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Sex & Sexuality + Women's Health > Sexually Transmitted Infections (STIs) > Flashcards

Sexually Transmitted Infections (STIs) Flashcards

1
Q

3 categories STIs can be

A
  • bacterial
  • viral
  • parasitic
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2
Q

how are STIs spread

A
  • thru sexual activity
  • vaginal, anal, oro-genital sex
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3
Q

more than half STIs are in which population/s

A
  • adolescents, young adults (15-24yo)
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4
Q

STIs commonly occur when

A
  • at young age when first starting intercourse and not using condoms
  • especially for first sexual intercourse
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5
Q

what is a reason why people might not know they have an STI

A

many STIs are asymptomatic

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6
Q

how to minimise risk of STI

A
  • safe sex eg/ barrier methods like condoms
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7
Q

what increases likelihood of STIs

A

multiple partners

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8
Q

how can STIs infect neonates

A

vertically from infected mothers

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9
Q

common STIs

A
  • gonorrhoea
  • chlamydia
  • mycoplasma genitalium
  • herpes simplex viruses
  • human papillomavirus (HPV)
  • syphilis
  • trichomoniasis
  • HIV / AIDS
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10
Q

chemically define gonorrhoea

A

gram negative intracellular diplococci infecting cuboidal and columnar cells in adults

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11
Q

what cant gonorrhoea infect in adults

A

squamous epithelial cells

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12
Q

gonorrhoea is more prevalent in which populations (3) and hence what should be done

A
  • men who have sex with men (MSMs)
  • ATSI
  • overseas travelers
    important to test these populations
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13
Q

where could be a reservoir to maintain the gonorrhoea epidemic & especially in which populations due to what nature of the site

A
  • throat
  • MSMs
  • asymptomatic
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14
Q

transmission of gonorrhoea

A

direct inoculation of infected secretions from one mucous membrane to another

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15
Q

what are some mucous membranes gonorrhoea spread thru

A

urethra, cervix, rectum, pharynx, eyes

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16
Q

gonorrhoea is spread through which contact

A
  • penile
  • vaginal
  • oral
  • anal
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17
Q

incubation period of gonorrhoea in men and women but also note what

A

men: 2-5 days
women: 5-10 days

note that can be asymptomatic

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18
Q

define incubation period

A

time between exposure to infectious agent & appearance of symptoms or signs of a disease / infection

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19
Q

[manifestations of gonorrhoea in men] what % of men are asymptomatic for gonorrhoea in the urethra

A

90%

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20
Q

if symptomatic in urethra from STI this can include

A
  • urethral discharge
  • dysuria (pain on urination)
  • urethral discomfort
  • erythematous swelling of urethral meatus
  • urethral itch
  • meatitis
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21
Q

if symptomatic in epididymis / testes from STI this is

A

epididymo-orchitis - scrotal pain / swelling

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22
Q

[manifestations of gonorrhoea in men] up to % of men are asymptomatic for gonorrhoea as rectal infection

A

90%

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23
Q

if symptomatic for rectal infection from STI this can include

A
  • anal pain, bleeding
  • anal discharge
  • tenesmus
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24
Q

[manifestations of gonorrhoea in men]
what symptom can have regarding eyes

A

conjunctivitis

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24
Q

[manifestations of gonorrhoea in men]
pharyngeal infection from gonorrhoea is mostly symptomatic or asymptomatic

A

asymptomatic

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25
Q

what is a rare complication of gonorrhoea that can occur for both men and women

A

disseminated gonococcal infection

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26
Q

[manifestations of gonorrhoea in women] what % of women are asymptomatic for gonorrhoea in the endo-cervix

A

40%

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27
Q

if symptomatic in endo-cervix for STI this can include

A
  • post-coital or intermenstrual bleeding
  • mucopurulent cervicitis
  • cervical discharge presenting as vaginal discharge
  • dysuria (pain on urination) due to urethral infection
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28
Q

if symptomatic with pelvic inflammatory disease (PID) from STI this can include

A
  • lower abdominal pain
  • deep dyspareunia
  • post-coital or intermenstrual bleeding
  • cervical discharge presenting as vaginal discharge
  • fever
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29
Q

