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STIs Flashcards

1
Q

What is chlamydia

A

Chlamydia trachomatis is a gram-negative bacteria

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2
Q

How does chlamydia trachomatis work

A

it enters and replicates within cells before rupturing the cell and spreading to others.

Microbiology also has good explanation dont forget

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3
Q

Most common STI?

A

Chlamydia

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4
Q

What makes you have a higher risk of catching the infection

A

-Being young,
-sexually active
-multiple partners increase the risk of catching the infection.

A large number of cases are asymptomatic (50% in men and 75% in woman). Asymptomatic patients can still pass the infection on.

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5
Q

What is the National Chlamydia Screening programme

A

Public Health England has set out a National Chlamydia Screening Programme (NCSP). This program aims to screen every sexually active person under 25 years of age for chlamydia annually or when they change their sexual partner.

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6
Q

2 types of swabs used in sexual health testing

A

Charcoal swabs
Nucleic acid amplification test (NAAT) swabs

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7
Q

What do Charcoal swabs allow for

A

microscopy (looking at the sample under the microscope),
culture (growing the organism)
sensitivities (testing which antibiotics are effective against the bacteria).
Charcoal swabs look like a long cotton bud that goes into a tube with a black transport medium at the end. The transport medium is called Amies transport medium, and contains a chemical solution for keeping microorganisms alive during transport.

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8
Q

What does microscopy involve

A

gram staining and examination under a microscope. A stain is used to highlight different types of bacteria with different colours. Charcoal swabs can be used for endocervical swabs and high vaginal swabs (HVS).

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9
Q

What testing is used specifically for Chlamydia and Gonorrhea

A

Nucleic acid amplification tests (NAAT) check directly for the DNA or RNA of the organism

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10
Q

Presentation of Chlamydia in women

A

Abnormal vaginal discharge
Pelvic pain
Abnormal vaginal bleeding (intermenstrual or postcoital)
Painful sex (dyspareunia)
Painful urination (dysuria)

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11
Q

Chlamydia presentation in men

A

Urethral discharge or discomfort
Painful urination (dysuria)
Epididymo-orchitis
Reactive arthritis

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12
Q

First line treatment for uncomplicated chlamydia

A

doxycycline 100mg twice a day for 7 days.

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13
Q

Doxycycline issues + alternatives

A

contraindicated in pregnancy and breastfeeding.

Erythromycin 500mg four times daily for 7 days
Erythromycin 500mg twice daily for 14 days
Amoxicillin 500mg three times daily for 7 days

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14
Q

Non medical management of chylmadia

A

Abstain from sex for seven days of treatment of all partners to reduce the risk of re-infection
Refer all patients to genitourinary medicine (GUM) for contact tracing and notification of sexual partners
Test for and treat any other sexually transmitted infections
Provide advice about ways to prevent future infection
Consider safeguarding issues and sexual abuse in children and young people

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15
Q

Normal complications of chlamydia

A

Pelvic inflammatory disease
Chronic pelvic pain
Infertility
Ectopic pregnancy
Epididymo-orchitis
Conjunctivitis
Lymphogranuloma venereum
Reactive arthritis

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16
Q

Pregnancy-related complications of chlamydia

A

Preterm delivery
Premature rupture of membranes
Low birth weight
Postpartum endometritis
Neonatal infection (conjunctivitis and pneumonia)

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17
Q

What is Lymphogranuloma Venereum

A

condition affecting the lymphoid tissue around the site of infection with chlamydia. It most commonly occurs in men who have sex with men (MSM). LGV occurs in three stages

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18
Q

3 stages of LGV

A

The primary stage involves a painless ulcer (primary lesion). This typically occurs on the penis in men, vaginal wall in women or rectum after anal sex.

The secondary stage involves lymphadenitis. This is swelling, inflammation and pain in the lymph nodes infected with the bacteria. The inguinal or femoral lymph nodes may be affected.

