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Y3 repro > STIs > Flashcards

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
Q

late complications of STIs

A

infertility - chlamydia
cancer - 250 000 deaths globally from cervical cancer (HPV)
300 000 adverse pregnancy outcomes from syphilis p/a

26
Q

where in the world are most deaths due to HIV

A

resource poor settings

27
Q

where in the world are most deaths due to STIs (not including HIV)

A

e.g. syphilis, donovanosis, chancroid
all more likely in resource poor settings
south asia, many african countries

28
Q

cost of resources for STIs

A

managing infertility due to chlamydia - IVF cost
cost of HIV medication/management of HIV related health conditions
taking time off work for treatment

29
Q

how common are STIs

A

> 1mln new STIs acquired every day

>500mln have genital herpes

30
Q

why do numbers of STI diagnoses change over time

A
  • true difference in number of cases

- change in diagnoses but no actual difference in number of cases

31
Q

changes in true number of cases - reproductive number

A

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
Q

what can we do to reduce transmissibility

A

vaccinate unexposed person before they are exposed to the organism

e.g. HPV

33
Q

changes in number of partners from 1990-2010

A

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
Q

why might there be a change in number of diagnoses over time but no chance in cases

A

greater awareness of STIs = more testing
more people asking for tests, more clinicians considering STIs and testing for them

better tests

35
Q

why are some STIs more common in some groups than others

A

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
Q

cores and assortative mixing theory

A

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
Q

examples of cores and assortative mixing

A

syphilis in people who exchange sex for drugs

lymphogranuloma venereum or HCV in HIV+ve MSM

38
Q

chains and random mixing

A

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
Q

management of someone w/ symptoms suggestive of STI

A

good hx
partner notification
HIV testing
health promotion

40
Q

consultation w/ someone w/ symptoms suggestive of STI

A

standard hx components - PC, HPC, PMH/SHx, DHx
gynae hx
direct questions about symptoms

41
Q

why is a sexual history necessary

A

determining possible cause of symptoms
detecting high risk behaviour and advising on risk reduction
tracing contacts

42
Q

questions to ask in sexual hx

A

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
Q

assessment of longer term sexual risks (men)

A

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
Q

what are the 2 ways of partner notification

A

patient tells contacts - client referral, preferred

NHS tells contact - provider referral

45
Q

recommended further testing in consultation

A

most STIs are risk factors for HIV acquisition and transmission
if someone has one STI they could have another

46
Q

health promotion in consultation

A 
condoms prevent transmission of some STIs
oral sex carries risks too
address hazardous drug use
vaccination
HIV pre-exposure prophylaxis
47
Q

pros and cons of condoms for prevention of tranmission

A

prevent transmission - HIV, chlamydia, gonorrhoea

not so good at preventing transmission of others - herpes, warts

48
Q

risks from oral sex

A

not as great as vaginal/anal sex

fellatio more than cunnilingus

Y3 repro (47 decks)

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