STIs Flashcards
what pathogen causes gonorrhoea
Neisseria gonorrhoeae
what type of tissues can gonorrhoeae affect
mucous membranes with columnar epithelium
Commonly - cervix, urethra, anus, throat.
Common in children - lining of eyes.
what are risk factors for gonorrhoeae
young
sexually active
multiple partners
MSM
what is the incubation period for gonorrhoea
usually 5-6 days
can range from 2-14 days
how does gonorrhoea present in women
most have no symptoms vaginal discharge (odourless, can be green or yellow) dysuria intermenstrual/post coital bleeding pelvic pain pharyngeal/rectal infection
how does gonorrhoea present in men
thick yellow discharge
rectal infection - usually asymptomatic, can cause discomfort and discharge
pharyngeal infection - usually asymptomatic, can cause sore throat
testicular pain/swelling
more likely to be symptomatic
what are complications of gonorrhoea
acute monoarthritis usually in elbow or shoulder disseminated gonococcal infection women - pelvic inflammatory disease men - epididymitis infertility
what investigations could you do for gonorrhoea
nucleic acid amplification testing - optimum
swabs - rectal and pharyngeal for MSM
urine sample for men
endocervical/urethral swab for microscopy, culture, abx sensitivities
gram stained smear in symptomatic people
how do you treat gonorrhoea
ceftriaxone 1g IM if sensitivities not known
oral ciprofloxacin if sensitivities known
follow up NAAT testing
- test of cure at 1 weeks
- test of reinfection at 3 months
give advice
test for other STIs
what pathogen causes chlamydia
chlamydia trachomatis serovars D to K
most common STI in UK
how does chlamydia present in women
over 80% are asymptomatic increased vaginal discharge dysuria intermenstrual/post-coital bleeding conjunctivitis pelvic pain painful sex - dyspareunia
how does chlamydia present in men
urethral discharge/discomfort
dysuria
epididmyo-orchitis
reactive arthritis
what are complications of chlamydia
men - epididymitis
women - ectopic pregnancy, pelvic pain, infertility
both - reactive arthritis, reiter’s syndrome
what investigations could you do for chlamydia
NAATs from swabs from cervix, urethra, rectum
how do you manage chlamydia
doxycycline 100mg 2x a day for 7 days
or oral azithromycin 1g if pregnant
test for reinfection at 3-12 months
dont do an earlier test of cure unless symptoms persist
need to trace sexual partners
avoid intercourse until treatment is complete
what is genital herpes caused by
herpes simplex virus 1 and 2
HSV-2 associated with genital herpes and is a co-factor in HIV transmissionHSV-1 with cold sores
how does genital herpes present
ulcers or blistering lesions in genital area
neuropathic pain in back, pelvis, legs
flu like symptoms
dysuria
80% asymptomatic
symptoms recur but are less severe in recurrent episodes
what are complications of genital herpes
autonomic neuropathy (urinary retention)
neonatal infection
secondary infection
what is the incubation time for herpes
5 days - months
what investigations could you do for genital herpes
swab the lesion, send to PCR
ask about contacts
how do you manage genital herpes
aciclovir
lidocaine ointment
for infrequent recurrences aciclovir 1.2g once daily until symptoms go
for frequent reoccurences give aciclovir 400mg 2x daily until symptoms stop
what is trichomoniasis caused by
trichomonas vaginalis (parasite)
what are symptoms of trichomoniasis
men are usually asymptomatic 10-30% of women are asymptomatic profuse vaginal discharge - greenish frothy and foul smelling - fishy vulvitis itch
what are complications of trichomoniasis
miscarrige
preterm labour
increased risk of HIV, cervical cancer, pelvic inflammatory disease, bacterial vaginosis
what investigations could you do for trichomoniasis
PCR of vaginal swab
microscopy of vaginal discharge
NAAT
culture
how do you treat trichomoniasis
metronidazole 400mg 2x/day for 5 days or 2g single dose
partner tracing + avoid intercourse until treatment is completed
what causes anogenital warts
human papilloma virus types 6 and 11
what are symptoms of anogenital warts
lumps
sometimes itching and bleeding
what are complications of anogenital warts
neonatal laryngeal papillomatosis
how do you treat anogenital warts
podophyllotoxin imiquimod cyrotherapy diathermy scissor removal
what is syphilis caused by
treponema pallidum
bacteria that gets into body through mucous membranes or skin.
