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3 Reproduction > STI > Flashcards

STI Flashcards

1
Q

what is the most common bacterial STI

A

chlamydia

70-80% of women are asymptomatic, 50% of men are asymptomatic

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2
Q

what are the characteristics of chlamydia bacteria

A

gram negative obligate intracellular bacterium

stain poorly with gram stains

cell walls lack peptidoglycan

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3
Q

how is chlamydia transmitted

A

vaginal, oral or anal sex

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4
Q

who is most likely to get chlamydia

A

20-24 year olds

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5
Q

what percentage of women with chlamydia go on to develop pelvic inflammatory disease

A

9%

an episode of PID increases the risk of an ectopic pregnancy x10

also carries risk of tubal factor infertility (15-20%)

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6
Q

how does chlamydia present in a female

A

post coital (after sex) or intermenstrual bleeding

lower abdominal pain

dyspareuria (painful sex)

mucopururlent cervicitis

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7
Q

how does chlamydia present in males

A

urethral discharge

dysuria

urethritis

epidididymo-orchitis (inflammation of epididymus and testes)

proctitis

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8
Q

what are the complications of chlamydia

A 
Pelvic inflammatory disease 
Ectopic pregnancy 
Reactive arthritis (reiter's syndrome)
Conjunctivitis 
Transmission to neonate (conjunctivitis and pneumonia)
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9
Q

what is some testing advice for chlamydia

A

dont test women >25 with vaginal discharge

do test women who have had CT in past year

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10
Q

what is LGV (lymphogranuloma veneereum)

A

a server of chlamydia trachoma’s

diagnosed in men who have sex with men

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11
Q

how does LGV present

A

Rectal pain
Discharge
Bleeding

high risk of concurrent STI

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12
Q

how do you diagnose chlamydia

A

test 14 days following exposure

Nucleic acid amplification test (NAAT) - females (vulvovaginal swab)

males - urine sample (avoid first urine)

Add a rectal swab id reciprocal anal intercourse

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13
Q

how do you treat chlamydia

A

doxycycline 100mg 2x daily for 1 week

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14
Q

what is mycoplasma genitalium

A

emerging sexually transmitted pathogen

associated with non-gonococcal urethritis

prevalence in 1-2% of the population

asymptomatic carriage

need NAAT test to diagnose

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15
Q

what bacteria is Gonorrhoea

A

gram negative intracellular diplococcus

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16
Q

where does gonorrhoea infect

A

mucus membranes of the urethra, endocervix, rectum and pharynx

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17
Q

how is gonorrhoea transmitted /incubated

A

incubation period or urethral infection in men is 2-5 days

20% risk from infected women to male partner

50-90% risk from infected man to female partner

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18
Q

how does gonorrhoea present in males

A

Asymptomatic <10%

urethral discharge >80%

Dysuria

Pharyngeal/rectal infections (Mostly asymptomatic)

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19
Q

how does gonorrhoea present in females

A

Asymptomatic (up 50 50%)

Increased/altered vaginal discharge

Dysuria

Pelvic pain

Pharyngeal and rectal infection (asymptomatic)

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20
Q

what are some complications of gonorrhoea

A

Lower genital tract:

  • bartholinitis (glands at either side of vagina)
  • tysonitis (Tyson gland infection)
  • periurethral abscess
  • rectal abscess
  • epididymitis
  • urethral stricture

upper genital tract:

  • endometritis
  • PID
  • hydrosalpinx
  • Infertility
  • Ectopic pregnancy
  • Prostatitis
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21
Q

how do you diagnose gonorrhoea

A

NAAT - nucleic acid amplification test (screening test)

microscopy (for symptomatic)

culture (if microscopy +ve or contact of GC)

22
Q

treatment for gonorrhoea

A

1st line - Ceftriaxone 500mg IM

2nd line - Cefixime 400mg oil (if IM is contraindicated)