[manifestations of gonorrhoea in women] list 4 types of infections can have

A
  • rectal infection
  • pharyngeal infection
  • conjunctivitis
  • infection of Bartholin’s abscess
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30
Q

[manifestations of gonorrhoea in women]
with disseminated gonococcal infection, are women or men more affected

A

1-2% of women more affected than men

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31
Q

what symptom can occur for neonates with gonorrhoea

A

conjunctivitis
- threatens sight
- needs immediate treatment

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32
Q

for diagnosis of STIs what can be done

A
  • microscopy
  • culture
  • nucleic acid amplification tests (NAAT)
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33
Q

for microscopy, gram stain of which mucous membranes are recommended and not recommended

A
  • urethral, cervical, rectal smears
  • pharyngeal smears not recommended
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34
Q

for which sites can culture be used for gonorrhoea

A

valid for all sites

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35
Q

for which sites can NAAT be used for gonorrhoea

A

valid for all sites

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36
Q

which is most sensitive testing diagnostic for gonorrhoea

A

NAAT

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37
Q

first line treatment of gonorrhoea

A
  • ceftriaxone 500mg IMI stat + azithromycin oral 1g stat
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38
Q

what is given for pharyngeal gonorrhoea

A

ceftriaxone 500mg IMI stat + azithromycin oral 2g stat + anti-emetic
ie/ higher dose azithromycin and anti-emetic

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39
Q

second line treatment of gonorrhoea

A

gentamicin 240mg IMI stat + azithromycin 2g stat

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40
Q

what non medical directions are there for treatment (1) of gonorrhoea

A
  • avoid sex for 7 days
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41
Q

what other directions must be taken regarding partners with gonorrhoea treatment

A

partner notification and treatment

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42
Q

what else should be offered alongside treatment for gonorrhoea (4)

A

ie/ check for blood borne viral infections
offer HIV, syphilis, hep B, hep C screening

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43
Q

what else should be offered for after initial testing for gonorrhoea

A

test of cure

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44
Q

why is azithromycin given at higher dose for pharyngeal gonorrhoea

A

due to increasing resistance of gonorrhoea particularly in the pharynx

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45
Q

regarding treatment of gonorrhoea what is a major problem worldwide

A

antibiotic resistance

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46
Q

most isolates for gonorrhora are resistant to which antibiotics (2)

A
  • penicilliin
  • ciprofloxacin
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47
Q

there is ___ grade resistance to azithromycin in SA

A

low grade

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48
Q

what is one thing you must do before treating a patient with gonorrhoea

A
  • essential to perform a culture from all sites
  • so antimicrobial sensitivity can be looked at
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49
Q

what STI is the most frequently reported in Australia

A

chlamydia

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50
Q

why is it very important to screen the main demographic (15-24yo) for chlamydia

A

due to asymptomatic nature of most chlamydia infections

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51
Q

age range of most chlamydia reports

A

15-24yo

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52
Q

5 associated risk factors for chlamydia

A
  • young age (<25yo)
  • high number of recent sexual partners
  • recent change in partner
  • inconsistent use of condoms
  • past chlamydia infection
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53
Q

how is chlamydia primarily transmitted

A
  • bodily fluids through penetrative intercourse
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54
Q

chlamydia incubation period

A

7-21 days

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55
Q

list of potential gonorrhoea symptoms in men

A
  • urethral symptoms (most asymptomatic)
  • epididymo-orchitis
  • rectal infection (most asymptomatic)
  • pharyngeal infection (most asymptomatic)
  • conjunctivitis
  • disseminated gonococcal infection
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56
Q