how does syphilis present (stages)
incubation period of 21 days
primary - chancre (painless ulcer)
secondary - systemic symptoms, maculopapular rash, condylomata lata, fever, lymphadenopathy, alopecia, oral lesions
latent stage - symptoms resolve but patient is still infected (early latent stage is within 2 years of initial infection, late latent stage is after 2 yrs)
tertiary - can happen many years after initial infection, gummas develop, can have CVS and neuro complications
neurosyphilis - infection involves CNS
what are complications of syphilis
neurosyphilis
CN palsies
cardiac or aortal involvement
congenital syphilis
what investigations could you do in syphilis
serology for TP IgGEIA, TPPA, RPR
samples from infection site can be sent for dark field microscopy, PCR
how do you treat syphilis
under 2years with no neuro invovement - IM benzathine penicillin or doxycycline 100mg bd 2wks
if late stage (over 2yrs) with no neuro invovement - IM benzathine penicillin for 3wks, doxycycline 100mg bd 28dys
screen for other STIs
what is genital candidiasis caused by
candidia albicans (thrush)
what are risk factors for genital candidiasis (thrush)
increased oestrogen
poorly controlled diabetes
immunosuppressants
broad-spectrum antibiotics
how does genital candidaisis present
itch
burning
thick white discharge
dyspareunia
what investigations can you do for genital candidiasis
test vaginal pH - usually <4.5, if its >4.5 consider trichomonas
swab for microscopy and culture
how can you manage genital candidiasis
antifungal cream or pessary - clotrimazole
if severe oral fluconazole
condoms will not be as effective for 5 days after so alternative contraception is needed
what are risk factors for genital candidiasis
pregnant
antibiotic therapy
DM
immunosuppressed
what causes bacterial vaginosis
overgrowth of bacteria in the vagina
how does bacterial vaginosis present
thin white fishy smelling discharge
like megans xx
no itch or pain
what investigations could you do for bacterial vaginosis
gram stain to examine vaginal flora
how do you manage bacterial vaginosis
oral or PV metronidazole
PV clindamycin
What are the signs and symptoms of neurosyphilis?
- Argyll- robertson pupil
- headache
- dementia
- tabes dorsalis (lots of presentations)
- paralysis
- sensory impairment
What is the feature of argyle’s Robertsons pupil?
- pupil changes for accommodation but DOESNT change in reaction to light
What is HIV?
Human immunodeficiency virus.
What is AIDS?
Acquired immunodeficiency syndrome - it occurs when HIV progresses and the person becomes immunodeficient.
What is the pathophysiology of HIV?
It enters the body and destroys CD4 T-helper cells.
(these are the cells that trigger the body’s response to an infection)
It can take up to 3 months for antibodies to be made
What are the signs and symptoms of HIV?
A flu like illness for the first few weeks (fever and body aches).
Asymptomatic after this until immunodeficient
How is HIV transmitted?
- Anal or vaginal sex
- from mother to baby either during pregnancy, birth or breast feeding (vertical transmission)
- mucous membrane, blood or open wound exposed to infected blood or bodily fluids
What is the pathophysiology of AIDS?
When the CD4 T-helper cells have dropped so low that opportunistic infections can occur.
What are examples of AIDS defining illnesses?
- tuberculosis
- candidiasis
- lymphomas
- cytomegalovirus
- kaposis sarcoma
- pneumocystitis pneumonia
When should repeat testing be done in HIV?
3 months after the initial contact with the virus, as this is when antibodies will have developed by.
When is HIV screened for?
When pregnant as routine.
What are the normal and AIDS levels of CD4?
Normal = 500-1200 cells/mm3
End stage HIV/AIDS = <200cells/mm3
What is an undetectable Viral load?
When the HIV RNA is under 50-100 copies/ml.
It can be in the hundreds of thousands in untreated patients.
What is the treatment for HIV?
- ART - antiretroviral therapy (offered to everyone with HIV regardless of CD4 count or viral load)
- Two NRTI’s -tenofovir and emtricitabine
- HAART
- prophylactic co -trimoxazole (if CD4<200)
How should HIV patients be treated when they have an infection?
If they have normal CD4 and undetectable viral load, they should be treated like non-HIV patients.
Make sure to check drug interactions with their HIV medications.
What are women with HIV at increased risk of?
HPV - cervical cancer
they receive yearly smears
What vaccines should HIV patients avoid?
Live vaccines.
What are mothers with HIV advised against?
Breastfeeding
even with undetectable viral load they can pass on HIV to baby
What is the prophylaxis therapy for contact with HIV?
Must be within 72hrs of contact
ART therapy - Truvada and raltegravir for 28 days