The tertiary stage involves inflammation of the rectum (proctitis) and anus. Proctocolitis leads to anal pain, change in bowel habit, tenesmus and discharge. Tenesmus is a feeling of needing to empty the bowels, even after completing a bowel motion.

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19
Q

Treatment for LGV

A

Doxycycline 100mg twice daily for 21 days is the first-line treatment for LGV recommended by BASHH. Erythromycin, azithromycin and ofloxacin are alternatives.

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20
Q

Chlamydial conjunctivitis

A

Chlamydia can infect the conjunctiva of the eye. Conjunctival infection is usually as a result of sexual activity, when genital fluid comes in contact with the eye, for example, through hand-to-eye spread. It presents with chronic erythema, irritation and discharge lasting more than two weeks. Most cases are unilateral.

Chlamydial conjunctivitis occurs more frequently in young adults. It can also affect neonates with mothers infected with chlamydia. Gonococcal conjunctivitis is a crucial differential diagnosis and should be tested.

21
Q

What is neisseria gonorrhea

A

gram-negative diplococcus bacteria. It infects mucous membranes with a columnar epithelium, such as the endocervix in women, urethra, rectum, conjunctiva and pharynx

22
Q

How does NG spread

A

spreads via contact with mucous secretions from infected areas.

23
Q

RFs for Gonorrhea

A

oung, sexually active and having multiple partners increases the risk of infection with gonorrhoea. Having other sexually transmitted infections, such as chlamydia or HIV, also increases the risk.

24
Q

Antibiotic resistance to gonorrhea

A

Traditionally ciprofloxacin or azithromycin was used to treat gonorrhoea. However, there are now high levels of resistance to these antibiotics.

25
Q

Presentation of Gonorrhea

A

More symptomatic than chlamydia
Female genital infections can present with:

Odourless purulent discharge, possibly green or yellow
Dysuria
Pelvic pain

Male genital infections can present with:

Odourless purulent discharge, possibly green or yellow
Dysuria
Testicular pain or swelling (epididymo-orchitis)

26
Q

What is used o diagnose Gonorrhea

A

Nucleic acid amplification testing (NAAT) is used to detect the RNA or DNA of gonorrhoea. Genital infection can be diagnosed with endocervical, vulvovaginal or urethral swabs

27
Q

Management of Gonorrhea

A

For uncomplicated gonococcal infections:

A single dose of intramuscular ceftriaxone 1g if the sensitivities are NOT known
A single dose of oral ciprofloxacin 500mg if the sensitivities ARE known

Different regimes are recommended for complicated infections, infections in other sites and pregnant women. Most regimes involve a single dose of intramuscular ceftriaxone.

28
Q

Test of cure

A

l patients should have a follow-up “test of cure” given the high antibiotic resistance. This is with NAAT testing if they are asymptomatic, or cultures where they are symptomatic. BASHH recommend a test of cure at least:

72 hours after treatment for culture
7 days after treatment for RNA NAAT
14 days after treatment for DNA NAAT

29
Q

Other factors to consider in Gonorrhea management

A

Abstain from sex for seven days of treatment of all partners to reduce the risk of re-infection
Test for and treat any other sexually transmitted infections
Provide advice about ways to prevent future infection
Consider safeguarding issues and sexual abuse in children and young people

30
Q

Complications of Gonorrhea

A

Pelvic inflammatory disease
Chronic pelvic pain
Infertility
Epididymo-orchitis (men)
Prostatitis (men)
Conjunctivitis
Urethral strictures
Disseminated gonococcal infection
Skin lesions
Fitz-Hugh-Curtis syndrome
Septic arthritis
Endocarditis

31
Q

Key complication to remember with gonorrhoea

A

gonococcal conjunctivitis in a neonate. Gonococcal infection is contracted from the mother during birth. Neonatal conjunctivitis is called ophthalmia neonatorum. This is a medical emergency and is associated with sepsis, perforation of the eye and blindness.

