Sexually Transmitted Infections (STIs) Flashcards
1
Q
3 categories STIs can be
A
- bacterial
- viral
- parasitic
2
Q
how are STIs spread
A
- thru sexual activity
- vaginal, anal, oro-genital sex
3
Q
more than half STIs are in which population/s
A
- adolescents, young adults (15-24yo)
4
Q
STIs commonly occur when
A
- at young age when first starting intercourse and not using condoms
- especially for first sexual intercourse
5
Q
what is a reason why people might not know they have an STI
A
many STIs are asymptomatic
6
Q
how to minimise risk of STI
A
- safe sex eg/ barrier methods like condoms
7
Q
what increases likelihood of STIs
A
multiple partners
8
Q
how can STIs infect neonates
A
vertically from infected mothers
9
Q
common STIs
A
- gonorrhoea
- chlamydia
- mycoplasma genitalium
- herpes simplex viruses
- human papillomavirus (HPV)
- syphilis
- trichomoniasis
- HIV / AIDS
10
Q
chemically define gonorrhoea
A
gram negative intracellular diplococci infecting cuboidal and columnar cells in adults
11
Q
what cant gonorrhoea infect in adults
A
squamous epithelial cells
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
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
14
Q
transmission of gonorrhoea
A
direct inoculation of infected secretions from one mucous membrane to another
15
Q
what are some mucous membranes gonorrhoea spread thru
A
urethra, cervix, rectum, pharynx, eyes
16
Q
gonorrhoea is spread through which contact
A
- penile
- vaginal
- oral
- anal
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
18
Q
define incubation period
A
time between exposure to infectious agent & appearance of symptoms or signs of a disease / infection
19
Q
[manifestations of gonorrhoea in men] what % of men are asymptomatic for gonorrhoea in the urethra
A
90%
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
21
Q
if symptomatic in epididymis / testes from STI this is
A
epididymo-orchitis - scrotal pain / swelling
22
Q
[manifestations of gonorrhoea in men] up to % of men are asymptomatic for gonorrhoea as rectal infection
A
90%
23
Q
if symptomatic for rectal infection from STI this can include
A
- anal pain, bleeding
- anal discharge
- tenesmus
24
Q
[manifestations of gonorrhoea in men]
what symptom can have regarding eyes
A
conjunctivitis
24
[manifestations of gonorrhoea in men]
pharyngeal infection from gonorrhoea is mostly symptomatic or asymptomatic
asymptomatic
25
what is a rare complication of gonorrhoea that can occur for both men and women
disseminated gonococcal infection
26
[manifestations of gonorrhoea in women] what % of women are asymptomatic for gonorrhoea in the endo-cervix
40%
27
if symptomatic in endo-cervix for STI this can include
- post-coital or intermenstrual bleeding
- mucopurulent cervicitis
- cervical discharge presenting as vaginal discharge
- dysuria (pain on urination) due to urethral infection
28
if symptomatic with pelvic inflammatory disease (PID) from STI this can include
- lower abdominal pain
- deep dyspareunia
- post-coital or intermenstrual bleeding
- cervical discharge presenting as vaginal discharge
- fever
29
[manifestations of gonorrhoea in women] list 4 types of infections can have
- rectal infection
- pharyngeal infection
- conjunctivitis
- infection of Bartholin's abscess
30
[manifestations of gonorrhoea in women]
with disseminated gonococcal infection, are women or men more affected
1-2% of women more affected than men
31
what symptom can occur for neonates with gonorrhoea
conjunctivitis
- threatens sight
- needs immediate treatment
32
for diagnosis of STIs what can be done
- microscopy
- culture
- nucleic acid amplification tests (NAAT)
33
for microscopy, gram stain of which mucous membranes are recommended and not recommended
- urethral, cervical, rectal smears
- pharyngeal smears not recommended
34
for which sites can culture be used for gonorrhoea
valid for all sites
35
for which sites can NAAT be used for gonorrhoea
valid for all sites
36
which is most sensitive testing diagnostic for gonorrhoea
NAAT
37
first line treatment of gonorrhoea
- ceftriaxone 500mg IMI stat + azithromycin oral 1g stat
