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AMC MCQ > STI > Flashcards

STI Flashcards

1
Q

Gonorrhoea

A
  • Gonorrhoea is most commonly diagnosed in men who have sex with men, young (heterosexual) Aboriginal and Torres Strait Islander people
  • travellers returning from high prevalence areas overseas.
  • Neisseria gonorrhoeae, (Gram-negative)
  • IP 2-7 days
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2
Q

Gonorrhoe - Clinical presentation

A
  • often asymptomatic
  • Penile urethral discharge
  • Dysuria
  • Vaginal discharge
  • Dyspareunia with cervicitis
  • Conjunctivitis: purulent, sight-threatening
  • Anorectal symptoms: discharge, irritation, painful defecation, disturbed bowel function
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3
Q

Gonorrhoe - Complication

A
  • Epididymo-orchitis (uncommon): painful, red swollen testicle/s
  • Prostatitis (very rarely)
  • Pelvic inflammatory disease (PID): dyspareunia, intermenstrual bleeding, post-coital bleeding, discharge
  • Bartholin gland abscess
  • Disseminated disease (rarely):
    macular rash that may include necrotic pustules
    septic arthritis
  • Meningitis or endocarditis (rarely)
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4
Q

Gonorrhoe - Diagnostic

A
  • First pass urine (FPU) - NAAT
  • Penile urethral swab ( just if discharge)
  • Clinician-collected endocervical swab -best
  • Clinician-collected endocervical swab (men)
  • Pharyngeal swab (men)
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5
Q

Gonorrhoe - Treatment uncomplicated

A
  • Ceftriaxone 500 mg IMI, stat. in 2 mL 1% lignocaine+ Azithromycin 1 g PO, stat.

same treatment in pregnancy

  • test 2 weeks after
  • Contact tracing 2month
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6
Q

Gonorrhoe - Treatment Conjunctivitis

A
  • Ceftriaxone 1 g IMI, stat. in 2 mL 1% lignocaine+
    Azithromycin 1 g PO, stat.
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7
Q

Gonorrhoe - other MX

A
  • no sexual contact for 7 days
  • Partner notification and testing ( 2 month back)
  • Notify health department
  • Testing for other STIs
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8
Q

Chlamydia

A
  • most commonly
  • Those < 30 years are at greatest risk.
  • Frequently asymptomatic.
  • Simple to test and treat
  • IP 5days to 12month

Chlamydia trachomatis

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9
Q

Chlamydia - Symptoms

A

85%-90% have no symptoms

  • Dysuria
  • Penile urethral discharge
  • Vaginal discharge
  • Testicular pain
  • Pelvic Pain
  • Intermenstrual bleeding
  • Postcoital bleeding
  • Pain with sex - dyspareunia
  • Anorectal symptoms
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10
Q

Clamydia - complications

A
  • Epididymo-orchitis
  • Pelvic inflammatory disease (PID)
  • Infertility
  • Pregnancy - Ectopic pregnancy, Premature rupture of the membranes, preterm delivery, and low-birthweight infants
  • Reactive arthritis: arthritis, sometimes with concurrent rash and gastrointestinal symptoms
  • Cervicitis
  • Conjunctivitis
  • Perihepatitis
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11
Q

Clamydia - Diagnostic

A
  • First pass urin ( NAAT)
  • Endocervical swab
  • Anorectal swab
  • Pharyngeal swab

NAAT highly sensitive

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12
Q

Chlamydia - Treatment

A

**For uncomlicated genital or pharyngial
** Doxycylin 100 mg for 7 days
* Alternative Azithromycin 1g, immed.

**Anorectal asymptomatic
** Doxycylin 100 mg for 7 days
* Alternative Azithromycin 1g, immedi repeat in 12-24 hrs

**Anorectal symptomatic
** Doxycylin 100 mg for 21 days
* Alternative Azithromycin 1g, stat repeat in 12-24 hrs

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13
Q

Chlamydia - further MX

A
  • No sexual contact for 7 days or until symptoms resolved
  • Contact tracing and testing 6 month
  • notify health department

