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Reproduction and Sexual Health > STI's > Flashcards

STI's Flashcards

1
Q

What is the most common STI?

A

Chlamydia

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2
Q

What % of women and men with chlamydia are asymptomatic?

A

70% of women.

50% of men

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3
Q

What type of bacterium is chlamydia?

A

Gram -ve

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4
Q

How can chlamydia be transmitted?

A

Vaginal, oral or anal

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5
Q

Who is the highest incidence of chlamydia in?

A

20-24 year olds, both male and female.

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6
Q

What is the % of women with chlamydia who develop PID estimated at?

A

9%

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7
Q

What are the risks of an episode of PID?

A

Risk of ectopic pregnancy increases 10-fold.

Risk of tubal factor infertility of 15-20%.

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8
Q

How does chlamydia present in males?

A
  • Urethral discharge (clearer than in gonorrhoea).
  • Dysuria.
  • Urethritis.
  • Epididymo-orchitis.
  • Proctitis (LGV).
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9
Q

How does chlaymdia present in females?

A

(often asymptomatic)

  • Post coital or intermenstrual bleeding (this is the most common red flag)
  • Lower abdominal pain
  • Dyspareunia (painful sex)
  • Mucopurulent cervicitis
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10
Q

What % of cases of PID does CT account for?

A

50%

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11
Q

What problems can arise as a result of tubal damage?

A
  • Infertility

* Ectopic pregnancy

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12
Q

How may CT transmitted to the neonate present?

A

17% conjunctivitis
OR
20% pneumonia.

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13
Q

What is the triad of symptoms in Reitiers?

A
  1. Conjunctivitis
  2. Urethritis
  3. Arthritis
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14
Q

Tayside is the worst area in Scotland for Chlamydia rates

A

Ooops

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15
Q

‘Piano string adhesions’ is the classic sign of?

A

Fitz-Hugh-Curtis Syndrome (Perihepatitis)

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16
Q

What is responsible for LGV?

A

L1-3 serovars of chlamydia trachomatis

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17
Q

What has happened to the rates of LGV?

A

They have been increasing from 2003.

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18
Q

Who mostly gets LGV?

A

MSM

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19
Q

What are the symptoms of LGV?

A
  • Rectal pain.
  • Discharge.
  • Bleeding.
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20
Q

With LGV, what is there a high risk of?

A

Concurrent STI’s (67% HIV).

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21
Q

When is the test for chlamydia done?

A

14 days following exposure

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22
Q

What tests are done for chlamydia in i) females ii) males iii) MSM?

A

i) NAAT – vulvovaginal swab.
ii) NAAT – first void urine.
iii) MSM – first void urine PLUS rectal swab if has had receptive anal intercourse.

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23
Q

How is chlamydia treated?

A

Doxycycline 100mg BD x 1 week

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24
Q

Describe the ‘test for cure in chlamydia’.

A

Not done routinely, but is done 3 weeks after treatment in pregnant women or for those with rectal infection.

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25
Q

Describe the bacteria in gonorrhoea.

A

Gram negative INTRACELLULAR diplococcus

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26
Q

What are the primary sites of infection in Gonorrhoea?

A

The mucous membranes of the urethra, endocervix, rectum and pharynx.

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27
Q

What is the incubation period of urethral infection in men?

A

Usually short – 2-5 days

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28
Q

What is the risk of transmission from an INFECTED WOMAN to MALE partner?

A

20%

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29
Q

What is the risk of transmission from INFECTED MAN to FEMALE partner?

A

50-90%

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30
Q

Who is gonorrhoea most common in?

A

Under 25’s

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31
Q

Is the presentation of gonorrhoea in men likely to be asymptomatic?

A

No - ≤10% of males with gonorrhoea have no symptoms

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32
Q

What is the most common sx? In what % of people with gonorrhoea does this occur?

A

Urethral discharge - >80%.

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33
Q

Describe urethral discharge in gonorrhoea.

A

Mucopurulent

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34
Q

What other urogenital sx is this often associated with?

A

Dysuria.

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35
Q

Pharyngeal/rectal infections are mostly asymptomatic in gonorrhoea

A

TRUE

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36
Q

What % of females with gonorrhoea will be asymptomatic?

A

Up to 50%

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37
Q

What sx may gonorrhoea present with in females?

A
  • Increased/altered vaginal discharge – 40%.
  • Dysuria.
  • Pelvic pain - <5%.
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38
Q

In what % of i) females ii) males do complications of gonorrhoea occur?

A

i) 3%.

ii) <1%.

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39
Q

Outline some upper genital tract complications of gonorrhoea.

A
  • Endometritis
  • PID
  • Hydrosalpinx
  • Infertility
  • Ectopic pregnancy
  • Prostatitis
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40
Q

Outline some lower genital tract complications of gonorrhoea.

A
  • Bartholinitis
  • Tysonitis
  • Periurethral abscess
  • Rectal abscess
  • Epididymitis
  • Urethral stricture
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41
Q

What is the screening test and gold standard for the dx of gonorrhoea?

A

NAATS >96% sensitivity (both symptomatic and asymptomatic)

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42
Q

What are the other options (minus NAAT’s`) for the diagnosis of gonorrhoea?

A

Microscopy

  • Urethral 90-95% sensitivity
  • Endocervical 37-50% sensitivity

Culture

  • > 95% sensitivity (male urethra)
  • 80-92% sensitive (female endocx)
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43
Q

What is the first line treatment for gonorrhoea?

A

Ceftriaxone 500mg IM
OR
Cefixime 400mg oral (only if IM injection is contra-indicated or refused by pt)

44
Q

What is gonorrhoea co-treated with?

A

Azithromycin 1g (regardless of Chlamydia result) given at the same time as gonorrhoea treatment.

45
Q

Why is gonorrhoea co-treated with Azithromycin?

A
  • Helps clear gonorrhoea.

* Given because of high rates of co-infection with chlamydia

46
Q

What should be done in all patients who are diagnosed with chlamydia?

A

Test for cure !!!

Many strains of gonorrhoea are resistant to antibiotics

47
Q

What do you need to decide in someone with genital herpes?

A
  • Primary infection.
  • Non-primary first episode.
  • Recurrent infection
48
Q

What is the intubation period of genital herpes?

A

3-6 days.

49
Q

What is the duration of the herpes virus?

A

14-21 days

50
Q

How does genital herpes present?

A
  • Blistering and ulceration of the external genitalia.
  • Pain.
  • External dysuria.
  • Vaginal or urethral discharge.
  • Local lymphadenopathy.
  • Fever and myalgia (prodrome).
51
Q

When diagnosing genital herpes, where should swabs be taken from?

A

Open lesions

52
Q

With what type of HSV are recurrent episodes more common?

A

HSV 2

53
Q

Why is herpes often overlooked/misdiagnosed?

A

It is often mistaken for ‘thrush’ – mild, localised anogenital tingling, burning or soreness.

54
Q

What do recurrent episodes of HSV usually present like?

A

As unilateral small blisters and ulcers

55
Q

Describe systemic symptoms is HSV.

A

Are minimal and resolve within 5-7 days

56
Q

How is genital herpes investigated?

A

Swab base of ulcer for HSV PCR.

57
Q

What is the causative virus in genital herpes?

A

HSV

58
Q

How is genital herpes treated?

A
  • Give oral antiviral treatment – acyclovir. (shortens current episode and relieves sx)
  • Consider topical Lidocaine 5% ointment if very painful.
  • Saline bathing.
  • Analgesia.
59
Q

Is viral shedding more common following infection with HSV 1 or 2?

A

2

60
Q

When is viral shedding more common in genital herpes infection?

A

In the first year of infection.

61
Q

Who does viral shedding in HSV occur more in?

A

Individuals with frequent recurrences.

62
Q

What is viral shedding in genital herpes reduced by?

A

Suppressive therapy.

63
Q

What is the most common VIRAl STI in the UK?

A

HPV

64
Q

What is the lifetime risk of acquiring HPV?

A

Up to 80%.

65
Q

How many different genotypes of HPV are there?

A

> 170

66
Q

What are the low risk genotypes of HPV?

A

6,11,42,43,44

67
Q

What are the high risk genotypes of HPV?

A

16,18,31,33,35,45,51,52,58 and 66

68
Q

What genotypes of HPV cause anogenital warts?

A

Types 6 and 11

69
Q

What genotypes of HPV cause cancer?

A

Types 16 and 18

70
Q

What genotypes of HPV causes palmar and plantar warts?

A

Types 1 and 2

71
Q

What % of the population will be exposed to HPV?

A

80%

72
Q

What % of the population probably harbour detectable infection of HPV?