38
what is given for pharyngeal gonorrhoea
ceftriaxone 500mg IMI stat + azithromycin oral 2g stat + anti-emetic
ie/ higher dose azithromycin and anti-emetic
39
second line treatment of gonorrhoea
gentamicin 240mg IMI stat + azithromycin 2g stat
40
what non medical directions are there for treatment (1) of gonorrhoea
- avoid sex for 7 days
41
what other directions must be taken regarding partners with gonorrhoea treatment
partner notification and treatment
42
what else should be offered alongside treatment for gonorrhoea (4)
ie/ check for blood borne viral infections
offer HIV, syphilis, hep B, hep C screening
43
what else should be offered for after initial testing for gonorrhoea
test of cure
44
why is azithromycin given at higher dose for pharyngeal gonorrhoea
due to increasing resistance of gonorrhoea particularly in the pharynx
45
regarding treatment of gonorrhoea what is a major problem worldwide
antibiotic resistance
46
most isolates for gonorrhora are resistant to which antibiotics (2)
- penicilliin
- ciprofloxacin
47
there is ___ grade resistance to azithromycin in SA
low grade
48
what is one thing you must do before treating a patient with gonorrhoea
- essential to perform a culture from all sites
- so antimicrobial sensitivity can be looked at
49
what STI is the most frequently reported in Australia
chlamydia
50
why is it very important to screen the main demographic (15-24yo) for chlamydia
due to asymptomatic nature of most chlamydia infections
51
age range of most chlamydia reports
15-24yo
52
5 associated risk factors for chlamydia
- young age (<25yo)
- high number of recent sexual partners
- recent change in partner
- inconsistent use of condoms
- past chlamydia infection
53
how is chlamydia primarily transmitted
- bodily fluids through penetrative intercourse
54
chlamydia incubation period
7-21 days
55
list of potential gonorrhoea symptoms in men
- urethral symptoms (most asymptomatic)
- epididymo-orchitis
- rectal infection (most asymptomatic)
- pharyngeal infection (most asymptomatic)
- conjunctivitis
- disseminated gonococcal infection
56
list of potential gonorrhoea symptoms in women
- 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
57
list of potential gonorrhoea symptoms in neonates
conjunctivitis
58
list of potential chlamydia symptoms in men
- urethral symptoms (half asymptomatic)
- epididymo-orchitis
- rectal infection (most asymptomatic)
- pharyngeal infection (mostly asymptomatic)
- conjunctivitis
- reactive arthritis
59
list of potential chlamydia symptoms in women
- endo-cervix symptoms (over half asymptomatic)
- pelvic inflammatory disease (PID)
- rectal infection
- pharyngeal infection
- conjunctivitis
- reactive arthritis
- Bartholin's abscess
60
list of potential chlamydia symptoms in neonates
- conjunctivitis
- otitis media
- pneumonia
- pharyngeal infection
61
[sequelae from chlamydia PID] __-__% of chlamydial infections can lead to PID
- 10-40%
- infertile
62
- 3 other sequelae from chlamydia PID
- tubal factor infertility
- ectopic pregnancy
- chronic pelvic pain
63
in men with chlamydia and urethra symptoms, __% can be asymptomatic
50%
64
in men with chlamydia and rectal infection, up to __% can be asymptomatic
up to 90
65
in men with chlamydia and pharyngeal infection are most or less asymptomatic
most
66
in women with chlamydia and endo-cervix symptoms, __% can be asymptomatic
70%
67
[sequelae from chlamydia PID] of those with PID, up to 20% can become ______
infertile
68
what is used for diagnosis of chlamydia
nucleic acid amplification tests (NAAT)
69
are cultures used for diagnosis of chlamydia
no
70
for how long after successful treatment of chlamydia can NAAT remain positive
4-5 weeks after
due to dead chlamydia
71
it is important not to forget about which test results especially if pre-test probability is low (chlamydia)
false positive
72
what are we looking for with NAAT diagnosis of chlamydia & how much do we need
- ribosomal RNA (rRNA)
- 5 copies of RNA enough to get positive result
73
possible samples used for diagnosis of chlamydia in males (NAAT)
- first pass urine
