciclovir
- clean area with plain water, apply vaseline or topical anaesthetic, analgesia, avoid tight fit clothes, avoid sharing towels/bedding
- avoid all sexual intercourse

Recurrent infection:
Episodic antiviral tx if pt has <6 episodes of herpes
- oral aciclovir, valaciclovir, or famciclovir

Suppressive antiviral tx if pt has ≥6 episodes of herpes
- daily oral aciclovir, valaciclovir, or famciclovir
- continue tx for a yr then stop to see if it returns

34
Q

What is trichomoniasis? How is it transmitted?

A

A sexually transmitted infection caused by flagellated protozoan Trichomonas vaginalis.

Transmitted via sexual intercourses only.

35
Q

Complications of trichomoniasis?

A

Perinatal complications
PID
Fascilitation of HIV transmission
Acute and chronic prostatitis
Infertility

36
Q

How is trichomoniasis presented?

A

Depends on where the infection is.

Cervical/vaginal infection
- 50% asymptomatic
- abnormal vaginal discharge (frothy, yellow-green)
- vaginal/vulvar pruritus, erythema
- dysuria
- strawberry cervix
- +/- pelvic pain
- +/- cervical motion tenderness

Urethral infection:
- 50% asymptomatic
- dysuria
- purulent urethral discharge

37
Q

How is trichomoniasis diagnosed?

A

Cervical/vaginal infection
- vaginal swab for pH test
- pH >4.5 = trichomoniasis
- pH 3.5 - 4.5 = normal

  • high vaginal swab for Gram staining

Urethral infection:
- culture and/or microscopy via urethral swab or first catch urine

38
Q

How is trichomoniasis managed?

A

Oral metronidazole 2g single dose or 400-500mg BD 5-7 days

Treat current sexual partners and any partners from within 4 wks before presentation.

Screen for other STIs.

Avoid all sex for at least one week and until all partners have completed tx.

39
Q

What is syphilis? How is it transmitted?

A

An infection caused by spirochete bacterium Treponema pallidum.

Transmitted via direct contact with infectious lesions, mother-child during pregnancy or needle sharing.

Infectious lesions are usually located on genital, rectal, or oral mucosal surfaces.

40
Q

Describe syphilis natural course?

A

Divided into early and late syphilis.

Early syphilis:
1. primary syphilis
(involves a painless ulcer called a chancre at the original site of infection)

  1. secondary syphilis
    (involves systemic symptoms, particularly of the skin and mucous membranes)
  2. early latent syphilis
    (no symptoms)

Late syphilis:
1. late latent syphilis
(no symptoms)

  1. tertiary syphilis
    (cardiovascular and neurological complications)
41
Q

How does primary syphilis present?

A
  • chancre (appears 9-90 days after infection; painless, indurated ulcer with sharp border)
  • localised lymphadenopathy
42
Q

How does secondary syphilis present?

A

Symptoms appear 4-12 weeks after chancre.

Non-pruritic maculopapular rash (palms and soles of feet)

Condyloma lata (grey-white wart-like lesions)

Snail tract lesions (patchy oral mucosa lesions)

Alopecia

43
Q

How does tertiary syphilis present?

A

Presents 10-30 years after initial infection.

Gummatous syphilis
- necrotic centra
- can affect skin, liver, brain, heart, bone

Cardiovascular syphilis
- aortic regurgitation
- aortic aneurysm
- heart failure

Neurosyphilis
- paraesthesias
- absent reflexes
- absent joint positions/vibration sense
- personality changes

44
Q

How is syphilis diagnosed?

A

Refer to GUM specialist.

Lab testing:
- dark-field microscopy or PCR via swab of chancre (not used frequently)

  • initial screening serological treponemal test (detect IgG and IgM), followed by non-treponemal test (RPR, venereal diseases research laboratory -high sensitivity in secondary and early latent syphilis)
  • lumbar puncture for CSF testing if suspecting neurosyphilis
45
Q

What is Human Immunodeficiency (HIV)?

A

It is a RNA-based retrovirus causing progressive immunodeficiency via infection and destruction of CD4 (T helper) cells.

It can leads to Acquired Immune Deficiency Syndrome (AIDS).