list of potential gonorrhoea symptoms in women

A
  • endo-cervix symptoms (almost half asymptomatic)
  • pelvic inflammatory disease (PID)
  • rectal infection
  • pharyngeal infection
  • conjunctivitis
  • disseminated gonococcal infection (1-2% women more affected than men)
  • Barthonlin’s abscess
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57
Q

list of potential gonorrhoea symptoms in neonates

A

conjunctivitis

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58
Q

list of potential chlamydia symptoms in men

A
  • urethral symptoms (half asymptomatic)
  • epididymo-orchitis
  • rectal infection (most asymptomatic)
  • pharyngeal infection (mostly asymptomatic)
  • conjunctivitis
  • reactive arthritis
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59
Q

list of potential chlamydia symptoms in women

A
  • endo-cervix symptoms (over half asymptomatic)
  • pelvic inflammatory disease (PID)
  • rectal infection
  • pharyngeal infection
  • conjunctivitis
  • reactive arthritis
  • Bartholin’s abscess
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60
Q

list of potential chlamydia symptoms in neonates

A
  • conjunctivitis
  • otitis media
  • pneumonia
  • pharyngeal infection
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61
Q

[sequelae from chlamydia PID] __-__% of chlamydial infections can lead to PID

A
  • 10-40%
  • infertile
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62
Q
  • 3 other sequelae from chlamydia PID
A
  • tubal factor infertility
  • ectopic pregnancy
  • chronic pelvic pain
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63
Q

in men with chlamydia and urethra symptoms, __% can be asymptomatic

A

50%

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64
Q

in men with chlamydia and rectal infection, up to __% can be asymptomatic

A

up to 90

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65
Q

in men with chlamydia and pharyngeal infection are most or less asymptomatic

A

most

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66
Q

in women with chlamydia and endo-cervix symptoms, __% can be asymptomatic

A

70%

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67
Q

[sequelae from chlamydia PID] of those with PID, up to 20% can become ______

A

infertile

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68
Q

what is used for diagnosis of chlamydia

A

nucleic acid amplification tests (NAAT)

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69
Q

are cultures used for diagnosis of chlamydia

A

no

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70
Q

for how long after successful treatment of chlamydia can NAAT remain positive

A

4-5 weeks after
due to dead chlamydia

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71
Q

it is important not to forget about which test results especially if pre-test probability is low (chlamydia)

A

false positive

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72
Q

what are we looking for with NAAT diagnosis of chlamydia & how much do we need

A
  • ribosomal RNA (rRNA)
  • 5 copies of RNA enough to get positive result
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73
Q

possible samples used for diagnosis of chlamydia in males (NAAT)

A
  • first pass urine
  • proximal urethral swab
  • rectal swab
  • pharyngeal swab
  • eye swab
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74
Q

for first pass urine sample it is recommend for patient to hold urine for at least how many minutes

A

20 minutes

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75
Q

possible samples used for diagnosis of chlamydia in females (NAAT)

A
  • endo-cervical swab
  • self-collected high vaginal swab (HVS)
  • first catch urine
  • rectal swab
  • pharyngeal swab
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76
Q

which is the least sensitive for females swab out of samples:
- endo-cervical swab
- self collected HVS
- first catch urine
what is a reason the least sensitive may be done though

A
  • first catch urine from females
  • more acceptable in GP set up
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77
Q

what is the standard treatment for chlamydia

A

doxycycline 100mg bd for 7 days

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78
Q

what is alternative treatment to chlamydia

A

azithromycin 1g stat

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79
Q

for complicated chlamydia infections (eg/ PID, epididyno-orchitis) what is treatment

A
  • doxycycline 100mg bd for 14 days
  • combined with other antibiotics
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80
Q

what other directions must be taken regarding partners with chlamydia treatment

A
  • partner notification (all sexual partners of patient in last 6 months) for testing AND treatment
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81
Q

what step to faculty above is needed for chlamydia

A

notification of infection to health department

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82
Q

what non medical directions are there for treatment (1) of chlamydia to the patient

A
  • avoid sex for 7 days
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83
Q

what directions are there for treatment (3) of chlamydia to the active sexual partners of the patient