- proximal urethral swab
- rectal swab
- pharyngeal swab
- eye swab
74
for first pass urine sample it is recommend for patient to hold urine for at least how many minutes
20 minutes
75
possible samples used for diagnosis of chlamydia in females (NAAT)
- endo-cervical swab
- self-collected high vaginal swab (HVS)
- first catch urine
- rectal swab
- pharyngeal swab
76
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
- first catch urine from females
- more acceptable in GP set up
77
what is the standard treatment for chlamydia
doxycycline 100mg bd for 7 days
78
what is alternative treatment to chlamydia
azithromycin 1g stat
79
for complicated chlamydia infections (eg/ PID, epididyno-orchitis) what is treatment
- doxycycline 100mg bd for 14 days
- combined with other antibiotics
80
what other directions must be taken regarding partners with chlamydia treatment
- partner notification (all sexual partners of patient in last 6 months) for testing AND treatment
81
what step to faculty above is needed for chlamydia
notification of infection to health department
82
what non medical directions are there for treatment (1) of chlamydia to the patient
- avoid sex for 7 days
83
what directions are there for treatment (3) of chlamydia to the active sexual partners of the patient
- get treatment
- no sex for 7 days
could be presumptive treatment or based on positive test result (require partner notification)
84
at adelaide sexual health centre, when is test of cure offered for chlamydia patients and which types of chlamydia patients (2)
- 4 weeks
- rectal chlamydia and pregnant women only
85
mycoplasma genitalium is transmitted thru
mucosal contacts
86
prevalence of 10-35% in men with non _____ and non _____ urethritis
non gonococcal
non chlamydial
87
why do penicillin and cephalosporins not work against mycoplasma genitalium
it does not have a cell wall
88
for males with mycoplasma genitalium symptoms in males
- urethral symptoms
- epididymo-orchitis
- rectal infection
- pharyngeal infection
- conjunctivitis
- reactive arthritis
89
for males with mycoplasma genitalium affecting the urethra what % are asymptomatic
30%
90
for males with mycoplasma genitalium causing rectal infection, are most or less patients asymptomatic
most
91
for males with mycoplasma genitalium causing pharyngeal infection, are most or less patients asymptomatic
asymptomatic
92
for females with mycoplasma genitalium symptoms
- endocervic symptoms
- PID
- rectal infection
- pharyngeal infection
- conjunctivitis
- reactive arthritis
93
for males with mycoplasma genitalium causing endocervix symptoms, between __-__% are asymptomatic
40-75%
94
studies have shown what for neonates regarding mycoplasma genitalium
mycoplasma genitalium in the respiratory tracts of neonates but clinical signif is unclear
95
what testing is done to diagnose mycoplasma genitalium
NAAT
96
what samples can be used for NAAT testing for mycoplasma genitalium in males (2)
- first pass urine
- rectal swab
97
what samples can be used for NAAT testing for mycoplasma genitalium in females (3)
- endocervical swab
- high vaginal swab
- first pass urine
98
first line treatment of uncomplicated mycoplasma genitalium
doxycycline followed by azithromycin
99
second line treatment of uncomplicated mycoplasma genitalium
doxycycline followed by moxifloxacin 400mg daily
for 10 days
100
if treatment not successful for uncomplicated mycoplasma genitalium, use antibiotics such as (2)
- pristinomycin
- minocycline
101
what is used for treatment of mycoplasma genitalium if PID or epididymo-orchitis is present
moxifloxacin 400mg daily
for 14 days
102
what other directions must be taken regarding partners with gonorrhoea treatment
partner notification
103
when is test of cure available after mycoplasma genitalium offered
4 weeks after treatment
104
how is syphilis transmitted
thru skin contact with syphilitic lesions
105
syphilis is more common among which 3 populations
- men who have sex with other men (MSMs)
- ATSI
- overseas populations living in australia
106
there has recently been a ____ epidemic of syphilis
heterosexual epidemic
107
is syphilis currently increasing or decreasing prevalence in aus
increasing
108
how many stages of syphilis are there
4
109
what is stage 1 of syphilis
1. primary syphilis - ulcer / chancre (sore caused by syphilis)
110
what is stage 2 of syphilis
2. secondary syphilis - systemic illness
111
what is stage 3 of syphilis
3.latent syphilis - asymptomatic stage
112
what is stage 4 of syphilis
4. tertiary syphilis - late symptomatic phase (cardiovascular system, central nervous system, gumma)
113
incubation of primary syphilis (chancre)
- 9-90 days (median 21 days)
114
what is primary syphilis symptoms (2)
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
how long does primary syphilis last for
3-6 weeks
116
when does secondary syphilis occur (with regard to primary syphilis)
4-8 weeks after chancre (but both primary and secondary can be present at same time)
117
symptoms of secondary syphilis
- 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
secondary syphilis resolves over how many weeks even without treatment
3-12 weeks
119
what do mucosal lesions in the genital area (condylomata lata) look like
- warts
120
what are the stages within latent syphilis - asymptomatic stage
- early latent stage
- late latent stage
121
describe the early latent stage (asymptomatic stage) of syphilis
within first 2 years of initial infection
122
describe the late latent stage (asymptomatic stage) of syphilis
after the first 2 years of initial infection
123
tertiary syphilis occurs if....
you don't treat syphilis
124
tertiary syphilis is characterised by (4)
- locally destructive lesions
- gummatous lesions (non-cancerous)
- cardiovascular impacts
- neurological impacts
125
(tertiary syphilis) gummatous lesions are granulomatous lesions
most commonly found in the ___ and ___
which causes ________ and ________
- skin and bone
- tissue damage and disfigurement
126
[tertiary syphilis] cardiovascular impacts occur when
15-30 years later
127
[tertiary syphilis] cardiovascular impacts include
- predominantly large vessel disease
(=> can get) aortic aneurysm and / or aortic valve incompetence
128
[tertiary syphilis] neurological impacts include
- syphilitic meningitis
- meningovascular syphilis
- cranial nerve palsies
- general paresis
- tabes dorsalis
129
what are granulomatous
- 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
infectious syphilis is usually infection when?
less than 2 years after acquisition
131
the stages of syphilis that are infectious include
- primary
- secondary
- early latent
132
treatment for infectious syphilis
benzathine penicillin 1.8 IM as a single dose
133
when is vertical transmission of syphilis possible
- during all stages
- in first 8-10 years after acquisition from the mother
134
which syphilis stages are not infectious sexually
- late latent stage (>2yrs after acquired; asymptomatic stage)
- tertiary syphilis
135
how to diagnose late latent (asymptomatic) stage of syphilis apart from early latent stage
disease acquired more than 2 years ago - confirmed thru no negative syphilis tests in last two years
136
how to diagnose late latent (asymptomatic) stage of syphilis apart from tertiary syphilis
- clinical examination of CVS and CNS to exclude tertiary syphilis
137
treatment of late latent (asymptomatic) stage syphilis
benzathine penicillin 1.8 IM
weekly (one dose) for 3 weeks
138
what is used for a definitive diagnosis of syphilis (4)
- dark ground microscopy (involves treponemes)
- direct fluorescent antibody (DFA) testing (involves treponemes)
- immunohistochemistry on biopsies
- PCR (esp for secondary syphilis and congenital syphilis)
139
how else is syphilis diagnosed
serology
140
serology involves which broad tests
- screening tests
- confirmatory tests - Treponemal tests
- syphilis disease activity
141
components that need to be done to differentiate between different stages of syphilis
- history
- examination
- epidemiology
- previous treatment history
- repeat syphilis disease activity test (RPR) 1-2 weeks later - if not sure if new infection
142
what (2) can cause genital herpes
- herpes simplex 1 (HSV-1)