23
Q

what are the characteristics of genital herpes

A

first a primary infection

then a non-primary first episode of herpes

then recurrent infection

24
Q

how long does a first episode of herpes tend to last

A

14-21 days

incubation 3-6 days

25
Q

how does herpes present

A 
Blistering and ulceration of external genetalia 
Pain 
External dysuria 
Vaginal or urethral discharge
Local lymphadenopathy 
Fever and myalgia
26
Q

how do recurrent episodes of herpes tend to present

A

unilateral, small blisters and ulcers

minimal systemic symtpoms

resolves within 5-7 days

27
Q

what investigations are done for herpes

A

swab base of ulcer for HSV PCR

28
Q

herpes treatment

A

Oral antiviral treatment (acyclovir 400mg 3x daily for 5-7 days)

if v painful lidocaine 5% ointment can be used

saline bathing

analgesia

29
Q

what to do if first episode of herpes happens in the 3rd trimester of preganancy

A

inform O+G to review birth plan

50% risk of transmission to neonate is primary HSV

30
Q

what is the most common viral STI in the uk

A

HPV

80% life time risk of getting infection

31
Q

how many HPV genotypes infect the anogenital epithelium

A

> 40

32
Q

what serotypes are associated with different clinical problems

A

anogenital warts - 6/11

palmar and plantar warts - 1/2

cellular dysplasia - 16/18

33
Q

what is the incubation period for HPV

A

3 weeks - 9 months

34
Q

HPV immunology

A

spontaneous clearance of wards - 20-24%

clearance with treatment - 60%

persistence despite treatment - 20%

35
Q

treatment for HPV

A

Podophyllotoxin (warticon)

  • cytotoxic
  • not licensed for extra genital warts

Imiquidmod (alder)

  • immune modifier
  • used on all anogenital warts

Cryotherapy

  • cyctolytic
  • needs repeat treatments

Electrocautery

36
Q

what bacteria causes syphilis

A

treponema pallidum

37
Q

how is syphylis transmitted

A

sexual contact
trans-placental/during birth
blood transfusions
non-sexual contact (health care workers)

38
Q

what are the 2 main classifications of syphilis

A

congenital

acquired

39
Q

what are the stages of acquired syphilis

A

Early infectious:

  • primary
  • secondary
  • early latent

late non-infectious:

  • late latent
  • tertiary
40
Q

what is the incubation period for primary syphilis

A

9-90 days

41
Q

how does primary syphilis present

A

Primary chancre (painless ulcer)

lesion appears at site of inoculation

genital (90%)
extra-genital (10%)

non-tender local lymphadenopathy

42
Q

when does secondary syphilis start

A

6 weeks to 6 months

43
Q

how does secondary syphilis present

A 
Rash on palms and soles 
Lesions of mucous membranes 
Generalised lymphadenopathy 
Pathcy alopecia 
Condylomata lata (v infectious lesions exuding a serum teeming with treponems)
44
Q

how do you diagnose sylphilis

A

Dark field microscopy
PCR
from lesions or infected lymph nodes

Serological testing to detect antibodies

45
Q

what non-treponemal serological tests are done for syphilis

A

Non-treponemal (look at biomarkers released in cellular damage)

VDRL - venereal disease research lab

RPR -rapid plasma reagin

46
Q

what treponemal serological tests are done for syphilis

A

TPPA (treponemal pallidum particle agglutination)

ELISA/EIA - enzyme immunoassay screening test

INNO-LIA - line immunoassay

FTA abs (fluorescent treponemal antibody absorbed)

47
Q

treatment for early syphilis

A

2.4 intramuscular Benzathine penicillin x1

48
Q

treatment for last syphilis

A

2.4 intramuscular benzathine penicillin x3

49
Q

what follow up is done for syphilis

A

syphilis becomes late syphilis when RPR is negative or serofast

titres should decrease fourfold by 3-6 months in early syphilis

50
Q

which type of genital herpes has higher rates of viral shedding

A

HSV 2

3 Reproduction (49 decks)

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