A

10%

73
Q

What % of people will develop anogenital warts?

A

1%.

74
Q

Who are people most likely to have acquired HPV from?

A

An asymptomatic partner

75
Q

What is the incubation period of HPV?

A

3 weeks to 9 months

76
Q

Subclincial disease of HPV is common where?

A

On all anogenital sites.

77
Q

Transmission of more than one HPV type is common

A

True

78
Q

What % of people with anogenital warts experience spontaneous clearance of warts?

A

20-34%

79
Q

What % of people with anogenital warts experience clearance with treatment?

A

60%

80
Q

What % of people with anogenital warts experience persistence despite treatment?

A

20%

81
Q

What are >90% of anogenital warts caused by?

A

HPV 6 and 11

82
Q

What are the 4 options of treatment of HPV?

A
  • Podophyllotoxin (Warticon).
  • Imiquimod (Aldara).
  • Cryotherapy.
  • Electrocautery.
83
Q

Who is offered the HPV vaccine?

A

MSM and people living with HIV.

84
Q

What is - Podophyllotoxin (Warticon), in the treatment of genital warts?

A
  • Cytotoxic.

* Not licensed for extra-genital warts, but widely used.

85
Q

What is - Imiquimod (Aldara), in the treatment of genital warts?

A
  • Immune modifier.

* Can be used on all Anogenital warts.

86
Q

What is the causative organism in syphilis?

A

Treponema pallidum (spirochete)

87
Q

What is syphilis usually transmitted through?

A
  • Sexual contact.
  • Trans-placental/during birth.
  • Blood transfusions.
  • Non-sexual contact – healthcare workers.
88
Q

How is syphilis categorised?

A
  • CONGENITAL.
    or
  • ACQUIRED.
89
Q

What is the intubation period of primary syphilis?

A

From 9-90 days (mean of 21 days).

90
Q

What is the lesion traditionally known as in primary syphilis?

A

A primary chancre (painless).

91
Q

Where do primary lesions in syphilis occur?

A

At the site of inoculation.

92
Q

Describe the primary sites in syphilis.

A

Sites are genital in 90% and extra-genital in 10%.

93
Q

As what as a primary chancre, what else may there be?

A

Non-tender local lymphadenopathy.

94
Q

What is the intubation period in secondary syphilis?

A

6 weeks to 6 months.

95
Q

Outline how secondary syphilis may present.

A
  • On skin as a macular, follicular or pustular rash on palms + soles.
  • Lesions on mucous membranes.
  • Generalized lymphadenopathy.
  • Patchy alopecia.
  • Condylomata lata (most highly infectious lesion in syphilis, exudes a serum TEEMING with TREPONEMES).
96
Q

Outline how a diagnosis of syphilis can be confirmed. Mention the 2 categories of ix.

A

Demonstration of Treponema Pallidum (from lesions or infected lymph nodes)

  • Dark Field Microscopy
  • PCR (polymerase chain reaction)

Serological Testing

  • Detects antibody to pathogenic treponemes
97
Q

Give 2 examples of non-treponemal serological tests.

A

VDRL – Venereal Disease Research Laboratory.

RPR – Rapid Plasma Reagin.

98
Q

Give 4 examples of treponemal serological tests.

A
  1. TPPA (Treponemal Pallidum Particle Agglutination)
  2. ELISA/EIA (Enzyme Immunoassay)
  3. INNO-LIA (Line immunoassay)
  4. FTA abs (Fluorescent Treponemal Antibody absorbed)
99
Q

Name a screening test for syphilis.

A

ELISA/EIA (Enzyme Immunoassay).

100
Q

How is early syphilis treated?

A

2.4 MU Benzathine penicillin x 1

101
Q

How is late syphilis treated?

A

2.4 MU Benzathine penicillin x 3

102
Q

For early/late syphilis, when should follow-up be done?

A

Until RPR is negative or serofast

103
Q

If early syphilis is successfully treated, what should happen to titres?

A

They should decrease four-fold by 3-6 months.

104
Q

If there is serological relapse/reinfection, what happens to titres?

A

They increase by fourfold.

105
Q

This STI is known as the “great imitator” because its symptoms resemble those of other infections

A

Syphilis

106
Q

The vaccine for HPV is currently recommended for females (HIV negative) ages …

A

11-13

Reproduction and Sexual Health (51 decks)

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