- herpes simplex 2 (HSV-2)
143
in HSV-2, what proportion of individuals develop symptoms at time of infection acquisition
1/3rd
144
other people with HSV-1 or HSV-2 without symptoms at infection acquisition might... (2)
- not recognise their infection
- show symptoms later in life (eg/ pregnancy)
145
how are HSV-1 and HSV-2 spread
- spread thru skin contact
- affecting areas where virus enters the body
- kissing, vaginal, oral, anal sex
146
define primary infection for HSV
- first infection with either HSV-1 or HSV-2 with no pre-existing antibodies to either type
- most are asymptomatic
147
define non-primary infection of HSV
- first infection with either HSV-1 or HSV-2 with pre-existing antibodies to the other type
- most are asymptomatic
148
define first episode (primary and non-primary) for herpes
- first clinical episode with either HSV-1 or HSV-2]
(not limited to infected dermatome)
149
define recurrent episode of herpes
recurrence of clinical symptoms due to reactivation of pre-existent HSV-1 or HSV-2 in sensory ganglia
150
most cases of recurrent (episode) genital herpes are caused by HSV?
HSV-2
151
recurrent outbreaks are limited to
the infected dermatome
152
describe asymptomatic viral shedding (infectious to other people)
- reactivation of HSV in sensory ganglia
- can cause shedding of virus from the dermatome without causing clinical symptoms (asymptomatic)
- not recurrent episode
153
more asymptomatic shedding is caused by which HSV
HSV-2
154
HSV-2 can cause ~x recurrent episodes per year; HSV1 can cause ~y recurrent episodes per year
- 4
- 1
155
given the natural history of herpes infection, the frequency of (2) reduces with ___
- recurrent episodes
- viral shedding
- time
156
herpes infection can be transmitted sexually via both
- clinical recurrences (symptomatic viral shedding) (and others)
- asymptomatic viral shedding
157
symptoms of herpes
- 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
when is herpes most infectious
visible blisters with genital ulcers
159
why is there dysuria in herpes
due to urethritis (inflammation of urethra)
160
why is there external dysuria in herpes
due to urine coming in contact with ulcers
161
list some constitutional symptoms of herpes
headaches, back-aches, flu-like illness
162
define proctitis
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
define pnuemonitis
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
signs of herpes
- multiple superficial genital ulcers
- vesicles
- tender, firm, mobile regional lymphadenopathy
- fever
- acute retention of urine
- anal pain / discharge - in MSMs
165
what are genital ulcers in herpes preceded by
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
diagnosis of herpes (2)
- PCR
- type specific serology
167
2 benefits of PCR for herpes for diagnosis
- very sensitive and very specific
- can swab at any site
168
for type specific serology, which antibodies are helpful to differentiate between HSV1 and HSV2
IgG antibodies
169
what would positive HSV IgG antibodies generally indicate & why
genital infection
since oral infections due to HSV2 is uncommon
170
what would positive HSV1 IgG antibodies generally indicate
indicate either oro-labial (mouth and lips) infection or a genital infection
171
limitations to type specific serology (3)
- 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
with type specific serology you can't get the time of infection - why regarding antibodies
- IgG antibodies indicate an infection sometime in the past
- IgM antibodies would indicate recent infection
- but IgM detection is unreliable
173
indications (when would we do) type specific serology
- 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
treatment and management of herpes for first clinical episode (primary and non primary)
- antivirals
- pain management
- consider saline washes (Sitz baths for females)
- patient education
175
what would be patient education in management of herpes for first clinical episode
- 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
with recurrent episodes of herpes, treatment needs to be started within first __ hours
