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Week 7 - microbiology > STI > Flashcards

STI Flashcards

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1
Q

With which presenting symptoms should you consider taking a sexual history/performing a sexual health screen?

A
  • Vaginitis
  • Urethritis
  • Epididymo-orchitis
  • Pelvic inflammatory disease
  • Proctitis
  • Ulcer/lumps on genitals
  • Possible syphilis
  • Possible HIV seroconversion
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2
Q

What are the symptoms of vaginitis?

A
  • Change in discharge (colour, consistency, volume)
  • Dysuria
  • Change in menstrual bleeding
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3
Q

What are the symptoms of vaginitis?

A
  • Change in discharge (colour, consistency, volume)
  • Dysuria
  • Change in menstrual bleeding
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4
Q

What are the symptoms of urethritis

A
  • Penile discomfort
  • Dysuria
  • Meatal discomfort
  • In women it rarely causes any symptoms
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5
Q

What are the symptoms of epididymo-orchitis

A

Swollen, painful testicle

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6
Q

What are the symptoms of pelvic inflammatory disease?

A
  • Pelvic pain
  • Fever
  • Change in discharge
  • Dyspareunia
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7
Q

What are the symptoms of proctitis?

A
  • Rectal discharge
  • Rectal pain
  • Bleeding
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8
Q

What is tested for on a standard sexual health screen?

A
  • Chlamydia and gonorrhoea (naat test)

* Syphilis and HIV (blood test)

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9
Q

Where are the swabs obtained for a sexual health screen?

A
  • Women: self taken vulvovaginal swab
  • men: urine
  • Men with male sexual partners: urine, throat and self taken rectal swab
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10
Q

Which groups are at a higher risk of gonorrhoea?

A
  • Men who have sex with men
  • Afro-carribean
  • Urban areas with deprivation
  • Women <25 years
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11
Q

What is gonorrhoea caused by?

A

Gram negative diplococcus N. gonorrhoeae

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12
Q

Where does N.gonorrhoeae infect?

A 
mucous membranes of:
•Urethra
•Endocervix 
•Rectum 
•Pharynx 
•Conjunctiva
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13
Q

How does gonorrhoea spread?

A

Inoculation through secretions from one mucous membrane to another

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14
Q

What are the symptoms of gonorrhoea in men?

A
  • Urethral discharge (yellow green)

* Dysuria

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15
Q

What are the symptoms of gonorrhoea in women?

A
  • Change in discharge
  • Abdominal/pelvic pain
  • Dysuria
  • Altered bleeding is rare
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16
Q

What are the symptoms of rectal gonorrhoea

A

Usually asymptomatic but can get anal discharge, pain or discomfort

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17
Q

Describe the diagnosis of gonorrhoea

A
  • NAAT testing - urine in male, self taken vaginal swab in women (takes up to a week)
  • Urethral sample microscopy - looking for gram negative diplococci, if positive treat straight away, if negative await NAAT testing don’t rule out
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18
Q

With Gonorrhoea, who should you treat?

A
  • Those with a positive test result
  • Clinical suspicion in certain cases (e.g. when no on the day microscopy is available)
  • Recurrent or ongoing sexual contact with gonorrhoea
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19
Q

What should you give to treat gonorrhoea?

A
  • Ceftriaxone 1g IM (or ciprofloxacin if sensitive)

* Repeat test after 2 weeks to ensure cure

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20
Q

What are the complications of gonorrhoea?

A
  • Epididymo-orchitis
  • Prostatitis
  • Pelvic inflammatory disease
  • Disseminated gonococcal infection (rare in the UK, usually affects the skin and joints)
  • Resistance (48.6% is restart to at least one antibiotic)
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21
Q

What is the most common bacterial STI in the UK?

A

Chlamydia

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22
Q

What are the risk factors for a chlamydia infection?

A
  • <25 years old
  • New sexual partner or >1 partner
  • Inconsistent condom use
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23
Q

What are the signs of a penile chlamydia infection?

A
  • Majority are asymptomatic
  • Discharge/dysuria/meatal discomfort
  • Normally the discharge is clear/white
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24
Q

What are the symptoms of vaginal chlamydia infection?

A
  • Most asymptomatic
  • Intermenstrual bleeding/ Post coital bleeding
  • Cervicitis or contact bleeding
  • Change in discharge
  • Pelvic pain
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25
Q

What are the symptoms of a rectal chlamydia infection?

A
  • Usually asymptomatic
  • Can present with proctitis (rectal pain, PR discharge/bleeding, tenesmus, constipation)
  • Lymphogranuloma venereum (chlamydia attacks the lymph nodes) subtype often presents as proctitis
26
Q

What is the diagnosis of chlamydia?

A
  • NAAT testing

* Same sample as gonorrhoea

27
Q

What is the treatment of chlamydia?