A
  • get treatment
  • no sex for 7 days

could be presumptive treatment or based on positive test result (require partner notification)

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84
Q

at adelaide sexual health centre, when is test of cure offered for chlamydia patients and which types of chlamydia patients (2)

A
  • 4 weeks
  • rectal chlamydia and pregnant women only
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85
Q

mycoplasma genitalium is transmitted thru

A

mucosal contacts

86
Q

prevalence of 10-35% in men with non _____ and non _____ urethritis

A

non gonococcal
non chlamydial

87
Q

why do penicillin and cephalosporins not work against mycoplasma genitalium

A

it does not have a cell wall

88
Q

for males with mycoplasma genitalium symptoms in males

A
  • urethral symptoms
  • epididymo-orchitis
  • rectal infection
  • pharyngeal infection
  • conjunctivitis
  • reactive arthritis
89
Q

for males with mycoplasma genitalium affecting the urethra what % are asymptomatic

A

30%

90
Q

for males with mycoplasma genitalium causing rectal infection, are most or less patients asymptomatic

A

most

91
Q

for males with mycoplasma genitalium causing pharyngeal infection, are most or less patients asymptomatic

A

asymptomatic

92
Q

for females with mycoplasma genitalium symptoms

A
  • endocervic symptoms
  • PID
  • rectal infection
  • pharyngeal infection
  • conjunctivitis
  • reactive arthritis
93
Q

for males with mycoplasma genitalium causing endocervix symptoms, between __-__% are asymptomatic

A

40-75%

94
Q

studies have shown what for neonates regarding mycoplasma genitalium

A

mycoplasma genitalium in the respiratory tracts of neonates but clinical signif is unclear

95
Q

what testing is done to diagnose mycoplasma genitalium

A

NAAT

96
Q

what samples can be used for NAAT testing for mycoplasma genitalium in males (2)

A
  • first pass urine
  • rectal swab
97
Q

what samples can be used for NAAT testing for mycoplasma genitalium in females (3)

A
  • endocervical swab
  • high vaginal swab
  • first pass urine
98
Q

first line treatment of uncomplicated mycoplasma genitalium

A

doxycycline followed by azithromycin

99
Q

second line treatment of uncomplicated mycoplasma genitalium

A

doxycycline followed by moxifloxacin 400mg daily
for 10 days

100
Q

if treatment not successful for uncomplicated mycoplasma genitalium, use antibiotics such as (2)

A
  • pristinomycin
  • minocycline
101
Q

what is used for treatment of mycoplasma genitalium if PID or epididymo-orchitis is present

A

moxifloxacin 400mg daily
for 14 days

102
Q

what other directions must be taken regarding partners with gonorrhoea treatment

A

partner notification

103
Q

when is test of cure available after mycoplasma genitalium offered

A

4 weeks after treatment

104
Q

how is syphilis transmitted

A

thru skin contact with syphilitic lesions

105
Q

syphilis is more common among which 3 populations

A
  • men who have sex with other men (MSMs)
  • ATSI
  • overseas populations living in australia
106
Q

there has recently been a ____ epidemic of syphilis

A

heterosexual epidemic

107
Q

is syphilis currently increasing or decreasing prevalence in aus

A

increasing

108
Q

how many stages of syphilis are there

A

4

109
Q

what is stage 1 of syphilis

A
  1. primary syphilis - ulcer / chancre (sore caused by syphilis)
110
Q

what is stage 2 of syphilis

A
  1. secondary syphilis - systemic illness
111
Q

what is stage 3 of syphilis

A

3.latent syphilis - asymptomatic stage

112
Q

what is stage 4 of syphilis

A
  1. tertiary syphilis - late symptomatic phase (cardiovascular system, central nervous system, gumma)
113
Q

incubation of primary syphilis (chancre)

A
  • 9-90 days (median 21 days)
114
Q

what is primary syphilis symptoms (2)