45
Q

How is syphilis managed?

A

Screen for other STIs (including HIV)

Contact tracing

Follow-up to detect re-infection or tx failure

Safe-sex counselling and education.

IM benzathine benzylpenicillin
- single dose for primary, secondary, and early latent syphilis
- three doses for late latent and tertiary syphilis

IV aqueous benzylpenicillin
- neurosyphilis

46
Q

How is HIV transmitted?

A

Contact with cell-containing bodily fluids
e.g. blood, semen, vaginal secretions, breast milk, amniotic fluid.

Sexual
Mother-child
IV drug use
Blood products

47
Q

Risk factors for Human Immunodeficiency (HIV)?

A

Condomless vaginal or anal sex
Having another STI
Sharing contaminated needles
Receiving unsafe blood transfusions
Accidental needle stick injuries

48
Q

Describe Human Immunodeficiency (HIV) natural course?

A

Acute HIV infection
- flu-like illness within 1-3 wks of initial infection

Chronic HIV infection
- asymptomatic, then develop HIV related symptoms and illness within 5-10 years of infection

AIDS
- develops 10-15 years after infection
- CD4 count <200 cells/μL

49
Q

How does acute Human Immunodeficiency (HIV) present?

A

fever
malaise
myalgias
sore throat
headache
arthralgias
night sweats
lymphadenopathy
maculopapular rash
diarrhoea
aphthous ulcerations

50
Q

How does chronic Human Immunodeficiency (HIV) present?

A

Variable or asymptomatic

Constitutional symptoms
- fever
- wt loss >10kg
- night sweats
- lymphadenopathy

Chronic diarrhoea

Severe, recurrent, or tx-resistant
- fungal skin & nail infections
- shingles
- seborrheic dermatitis
- candidiasis (oral, oesophageal, vulvovaginal)
- aphthous ulcers

Opportunistic infections and malignancies.

51
Q

What conditions in addition to being HIV positive confirms AIDS (AIDS-defining illnesses)?

A

Candidiasis of lungs or oesophagus
Coccidioidomycosis
Cryptococcal meningitis
Toxoplasmosis
CMV
TB
Mycobacterium avium-intracellulare infection (MAI)
Pneumocystis jirovecii pneumonia
Disseminated histoplasmosis
Kaposi’s sarcoma
HIV-related lymphoma

52
Q

When would you consider HIV testing?

A

Consider HIV testing if pt presents with one or more of the following:
- severe, prolonged, recurrent or unexplained common symptoms or infections
- persistent lymphadenopathy
- conditions related to immunosuppression (e.g. oral candidiasis, bilateral shingles)
- glandular fever-like illness
- unintended wt loss >10kg
- risk factors for HIV present

53
Q

How is HIV diagnosed?

A

Consider the ‘window period’ when ordering a test.

Serum HIV RNA PCR
- viral load
- use if they have suspected acute HIV infection

Serum combined HIV antibody & p24 antigen test
- ‘4th generation’ test
- accurate around 4 wks after infection

Rapid tests
- detect HIV antibodies only
- done by finger-prick or mouth swabs
- accurate 3 months after infection
- results known within 5-10 minutes
- can be done at home

54
Q

What to do with HIV test results?

A

If HIV positive, aim to have a face-to-face appt to discuss the results.

Negative → consider if different HIV test needed to cover window period

Positive → confirm via serum HIV RNA PCR

Equivocal (test result not certain) → refer to GUM clinic

55
Q

Who do you offer HIV screening to?

A

Offer HIV screening to people who:
- request a HIV test
- have risk factors for HIV
- have been diagnosed with an STI
- pregnant

56
Q

How is HIV managed?

A

Refer urgently to HIV specialist or GUM clinic if new diagnosis.

Provide sources of information and support.

Advice about risk reduction strategies (e.g. safer sex practices)

Pharmacotherapy
- antiretroviral therapy (ART) →combination of three drugs in one pill
- must be adherent (as HIV can mutate quickly)

Monitoring
- serum CD4 count and HIV RNA PCR (‘viral load’)
- tx goal →have undetectable viral load (<20 copies/mL)

Sexual Health + Obs & Gynae (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions