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STDs and HIV Flashcards

1
Q

How are infections transmitted during sex (6 methods)?

A 
Direct innoculation, e.g: Herpes Simplex Virus
Trauma, e.g: hepatitic C virus
IV drug use, e.g: HIV and hep C
Fomites (objects), e.g: gonorrhea
Ingestion, e.g: shigella
Sexual/genital secretions
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2
Q

Which STIs can affect the mouth/oropharynx?

A

HPV, HSV, Chlamydia, LGV, Gonorrhea, Syphilis, HIV

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3
Q

Which STIs can affect the liver/biliary tract?

A

Chlamydia
Syphilis
HIV
Hep A, B, C

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4
Q

Which STIs can affect the stomach?

A

Syphilis

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5
Q

Which STIs can affect the small bowel?

A

HIV, Giardia, Shigella

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6
Q

Which STIs can affect the large bowel?

A

Chlamydia, LGV, Gonorrhea, Syphilis, HIV

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7
Q

Which STIs can affect the rectum?

A

HPV, HSV, Chlamydia, LGV, Gonorrhea, Syphilis, HIV

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8
Q

Which STIs can affect the anus?

A

HPV, HSV, LGV, Syphilis, HIV

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9
Q

What would be on an STI differential diagnosis?

A

Inflammatory Bowel Disease

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10
Q

Testing for STIs?

A

Urethral swab for microscopy; can also use NAAT (nucleic acid amplification test)

Stool culture

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11
Q

Cause of rectal gonorrhea and transmission?

A

Neisseria gonorrhea transmitted by direct contact of mucosal surfaces

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12
Q

How is gonorrhea spread for proctitis?

A

Anal sex, transmucosal spread, fomite

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13
Q

Symptoms of gonorrhea and differentiation from IBD?

A

Short incubation period (5-10 days):
Lower abdominal pain, diarrhoea, rectal bleeding, anal discharge, tenesmus

May have assoc. symptoms:
Urethral/vaginal discharge and dysuria (not in IBD)

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14
Q

What does proctoscopy show with gonorrhea?

A

Inflamed mucosae and purulent exudate

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15
Q

Complications of rectal gonorrhea?

A

Abscess formation and increased susceptibility to HIV (in response to inflammation, there are many CD4+ cells)

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16
Q

Cause of rectal chlamydia and tranmission?

A

Chlamydia trachomatis transmitted by direct contact between mucosal surfaces

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17
Q

Why can Chlamydia diagnosis be missed if only urine is tested?

A

50% of Chlamydia in MSM is found solely in the rectum

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18
Q

Symptoms of rectal chlamydia?

A

70% asymptomatic but, when symptomatic, tends to be milder than Gonorrhea (proctoscopy is less severe); inc. anal discomfort/itch, discharge and assoc. symptoms

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19
Q

Testing for rectal chlamydia?

A

NAAT

CT and GC

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20
Q

Signs of primary syphilis?

A

Solitary painless ulcer

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21
Q

Signs of secondary syphilis?

A

Mucosal patches and ulcers
Mouth, anogenital, rectal

Condylomata lata - warty lesions that can form in the anal cleft

Hepatitis

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22
Q

Transmission of herpes simplex virus?

A

Ano-genital or oro-anal

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23
Q

Type of HSV in proctitis?

A

Usually, HSV 2 affecting the peri-anal mucosa, but may extend into rectum

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24
Q

Symptoms of HSV?

A

Pain and ulcers
Painful defecation, with bleeding and mucous

Viraemic symptoms (in primary infection)

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25
Q

Transmission of human papillomavirus (HPV)?

A

Ano-genital, oro-anal

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26
Q

What is Lymphogranuloma venereum?

A

Primarily an infection of lymphatics and lymph nodes, caused by Chlamydia trachomatis

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27
Q

Risk factors for LGV?

A

Group sex
Drug use
Syphilis and hep C

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28
Q

Primary, secondary and tertiary features of LGV?

A

Primary (3-30 days): ulcer
Secondary (3-6/12): inguinal syndrome, ano-rectal syndrome
Tertiary: strictures, fistulae, genital elephantiasis

29
Q

Testing for LGV?

A

MSM with haemorrhagic proctitis

HIV + MSM with +ve rectal chlamydia

Failed chlamydia test of cure

Contact of LGV

30
Q

In somebody diagnosed for LGV, what else should be tested for?

A

HIV, hep C, syphilis

31
Q

What is GALT?

A

Gut-assoc. lymphoid tissue - largest immune compartment in the body

32
Q

Where are the mucosal lymphocytes present in the GI tract and why do they allow HIV to enter the host cell?

A

Rectum, foreskin and cervico-vagina have a higher proportion of CD4+ T helper cells (express CCR5 - co-receptor for HIV entry into the host cell)

33
Q

What happens to the GALT in HIV?

A

Depletion of intestinal GALT regardless of site of infection - can lose up to 60% by day 14

34
Q

Clinical result of GALT loss?

