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STIs Flashcards

1
Q

define commensal micro-organism

A

a micro-organism that derives food/other benefits from another organism w/o hurting or helping it

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2
Q

define pathogen

A

micro-organism that causes disease

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3
Q

define infection

A

invasion of all/part of the body by an organism
sub-clinical - asymptomatic
clinical - symptomatic

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4
Q

define sexually transmissable organism

A

virus/pathogen/insect/arthropod which can be spread by sexual contact
commensal/pathogen

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5
Q

define sexually transmitted infection - STI

A

infection by a sexually transmissable pathogen which is unlikely to be transmitted by non-sexual means
e.g. Neisseria gonorrhoeae, HPV type 6

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6
Q

define sexually transmitted disease - STD

A

disorder of structure/function caused by a sexually transmitted pathogen
e.g. pelvic inflammatory disease, genital warts

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7
Q

examples of bacterial sexually transmitted organisms in UK

A 
Chlamydia trachomatis
Klebsiella granulomatis 
Mycoplasma genitalium 
syphilis - treponema pallidum pallidum 
Neisseria gonorhoeae 
Chancroid - haemophilus ducreyi
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8
Q

examples of viral sexually transmitted organisms in uK

A

HSV
HIV
HPV
molluscum contagiosum virus

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9
Q

examples of parasitic sexually transmitted organisms in UK

A

pthirus pubis
sarcoptes scabei
trichomonas vaginalis

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10
Q

characteristics and their implications of STIs

A

contagious - sexual contact tracing
mostly asymptomatic - can’t eradicate just by treating symptom
unpredictable minority suffer significant complications - early detection and treatment needed
avoidable - 1y prevention is the goal

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11
Q

what is meant by sexually transmitted - different types of sexual contact

A 
group sex
anal sex
vaginal sex
oral sex - cunnilingus, fellatio
touching someone else's genitals w/ your genitals
mutual masturbation
'pants on'

increasing chance of catching infection the higher up the list

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12
Q

activity required for transmission examples

A 
skin contact only:
pubic lice
scabies
warts
herpes

penetrative sex - chlamydia, gonorrhoea
group sex - hep C

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13
Q

pubic lice causative organism

A

pthirus pubis

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14
Q

scabies causative organism

A

sarcoptes scabeii

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15
Q

warts causative organism

A

HPV 6, 11

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16
Q

herpes causative organism

A

HSV 1, 2

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17
Q

why are STIs important

A
  1. morbidity and mortality - unpleasant symptoms - grouped into syndromes, psychological distress
  2. resources cost
  3. common
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18
Q

examples of symptoms caused by STIs

A 
ulceration
lumps
genital discharge
non-genital discharge 
rashes
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19
Q

examples of STIs that cause ulceration

A

2y syphilis
HSV

less common - chancroid, donovanosis

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20
Q

examples of STIs that cause lumps

A

genital warts

molluscum contagiosum

21
Q

examples of STIs that cause genital discharge

A 
penile, vaginal, rectal 
gonorrhoea
chlamydia
mycoplasma genitalium 
trichomoniasis - vaginal
22
Q

examples of STIs that cause non-genital discharge

A

gonorrhoea - eyes

chlamydia - eyes

23
Q

examples of STIs that cause rashes

A 
scabies
syphilis 
HIV
crab lice
molluscum contagiosum and other lump causing organisms
24
Q

systemic symptoms of STIs

A 
fever
rash 
lymphadenopathy 
malaise
arthralgia and arthritis

e.g. HIV, syphilis

25
late complications of STIs
infertility - chlamydia cancer - 250 000 deaths globally from cervical cancer (HPV) 300 000 adverse pregnancy outcomes from syphilis p/a
26
where in the world are most deaths due to HIV
resource poor settings
27
where in the world are most deaths due to STIs (not including HIV)
e.g. syphilis, donovanosis, chancroid all more likely in resource poor settings south asia, many african countries
28
cost of resources for STIs
managing infertility due to chlamydia - IVF cost cost of HIV medication/management of HIV related health conditions taking time off work for treatment
29
how common are STIs
>1mln new STIs acquired every day | >500mln have genital herpes
30
why do numbers of STI diagnoses change over time
- true difference in number of cases | - change in diagnoses but no actual difference in number of cases
31
changes in true number of cases - reproductive number
reproductive number (R0) = likelihood of transmission per encounter x rate of acquiring new partners x duration of infectivity R0 >1 then epidemic is sustained R0 <1 then epidemic reduces
32
what can we do to reduce transmissibility
vaccinate unexposed person before they are exposed to the organism e.g. HPV
33
changes in number of partners from 1990-2010
increased numbers of partners/person increased concurrent partners more people having anal sex more men reporting sex with men more condom use easier ways to find sexual partners e.g. apps alcohol - hazardous drinkers
34
why might there be a change in number of diagnoses over time but no chance in cases
greater awareness of STIs = more testing more people asking for tests, more clinicians considering STIs and testing for them better tests
35
why are some STIs more common in some groups than others
e.g. syphilis large proportion of cases occuring in men who have sex with men cores and associative mixing theory; chains and random mixing
36
cores and assortative mixing theory
some people have sex with people like them - similar lifestyle, same ethnicity etc high prevalence within a subpopulation (core) but limited spread through the community
37
examples of cores and assortative mixing
syphilis in people who exchange sex for drugs | lymphogranuloma venereum or HCV in HIV+ve MSM
38
chains and random mixing
some cores are very big e.g. heterosexual M and F random mixing leads to lower prevelance but wider dissemination along chains - most people have few sexual contacts over a given period of time and so chains are quite short - if this was generalised, STI epidemics wouldn't be sustained
39
management of someone w/ symptoms suggestive of STI
good hx partner notification HIV testing health promotion
40
consultation w/ someone w/ symptoms suggestive of STI
standard hx components - PC, HPC, PMH/SHx, DHx gynae hx direct questions about symptoms
41
why is a sexual history necessary
determining possible cause of symptoms detecting high risk behaviour and advising on risk reduction tracing contacts
42
questions to ask in sexual hx
when did you last have sexual contact casual contact vs regular partner - how long have you been together for were they M/F nature of sex act (often not relevant) - anxiety about specific incident, will it alter where you swab from were condoms used other contraception used nationality of contact
43
assessment of longer term sexual risks (men)
have you ever had sexual contact with another man have you ever injected drugs sexual contact w/ - IDU, someone outside UK (clarify) medical treatment outside UK (clarify) paid for sex/been paid
44
what are the 2 ways of partner notification
patient tells contacts - client referral, preferred | NHS tells contact - provider referral
45
recommended further testing in consultation
most STIs are risk factors for HIV acquisition and transmission if someone has one STI they could have another
46
health promotion in consultation
``` condoms prevent transmission of some STIs oral sex carries risks too address hazardous drug use vaccination HIV pre-exposure prophylaxis ```
47
pros and cons of condoms for prevention of tranmission
prevent transmission - HIV, chlamydia, gonorrhoea | not so good at preventing transmission of others - herpes, warts
48
risks from oral sex
not as great as vaginal/anal sex | fellatio more than cunnilingus

Y3 repro (47 decks)

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