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Repro and Sexual Health > STI > Flashcards

STI Flashcards

1
Q

What is the most commonly reported bacterial STI in sexual health clinics in the UK?

A

Chlamydia

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2
Q

Do people tend to present with symptoms in chlamydia?

A

70-80% of woman are asymptomatic

50% of men are asymptomatic

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3
Q

What type of bacterial is chlamydia?

A

Gram negative obligate intracellular bacterium

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4
Q

How can chlamydia be transmitted?

A

Vaginal
Oral
Anal

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5
Q

In what age group is chlamydia most common?

A

20-24 years

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6
Q

What percentage of women with chlamydia will develop PID?

A

9%

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7
Q

What is the sequelae of PID infection?

A

Increases the risk of ectopic pregnancy ten fold

Carries a risk of tubal factor infertility of 15-20%

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8
Q

How does chlamydia present in females?

A

Post coital or intermenstrual bleeding
Lower abdo pain
Dyspareunia
Mucopurulent cervicitis

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9
Q

How does chlamydia present in men?

A 
Urethral discharge
Dysuria
Urethritis 
Epididymo-orchitis
Proctitis (LGV)
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10
Q

What are the complications of CT?

A 
PID
Tubal damage (infertility, ectopic pregnancy), chronic pelvic pain, transmission to neonate (conjunctivitis and pneumonia), adult conjunctivitis, sexually acquired reactive arthritis, Fitz-Hugh-Curtis Syndrome
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11
Q

What is Fitz-Hugh-Curtis Syndrome?

A

Development of perihepatitis in association with pelvic inflammatory disease

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12
Q

Who should you test for CT?

A

Should stop testing women over 25 who present with vaginal discharge
Women who have had CT in past year
One in 5 women with diagnosed and treated chlamydia are estimated to become re-infected within 10 months after initial treatment

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13
Q

What is LGV?

A

Servoras L1-3 of chlamydia

Diagnosed in MSM

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14
Q

What are the symptoms of LGV?

A

Rectal pain
Discharge
Bleeding
High risk of concurrent STIs

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15
Q

When can CT be diagnosed?

A

Test 14 days post exposure
NAAT
If MSM add rectal swab if receptive anal intercourse

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16
Q

What is the difference between NAAT testing in men and women?

A

Women; vulovaginal swab

Men; first void urine

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17
Q

What is the treatment of chlamydia?

A

Doxycycline 100mg BD x 1 week

Azithromycin 1G stat followed by 500mg daily for 2 days

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18
Q

What is mycoplasma genitalium associated with?

A

Non gonococcal urethritis

PID

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19
Q

Is mycoplasma genitalium always symptomatic?

A

Majority is asymptomatic

BUT high levels of macrolide resistance

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20
Q

What is the gram stain of gonorrhoea?

A

Gram negative intracellular diplococcu s

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21
Q

Where can the primary sites of infection for gonorrhoea be found?

A

Mucous membranes of urethra
Endocervix
Rectum
Pharynx

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22
Q

What is the incubation period for gonorrhoea?

A

In men with a urethral infection; 2-5 days

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23
Q

How is gonococcus transmitted?

A

20% risk from infected woman to male partner

50-90% risk from infected man to female partner

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24
Q

How does gonorrhoea present in men?

A

Asymptomatic <10%
Urethral discharge >80%; tends to be green/yellow and purulent
Dysuria
Pharyngeal/ rectal infections

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25
Q

How does gonorrhoea present in women?

A

Asymptomatic in up to 50%
Increased/ altered vaginal discharge in 40%
Dysuria
Pelvic pain
Pharyngeal and rectal infection usually asymptomatic

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26
Q

Complications of gonorrhoea in lower genital tract?

A 
Bartholinitis
Tysonitis
Periurethral abscess
Rectal abscess
Epididymitis
Urethral stricture
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27
Q

Complications of gonorrhoea in upper genital tract?

A 
Endometritis
PID
Hydrosalpinx
Infertility
Ectopic pregnancy
Prostatitis
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28
Q

How is gonorrhoea diagnosed?

A

NAAT; screening test
If symptomatic; microscopy
If microscopy positive or known contact of GC; do culture to look for antibiotic sensitivities

29
Q

What is the treatment for gonorrhoea?

A

1st line: ceftriaxone 1g IM

2nd line: cefixime 400 mg PO and azithromycin 2g PO (only if IM CI or refused)

30
Q

When should a test of cure be performed in gonorrhoea?

A

2 weeks

31
Q

What are the different types of genital herpes?

A

Primary infection
Non-primary infection
Recurrent infection

32
Q

Which episode will be the worst in genital herpes?

A

Primary

33
Q

What is the incubation period of primary genital herpes?