Pregnancy : Azythromycin 1g immed

Retest in 3 month

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14
Q

Syphillis

A
  • high prevalence : homosexual, Abor/torres
  • in pregnancy - congenital syphylis ( urgent specialist advice

Treponema Palidum

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15
Q

Syphillis- Clinic

A
  • 50% asymptomatic
  • mimic many other conditions , consider testing in all pat with unexplained symptoms
  • 3 stages
    early infectious
    late latent
    tertiary or late symptomatic
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16
Q

Syphylis - early

A
  • primary and secondary and early latent infection
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17
Q

Syphylis - Primary

A
  • genital, anal, oral ulcer (chancre)
  • enlarge LN, rubbery non tender
  • mostly painless
  • Incubation 10-90 days
  • high infectious
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18
Q

Syphylis - secondary

A
  • more than 6 weeks after infection
  • systemic signs and symptoms
  • fever, malaise, headache and Lymphadenopathy
  • rash( 90%) trunk, palms and soles
  • Incubation averrage 6 Weeks
  • highly infectious
  • psoriatic rahes/warty lesion
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19
Q

Syphylis - early latent

A
  • <2 years
  • positive syphilis serology with no clinical symptoms
  • high infectious
20
Q

Syphylis - late

A
  • > 2years
  • absence of any symptoms
  • no longer infectious to sexual partners but transmitted during pregnancy
21
Q

syphylis - Tertiary

A
  • development of complication:
    Skin lessions ( gumma)
    Cardiovascular
    neurological (visual changes, tinnitus, deafness, cranial nerve palsies, meningitis), require intravenous treatment.)
22
Q

Syphylis - congenital

A
  • severe multi-organ disease with very high mortality and morbidity in both in-utero and neonatal periods
23
Q

Syphylis - Diagnostic

A
  • Blood Serolgy ( antibody)
  • Swab of ulcer (NAAT/PCR)
  • Test in pat with HIV
  • In remote Australia include donovanosis Pcr
24
Q

Syphilis Treatment early stage

A
  • Benzathine benzylpenicillin 2.4 MU (1.8 g) IMI, Stat, given as 2 injections containing 1.2 MU
25
Q

Syphilis Treatment Late/ unclear stage

A
  • Benzathine benzylpenicillin 2.4 MU (1.8 g) IMI, given as 2 injections containing 1.2 MU (0.9 g)

weekly for 3 weeks

26
Q

Jarisch-Herxheimer reaction

A
  • common reaction to treatment in patients with primary and secondary syphilis
  • 6-12 hours after commencing treatment
  • fever, headache, malaise, rigors and joint pains, and lasts for several hours
  • analgesics and rest
  • Patients should be alerted to the possibility of this reaction and reassured accordingly.
26
Q

Syphilis - further Mx

A
  • no sexual contact for 7 days or symptoms resolve
  • Contact tracing 3 month/6month/12month
  • Notify health department
27
Q

Discharge

A

Bacterial vaginosis: thin, grey-white, offensive and fishy odour

Candidiasis: thick, white, non-offensive

Chlamydia and M. genitalium: minimal discharge or purulent (cervicitis)

Gonorrhoea: purulent (cervicitis)

* Trichomoniasis: offensive green and yellow, scanty to profuse and frothy (vaginitis)

28
Q

Donovaosis granuloma inguinale

A
  • Indigenous
  • sores , destructive infection
  • NAAT
  • Azithromycin or Doxycyclin for 4 weeks
29
Q

Bacterial vaginosis

A
  • Garnerella
  • Amsel test : ph>4.5, Clue cells, Amin test pos
  • thin, grey-white, offensive and fishy odour
  • mc cause of Vaginitis
  • oral metronidazol or tinizole
  • Clindamycin in pregnancy
  • no need to treat partner
30
Q

Candidiases

A
  • thick, white, non-offensive
  • pruritus /Brick like vagina/dysuris
  • Clotrimazole vag tabl and cream
  • Nystatin for recurent
  • fluconazol ( not in preg)
31
Q

