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Reproductive > STI Pathologies > Flashcards

STI Pathologies Flashcards

1
Q

Please see general info regarding STIs before we start:

A
  • Most people with STIs are asymptomatic most of the time - hence they are still rife
  • Delay in diagnosis can lead to an increased chance of transmission and complications
  • Having an STI can be psychologically traumatising for many people. Often more damaging than the physical effects.
    • Patients need information, a sensitive approach and appropriate follow up.
  • If you diagnose someone with say chlamydia but haven’t made arrangements for their sexual contact(s) to be treated then you haven’t finished the job.
  • STI control is a multidisciplinary field
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2
Q

Gonorrhea

What is causative organism?

A
  • Neisseria gonorrhoeae
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3
Q

Gonorrhoea

SSx?

A

Male:

  • 10% of males have no symptoms though might have clinical signs if examined. Thick, profuse yellow discharge, dysuria. Rectal and pharyngeal infection often asymptomatic.

Female:

  • >50% have no symptoms.
  • vaginal discharge, dysuria or intermenstrual/post-coital bleeding
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4
Q

Gonorrhoea

Complications?

A

Male:

  • Epididymitis

Female:

  • PID, Abscess

Both

  • Acute monoarthritis usually elbow or shoulder. Disseminated Gonococcal Infection: skin lesions - pustular with halo
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5
Q

Gonorrhoea

What is the incubation period?

A

Average 5-6 days

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6
Q

Gonorrhoea

Epidemiology?

A
  • Approx 150 cases/yr in Grampian. Much less common than chlamydia. Most cases are in men, often in men who have sex with men (MSM).
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7
Q

Gonorrhoea

How do we make Dx?

A
  • Nucleic Acid amplification test (NAAT) on urine or swab from affected site (vagina, rectum, throat)
  • Gram stained smear from urethra/cervix/rectum in symptomatic people.
  • Culture of swab-obtained specimen from an exposed site using highly selective lysed blood agar in a 5% CO2 environment. Should be done for all confirmed cases to assess antibiotic sensitivity.
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8
Q

Gonorrhoea

Rx?

A
  • Blind treatment with ceftriaxone 500mg im once plus Azithromycin 1g.
  • Can also treat according to antibiotic sensitivities
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9
Q

Gonorrhoea

Follow up?

A

Test of cure at 2 weeks and test of reinfection at 3 months

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10
Q

Chlamydia

Caused by?

A

Chlamydia trachomatis serovars D to K

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11
Q

Chlamydia

SSx?

A

Men:

  • >70% asymptomatic
  • Slight watery discharge, dysuria,

Female:

  • >80% asymptomatic
  • vaginal discharge, dysuria, intermenstrual/post-coital bleeding.

Both

  • Conjunctivitis
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12
Q

Chlamydia

Complications?

A

Male:

  • Epididymitis

Female:

  • PID and hence ectopic pregnancy, pelvic pain and infertility. Probably only ~1% of women who get chlamydia will develop a problem with their fertility

Both:

  • Reactive arthritis/ Reiter’s syndrome – urethritis/cervicitis + conjunctivitis + arthritis
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13
Q

Chlamydia

Epidemiology?

A

Common. Approx 2000/yr in Grampian. Most cases in people under 25, especially sexually active teenage women.

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14
Q

Chlamydia

How do we make Dx?

A
  • First void urine in men.
  • Self-taken or clinician-taken swab from cervix, urethra, rectum as appropriate.
  • All specimens tested using a NAAT
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15
Q

Chlamydia

Rx?

A
  • Azithromycin 1g po once.
  • Doxycycline 100mg bd 1 week if rectal infection.
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16
Q

Chlamydia

Follow up?

A

Test for reinfection at 3-12 months. Earlier test of cure not needed unless symptoms persist.

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17
Q

Herpes

Caused by?

A

Herpes Simplex Virus types 1 and 2

18
Q

Herpes

SSx?

A
  • 80% have no symptoms. The rest have recurring symptoms – monthly, annually. Burning/itching then blistering then tender ulceration.
  • Tender inguinal lymphadenopathy. Flu-like symptoms.
  • Dysuria, Neuralgic pain in back, pelvis and legs,
19
Q

Herpes

Complications?

