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Infectious Disease > STIs > Flashcards

STIs Flashcards

1
Q

What are the differential diagnosis for a genital ulcer?

A 
Herpes 
Syphilis 
LGV
Chancroid 
Donovanosis 
Trauma
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2
Q

What are the differential diagnosis for vaginal discharge?

A

(3 most common)
Bacterial vaginosis
Thrush
Trichomonas vaginalis

Chlamydia
Gonorrhea 
Physiological 
Malignancy 
Foreign body
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3
Q

What are examples of bacterial STIs?

A 
Chlamydia (most common) 
Gonorrhoea 
MGEN 
LGV
Syphilis 
Chancroid
Donovanosis
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4
Q

How might someone with chlamydia present?
How is chlamydia diagnosed?
What is the management?
What complications can occur?

A

F

  • mostly asymptomatic
  • increased vaginal discharge
  • post-coital or inter-menstrual bleeding
  • dysuria
  • lower abdo pain and dyspareunia

M

  • v mild
  • urethral discharge
  • dysuria

Dx:

  • F= swab
  • M= 1 st catch urine
  • partner needs to be tested but needs WINDOW TESTING PERIOD i.e. 2 weeks after sex

Tx:
-Doxycycline for 1 week (and partner)

Complications:

  • SARA= sexually acquired reactive arthritis i.e. young person presenting with single red/swollen joint
  • perihepatitis
  • Pelvic inflammatory disease
  • epididymo-orchitis (pain in testes)
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5
Q

What is window period testing and what is its role in chlamydia?

A

Describes the 2 week wait after sex with potentially infected person due to taking time for sufficient DNA to be present for test to work

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6
Q 
What is lymphogranuloma venereum (LGV)?
Who is most at risk of LGV infection? 
What might somone present with at the different stages of disease? 
How is it diagnosed? 
What is the treatment?
A

Serovar L1/2/3 of chlamydia trachomatis which is not routinely screened for in chlamydia testing
Men who have sex with men= most at risk

1st:

  • papule + ulcers
  • bloody diarrhoea i.e. LGV proctitis

2nd:
-LN involvment -buboes form (painful swelling)

3rd:

  • proctocolitis-> mimics crohn disease
  • strictures + fistulas

Dx= NAATs

Tx:
-doxycyline for 3 weeks

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7
Q 
What organism is responsible for gonorrhoea infection? 
How might somone present? 
What are the signs of disseminated GC? 
How is gonorrhoea diagnosed?
How is it managed?
A

Gram-negative diplococcus nisseria gonorrhoea

F:
-discharge (50%)
-abdo pain 
M:
-thick creamy discharge +/- dysuria (>90%)

Disseminated= skin/joint/tenosynovitis i.e. might have reactive arthritis

Dx:

  • swab + microscopy
  • NAAT
  • Culture= looking at antibiotic sensitivity

Tx:
-Ceftriaxone 1g + increased until reached minimum inhibitory dose
NOTE: becoming harder to treat due to Abx resistance
-full STI screen
-Test of Cure (TOC)
-partner notification

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8
Q

How does MGEN present?
What is used to diagnose MGEN?
What is the problem with treating MGEN?

A

(Mycoplasma genitalium)
Presents very similarly to chlamydia i.e. urethritis + PID

Dx:
-NAAT rather than culture due to being to slow growing for culture

It lacks a cell wall meaning penicillin and cephalosporins won’t work
Some resistent to macrolides (arythomycin)
-need to test for macrolide resistance to see if can treat with arythromycin

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9
Q

What are the 2 top differentials for genital ulcer disease (GUD)?
What is the difference in their presentation?

A

Herpes

  • multiple shallow ulcers
  • were blisters initially

Syphilis
-single with raised edges i.e. indurated

NOTE:
Can appear very similar so need to do test to differentiate

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10
Q

Apart from ulcers, what else might someone with syphylis present with?
How can you diagnose syphilis?
What is the management?

A

NOTE has 9-90 day incubation period so might not present with anything initially

Secondary symptoms: (1/4 when untreated)

  • hepatitis
  • glomerulonephritis
  • splenomegaly
  • acute meningitis

Tertiary symptoms (1/3 when untreated)
-neurosyphilis
-gummatous
I.e. occurs 20-40 years after infection

Dx:

  • swab ulcer -> PCR
  • blood tests for antibodies i.e. treponemal EIA/TPPA
  • syphilis POCT (similar to lateral flow) i.e. takes 20 mins to get results
  • quantitative RPR i.e. can monitor activity

Tx:

  • early= Benzathine penicillin 1 dose
  • late= Benzathine penicillin weekly dose/3 weeks
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11
Q

What is the Jarisch-Herxheimer reaction and why does it occur?

A

Occurs when Abx treatment started for syphillus
Abx kill treponema pallidum which leads to release of endotoxin-like substances
Leads to flu-like symptoms w/i 24hrs of abx treatment

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12
Q

What is done as part of syphilis follow up?

A 
Monitor RPR (rapid plasma reagin) response 
-measures the levels of antibodies in the serum

Partner notification

Syphilis birth plan for pregant mothers
I.e. need to treat effectively to prevent transmission due to potentially having serious long-term impact on foetus

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13
Q

Which are the only 2 bacterial STIs which can be looked for using microscopy?

A

Syphilis

Gonorrhoea

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14
Q

What are the possible viral causes of STIs?

A 
Herpes
Genital warts (HPV)
HIV
Hepatitis A + B + C
Molluscum contagiosum
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15
Q

What genotype of HPV is associated with gential warts?
How is it treated?
Why are cases of genital warts decreasing?

A

Type 6 + 11

Topical or ablative

HPV vaccine now includes protection against gential warts genotypes

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16
Q

What is differential for gential warts?

How is it managed?

A 
Molluscum contagiosum (small round raised lumps) 
-spread through skin to skin contact i.e. risk of autoinoculation

No treatment but adviced to avoid waxing or shaving

17
Q 
What are the 2 types of Herpes simplex virus?
How might someone present? 
How is it diagnosed? 
What complications can occur with HSV?
How is HSV managed?
A

HSV-1 + HSV2
-HSV-2 has 4x recurrence rate of HSV-1

Can be asymptomatic 
Painful ulceration 
Dysuria 
Vag or urethral discharge 
Fever + myalgia

Dx:

  • NAAT= can give the specific type of HSV
  • HSV-type specific antibodies (only really done in pregnancy

Complications:
-aseptic meningitis
Autonomic neuropathy-> can cause urinary retention

Tx:

  • can not be cured
  • antiviral course can shorten outbreak to lessen the symptoms
18
Q

How might someone with thrush present?
What might be seen on microscopy?
How is it treated?

A

White vaginal discharge

Candida hyphae + spores

Tx: (don’t need to treat partners)

  • anti-fungal
  • suppressive treatment when there is recurrent infections

Infectious Disease (19 decks)

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