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GORGAS > STIs > Flashcards

STIs Flashcards

1
Q

How do you treat Niserria Gonnorhoea

A

IM Ceftriaxone

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2
Q

Major causes of cervicitis?

A

Gonnorhoea and Chlamydia are the major causes
Occasionaly see HSV, adenovirus and CMV

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3
Q

Typical signs of cervicitis?

A

Friability
Mucopurulent discharge

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4
Q

What are most Cervical Gonnorhoea and Chlamydia infections presentation?

A

Predominantly asymptomatic

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5
Q

What is PID? Causes?

A

Any inflammatory process involving the upper genital tract including
-endometritis
-salpingitis
-oophritis
-tub-ovarian abscess
-pelvic peritonitis
-Perihepatitis

Caused by chlamydia, gonnorhoea, anaerobes, GBS, streptococci

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6
Q

Symptoms suggestive of PID?

A

Lower Abdominal pain
Dyspareunia
Vaginal discharge
Menometrorrhagia

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7
Q

Consequences of acute PID?

A

1 in 4 women will get any sequale:
-Infertility
-Ectopic pregnancies

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8
Q

Tx of PID?

A

Ceftriaxone IV plus doxycycline plus Metronidazole

Or ceftriaxone IM plus doxycycline with Metronidazole for 14 days

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9
Q

PID in pregnancy

A

Need hospitalised, same tx!

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10
Q

Urethritis presentation and causes?

A

Urethral discharge, dysuria, burning, hesitancy and itching.

Chlamydia trachomatis
Neisseria gonnorhoea
Trichomoniasis
Mycoplasma genitalium

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11
Q

Gonococcal urethritis presentation

A

Typically discharge

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12
Q

If someone presents with discarhge what do you treat for?

A

Treat for Chlamydia and Gonnorhoea

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13
Q

Gonnorhoea treatment?

A

Ceftriaxone IM, if Chlamydia not been excluded need to give doxycycline for 7 days also

Can give azithromycin and Gentamicin

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14
Q

Chlamydia tx?

A

Doxycycline for 7/7

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15
Q

Mycoplasma genetalium tx?

A

Doxycycline for 7 days followed by azithromycin

Can try Moxifloxacin

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16
Q

Proctitis presentation and causes?

A

Rectal discharge, pain and tenesmus

Gonnorhoea, chlamydia, HSV, CMV

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17
Q

What is Lymphogranuloma verenerum? Cause? Presentation and treatment?

A

It is caused by chalymdia trachomatis serovars L1, 2 and 3
Primary Infection is a genital ulcer that heals within few days and then progresses to Inguinal lymph node infection
Treat with doxy for 21 days

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18
Q

What is Disseminated gonococcal infection? Dx? Tx?

A

Typically causes migratory Polyarthralgia
Tenosynovitis and pustular skin lesions

PCR, culture of skin lesions or joint aspirations. Blood cultures do not help

Tx with IV ceftriaxone

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19
Q

Optimal vaginal microbiome? Reasons for this?

A

acidic
prevention of pathogens
for optimal birth outcomes

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20
Q

Main pathogen in normal vaginal flora?

A

Lactobacillus

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21
Q

Usual causes of vaginitis? symptoms?

A

Symptoms are discharge/itching/odour

Bacterial vaginosis
Vulvovaginal candidiasis
Trichomoniasis

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22
Q

Tx of vaginal discharge syndrome

A

Ensure no Abdominal tenderness or Cervical involvement- if so tx for Gonnorhoea and chlamydia
Tx BV with 1/52 Metronidazole

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23
Q

What does normal vaginal PH indicate?

A

Can be Trichomoniasis or candidiasis
BV is always vaginal discharge >4.5

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24
Q

How does BV form?

A

Profound loss of lactobacillus
Anaerobic overgrowth such as gardenerella vaginalis and biofilm formation

25
Q

Risk factors for BV?

A

Black race
Unprotected sex with male partner
Female partner
HIV

26
Q

Dx of BV?

A

Greyish discharge
PH >4.5
Clue cells
Amine odor on addition to KOH

POC tests not very reliable

27
Q

Tx of BV? Tx in pregnancy?

A

Metronidazole orally BD or
Metronidazole applicator or
Clindamycin cream

In pregnancy generally oral treatments preferred, women should absolutely be treated. Avoid tinidazole

28
Q

What is trichomonas vaginalis?

A

Sexually transmitted parasite
Prevalence increases with age

29
Q

Clinical signs of TV?

A

Strawberry cervix
Dysuria, vaginal discharge, itching, burning, dyspareunia

30
Q

How do you diagnose Trichomoniasis vaginalis?

A

NAAT
Saline wet mount and culture possible

31
Q

Tx of TV?

A

Metronidazole BD for 7/7
Or 2g PO for men

Treat partners!
Repeat tests in 3 months to ensure its gone

32
Q

Risk of TV in pregnancy?

A

LBW
Preterm delivery

33
Q

Most common cause of Vulvovaginal candidiasis?

A

Candida albicans

34
Q

Signs of VVC?

A

Erythema of labia
Clumpy white discharge
Pruritis most common symptom
Sattelite lesions like nappy rash
Wet prep with pesudohyphae

35
Q

Dx of VVC?