32
Q

Disseminated Gonococcal infection

A

complication of untreated gonococcal infection, where the bacteria spreads to the skin and joints. It causes:

Various non-specific skin lesions
Polyarthralgia (joint aches and pains)
Migratory polyarthritis (arthritis that moves between joints)
Tenosynovitis
Systemic symptoms such as fever and fatigue

33
Q

What is Syphilis caused by?

A

complication of untreated gonococcal infection, where the bacteria spreads to the skin and joints. It causes:

34
Q

Treponema Pallidum

A

pirochete, a type of spiral-shaped bacteria. The bacteria gets in through skin or mucous membranes, replicates and then disseminates throughout the body. It is mainly a sexually transmitted infection.

incubation period between the initial infection and symptoms is 21 days on average.

35
Q

Syphilis transmission

A

Oral, vaginal or anal sex involving direct contact with an infected area
Vertical transmission from mother to baby during pregnancy
Intravenous drug use
Blood transfusions and other transplants (although this is rare due to screening of blood products)

36
Q

Stages of Syphilis

A

Primary
Secondary
Latent
Tertiary
Neurosyphilis

37
Q

Primary syphilis

A

involves a painless ulcer called a chancre at the original site of infection (usually on the genitals).

38
Q

Secondary Syphilis

A

involves systemic symptoms, particularly of the skin and mucous membranes. These symptoms can resolve after 3 – 12 weeks and the patient can enter the latent stage.

39
Q

Latent Syphilis

A

occurs after the secondary stage of syphilis, where symptoms disappear and the patient becomes asymptomatic despite still being infected.

Early latent syphilis occurs within two years of the initial infection, and late latent syphilis occurs from two years after the initial infection onwards.

40
Q

Tertiary Syphilis

A

can occur many years after the initial infection and affect many organs of the body, particularly with the development of gummas and cardiovascular and neurological complications.

41
Q

Neurosyphilis

A

occurs if the infection involves the central nervous system, presenting with neurological symptoms.

42
Q

Primary syphilis presentation

A

A painless genital ulcer (chancre). This tends to resolve over 3 – 8 weeks.
Local lymphadenopathy

43
Q

Secondary syphilis

A

Maculopapular rash
Condylomata lata (grey wart-like lesions around the genitals and anus)
Low-grade fever
Lymphadenopathy
Alopecia (localised hair loss)
Oral lesions

44
Q

Tertiary syphilis presentation

A

Key features to be aware of are:

Gummatous lesions (gummas are granulomatous lesions that can affect the skin, organs and bones)
Aortic aneurysms
Neurosyphilis

45
Q

Neurosyphilis

A

Headache
Altered behaviour
Dementia
Tabes dorsalis (demyelination affecting the spinal cord posterior columns)
Ocular syphilis (affecting the eyes)
Paralysis
Sensory impairment

46
Q

Specific finding in neurosyphilis

A

Argyll-Robertson pupil is a specific finding in neurosyphilis - constricted pupil

47
Q

Diagnosis for Syphilis

A

Antibody testing for antibodies to the T. pallidum bacteria can be used as a screening test for syphilis.

Samples from sites of infection can be tested to confirm the presence of T. pallidum with:

Dark field microscopy
Polymerase chain reaction (PCR)

48
Q

Management of syphilis

A

All patients should be managed and followed up by a specialist service, such as GUM. As with all sexually transmitted infections, patients need:

Full screening for other STIs
Advice about avoiding sexual activity until treated
Contact tracing
Prevention of future infections

49
Q

Standard Treatment

A

A single deep intramuscular dose of benzathine benzylpenicillin (penicillin) is the standard treatment for syphilis.

Alternative regimes and types of penicillin are used in different scenarios, for example, late syphilis and neurosyphilis. Ceftriaxone, amoxicillin and doxycycline are alternatives.

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