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Reproduction and Sexual health > STI > Flashcards

STI Flashcards

1
Q

What is the main bacteria of vaginal flora?

A

lactobacillus

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2
Q

what is the role of lactobacillus?

A

prevent pathological prevention by producing lactic acid and H202

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3
Q

what type of gram stain is chlamydia?

A

gram negative bacterium

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4
Q

what is the cause of chlamudia?

A

chlamydia trachomatis

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5
Q

what are the serological groupings of chlamydia and their associated infections:

A

A-C: Eyes - trachoma

D-K: genital

L1-L3: Lymphogranuloma venerum (seen in HIV patients, features: genital ulcers+ painful inguinal lymphadenopathy)

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6
Q

what are the clinical features of chlamydia?

A

asymptomatic in majority of women cases and half of mens

men:

urethral discharge

dysuria

women:

cervicitis (discharge, bleeding)

dysuria

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7
Q

what are the potential complications of chlamydia?

A

PID

endometritis

Epididymitis

infertility

increased incidence of ectopic pregnancies

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8
Q

how do you diagnose chlamydia?

A

screening:

open to all men and women 15-24 years old

Investigation:

women:
NAATs = investigation of choice

alternatives to NAATs: vulvovaginal swab or cervical swab

men:

Urine test is first line

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9
Q

how do you manage chlamydia?

A

doxycycline (7 day course) 1st line

azithromycin used if contraindicated

pregnant:

azithromycin (1st choice)

can also used erythromycin or amoxicillin

for women and asymptomatic men:

contact all partners of past 6 months

men with urethral symptoms:

all contacts since and in the 4 weeks prior to symptoms

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10
Q

what is the cause of gonorrhoeae?

A

gram negative diplococcus Neisseria gonorrhoeae

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11
Q

how long is the incubation of gonorrhoeae?

A

short 2-5 days

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12
Q

what are the clinical features of gonorhoeae?

A

asymptomatic in less than 10% of men.

men:
smelly

yellow discharge

associated dysruia

can also cause anal discharge

women:

Increased or altered vaginal discharge

Lower abdominal pain

Dysuria

n.b. rectal and pharyngeal infection is usually asymptomatic

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13
Q

how do you diagnose gonorrhoeae?

A

men: first pass urine
women: vulvovaginal swab

NAAT - tests for chlamydia and gonorrhoea

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14
Q

how do you manage gonorrhoeae?

A

1st line ceftriaxone IM 1g

use oral cefixime 400mg 1 dose + oral azithromycin 2g 2 dose

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15
Q

what are the complications of gonorrhoeae?

A

uretheral strictures

epididymitis

salpingitis

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16
Q

what are the key features of disseminated gonococcal infection?

A

tenosynovitis

migratory polyarthritis

dermatitis

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17
Q

what causes syphillis?

A

treponema pallidum

18
Q

what are the clinical features of syphillis?

A

1.primary 9-90 days:

painless genital ulcer - chancre

2.secondary (6 weeks - 6 months):

mouth ulcers

generalised maculo-papular rash

condylomata lata - highly infective, wart like lesions on genitals

Flu like symptoms - arthlagia, malaise, fever, sore throat

3.Latent:

Asymptomatic

Early: <2 years after infection

Late: >2 years after infection

from late latent and beyond considered non infectious

  1. Tertiary:

Gummatous syphilis:

Gumma — granulomatous lesions with a necrotic centre.

Can develop anywhere but most often affect skin and bone.

cardiovascular syphillis:

Cardiovascular disease — often due to vasculitis and chronic inflammation of the aortic vasa vasorum.

Neurosyphilis:

Tabes dorsalis (inflammation of spinal dorsal column/nerve roots)

argyl robertsol pupil - bilateral small pupils that reduce in size on a near object

19
Q

how do you diagnose syphillis?

A

Non treponemal tests:

non specific for syphilis - false positive risks

e.g. rapid plasma reagin

venereak disease research laboratory

treponemal specific tests:

TP EIA (T pallidum enyme immunoassay)

Pos non treponemal + pos treponemal test= consistent with active syphilis

pos Non treponemal + negative tepronemal = false positive

Neg non treponemal + pos treponemal= successfully treated syphilis

20
Q

how do you manage syphillis?