A

PH is usually normal, if >4.5, consider concurrent BV or TV
Cultures not useful
Can sometimes see yeast on KOH prep

36
Q

What is uncomplicated VVC? Tx

A

Immunocompetent host
not had recurrent infections
Mild to moderate symptoms

Tx: It responds to shorter courses such as fluconazole single dose or creams such as clotrimazole

37
Q

Tx of VVC in pregnancy?

A

7 days of vaginal imidazoles such as clotrimazole (NO fluconazole)

38
Q

What is atrophic vaginitis?

A

Seen in estrogen deficiency such as postpartum, postmenopausal,
In younger women assoc with breast feeding, female athletes who are not menstruating, women on tamoxifen or with ovarian dysfunction

39
Q

Presentation of vaginitis?

A

Thin, scanty often bloody discharge

40
Q

What is streptococcal vaginitis?

A

Relatively rare cause of purulent vaginitis
Typically seen in pre-pubertal females
– Vulvar erythema
– Purulent vaginal discharge, itching, pain
– PMN’s, cocci on vaginal wet prep
Recurrent vaginitis in older women

Associated carriage (rectal, oral) of identical GAS strains in male
partners
Eradication of carriage in partners and patients effected cure of
vaginitis recurrence

41
Q

Difference between Syphillis chancre and chancroid chancre?

A

Syphillis typically Painless whereas chancroid is painFUL

42
Q

If you have HSV-1 is it protective for HSV-2?

A

It won’t prevent you getting it but it does mean outbreaks of HSV-2 less severe

43
Q

How does recurrent general herpes present?

A

The first year is the worst, outbreaks will be roughly 4x a year
After this will get better

44
Q

How do you diagnose HSV?

A

PCR or culture
PCR preferred

Step 1: IgG assay
Step 2: Confirm with a 2nd test that uses a different antigen

45
Q

Tx of HSV?

A

Acyclovir TDS for 7-10 days

46
Q

How do you avoid HSV-2 shedding?

A

Avoid sex with lesions
Condoms will reduce transmission by 30%
Suppressive antiviral therapy

47
Q

How does genital HSV-1 present?

A

First episode is severe
Outbreaks much less frequent
Shedding much less frequent

48
Q

How does Mpox present?

A

A prodorme of fevers, chills, malaise
Umbilicated lesions start on face and spread outward to palms and soles and can be painful

49
Q

Dx of monkeypox? Tx?

A

PCR
Tx is mostly supportive care as is mild in immunocompetent
Can use Tecovirimat

50
Q

Who do you treat for Mpox rather than just supportive care?

A

Treat anyone immunocmpromised, extremes of age, pregnancy, people with atopic dermatitis
Tx the severe cases infection which involves eye, mouth or other anatomic areas

51
Q

HPV strains which cause warts vs oncogenic strains?

A

6 and 11 cause warts
14 and 16 cause cancer

52
Q

What is the clinical presentation of secondary syphillis?

A

Generalised rash
Condyloma lata
Fever, malaise, generalized, lymphadenophathy, alopecia, interstitial
keratitis, uveitis, liver/kidney involvement

53
Q

What are Condyloma lata?

A

Seen in secondary syphillis
NOT Condyloma acuminata
Look like warts, but are fleshy and soft topped not verrucous
Indicative of high number of treponemes
Highly contagious
Occur at moist body sites

54
Q

What is the latent stage?

A

This is the positive treponema serology in the absence of clinical manifestations
<1yr is early latent
>1yr is late latent

2/3 of people with untreated syphillis will remain in the latent stage

55
Q

What comprises neuropsyphilis?

A

Meningitis, chronic or acute meningitis
Meningovasuclar, think about this when stroke in young person
Parenchymatous disease
Posterior column (tables dorsalis) which is ataxia, charcot joint, lightening pain in the legs and optic nerve degeneration

56
Q

What VDRL and RPR

A

Non treponema tests, not specific to T Pallidum
Can quantify the titre
Used to follow treatment response
RPR is 1 to 2 dilutions higher that VDRL, therefore always use the same test when monitoring

57
Q

What are TP-PA and FTA-ABS and EIA?

A

TP-PA and FTA-ABS are qualitative tests, not quantitative

EIA: treponemal test often used for screening

58
Q

Tx of early syphillis, late syphillis and neuropsyphillis?

A

Early syphilis (primary, secondary, early latent)
– BZN PCN (L-A) single dose IM 2.4 million units

Late latent
– BZN PCN (L-A) IM 2.4 million units weekly x 3 doses (7.2 million units)

Neuropsyphilis
-Aqueous PCN G 18-24 million units/day x 10-14 days
• Procaine PCN G 2.4 million units/day PLUS probenecid 500 mg PO qid x 10-
14 days
• Ceftriaxone 2 g IV daily x 10-14 days (alternative)

59
Q

Some of the reasons for false positive?

A

• Risk increases with age

• Acute conditions:
– recent viral illness/immunization
– pregnancy (uncommon)

• Chronic conditions:
– autoimmune disease (SLE, RA)
– hypergammaglobulinemia
– IDU

GORGAS (33 decks)

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