A

chancre / ulcer
- painless, indurated (thickening underneath ulcer when felt with 2 fingers) ulcer in genitals, perianal area, anal canal, cervix, mouth

regional lymphadenopathy
- non tender, rubbery

115
Q

how long does primary syphilis last for

A

3-6 weeks

116
Q

when does secondary syphilis occur (with regard to primary syphilis)

A

4-8 weeks after chancre (but both primary and secondary can be present at same time)

117
Q

symptoms of secondary syphilis

A
  • feel generally unwell
  • fever
  • rash also involving palms and soles (most common are maculopapular rash)
  • mucosal lesions, (including in genitals - condylomata lata)
  • patchy (non-scarring) alopecia
  • lymphadenopathy
  • headache
  • mild hepatitis (inflammation of liver)
118
Q

secondary syphilis resolves over how many weeks even without treatment

A

3-12 weeks

119
Q

what do mucosal lesions in the genital area (condylomata lata) look like

A
  • warts
120
Q

what are the stages within latent syphilis - asymptomatic stage

A
  • early latent stage
  • late latent stage
121
Q

describe the early latent stage (asymptomatic stage) of syphilis

A

within first 2 years of initial infection

122
Q

describe the late latent stage (asymptomatic stage) of syphilis

A

after the first 2 years of initial infection

123
Q

tertiary syphilis occurs if….

A

you don’t treat syphilis

124
Q

tertiary syphilis is characterised by (4)

A
  • locally destructive lesions
  • gummatous lesions (non-cancerous)
  • cardiovascular impacts
  • neurological impacts
125
Q

(tertiary syphilis) gummatous lesions are granulomatous lesions
most commonly found in the ___ and ___
which causes ________ and ________

A
  • skin and bone
  • tissue damage and disfigurement
126
Q

[tertiary syphilis] cardiovascular impacts occur when

A

15-30 years later

127
Q

[tertiary syphilis] cardiovascular impacts include

A
  • predominantly large vessel disease
    (=> can get) aortic aneurysm and / or aortic valve incompetence
128
Q

[tertiary syphilis] neurological impacts include

A
  • syphilitic meningitis
  • meningovascular syphilis
  • cranial nerve palsies
  • general paresis
  • tabes dorsalis
129
Q

what are granulomatous

A
  • formation of granulomas
  • granulomas are small organised collections of immune cells that form a cluster around foreign substances (as a response from the immune system)
130
Q

infectious syphilis is usually infection when?

A

less than 2 years after acquisition

131
Q

the stages of syphilis that are infectious include

A
  • primary
  • secondary
  • early latent
132
Q

treatment for infectious syphilis

A

benzathine penicillin 1.8 IM as a single dose

133
Q

when is vertical transmission of syphilis possible

A
  • during all stages
  • in first 8-10 years after acquisition from the mother
134
Q

which syphilis stages are not infectious sexually

A
  • late latent stage (>2yrs after acquired; asymptomatic stage)
  • tertiary syphilis
135
Q

how to diagnose late latent (asymptomatic) stage of syphilis apart from early latent stage

A

disease acquired more than 2 years ago - confirmed thru no negative syphilis tests in last two years

136
Q

how to diagnose late latent (asymptomatic) stage of syphilis apart from tertiary syphilis

A
  • clinical examination of CVS and CNS to exclude tertiary syphilis
137
Q

treatment of late latent (asymptomatic) stage syphilis

A

benzathine penicillin 1.8 IM
weekly (one dose) for 3 weeks

138
Q

what is used for a definitive diagnosis of syphilis (4)

A
  • dark ground microscopy (involves treponemes)
  • direct fluorescent antibody (DFA) testing (involves treponemes)
  • immunohistochemistry on biopsies
  • PCR (esp for secondary syphilis and congenital syphilis)
139
Q

how else is syphilis diagnosed

A

serology

140
Q

serology involves which broad tests

A
  • screening tests
  • confirmatory tests - Treponemal tests
  • syphilis disease activity
141
Q

components that need to be done to differentiate between different stages of syphilis

