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AMC MCQ - You Can Do It!!!!!❤️❤️ > 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)
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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
  1. Epididymo-orchitis:
    • Symptoms: Painful, red, swollen testicles.
    • Frequency: Uncommon.
  2. Prostatitis:
    • Symptoms: Inflammation of the prostate.
    • Frequency: Very rare.
  3. Pelvic Inflammatory Disease (PID):
    • Symptoms: Dyspareunia (painful intercourse), intermenstrual bleeding, post-coital bleeding, discharge.
  4. Bartholin Gland Abscess:
    • Symptoms: Swelling and pain in the Bartholin glands.
  5. Disseminated Disease:
    • Symptoms:
      • Skin: Macular rash, necrotic pustules.
      • Joints: Septic arthritis.
      • Other: Rarely, meningitis or endocarditis.

Gonorrhea can lead to several complications, including epididymo-orchitis, prostatitis, PID, Bartholin gland abscess, and disseminated disease, which may present with skin rashes, septic arthritis, and, rarely, meningitis or endocarditis.

  • 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

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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.

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
17
Q

Syphylis - Primary

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

Syphilis - further Mx

A
  • no sexual contact for 7 days or symptoms resolve
  • Contact tracing
  • Notify health department
27
Q
A
28
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)

29
Q
A
30
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.

AMC MCQ - You Can Do It!!!!!❤️❤️ (50 decks)

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