A

Doxycycline 100mg BD 7/7 (weeks Course)

28
Q

What are the complications of chlamydia?

A
  • Pelvic inflammatory disease

* Epididymo-orchitis

29
Q

What are the complications of pelvic inflammatory disease?

A
  • Tubal infertility (1-20%)
  • Ectopic pregnancy
  • Fitz-hugh-curtis syndrome
30
Q

How is mycoplasma genitalium infection diagnosed?

A

NAAT (urine/self taken swab)

31
Q

What are the symptoms of a mycoplasma genitalium infection?

A
  • Some people get symptoms of urethritis/PID

* Some asymptomatic

32
Q

Who is treated for mycoplasma genitalium infection?

A

Only those with symptoms or partners of those with symptoms (to stop the chain of infection)

33
Q

What is trichomonas vaginalis?

A

Protozoan with flagella

34
Q

What are the symptoms of a vaginal trichomonas vaginalis infection?

A
  • Often asymptomatic
  • Frothy yellow discharge with intense itch
  • ‘Strawberry cervix’ in 2%
35
Q

What are the symptoms of a penile trichomonas vaginalis infection?

A
  • Usually asymptomatic

* Can have urethritis

36
Q

How is trichomonas vaginalis diagnosed?

A

Microscopy/culture

37
Q

How is trichomonas vaginalis infection treated?

A

Metraonidazole

38
Q

What causes syphilis?

A

A gram negative spirochete bacterium called treponema palladium

39
Q

Describe the transmission of syphilis

A
  • Normally transmitted sexually

* Can be transmitted vertically

40
Q

What is it called if someone is asymptomatic but tests positive for syphilis?

A

Latent syphilis

41
Q

What is the classical presentation of primary syphilis?

A
  • Chancre
  • Usually single and painless ulcer, clear fluid
  • May be on the genitals, peri anal, in the mouth
  • 9-90 days
42
Q

What is the classical presentations of secondary syphilis?

A
  • usually a generalised rash affecting the palms and sole
  • Muco-cutaneous lesions, condylomata lata, lymphadenopathy and fever
  • Occurs in 25%, 3 months- 2 years
43
Q

What is the classical presentation of tertiary syphilis?

A 
• Neurosyphilis: 
  - variation of neurological symptoms 
•Cardiovascular syphilis 
  - Aortic valve disease, aortic aneurysm, aortitis 
•Gummatous syphilis
44
Q

What is the diagnosis of syphilis?

A

• If there is a chancre: dark ground microscopy/viral PCR swab
•bloods for antibody
- 3 month window period
- stays positive even after treatment completed
• Rapid plasma reagin
- quantitative marker

45
Q

What is the treatment of syphilis?

A

Benzathine penicillin

46
Q

What causes anogenital warts?

A

Human papilloma virus (HPV), most commonly types 6 and 11

47
Q

What are the symptoms of anogenital warts?

A

Normally only itch, aesthetics usually main problem

48
Q

What is the advice given to those with anogenital warts?

A
  • Reassure high prevalence and benign
  • No requirement for partner notification but condoms reduce transmission
  • Many people clear virus
  • Smoking/hair removal slows down the ability to self clear
49
Q

What is the treatment of anogenital warts?

A
  • Cryotherapy
  • Topical treatments: podophyllotoxin/imiquimod
  • Surgical excision (rarely required)
50
Q

How is herpes simplex virus diagnosed?

A

Viral PCR swab

51
Q

What advice should be given to those with HSV?

A
  • Reassure, high prevalence
  • Possible future recurrence
  • Condoms reduce transmission
52
Q

What are the complications of herpes?

A
  • CNS infection, balanitis, proctitis, urinary retention (only if sig swelling)
  • If first episode is in pregnancy there is a risk of neonatal infection
53
Q

What is the treatment of herpes?

A
  • Aciclovir
  • Can give long term if frequent recurrences
  • A lukewarm bath with some salt can help to alleviate some of the symptoms
54
Q

What are the symptoms of scabies?

A
  • Itch, especially at night

* rash

55
Q

What causes scabies?

A

Hypersensitivity reaction triggered by mite excrement

56
Q

Where are the classical burrows in scabies?

A
  • Web spaces
  • Wrist
  • Elbows
  • Nipples
57
Q

How is scabies diagnosed?

A

On clinical appearance

58
Q

What is the treatment of scabies?

A
  • Permethrin 5% or malathion 0.5%
  • Wash off after 24 hours
  • Wash contaminated clothes at 50 degrees celsius
59
Q

Explain phthirus pubis infection

A
  • Transmitted by close bodily contact
  • Lives on coarse body hair
  • It needs hair to stay alive
  • Incidence is decreasing
60
Q

What is the treatment of phthirus pubis infection?

A

Malathion 0.5% or permethrin 1% cream

Week 7 - microbiology (12 decks)

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