A

Unknown but may inc:
HIV enteropathies
Opportunistic infection
Persistent immune activation (microbial translocation)
Accelerated immunosecescence (aging of the immune system)

35
Q

STI risk factors?

36
Q

Which STIs can affect the mouth/oropharynx?

A

HPV, HSV, Chlamydia, LGV, Gonorrhea, Syphilis, HIV

37
Q

Which STIs can affect the liver/biliary tract?

A

Chlamydia
Syphilis
HIV
Hep A, B, C

38
Q

Which STIs can affect the stomach?

39
Q

Which STIs can affect the small bowel?

A

HIV, Giardia, Shigella

40
Q

Which STIs can affect the large bowel?

A

Chlamydia, LGV, Gonorrhea, Syphilis, HIV

41
Q

Which STIs can affect the rectum?

A

HPV, HSV, Chlamydia, LGV, Gonorrhea, Syphilis, HIV

42
Q

Which STIs can affect the anus?

A

HPV, HSV, LGV, Syphilis, HIV

43
Q

What would be on an STI differential diagnosis?

A

Inflammatory Bowel Disease

44
Q

Testing for STIs?

A

Urethral swab for microscopy; can also use NAAT (nucleic acid amplification test)

Stool culture

45
Q

Cause of rectal gonorrhea and transmission?

A

Neisseria gonorrhea transmitted by direct contact of mucosal surfaces

46
Q

How is gonorrhea spread for proctitis?

A

Anal sex, transmucosal spread, fomite

47
Q

Symptoms of gonorrhea and differentiation from IBD?

A

Short incubation period (5-10 days):
Lower abdominal pain, diarrhoea, rectal bleeding, anal discharge, tenesmus

May have assoc. symptoms:
Urethral/vaginal discharge and dysuria (not in IBD)

48
Q

What does proctoscopy show with gonorrhea?

A

Inflamed mucosae and purulent exudate

49
Q

Complications of rectal gonorrhea?

A

Abscess formation and increased susceptibility to HIV (in response to inflammation, there are many CD4+ cells)

50
Q

Cause of rectal chlamydia and tranmission?

A

Chlamydia trachomatis transmitted by direct contact between mucosal surfaces

51
Q

Why can Chlamydia diagnosis be missed if only urine is tested?

A

50% of Chlamydia in MSM is found solely in the rectum

52
Q

Symptoms of rectal chlamydia?

A

70% asymptomatic but, when symptomatic, tends to be milder than Gonorrhea (proctoscopy is less severe); inc. anal discomfort/itch, discharge and assoc. symptoms

53
Q

Testing for rectal chlamydia?

A

NAAT

CT and GC

54
Q

Signs of primary syphilis?

A

Solitary painless ulcer

55
Q

Signs of secondary syphilis?

A

Mucosal patches and ulcers
Mouth, anogenital, rectal

Condylomata lata - warty lesions that can form in the anal cleft

Hepatitis

56
Q

Transmission of herpes simplex virus?

A

Ano-genital or oro-anal

57
Q

Type of HSV in proctitis?

A

Usually, HSV 2 affecting the peri-anal mucosa, but may extend into rectum

58
Q

Symptoms of HSV?

A

Pain and ulcers
Painful defecation, with bleeding and mucous

Viraemic symptoms (in primary infection)

59
Q

Transmission of human papillomavirus (HPV)?

A

Ano-genital, oro-anal

60
Q

What is Lymphogranuloma venereum?

A

Primarily an infection of lymphatics and lymph nodes, caused by Chlamydia trachomatis

61
Q

Risk factors for LGV?

A

Group sex
Drug use
Syphilis and hep C

62
Q

Primary, secondary and tertiary features of LGV?

A

Primary (3-30 days): ulcer
Secondary (3-6/12): inguinal syndrome, ano-rectal syndrome
Tertiary: strictures, fistulae, genital elephantiasis

63
Q

Testing for LGV?

A

MSM with haemorrhagic proctitis

HIV + MSM with +ve rectal chlamydia

Failed chlamydia test of cure

Contact of LGV

64
Q

In somebody diagnosed for LGV, what else should be tested for?

A

HIV, hep C, syphilis

65
Q

What is GALT?

A

Gut-assoc. lymphoid tissue - largest immune compartment in the body

66
Q

Where are the mucosal lymphocytes present in the GI tract and why do they allow HIV to enter the host cell?

A

Rectum, foreskin and cervico-vagina have a higher proportion of CD4+ T helper cells (express CCR5 - co-receptor for HIV entry into the host cell)

67
Q

What happens to the GALT in HIV?

A

Depletion of intestinal GALT regardless of site of infection - can lose up to 60% by day 14

68
Q

Clinical result of GALT loss?

A

Unknown but may inc:
HIV enteropathies
Opportunistic infection
Persistent immune activation (microbial translocation)
Accelerated immunosecescence (aging of the immune system)

69
Q

Public health interventions with STDs and HIV?

A

Prevent re-infection

Maintain good sexual health for future

Clinical (54 decks)

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