STI

Question 1

If you see genital lesions what should you test for?

Answer 1

Syphilis and herpes! You won’t go wrong!

Question 2

Which two STI’s are often asymptomatic?

Answer 2

Gonorrhoea and Chlamydia! Although presence of discharge is probably most common symptom!

Question 3

Gonorrhoea:

• Pathogen
• Stain
• Pathogenesis
• Symptoms
• Sequelae
• Diagnosis tests
• Treatment

Answer 3

Gonnorrhea
- Pathogen: Neisseria gonorrhoeae
- Stain: Gram negative, oxidase positive, aerobic
- Pathogenesis: Attached of piliated gonorrhea to surface of cell which doesn’t have cilia. Endocytosis and loss of cilia on adjacent cells. Trasport through epithelial cell where gonorrhea replicates. Organisms then released into subepithelial space.
- Symptoms: Often asymptomatic
- Sequelae: Infertility, REACTIVE ARTHRITIS, Disseminated gonococcal infection
- Disseminated gonococcal infection: syndrome of polyarthritis and dermatitis. Rarely it can cause meningitis, endocarditis, and osteomyelitis. Females happens more!
- Diagnosis tests: Antimicrobial susceptibility, Culture (preferred), and Nucleic acid tests
Treatment: Depends on area. Gonorrhea has developed resistance to every drug within a short time.
- For MSM… use Ceftriaxone plus Azithromycin
- For Heterosexual and pregnant use Cefixime plus Azithromycin

Question 4

Diseases based off of Vaginal discharge coming from either cervicitis or vaginitis

Answer 4

• Cervicitis: Gonorrhea, Chlamydia, Cervicitis

- Vaginitis: Candidiasis, vaginosis, Trichomonas

Question 5

If patient comes in with strange vaginal discharge what MUST you do?

Answer 5

• Must examin patient and do a speculum and bimanual examination… one hand in vagina one on abdomen

Question 6

Chlamydia

Answer 6

• Most common reportable disease in Canada
• This disease is growing more prevalent!
• Often asymptomatic… although white discharge often
• Major Sequelae:
  Reiters syndrome (post inflammatory reactive arthritis… skin lesions)
  Fitz High Curtis Syndrome: Inflammation of the liver
• Diagnosis: Nucleic Acid Tests!
• Treatment: Azithromycin, oral doxycycline

Question 7

Co-infections with STI’s

Answer 7

• People infected with gonorrhea are frequently infected with chlamydia
• Persons infected with one STI are at risk for other STI’s and should be screened!
• Screen for HIV! STi’s facilitate HIV transmission and acquisition!

Question 8

Syphilis:

• Pathogen
• Pathogenesis
• Clinical Manifestations
• Diagnosis:
• Primary syphilis vs secondary vs tertiary
• Treatment

Answer 8

Syphilis:

• Pathogen: Treponema pallidum… spirochete
• Doubled in 2015!
• Pathogenesis: Attaches to host cell, corkscrews to travel to lymph nodes, causes loss of blood supply creating a genital ulcer!
• Clinical Manifestations: Lesions, rash
• Diagnosis:
  
  • EIA: measures IgM or IgG antibodies = screening test. Stays for life in patient!
  • RPR titre.. detects reinfection
  • Inno-Lia… = supplemental test
• Primary Syphilis: may be multiple painful lesions.. or just one not painful. Oral sex is a risk factor!
• Secondary Syphilis: Rash may involve palms and soles!
• Latent stage: period when asymptomatic but serologic tests positive. Early = <1 year = infectious. Late = >1 year = noninfectious
• Tertiary syphilis: neurosyphilis!
• Congenital syphilis: Risk of transmission is highest in primary! 40% in early latent, and 10% in late latent
• Treatment: Benzathine penicillin G

Question 9

Herpes Simplex Virus

• Tranmission
• Clinical manifestations
• Diagnostic Tests
• Recurrent Genital Herpes
• Management
• Treatment

Answer 9

Herpes Simplex Virus
- Transmission mainly done during asymptomatic times!
- Clinical Manifestations: Superficial ulcers! Painful!
- Recurrent Genital Herpes: Localized to genitals, usually unilateral, shorter and less severe, often prodrome (tingling and pain)
- Diagnostic Tests:
- Viral culture: GOLD STANDARD
- PCR
- Type specific serology
- Management: Counselling, antiviral therapy. It is not curative! Just shortens duration and severity!
- Treatment: Antivirals … ex. Acyclovir.
Episodic: short ourse!
Suppressive treatment: dialy antiviral

Question 10

Human Papilloma Virus (HPV)

• Pathogenesis
• Transmission
• Risk Factors
• Diagnosis
• Treatment

Answer 10

• Virus gets into basal epithelium at trauma sites or where epithelium is thin.
• Transmission: Direct skin to skin contact
• Persistent HPV required for genital warts or pre-cancers and cancers to develop!
• Risk factors: male, smoking, old
• Diagnosis: Examination
• No treatment exists.
• There are vaccinations! Gardasil 4.. protects for 16 and 18 which cause cervical cancer!