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STIs Flashcards

1
Q

What is a commensal organism?

A

A micro-organism that derives food or other benefits from another organism without hurting or helping it

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2
Q

What is a micro-organism that can cause disease called?

A

A Pathogen

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3
Q

What is an infection?

A

The invasion of all or part of the body by a micro-organism

No symptoms=Sub-clinical
Symptoms=Clinical

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4
Q

What is a sexually transmissible organism?

A

A virus, bacteria, protozoan, insect or arthropod which can be spread by sexual contact (commensal or pathogen)

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5
Q

What is the difference between an STI & STD?

A

STI=An infection by a pathogen which is sexually transmissible and which is unlikely to be transmitted by non-sexual means
(Neisseria gonorrhoeae, HPV type 6)

STD=A disorder of structure or function caused by a sexually transmitted pathogen (organism on you as an infective process that is now causing harm)
(Pelvic inflammatory disease, Genital warts)

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6
Q

What is Chancroid & what organism causes it?

A

Bacterial sexually transmitted infection characterized by painful sores on the genitalia.

Haemophilus ducreyi

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7
Q

What are some examples of bacteria, viruses or parasites that are sexually transmitted organisms?

A

Bacteria:
Chlamydia trachomatis
Klebsiella granulomatis
Mycoplasma genitalium

Viruses: HSV, HPV, HIV

Parasites:
Pthirus pubis
Sarcoptes scabei
Trichomonas vaginalis

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8
Q

What are some pathogens that can be passed on through sex but are not classed as STIs?

A
  • Sars CoV2
  • Ebola
  • Rika
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9
Q

What are some key implications of these characteristics of STIs?
1) They are contagious
2) Asymptomatic most of the time
3) Unpredictable minority suffer significant complications
4) Totally avoidable

A

1) Sexual contact tracing
2) Can’t eradicate by just treating the symptomatic
3) Early detection & treatment needed
4) Primary prevention is the goal

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10
Q

What does ‘sexually transmitted’ mean?

A

Not completely clear as there are lots of different types of sexual contact- some forms increase the chance of catching an infection

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11
Q

What type of infection is more commonly transmitted in group sex?

A

Hepatitis C

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12
Q

What can be spread by skin contact only?

A

Pubic lice (Pthirus pubis)
Scabies (Sarcoptes scabeii)
Warts (human papilloma virus types 6 &11)
Herpes (Herpes Simplex Virus types 1 & 2)

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13
Q

Why are STIs important if so many asymptomatic?

A

STDs cause morbidity & can even kill

They have unpleasant symptoms-grouped into syndromes

Psychological distress

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14
Q

What are some symptoms of STIs?

A
  • Ulceration (e.g.HSV)
  • Lumps (e.g. Mulloscum contagiosum)
  • Genital discharge
  • Non-genital discharge
  • Rashes (syphilis & HIV both cause a rash that looks like measles)
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15
Q

What are the systemic symptoms of STIs?

A
  • Fever
  • Rash
  • Lymphadenopathy
  • Malaise
  • Arthralgia & arthritis
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16
Q

What can be late complications of STIs?

A
  • Infertility-chlamydia
  • Cancer - e.g. cervical cancer-HPV
  • Adverse pregnancy outcomes-syphilis
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17
Q

In what ways are STIs a drain on resources?

A

Managing infertility due to chlamydia: cost of IVF.

Cost of HIV medication/ management of HIV related health conditions

Taking time off work to get your warts frozen.

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18
Q

Are STIs common?

A

YES

More than 1M new STIs acquired every day.
More than 500M people have genital herpes

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19
Q

Why is the No. of people infected showing not many real signs of declining?

A

Partly due to ability to keep people alive for almost a normal lifespan

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20
Q

What does diagnoses of STIs not necessarily equate to?

A

Number of infected people

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21
Q

Why do diagnoses of STIs change over time?

A
  • A true difference in the no. of cases
  • A change in diagnoses but no actual difference in no. of cases
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22
Q

What does R number apply to and what is it?

A

R=average number of infections produced

It applies to every communicable disease

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23
Q

If R<1 what does this mean?

A

Epidemic reduces

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24
Q

If R>1 what does this mean?

A

Epidemic is sustained

25
Q

How is Reproductive number calculated?

A

R0=BcD

 = likelihood of transmission per encounter
c = rate of acquiring new partners
D = duration of infectivity

26
Q

Why do we vaccinate unexposed person?