72 hours
177
treatment of recurrent episodes of herpes reduce ____ _ _____ by median of _-_ days
duration of illness
1-2 days
178
treatment of recurrent episodes
antivirals
179
suppressive therapy for herpes reduces:
- recurrences by x-y%
- asymptomatic shedding by a-b%
- 70-80%
- 80-90%
180
indications for suppressive therapy for herpes
- 6 or more recurrences per year
- severe recurrences
- pregnancy - to prevent neonatal herpes
- consider in discordant couples to reduce sexual transmission
181
suppressive therapy for herpes in pregnant women in last trimester acquisition and first/second trimester or pre-pregnancy acquisition
last trimester acquisition: from day of finishing first episode therapy until delivery
pre-pregnancy or 1st/2nd trimester: from 36 weeks onward
182
why are pregnant women given suppressive therapy for herpes
to prevent transmission to neonates (neonatal herpes)
183
human papillomavirus (HPV) has >__ types identified, with more than __-__ types affecting genital area, and usually are ___ specific
- 100
- 40-50
- site specific
184
which is the most common STI generally
HPV
185
with HPV, immune system clears infection naturally within x years in y% cases
2 years
90% of cases
186
how is HPV transmitted
- skin to skin contact - genital contact and orally
187
__% of clinically visible genital warts are caused by types _, __ - low ____ potential
- 90% of genital warts
- types 6, 11
- low oncogenic
188
70% of ___ / __ cancers are caused by HPV oncogenic types __, __
type 16 alone would cause __% of these
- cervical / anal cancers
- types 16, 18
- 50%
189
most HPV infections are clinically detectable - T or F
F, subclinical
190
are most HPV infectious self-limiting (condition that resolves on its own without requiring significant medical intervention)
yes
191
oncogenic types of HPV are commonly _______ and cause persistent ____
- asymptomatic
- infections
192
can you be infected and asymptomatic with HPV
yes
193
symptoms of HPV infection - genital types
- 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
diagnosis of HPV
clinical
- warts: can be papular, hard, soft, singular or multiple
- atypical warts or pigmented warts need biopsy
195
what are papules
small pimple or swelling on skin; often forming part of a rash
196
treatment options of HPV
- cryotherapy
- wartec (podophyllin)
- aldara (imiquamod)
- none (may resolve with time)
197
known low risk types (2) of HPV
- type 6, type 11
198
what is used for prevention of HPV
vaccines
199
list (3) types of HPV vaccines and what they prevent
- 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
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
- preventative
- exposures
- recurrent high-grade lesions
201
describe trichomonas vaginalis (TV)
sexually transmitted infection or vagina and urethra
202
what is the causative agent of trichomonas vaginalis
trichomonas vaginalis
203
most commonest STI worldwide
trichomonas vaginalis
204
trichomonas vaginalis is more common in which communities in australia
aboriginal communities
205
trichomonas vaginalis is asymptomatic in what % in women and men
10-50% of women
15-50% of men
206
symptoms of trichomonas vaginalis in women
- 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
symptoms of trichomonas vaginalis in men
- dysuria
- urethral discharge
208
diagnosis of trichomonas vaginalis
- microscopy: observation of trichomonads (on wet-mount preparation)
- pap smear: cervical cytology smear preparations
- PCR
209
microscopy for trichomonas vaginalis has a sensitivity rate of __-__%
40-70%
210
cervical cytology smear preparations has a false positive rate of x%
30%
211
treatment options of trichomonas vaginalis
antibiotics
- tinidazole 2g PO single dose
- metronidazole 400mg BD PO for 7 days
- metronidazole 2g PO single dose (not in pregnancy)
212
for treatment of trichomonas vaginalis why are topical treatments usually ineffective
because trichomonas vaginalis infect urethra, paraurethral glands, Bartholin glands
213
in trichomonas vaginalis, who should also be screened and treated
male partners
