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Y4: Infectious diseases > STIs > Flashcards

STIs Flashcards

1
Q

BV is an overgrowth of ___ bacteria in the vagina Examples?

A

anaerobic Gardnerella vaginalis (most common) Mycoplasma hominis Prevotella species

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2
Q

T/F: BV is a sexually transmitted infection

A

False- is caused by LOSS of health vaginal bacteria Can increase risk of STIs occurring

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3
Q

main component of the healthy vaginal flora?

A

lactobacilli (produce lactic acid that keep pH <4.5) loss of lactobacilli > pH rises > anaerobic bacteria grow > BV

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4
Q

risk factors for BV?

A

multiple sexual partners excessive vaginal cleaning recent antibiotics smoking copper coil

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5
Q

presentation of BV?

A

Classic: fishy grey/white vaginal discharge. 50% asymptomatic Not often ass. with itching, irritation or pain (suggests concurrent infection)

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6
Q

Ix in BV?

A

vaginal swab: pH> 4.5 Charcoal vaginal swab (high if speculum, low if self-taken) for microscopy > clue cells assess risk of additional pelvic infections: swabs for chlamydia and gonorrhoea where appropriate

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7
Q

Treatment of BV?

A

Asymptomatic: often no treatment, may self-resolve Symptomatic: metronidazole PO/ topical gel Advice: risk reduction (avoiding irritation soaps/ douching)

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8
Q

Advice when prescribing metronidazole?

A

avoid alcohol throughout treatment causes disulfiram-like reaction (N&V, flushing, sometimes shock and angiodema)

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9
Q

complications of BV?

A

increased STI risk: chlamydia, gonorrhoea, HIV in pregnancy: miscarriage, preterm delivery, PROM, chorioamnionitis, LBW, postpartum endometritis

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10
Q

T/F: BV occurs more frequently in women taking the COCP

A

false - less common also less common in those who use condoms effectively

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11
Q

most common cause of thrush?

A

candida albicans

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12
Q

T/F: candida may colonise the vagina without causing symptoms

A

true - then cause symptoms in certain situations e.g. pregnancy then progresses to infection with right environment e.g. pregnancy/ post broad-spec Abx that alter the vaginal flora.

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13
Q

risk factors for vaginal candidiasis?

A

increased oestrogen (higher in pregnancy, lower pre-puberty and post-menopause) poorly controlled diabetes immunosuppression (corticosteroids) broad-spec Abx

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14
Q

vaginal candidiasis presentation?

A

non-smelly thick, white vaginal d/c vulval and vaginal itching, irritation, discomfort more severe: erythema, fissures, oedema, dyspareunia, dysuria, excoriations

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15
Q

Ix in vaginal candidiasis?

A

often treated empirically swab for vaginal pH can differentiate between BV and trichomonas (pH >4.5) and candidiasis (pH <4.5) charcoal swab for microscopy can confirm diagnosis

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16
Q

initial uncomplicated vaginal candidiasis treatment?

A

clotrimazole cream (single dose at night 5g 10% cream) or clotrimazole pessary (single 500mg at night or three 200mg over 3 nights) or oral fluconazole (single dose, 150mg)

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17
Q

advice for women taking antifungal creams/ pessaries?

A

can damage latex condoms/ prevent spermacides from working so alternative contraception needed for at least 5 days after use

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18
Q

most common STI in the UK?

A

chlamydia (significant cause of infertility)

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19
Q

Chlamydia 1) gram NEGATIVE/ POSITIVE bacteria 2) INTRACELLULAR/ EXTRACELLULAR

A

1) -VE 2) intracellular

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20
Q

T/F: many cases of chlamydia are asymptomatic

A

true 75% in women 50% in men

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21
Q

T/F: asymptomatic patients can still pass the infection on

A

true

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22
Q

what is tested for when a patient attends GUM clinic for STI screening

A

chlamydia gonorrhoea syphilis HIV

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23
Q

name the 2 types of swabs used in sexual health testing and what they are used for

A

charcoal swab- microscopy, culture and sensitivities NAAT- test directly for DNA/ RNA of the organism

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24
Q

charcoal swabs can confirm which STIs?

A

BV (clue cells) candidiasis Gonorrhoea (specifically endocervical) Trichomonas vaginalis (specifically swab from posterior fornix) Other bacteria e.g. group B strep

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25
Q

what kind of swabs can charcoal swabs be used for?

A

endocervical or high vaginal swabs

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26
Q

NAAT swabs are used to test for which STIs?

A

gonorrhoea chlaymdia mycoplasma genitalium

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27
Q

In women, what kind of samples can NAAT be performed on? Order of preference?

A

endocervical vulvovaginal (self-taken lower vaginal swab) first-catch urine (think inside to out)

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28
Q

In men, what kind of samples can NAAT be performed on? Order of preference?

A

first-catch urine urethral

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29
Q

what swabs can be taken to diagnose chlamydia in the rectum and throat?

A

rectal or pharyngeal NAAT swabs (consider after oral/ anal sex)

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30
Q

Where gonorrhoea is suspected or demonstrated on a NAAT test, what further test is needed?

A

endocervical charcoal swab for microscopy, culture and sensitivities

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31
Q

presentation of chlamydia in women?

A

75% asymptomatic suspect if - Abnormal vaginal discharge/ bleeding - Pelvic pain - dysuria/ pareunia

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32
Q

presentation of chlamydia in men?

A

50% asymptomatic suspect if - urethral discharge/ discomfort - dysuria - epididymo-orchitis - reactive arthritis

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33
Q

It is worth considering rectal chlamydia and lymphogranuloma venereum in pts presenting with that symptoms?

A

anorectal symptoms - discomfort, dishcarge, bleeding, change in bowel habits

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34
Q

diagnosis of chlamydia 1) in women 2) in men

A

1) NAAT vulvovaginal swab 2) NAAT first-catch urine swab are first line tests

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35
Q

Chlamydia treatment 1) 1st line, uncomplicated 2) when is this contraindicated? 3) alternatives in this group?

A

1) doxycycline 100mg BD 7 days 2) pregnancy, breastfeeding 3) azithromycin, erythromycin, amoxicillin

36
Q

T/F: test of cure is recommended in chlamydia and gonorrhoea

A

not routinely in chlamydia (used in: pregnancy, persistent symptoms, rectal chlamydia) yes in gonorrhoea (given the high rate of antibiotic resistance)

37
Q

Other factors in the management of chlamydia patient?

A

avoid spread: avoid sex for 7 days during treatment, refer to GUM for contact tracing and notification co-infection: screen for other STIs prevent recurrence: education regarding protection safeguarding: sexual abuse in children

38
Q

Lymphogranuloma venereum (LGV) Is a condition affecting the ____ tissue around the site of infection with chlamydia. It most commonly occurs in which patient demographic?

A

lymphoid MSM

39
Q

3 stages of Lymphogranuloma Venereum?

A

Primary: painless ulcer on penis/ vaginal wall/ rectum Secondary: lymphadenitis (inflammation and pain or inguinal/ femoral lymph nodes) Tertiary: proctitis, proctocolitis - anal pain, change in bowel habit, tenesum, discharge

40
Q

1st line treatment of LGV?

A

Doxycycline 100mg BD 21 days

41
Q

examination findings in chlamydia?

A

pelvic/ abdo tenderness cervical motion tenderness (cervical excitation) inflamed cervix (cervicitis) purulent d/c

42
Q

describe the Neisseria gonorrhoeae bacteria

A

gram negative diplococcus

43
Q

T/F: having other STIs increases the risk of getting gonorrhoea

A

true

44
Q

T/F: there is a high level of antibiotic resistance to gonorrhoea

A

true

45
Q

T/F: gonorrhoea is more likely to be asymptomatic than chlamydia

A

false 90% symptomatic in men 50% in women

46
Q

presentation of gonorrhoea in 1) women 2) men

A

1) odourless purulent discharge (green/ yellow), dysuria, pelvic pain 2) odourless purulent discharge (green/ yellow), dysuria, epididymo-orchitis

47
Q

presentation of 1) rectal 2) pharyngeal gonorrhoea?

A

1) often asymptomatic, can cause pain and d/c 2) often asymptomatic, can cause sore throat

48
Q

diagnosis of gonorrhoea in 1) women 2) men

A

1) NAAT- vulvovaginal swab 2) NAAT- first catch urine swab are first line

49
Q

who should receive rectal and pharyngeal swabs for gonorrhoea?

A

all MSM or risk factors: anal/ oral sex or symptomatic in these areas

50
Q

T/F: a charcoal endocervical swab should be taken before starting antibiotics in gonorrhoea

A

true- for micoscopy, culture and sensitivities (imp due to hgih rate of Abx resistance) so NAAT for diagnosis followed by charcoal for confirming antibiotic sensitivities if positive

51
Q

Gonorrhoea treatment 1) uncomplicated, sensitivities not known 2) uncomplicated, sensitivities not known, needle phobic 3) uncomplicated, sensitivities known

A

1) IM ceftriaxone 1g (have to TRI something) 2) oral cefixime + oral azithromycin 3) oral ciprofloxacin 500mg

52
Q

Test of cure in gonorrhoea 1) what test 2) when

A

1) NAAT if asymptomatic, cultures if symptomatic 2) 72 hours post-treatment for culture. 7 days post-treatment for RNA NAAT (14 for DNA)

53
Q

other important points in the management of gonorrhoea?

A

avoid spread: avoid sex for 7 days during treatment, refer to GUM for contact tracing and notification co-infection: screen for other STIs prevent recurrence: education regarding protection safeguarding: sexual abuse in children

54
Q

Gonococcal infection in neonates can be contracted from the mother during birth What medical emergency can this lead to?

A

gonococcal neonatal conjunctivitis (ophthalmia neonatorum) can lead to sepsis, perforation of the eye and blindness

55
Q

complication of untreated gonococcal infection? presentation?

A

disseminated gonococcal infection- bacteria spreads to the skin and joints Non-specific skin lesions Polyarthralgia Migratory polyarthritis Tenosynovitis Fever, fatigue

56
Q

Although caused by Chlamydia trachomatis, the majority of patients in the UK with lymphogranuloma venereum will be positive for which other STI?

A

HIV (must test for that too)

57
Q

name a bacteria that causes non-gonococcal urethritis other than chlamydia trachomatis

A

Mycoplasma genitalium

58
Q

T/F: most cases of mycoplasma genitalium are asymptomatic

A

true

59
Q

Presentation of mycoplasma genitalium?

A

URETHRITIS is key epididymitis cervicitis endometritis PID reactive arthritis preterm delivery tubal infertility

60
Q

Ix in Mycoplasma genitalium?

A

NAAT (culture too slow) - first pass urine in men - vaginal swab in women

61
Q

Rx of Mycoplasma genitalium? what about in pregnancy and breastfeeding?

A

doxycycline or azithromycin azithromycin in pregnancy and breastfeeding (doxy contraindicated)

62
Q

what is pelvic inflammatory disease

A

inflammation and infection of the female pelvic organs (uterus, ovaries, tubes, parametrium, peritoneum) usually due to ascending infection from endocervix

63
Q

causes of PID? (most common?)

A

chlamydia- most common gonorrhoea, MG also Gardnerella vaginalis, Haemophilus influenzae and E coli

64
Q

signs and symptoms of PID?

A

lower abdo pain, fever, deep dyspareunia, dysuria and menstrual irregularity, discharge, cervical excitation

65
Q

Ix in PID 1) testing for causative organisms and other STIs 2) the absence of ___ cells on microscopy is a useful test of exclusion (swab vagina/ endocervix) 3) what other test should be performed on sexually active women with lower abdo pain? 4) ___ markers are raised

A

1) NAAT for gonorrhoea, chlamydia, MG. HIV test, syphilis test. High vaginal swab for BV, candida, trichomonas 2) pus 2) pregnancy- ?ectopic 4) inflammatory- ESR, CRP

66
Q

What is Fitz-Hugh-Curtis Syndrome?

A

complication of PID? inflammation of liver capsule > RUQ pain, can refer to shoulder tip

67
Q

Rx of PID?

A

PO ofloxacin + PO metronidazole/ IM ceftriaxone + PO doxycycline + PO metronidazole

68
Q

what is Trichomonas vaginalis where does it live

A

sexually transmitted protozoan parasite lives in vagina in women and urethra in men

69
Q

Trichomonas can increase the risk of: 1) contracting ____ 2) bacterial ____ 3) ____ cancer 4) pelvic ___ ___ 5) ____-related complications

A

1) HIV 2) BV 3) cervical 4) PID 5) pregnancy (preterm)

70
Q

presentation of Trichomonas?

A

women- offensive, yellow-green frothy d/c, vulvovaginits, strawberry cervic men- may get urethritis

71
Q

Trichomonas vaginalis is associated with a vaginal pH LESS/ GREATER than 4.5

A

GREATER than (same as BV)

72
Q

Ix in Trichomonas vaginalis?

A

charcoal swab > microscopy of a wet mount > motile trophozoites

73
Q

Rx of Trichomonas vaginalis?

A

oral metronidazole

74
Q
A
75
Q

HSV-1 most often caues ___ lesions

HSV-2 most often caues ____ lesions

(although there’s considerable overlap)

A

oral (cold sores)

genital

76
Q

features of genital herpes?

A

painful genital blisters

may be dysuria, pruritis

neuropathic pain

tender inguinal lymphadenopathy

primary infection typically more severe than recurrences (systemic features: HA, fever, malaise)

77
Q

Ix of choice in genital herpes?

A

NAAT

78
Q

management of genital herpes?

A

symptomatic

  • topical lidocaine
  • analgesia
  • saline bathing

Oral aciclovir

79
Q

Treatment of genital herpes in pregnancy + delivery method

  1. Primary genital herpes contracted before 28 weeks
  2. Primary genital herpes contracted after 28 weeks
  3. Recurrent genital herpes in pregnancy
A
  1. oral aciclovir + prophylactic doses commenced >36 weeks. Can VD if asymptomatic
  2. oral aciclovir + prophylactic doses commenced immediately. Must have electic c/s
  3. low risk of transmission even if symptomatic. Given prophylactic aciclovir from 36 weeks
80
Q

Syphilis

  1. causative bacteria?
  2. average incubation period between the initial infection and symptoms?
  3. methods of transmission?
A
  1. Treponema pallidum (spirochete)
  2. 21d
  3. mainly sexual, also: vertical (mother to child), IVDU, blood transfusion
81
Q

Stages of syphilis?

A

Primary: single painless chancre ulcer, non-tender local lymphadenopathy

Secondary: systemic symptoms: fever, maculopapular rash on trunks, palms and soles, snail trail buccal ulcers, condylomata lata

Latent: asymptomatic

Tertiary: gummas, aortic aneurysms, neurosyphilis, paralysis, Argyll-Robertson pupil

82
Q

features of congenital syphilis?

A

ears, eyes, nose, mouth

  • deafness
  • keratitis
  • saddle nose
  • blunted upper incisor teeth (Hutchinson’s teeth), ‘mulberry’ molars, rhagades (linear scars at the angle of the mouth)
  • saber shins
83
Q

what is an argyll-Robertson pupil?

A

a constricted pupil that accommodates when focusing on a near object but does not react to light

a finding in neurosyphilis (Tertiary)

aka “prostitutes pupil” – “it accommodates but does not react“.

84
Q

Ix in syphilis?

A

dark field microscopy (T. pallidum)

serology

  • VDRL: becomes -ve post-treatment
  • TPHA: remains +ve post-treatment
85
Q

treatment of syphilis?

A

IM benzathine benzylpenicillin

(alt: doxycline)

86
Q

what reaction is sometimes seen after treatment of syphilis?

A

Jarisch-Herxheimer reaction

  • fever, rash, tachycardia after the first dose of antibiotic
  • no wheeze or hypotension (c.f. anaphylaxis)
  • Rx: antipyretics
87
Q

Disseminated gonococcal infection triad

A
  • tenosynovitis
  • migratory polyarthritis
  • dermatitis

Y4: Infectious diseases (17 decks)

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