Trichimoniasis

A
  • offensive green and yellow, scanty to profuse and frothy (vaginitis)
  • Inv PCR
  • Strawberry cervix
  • Metronidazol or tinidazol
  • treat partner
32
Q

HIV - investigation

A
  • Elisa- antibody screning
  • Western blot - to confirm Elisa
  • Immune function - CD4 cell count
  • Viral load - treatment response
33
Q

HIV acute seroconvertion

A
  • within 6 weeks, flue like symptoms
  • Headache, malaise, photophobia
  • fever night sweats, anorexia, sore throat, diarrhoe, lymphadenopathy

Resemble ebv inifection( monospot test)

34
Q

HIV - Clinic

A
  • Fever
  • weight loss
  • respiratory: Pneumocystis Jerovicii Pneumonia/Tb reactivation
  • GI : diarrhoe
  • Neuro GBS HIV encephalopathy, Cryptococcal meningitis
  • Kaposy sarcoma, Herpes
  • Sti, candidiasis
  • Ulcer
35
Q

What is its significance in HIV?

A
  • As the antibodies take about 2-8 weeks to
    present in the blood stream, the window
    period varies between 3 - 12 weeks in
    case of HIV.
36
Q

What is the window period?

A

time between the initial infection and a positive test
results.

37
Q

PrEP - Pre-exposure prophylaxis

A

Perform a risk assessment to determine
the risk of HIV INFECTION:
* men who have sex with men - MSM
* transgender and gender diverse people
* heterosexual people
* people who inject drugs
3 months is the key word

38
Q

Before prescribing HIV PrEP

A

Perform baseline testing:
* HIV,
* Hepatitis B and C virus
* Sexually transmitted infections
* RFT - LFT
* Pregnancy

USE:
Tenofovir + Emtricitabine (Truvada) orally, daily.

39
Q

When do you start Antiretroviral therapy

A
  • Reduces morbidity and mortality regardless of CD4 cell count, so it is recommended for all people with HIV infection.
  • For patients without opportunistic or co-infections, start antiretroviral
    therapy as soon as possible.
  • Once started, treatment should be continued indefinitely without
    interruption, unless oral therapy cannot be taken, or severe toxicity develops.
39
Q

Guidelines before starting antiretroviral therapy in Australia:

A

HIV antibody - antigen
* CD4 cell count
* Plasma HIV RNA (viral load)
* HIV genotypic resistance as soon as possible after diagnosis
* Hepatitis B and C virus serology
* FBE – RFT – LFT
* FBS and serum lipids
* Serum cryptococcal antigen if CD4 cell count is less than 100 cells/ microlitre
* Tests to exclude opportunistic and co-infections if the patient is symptomatic.

40
Q

Pregnancy and HIV

A
  • Risk of transmission: 15 to 25%
  • Antiretroviral therapy given to the mother during pregnancy
    and to the infant post delivery
  • Caesarean section delivery
  • Exclusive formula feeding.
40
Q

HIV antiviral therapy

A

Dolutegravir + abacavir + lamivudine=
Triumeq
* Tenofovir alafenamide + emtricitabine +
bictegravir = Biktarvy
* Tenofovir alafenamide + emtricitabine +
elvitegravir + cobicistat = Genvoya

41
Q

HIV Infant management

A
  • 4-week course of oral zidovudine prophylaxis for all HIV-exposed
    infants
  • Started ORALLY or IV as soon after birth as possible, within 6 hours
    of delivery
42
Q

DX of HIV in Infant

A

During pregnancy, the foetus passively acquires maternal HIV
antibodies across the placenta – so Elisa/WB will be (+)

  • It can take up to 12 to 18 months for an infant to clear these
    maternal antibodies.
43
Q

HIV post- exposure prophylaxis

A

LOW RISK:
* Zidovudine + Lamivudine 12 hourly for 4 weeks

HIGH RISK: (ASAP)
* Zidovudine + Lamivudine + Indinavir within 8 hrs for 6 weeks

MONITORING at 0,4,6,12,24 and 52 weeks.

44
Q
A

AMC MCQ (49 decks)

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