A
  • history
  • examination
  • epidemiology
  • previous treatment history
  • repeat syphilis disease activity test (RPR) 1-2 weeks later - if not sure if new infection
142
Q

what (2) can cause genital herpes

A
  • herpes simplex 1 (HSV-1)
  • herpes simplex 2 (HSV-2)
143
Q

in HSV-2, what proportion of individuals develop symptoms at time of infection acquisition

A

1/3rd

144
Q

other people with HSV-1 or HSV-2 without symptoms at infection acquisition might… (2)

A
  • not recognise their infection
  • show symptoms later in life (eg/ pregnancy)
145
Q

how are HSV-1 and HSV-2 spread

A
  • spread thru skin contact
  • affecting areas where virus enters the body
  • kissing, vaginal, oral, anal sex
146
Q

define primary infection for HSV

A
  • first infection with either HSV-1 or HSV-2 with no pre-existing antibodies to either type
  • most are asymptomatic
147
Q

define non-primary infection of HSV

A
  • first infection with either HSV-1 or HSV-2 with pre-existing antibodies to the other type
  • most are asymptomatic
148
Q

define first episode (primary and non-primary) for herpes

A
  • first clinical episode with either HSV-1 or HSV-2]
    (not limited to infected dermatome)
149
Q

define recurrent episode of herpes

A

recurrence of clinical symptoms due to reactivation of pre-existent HSV-1 or HSV-2 in sensory ganglia

150
Q

most cases of recurrent (episode) genital herpes are caused by HSV?

A

HSV-2

151
Q

recurrent outbreaks are limited to

A

the infected dermatome

152
Q

describe asymptomatic viral shedding (infectious to other people)

A
  • reactivation of HSV in sensory ganglia
  • can cause shedding of virus from the dermatome without causing clinical symptoms (asymptomatic)
  • not recurrent episode
153
Q

more asymptomatic shedding is caused by which HSV

A

HSV-2

154
Q

HSV-2 can cause ~x recurrent episodes per year; HSV1 can cause ~y recurrent episodes per year

A
  • 4
  • 1
155
Q

given the natural history of herpes infection, the frequency of (2) reduces with ___

A
  • recurrent episodes
  • viral shedding
  • time
156
Q

herpes infection can be transmitted sexually via both

A
  • clinical recurrences (symptomatic viral shedding) (and others)
  • asymptomatic viral shedding
157
Q

symptoms of herpes

A
  • genital ulcers - painful
  • dysuria
  • external dysuria
  • fever
  • constitutional symptoms
  • sensory neuropathy
  • acute retention of urine, esp in females
  • proctitis - in MSMs
  • pneumonitis, PID - rare
  • aseptic meningitis - rare (meningitis not caused by bacteria eg/ parasitic, viral)
  • disseminated (spread thru an organ or the body) infection - rare
158
Q

when is herpes most infectious

A

visible blisters with genital ulcers

159
Q

why is there dysuria in herpes

A

due to urethritis (inflammation of urethra)

160
Q

why is there external dysuria in herpes

A

due to urine coming in contact with ulcers

161
Q

list some constitutional symptoms of herpes

A

headaches, back-aches, flu-like illness

162
Q

define proctitis

A

inflammation of lining of rectum
(rectum - muscular tube connected to end of colon; function is to collect and hold poop until time to release; relaxes and stretches as collects waste; absorbs remaining water and electrolytes to further solidify wastes; exits thru anus)

163
Q

define pnuemonitis

A

inflammation in lung tissues without infection; affects walls of alveoli but does not cause fluid or pus to build up; can cause dry cough

pneumonia = infection in lungs

164
Q

signs of herpes

A
  • multiple superficial genital ulcers
  • vesicles
  • tender, firm, mobile regional lymphadenopathy
  • fever
  • acute retention of urine
  • anal pain / discharge - in MSMs
165
Q

what are genital ulcers in herpes preceded by

A

vesicles
(small, fluid-filled sacs or blisters that can form on skin or mucous membranes; often initial stage of certain skin conditions or infections)