A

Autonomic neuropathy (urinary retention), neonatal infection, secondary infection

20
Q

Herpes

Incubation period?

A

About 5 days to months. Some people never report symptoms

21
Q

Herpes

Epidemiology?

A

Very common ~ 15-20% of UK population has it. Both strains equally common in genital infection. Roughly equal between sexes. HSV2 is important co-factor for HIV transmission.

22
Q

Herpes

How do we make Dx?

A
  • Clinical impression.
  • Swab from lesion tested using PCR.
23
Q

Herpes

Rx?

A
  • Primary outbreak:
    • Aciclovir: various regimens – eg 400mg tds for 5 days Lidocaine ointment
  • Infrequent recurrences:
    • Lidocaine ointment. Aciclovir 1.2g once daily until symptoms gone (1-3 days)
  • Frequent recurrences:
    • Aciclovir 400bd long-term as suppression.
24
Q

Trichomoniasis

Causative organism?

A

Trichomonas vaginalis

25
Q

Trichomoniasis

SSx?

A
  • Men: usually asymptomatic
  • Women: 10-30% asymptomatic
    • Profuse thin vaginal discharge - greenish, frothy and foul smelling. Vulvitis.
26
Q

Trichomoniasis

Epidemiology?

A

Uncommon, approx 100/yr in Grampian. More common in middle aged women than some other STIs are.

27
Q

Trichomoniasis

Complications?

A

Miscarriage and preterm labour

28
Q

Trichomoniasis

How do we make Dx?

A
  • PCR on a vaginal swab. NB not on urine yet so no test for men.
  • Point of Care - Microscopy of wet preparation of vaginal discharge.
29
Q

Trichomoniasis

Rx?

A

Metronidazole 400mg po bd for 5 days or 2g single dose.

30
Q

Anogenital Warts

Caused by?

A

Human Papilloma Virus types 6 and 11 (and occasionally type 1). (NB different strains from those that cause cervical cancer.

31
Q

Anogenital warts

SSx?

A

Lumps with a surface texture of a small cauliflower. Occasionally itching or bleeding especially if perianal or intraurethral.

32
Q

Anogenital warts

Epidemiology?

A

>90% of UK population have a genital HPV infection at some point in their life.

Only about 20% of those infected with a wart-causing strain of human papilloma virus get warts.

A drop in cases is anticipated in response to quadrivalent HPV vaccine

33
Q

Anogenital warts

Complications?

A

None common

34
Q

Anogenital warts

How do we make Dx?

A

Appearance. Biopsy if unusual – to exclude intraepithelial neoplasia, but this is rarely needed.

35
Q

Anogenital warts

Rx?

A
  • Podophyllotoxin (brands warticon and condyline), imiquimod (brand Aldara). Both home treatments. Others – cryotherapy
  • Bulky warts – diathermy, scissor removal.
36
Q

Syphilis

Causative organism?

A

Treponema pallidum subspecies pallidum

37
Q

Syphillis

SSx?

Stages?

A

Very diverse presentation

Often entirely asymptomatic or mild symptoms which go unreported.

  • Primary stage: Local ulcer
  • Secondary: Rash, mucosal ulceration, neuro symptoms, patchy alopecia
  • Early latent: no symptoms but <2 yrs since diagnosis
  • Late latent: no symptoms but >2yrs since diagnosis
  • Tertiary: Neurological, cardiovascular or gummatous – skin lesions, (all v rare).
38
Q

Syphillis

Epidemiology?

A

Approx 20 cases/yr in Grampian. >90% of cases in Scotland are in men who’ve had sex with men.

39
Q

Syphillis

Complications?

A

neurosyphilis – cranial nerve palsies are commonest, cardiac or aortal involvement.

Congenital syphilis (extremely rare in Scotland).

40
Q

Syphillis

How do we make Dx?

A
  • Clinical signs
  • Serology for TP IgGEIA, TPPA and RPR PCR on sample from an ulcer
41
Q

Syphillis

Rx?

A
  • Early (<2 yrs and no neurological involvement):
    • Benzathine penicillin 2.4 MU im once Or Doxycycline 100mg bd po 2 weeks
  • Late (>2 years) and no neurological involvement:
    • Benzathine penicillin 2.4MU im weekly for 3 doses Doxycycline 100mg bd po 28 days

Reproductive (34 decks)

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