A

Reduce the transmission of the organism before they are even exposed to it

Eradicate main diseases caused by HPV

27
Q

How do we know that there is a greater awareness of STIs?

A

More testing

  • More people asking for tests
  • More clinicians considering STIs and testing for them

(Better tests too- e.g. nucleic acid amplification tests vs enzyme immunoassays for chlamydia)

28
Q

Describe Modelling and mapping the spread of STIs - Sexual network analysis?

A

’ Cores’ & assortative mixing

Some people have sex with people like them (similar lifestyle – eg IDU, same ethnicity)-leads to high prevalence within a subpopulation (core) but limited spread through the wider community.

E.g. syphilis in people who exchange sex for drugs or lymphogranuloma venereum or HCV in HIV+ve MSM

Core transmission – can link out to a wider population
Cores linked in the network

29
Q

What are ‘chains’ & random mixing in sexual network analysis?

A
  • Some ‘cores’ are very big – eg heterosexual men and women.
  • Random mixing leads to lower prevalence 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

30
Q

What is crucial in the management of someone with symptoms suggestive of an STI?

A

A GOOD HX
HEALTH PROMOTION

  • Partner notification
  • HIV testing
31
Q

What histories should also be included in the consultations?

A

Sexual and gynae histories

Also need to ask direct questions about symptoms- Get thoughts on their condition & what they think it might be

32
Q

What is a sexual Hx necessary for?

A
  • Determining possible cause of symptoms
  • Detecting high risk behaviour & advising on risk reduction
  • Tracing contacts
33
Q

What questions should be asked in a sexual Hx?

A
  • When did you last have sexual contact?
  • Casual contact vs ‘regular’ partner?
    (How long were you going out with them for?)
  • Were they male or female?
  • Asking about nature of sex act sometimes useful (anxiety about a specific incident or
    If it’s going to alter where you swab from eg MSM)
  • Did you use condoms?
  • Other contraception used
  • Nationality of contact
34
Q

In men what questions are asked to assess for longer term sexual risks?

A

Have you ever had sexual contact with another man?

Have you ever injected drugs?

Sexual contact with
anyone who’s injected drugs?
someone from outside the UK? (clarify)

Medical treatment outside UK? (clarify)

Paid for sex or been paid?

35
Q

What are the 2 ways of partner notification aka contact tracing?

A
  • Client referral (Patient tells contacts)
  • Provider referral (NHS tells contact)
36
Q

Why is further testing offered/recommended?

A

Most STIs are risk factors for HIV acquisition and transmission.

If someone has one STI (eg chlamydia) they could have another (eg HIV)

37
Q

Do condoms prevent transmission of all STIs?

A

No but some- e.g. HIV, chlamydia, gonorrhoea

Not so good at preventing transmission of others such as herpes & warts

38
Q

Does oral sex carry risks too?

A

Yes, not as great risks as vaginal or anal sex

Fellatio more than cunnilingus

39
Q

Apart from use of condoms & risk awareness what should also be involved in health promotion?

A
  • Address hazardous drug use
  • Vaccination
  • HIV pre-exposure prophylaxis
40
Q

How will eradication most likely be achieved?

A

Through vaccination

41
Q

How can you go about identifying and informing sexual contacts of someone with an STI?

A

‘Partner notification’ or ‘contact tracing’

(Don’t usually trace sexual contacts of people with warts or herpes as we have no tests or treatment for asymptomatic contacts.)

42
Q

What are the signs of gonorrhoea (caused by Neisseria gonorrhoeae) in males compared to females?

A

Men
- 10% of males have no symptoms though might have clinical signs if examined.
- Thick, profuse yellow discharge, dysuria. Rectal and pharyngeal infection often
asymptomatic.

Women
- >50% have no symptoms.
- vaginal discharge, dysuria or intermenstrual/post-coital bleeding

43
Q

What are the possible complications of gonorrhoea?

A

Male: Epididymitis

Female: Pelvic inflammatory disease. Bartholin’s abscess. [Gonococcal ophthalmia neonatorum.]

Both: Acute monoarthritis usually elbow or shoulder. Disseminated Gonococcal Infection: skin lesions - pustular with halo. (both v rare).

44
Q

How is gonorrhoea diagnosed and treated?