166
Q

diagnosis of herpes (2)

A
  • PCR
  • type specific serology
167
Q

2 benefits of PCR for herpes for diagnosis

A
  • very sensitive and very specific
  • can swab at any site
168
Q

for type specific serology, which antibodies are helpful to differentiate between HSV1 and HSV2

A

IgG antibodies

169
Q

what would positive HSV IgG antibodies generally indicate & why

A

genital infection
since oral infections due to HSV2 is uncommon

170
Q

what would positive HSV1 IgG antibodies generally indicate

A

indicate either oro-labial (mouth and lips) infection or a genital infection

171
Q

limitations to type specific serology (3)

A
  • no indication as to what the site or time of infection
  • false negative (initial stage) and false positive test results
  • if unnecessary antibody testing done can cause more confusion than resolving clinical problem
172
Q

with type specific serology you can’t get the time of infection - why regarding antibodies

A
  • IgG antibodies indicate an infection sometime in the past
  • IgM antibodies would indicate recent infection
  • but IgM detection is unreliable
173
Q

indications (when would we do) type specific serology

A
  • recurrent genital symptoms
  • atypic symptoms with negative HSV PCR
  • clinical diagnosis of genital herpes without lab confirmation (means diagnosis was made based on clinical presentation)
  • a patient whose partner has genital herpes, esp in pregnancy
  • when considering suppressive treatment to the positive partner to reduce risk of sexual transmission
174
Q

treatment and management of herpes for first clinical episode (primary and non primary)

A
  • antivirals
  • pain management
  • consider saline washes (Sitz baths for females)
  • patient education
175
Q

what would be patient education in management of herpes for first clinical episode

A
  • possibility of acute retention of urine due to both severe pain and neuropathy
  • natural history of HSV infections and latency
  • recurrent episodes and asymptomatic viral shedding
  • episodic and suppressive treatment
  • condom use (may reduce sexual transmission)
  • offer full STI including serology of blood borne infections like HIV, syphilis
176
Q

with recurrent episodes of herpes, treatment needs to be started within first __ hours

A

72 hours

177
Q

treatment of recurrent episodes of herpes reduce ____ _ _____ by median of - days

A

duration of illness
1-2 days

178
Q

treatment of recurrent episodes

A

antivirals

179
Q

suppressive therapy for herpes reduces:
- recurrences by x-y%
- asymptomatic shedding by a-b%

A
  • 70-80%
  • 80-90%
180
Q

indications for suppressive therapy for herpes

A
  • 6 or more recurrences per year
  • severe recurrences
  • pregnancy - to prevent neonatal herpes
  • consider in discordant couples to reduce sexual transmission
181
Q

suppressive therapy for herpes in pregnant women in last trimester acquisition and first/second trimester or pre-pregnancy acquisition

A

last trimester acquisition: from day of finishing first episode therapy until delivery
pre-pregnancy or 1st/2nd trimester: from 36 weeks onward

182
Q

why are pregnant women given suppressive therapy for herpes

A

to prevent transmission to neonates (neonatal herpes)

183
Q

human papillomavirus (HPV) has >__ types identified, with more than __-__ types affecting genital area, and usually are ___ specific

A
  • 100
  • 40-50
  • site specific
184
Q

which is the most common STI generally

A

HPV

185
Q

with HPV, immune system clears infection naturally within x years in y% cases

A

2 years
90% of cases

186
Q

how is HPV transmitted

A
  • skin to skin contact - genital contact and orally
187
Q

__% of clinically visible genital warts are caused by types _, __ - low ____ potential

A
  • 90% of genital warts
  • types 6, 11
  • low oncogenic
188
Q

70% of ___ / __ cancers are caused by HPV oncogenic types __, __

type 16 alone would cause __% of these

A
  • cervical / anal cancers
  • types 16, 18
  • 50%
189
Q

most HPV infections are clinically detectable - T or F

A

F, subclinical

190
Q

are most HPV infectious self-limiting (condition that resolves on its own without requiring significant medical intervention)