A

IM benzathine penicillin - 1st line

alternative= doxycycline

jarisch- herxheimer reaction sometimes seen following treatment ( rash, fever, tachycardia)

give antipyretics

21
Q

what is herpes?

A

an enveloped DNA virus

22
Q

what are the two strains of Herpes?

A

HSV-1 - causes most of oral cases. causes 50% of genital infections

HSV-2 - causes 50% of genital infection. 10% of oral cases

23
Q

what are the clinical features of Herpes simplex?

A
  1. primary infection: may present with a severe gingivostomatitis
  2. cold sores
  3. painful genital ulcerations

Recurrent genital herpes occur due to reactivation of pre-existent HSV infection after a latent period.

People typically present with painful blisters or ulcers unilaterally in a single anatomical site, and prodromal tingling and burning symptoms may precede the development of lesions by hours or days.
Systemic symptoms such as fever and malaise are less common than initial episodes, and recurrent attacks are usually less severe, lasting between 5–10 days.

24
Q

what are the risk factors of HSV?

A

Age — peak incidence of HSV is in people aged 15–24 years.

Previous history of STIs.

A high number of lifetime sexual partners.

More than one partner in the last year, or a recent new partner.

Early age of first sexual intercourse.

Unprotected sexual intercourse.

Men who have sex with men.

Female sexual partners of men who have sex with men.

HIV infection.

People who are immunocompromised.

25
Q

how do you investigate HSV?

A

Take a swab from the base of a lesion for viral culture

26
Q

how do you manage HSV?

A

gingivostomatitis: oral aciclovir, chlorhexidine mouth wash

Cold sores: topical aciclovir

Genital herpes: oral aciclovir

Herpes pregnancy:

primary attack: elective CS during pregnancy at greater than 28 weeks gestation

recurrent herpes: treat with suppressive therapy and reassure that risk of transmission to baby is low

27
Q

what type of infection is trichomonas vaginalis ?

A

protazoal infection

28
Q

what are the clinical features of trichomonas vaginalis?

A

male: urethritis

Female: Frothy green discharge, itch, strawberry cervix

High pH (>4.5)

29
Q

how do you investigate for trichomonas vaginalis?

A

microscopy of a wet mount shows motile trophozoites

30
Q

how do you manage tichomonas vaginalis?

A

oral metronidazole for 5-7 days

can give one of 2g metronidazole

31
Q

how do you treat vaginal warts?

A
  1. cryotherapy
  2. Phodophyllotoxin
  3. imiquimod
32
Q

what is the cause of vulvovaginal candidiasis (Gential thrush)?

A

Candida albicans

yeast like fungus

33
Q

what are the risk factor of vaginal candidiasis?

A

Non-compliance with treatment

immunosuppressed

poorly controlled Diabetes

pregnancy

34
Q

what are the clinical features of Vaginal candidiasis?

A

cottage cheese - non offensive discharge

vulvitis - superificial dyspareunia, dysuria

itch

vulval erythema, fissuring, satellite lesions may be seen

35
Q

how do you diagnose vaginal candidiasis?

A
  1. Prescribe empirical treatment without further investigation
  2. penile or high vaginal swab

(not routinely indicated if the clinical features are consistent with candidiasis)

High vaginal swabs for culture to confirm the diagnosis would be indicated if an alternative diagnosis was queried or if the patient was failing to respond to treatment.

36
Q

how do you manage Vaginal candidiasis?

A

oral fluconazole 150mg as a single dose 1st line

clotrimazole 500mg intravaginal pessary as a single dose if contraindicated

add topical imidazole for vulval symptoms

pregnant:

only local treatment - e.g. cream or pessaries can be used

recurrent:

confirm diagnose - high vaginal swab for microscopy and culture

then induction-maintenance regime:

oral fluconazole every 3 days for 3 doses

maintenance: oral fluconazole weekly for 6 months.

37
Q

what are the clinical features of bacterial vaginosis?

A

watery vaginal discharge with fishy smell

38
Q

what investigations do you do for bacterial vaginosis?

A

discharge pH - 4.5

high vaginal swab - clue cells

39
Q

how do you manage bacterial vaginosis?

A

oral metronidazole

40
Q

which Genital infections do you not trace?

A

warts

herpes

thrush

bacterial vaginosis

Reproduction and Sexual health (4 decks)

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