A

3-6 days

34
Q

What is the duration of primary genital herpes?

A

14-21 days

35
Q

What are the symptoms of a primary genital herpes infection?

A 
Blistering and ulceration of external genitalia
Pain
External dysuria
Vaginal or urethral discharge 
Local lymphadenopathy
Fever and myalgia (prodrome)
36
Q

With what strain of HSV are recurrent episodes more common?

A

HSV-2; usually unilateral, small blisters and ulcers

37
Q

How long will recurrent genital herpes tend to last?

A

5-7 days with minimal systemic upset

38
Q

What investigations should be done to diagnose HSV?

A

Swab base of ulcer for HSV PCR

39
Q

What is the treatment for genital herpes?

A

Oral antiviral treatment (aciclovir 400mg TDS x 5/7)
Topical lidocaine 5% ointment
Saline bathing
Analgesia

40
Q

Which strain of HSV is more prone to viral shedding?

A

HSV 2

More frequent in first year of infection

41
Q

What treatment can be given to people with 6+ recurrent episodes a year?

A

Aciclovir

42
Q

What is important regarding genital herpes and pregnancy?

A

If 1st primary episode in 3rd trim or within 6 weeks of EDD; need to review birth plan as HSV in neonate can cause a disseminated infection, encephalitis and death

43
Q

Why is it important to distinguish between primary and non-primary genital herpes in pregnancy?

A

If non-primary; then antibodies will cross placenta and protect the baby

44
Q

What is the most common viral STI in the UK?

A

HPV

45
Q

What is the lifetime risk of acquiring HPV?

A

80%

46
Q

What HPV genotypes cause genital warts?

A

6 and 11

47
Q

What HPV genotypes cause cervical cancer?

A

16 and 18

48
Q

What strains of HPV are the new vaccines protecting against?

A

6, 11, 16, 18, 31, 33, 45, 51, 58

49
Q

Which HPV strains are assoc with anogenital warts, palmar and plantar warts and cellular dysplasia?

A

Anogenital warts = 6 /11
Palmoplantar = 1/2
Cellular dysplasia = 16/18

50
Q

How is HPV transmitted?

A

Likely to have acquired HPV from asymptomatic partner
Incubation period is 3 weeks to 9 months
Subclinical disease is common on all anogenital sites
HPV strains come in packs

51
Q

How many people will have spontaneous clearance of anogenital warts?

A

20-34%

52
Q

What is the treatment of HPV warts?

A

Podophyllotoxin
Imiquimod
Cryotherapy
Electrocautery

53
Q

What has been the impact of HPV vaccination?

A

79% reduction in CIN1
88% reduction in CIN 2
89% reduction in CIN 3

54
Q

What causes syphilis?

A

Treponema Pallidum

55
Q

What will treponema pallidum look like on dark light microscopy?

A

Spirochetes

56
Q

How is syphilis transmitted?

A

Sexual contact
Trans-placental/ during birth
Blood transfusion
Non-sexual contact; health care

57
Q

What are the different classifications of syphilis infections?

A

Congenital

Acquired

58
Q

What are the early forms of acquired syphilis?

A

Primary
Secondary
Early latent

59
Q

What are the late forms of acquired syphilis?

A

Late latent

Tertiary

60
Q

What is the incubation period of primary syphilis?

A

9-90 days (mean of 21)

61
Q

What is the main lesion of primary syphilis?

A

Primary chance; painless
At site of sexual inoculation
Non-tender local lymphadenopathy

62
Q

What is the incubation period of secondary syphilis?

A

6 weeks to 6 months

63
Q

What are the sequelae of secondary syphilis?

A 
Skin; macular, follicular or pustular rash on palms + soles
Lesions of mucous membranes
Generalized lymphadenopathy
Patchy alopecia
Condylomata lata 
Proctitis
Ophthalmology
64
Q

How is syphilis diagnosed?

A

Demonstration of treponema; dark field microscopy or PCR from lesions or infected lymph nodes
Serological testing; detects antibodies to pathogeic treponemes

65
Q

What test show the marker of syphilis disease activity?

A

VDRL

RPR; used in tayside

66
Q

What is the screening serological test for syphilis?

A

ELISA

67
Q

What test is done post +ve ELISA ?

A

TPPA

68
Q

What is the treatment for early and late syphilis?

A

Early; 2.4 MU Benzathine penicillin x1

Late: 2.4 MU Benzathine penicillin x3

69
Q

What is the follow up foro syphilis?

A

Follow up serologically until RPR is negative
Titres should decreased fourfold by 3-6 months in early syphilis
Serological relapse/ reinfection if titres increase by fourfold

Repro and Sexual Health (77 decks)

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