A

yes

191
Q

oncogenic types of HPV are commonly _______ and cause persistent ____

A
  • asymptomatic
  • infections
192
Q

can you be infected and asymptomatic with HPV

A

yes

193
Q

symptoms of HPV infection - genital types

A
  • genital, perianal, anal warts
  • warts in oral cavity, eyes
  • giant warts = Buschke-Lowenstein tumour (are benign - types 6-11)
  • cervical, vulval, anal intra-epithelial neoplasia (can be benign or malignant)
  • cervical, vulval, anal, tonsillar carcinoma (malignant)
  • recurrent respiratory papillomatosis (types 6-11) (skin surface elevation caused by hyperplasia and enlargement of contiguous dermal papillae; affecting respiratory tract)
194
Q

diagnosis of HPV

A

clinical
- warts: can be papular, hard, soft, singular or multiple
- atypical warts or pigmented warts need biopsy

195
Q

what are papules

A

small pimple or swelling on skin; often forming part of a rash

196
Q

treatment options of HPV

A
  • cryotherapy
  • wartec (podophyllin)
  • aldara (imiquamod)
  • none (may resolve with time)
197
Q

known low risk types (2) of HPV

A
  • type 6, type 11
198
Q

what is used for prevention of HPV

A

vaccines

199
Q

list (3) types of HPV vaccines and what they prevent

A
  • bivalent (prevent subtype 6 and 11; prevent 90% genital warts)
  • quadrivalent (prevent subtype 6,11,16,18; prevent 90% genital warts & 70% cervical and anal cancer)
  • ninevalent (prevent subtypes 6,11,16,18 + 5 more; prevent 90% of genital warts & 85% cervical and anal cancer)
200
Q

for HPV, all vaccines are _____ and need to be given before ____ occur

however latest studies show that HPV vaccines given after treatment of high grade intraepithelial lesions showed significantly low rates of ______ _____ _____ __ in both men and women

A
  • preventative
  • exposures
  • recurrent high-grade lesions
201
Q

describe trichomonas vaginalis (TV)

A

sexually transmitted infection or vagina and urethra

202
Q

what is the causative agent of trichomonas vaginalis

A

trichomonas vaginalis

203
Q

most commonest STI worldwide

A

trichomonas vaginalis

204
Q

trichomonas vaginalis is more common in which communities in australia

A

aboriginal communities

205
Q

trichomonas vaginalis is asymptomatic in what % in women and men

A

10-50% of women
15-50% of men

206
Q

symptoms of trichomonas vaginalis in women

A
  • vaginal discharge: thin and scanty (low amount) or profuse and thick, frothy, yellow (10-30% experience)
  • vulval itching / soreness
  • vaginal and vulval inflammation
  • external dysuria
  • Bartholin’s abscess - rare
207
Q

symptoms of trichomonas vaginalis in men

A
  • dysuria
  • urethral discharge
208
Q

diagnosis of trichomonas vaginalis

A
  • microscopy: observation of trichomonads (on wet-mount preparation)
  • pap smear: cervical cytology smear preparations
  • PCR
209
Q

microscopy for trichomonas vaginalis has a sensitivity rate of __-__%

A

40-70%

210
Q

cervical cytology smear preparations has a false positive rate of x%

A

30%

211
Q

treatment options of trichomonas vaginalis

A

antibiotics
- tinidazole 2g PO single dose
- metronidazole 400mg BD PO for 7 days
- metronidazole 2g PO single dose (not in pregnancy)

212
Q

for treatment of trichomonas vaginalis why are topical treatments usually ineffective

A

because trichomonas vaginalis infect urethra, paraurethral glands, Bartholin glands

213
Q

in trichomonas vaginalis, who should also be screened and treated

A

male partners

Sex & Sexuality + Women's Health (4 decks)

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