A

Nucleic Acid Amplification Test (NAAT) on urine or swab from an exposed site – vagina, rectum, throat. Could be self-obtained or clinician-obtained.

Blind treatment with ceftriaxone 1g im. Can also treat according to antibiotic sensitivities.

Follow-up: Test of cure at 2 weeks and test of reinfection at 3 month

45
Q

What symptoms can chlamydia present with (majority are asymptomatic)?

A

Men=slight watery discharge, dysuria

Women=vaginal discharge, dysuria, intermenstrual bleeding/post coital bleeding

Both=Conjunctivitis

46
Q

What are the complications of chlamydia?

A

Men Epididymitis.

Women: PID and hence ectopic pregnancy, pelvic pain and infertility.

Both: Reactive arthritis/ Reiter’s syndrome – urethritis/cervicitis + conjunctivitis + arthritis

47
Q

How is chlamydia diagnosed and treated?

A

First void urine in men. Self-taken or clinician-taken swab from cervix, urethra, rectum as appropriate.

All specimens tested using a NAAT

Treatment:
Doxycycline 100mg bd 1 week
Azithromycin 1g po once if pregnant

Follow-up: Test for reinfection at 3-12 months. Earlier test of cure not needed unless symptoms persist.

48
Q

What are the symptoms of herpes?

A

80% have no symptoms. The rest have recurring symptoms – monthly, annually.

Burning/itching then blistering then tender ulceration

Tender inguinal lymphadenopathy. Flu-like symptoms.

Dysuria, Neuralgic pain in back, pelvis and legs,

49
Q

What are the complications of herpes?

A

Autonomic neuropathy (urinary retention), neonatal infection, secondary infection

50
Q

..?.. is important co-factor for HIV transmission

A

HSV2

51
Q

How is herpes diagnosed and treated?

A

Clinical impression.
Swab from lesion tested using PCR.

Treatment:
- Primary outbreak: Aciclovir: various regimens
Lidocaine ointment

= Infrequent recurrences: Lidocaine ointment. Aciclovir once daily until symptoms gone (1-3 days)

  • Frequent recurrences: Aciclovir 400bd long-term as suppression.
52
Q

How does trichomoniasis present if it is not symptomatic in women (in men it is usually asymptomatic)?

A

Profuse thin vaginal discharge - greenish, frothy and foul smelling. Vulvitis

Complications=miscarriage and preterm labour

53
Q

How is trichomoniasis diagnosed and treated?

A

Diagnosis: PCR on a vaginal swab. NB not validated on urine yet so no test for men.
Point of Care - Microscopy of wet preparation of vaginal discharge.

Treatment: Metronidazole

54
Q

What causes anogenital warts?

A

Human Papilloma Virus types 6 and 11 (and occasionally type 1). (NB different strains from those that cause cervical cancer)

55
Q

What are the symptoms of anogenital warts?

A

Lumps with a surface texture of a small cauliflower. Occasionally itching or bleeding especially if
perianal or intraurethral

56
Q

What is the diagnosis and treatment of anogenital warts?

A

Diagnosis: Appearance. Biopsy if unusual – to exclude intraepithelial neoplasia, but this is rarely needed.

Treatment: Podophyllotoxin (brands warticon and condyline), imiquimod (brand Aldara). Both home treatments.
Others – cryotherapy
Bulky warts – diathermy, scissor removal

57
Q

What is syphilis caused by and what are the symptoms?

A

Treponema pallidum

Often entirely asymptomatic or mild symptoms which go unreported.

Primary Local ulcer (chancre)
Secondary Rash, mucosal ulceration, neuro symptoms, patchy alopecia, other symptoms.
Early latent no symptoms but <2years since caught.
Late latent no symptoms but >2 years since caught.

Tertiary Neurological, cardiovascular or gummatous – skin lesions, (all v rare).

58
Q

What are the complications of syphilis?

A

Neurosyphilis – cranial nerve palsies are commonest, cardiac or aortal involvement.

Congenital syphilis (extremely rare in Scotland).

59
Q

How is syphilis diagnosed and treated?

A

Diagnosis: Clinical signs
Serology for TP IgGEIA, TPPA and RPR
PCR on sample from an ulcer

Treatment:
Early (<2 yrs and no neurological involvement):
- Benzathine penicillin
- Or Doxycycline

Late (>2 years) and no neurological involvement
- Benzathine penicillin
- Doxycycline (different dosing)

Reproduction (17 decks)

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