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MRCP Infectious Diseases > STIs > Flashcards

STIs Flashcards

1
Q

Overgrowth of what organism is commonly found in Bacterial Vaginosis (BV)

A

anaerobic organisms e.g. Gardnerella vaginalis

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2
Q

Is vaginal pH low of high in BV?

A

Raised

Colonisation with anaerobic organisms = fall in lactic acid producing aerobic lactobacilli

=> higher vaginal pH.

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3
Q

Features of BV

A

vaginal discharge: ‘fishy’, offensive
asymptomatic in 50%
only occurs in sexually active women, but is not sexually transmitted

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4
Q

Criteria for BV (need 3/4 for diagnosis)

A
  • thin, white discharge
  • clue cells on microscopy
  • vaginal pH > 4.5
  • positive whiff test (addition of potassium hydroxide results in fishy odour)
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5
Q

Management of BV

A
  1. Asymptomatic
    - Tx not req’d
  2. Symptomatic:
    - oral metronidazole 5-7 days
    - Alternatives: topical metronidazole/ clindamycin
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6
Q

Risk of BV in pregnancy

A

increased risk of:
- preterm labour
- low birth weight
- chorioamnionitis
- late miscarriage

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7
Q

Organism which causes chlamydia

A

Chlamydia trachomatis

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8
Q

Incubation period of chlamydia

A

7-21 days

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9
Q

Clinical features of chlamydia

A

asymptomatic

women: cervicitis (discharge, bleeding), dysuria

men: urethral discharge, dysuria

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10
Q

Complications of chlamydia

A

epididymitis
pelvic inflammatory disease
endometritis
increased incidence of ectopic pregnancies
infertility
reactive arthritis
perihepatitis (Fitz-Hugh-Curtis syndrome)

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11
Q

Ix for chlamydia

A

Nuclear acid amplification tests (NAATs)

Females - vulvovaginal swab
Males - first void urine

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12
Q

Ideally when should testing for chlamydia be carried out

A

2 weeks after a possible exposure

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13
Q

Management of chlamydia

A

1st Line:
- doxycycline (7 day course)

2nd Line:
- Azithromycin 1g OD for one day then 500mg OD for 2 days
- Partner/contact tracing

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14
Q

Who should be contacted in chlamydia contact tracing?

A

men with urethral symptoms:
- all partners from 4 wks prior to symptom onset

for women and asymptomatic men:
- all partners from the last 6 months

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15
Q

What virus group s responsible for genital herpes?

A

HSV

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16
Q

Symptoms of genital herpes

A
  • painful ulcers
  • dysuria
  • pruritis
  • systemic symptoms e.g. headache/fever
  • tender inguinal lymphadenopathy
  • urinary retention
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17
Q

Primary infection with genital herpes is often more severe than recurrent episodes. TRUE/FALSE?

A

TRUE

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18
Q

Diagnostic investigations to look for genital herpes

A

nucleic acid amplification tests (NAAT)

HSV serology

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19
Q

Management of genital herpes

A
  • analgesia
  • topical anaesthetic e.g. lidocaine
  • oral aciclovir
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20
Q

If a lady who is >28 weeks pregnant develops a Primary genital herpes infection, what type of delivery is preferable at term?

A

elective caesarean section

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21
Q

women with recurrent herpes during pregnancy should be reassured that risk of transmission to their baby is low. TRUE/FALSE?

A

TRUE

treat with suppressive therapy even during pregnancy

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22
Q

What are condylomata accuminata more commonly known as?

A

Genital warts

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23
Q

What virus is responsible for genital warts?

A

human papillomavirus HPV
- types 6 & 11

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24
Q

A patient presents with new lesions appearing on their genitals. They appear as small (2 - 5 mm) fleshy protuberances which are slightly pigmented
may bleed or itch. What are these?

A

Genital warts

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25
Q

Management of genital warts

A

1st Line:
- topical podophyllum (if multiple)
- cryotherapy (if single lesion)

2nd Line:
- imiquimod

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26
Q

Genital warts are often resistant to treatment. TRUE/FALSE?

A

TRUE
- recurrence is common

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27
Q

Organism causing gonorrhoea

A

Neisseria gonorrhoeae
(Gram-negative diplococcus)

28
Q

Apart from genitourinary infection, where else can gonorrhoea affect?

A

rectum and pharynx

29
Q

What is the incubation period of gonorrhoea?

A

2-5 days

30
Q

Clinical features of gonorrhoea

A

Males:
- urethral discharge
- dysuria

Females:
- cervicitis => vaginal discharge

31
Q

Rectal and pharyngeal gonorrhoea infection is usually asymptomatic. TRUE/FALSE?

A

TRUE

32
Q

Why is reinfection with gonorrhoea common?

A
  • no vaccine
  • antigen variation
33
Q

Local complications of gonorrhoea

A
  • urethral strictures
  • epididymitis
  • salpingitis => may lead to infertility
34
Q

Management of gonorrhoea

A

1st line:
- IM ceftriaxone 1g

If sensitivities to cipro-
=> oral ciprofloxacin 500mg

35
Q

3 features of disseminated gonococcal infection

A
  • tenosynovitis
  • migratory polyarthritis
  • dermatitis (lmaculopapular or vesicular)
36
Q

Complications of gonococcal arthritis

A

septic arthritis
endocarditis
perihepatitis (Fitz-Hugh-Curtis syndrome)

37
Q

Incubation period for pubic lice

A

5 days

38
Q

Typical symptoms/signs of pubic lice

A
  • Itching worse at night
  • ‘black/rust-coloured powder’ in underwear
  • Excoriation marks
  • blue macules
39
Q

Investigation of pubic lice

A
  • Microscopic evaluation of hair to identify presence of lice/ eggs
  • full sexual health screen
40
Q

Management of pubic lice

A
  • wash clothing and bed linen
  • malathion 0.5% OR permethrin 1%
  • re-applied after 3-7 days (lice and eggs at different stages of their life cycle)
  • nit-combs
41
Q

Who should be contact traced after a case of pubic lice?

A
  • any sexual partners within the past 3 months
42
Q

Painful genital ulcers associated with unilateral, painful inguinal lymph node enlargement.

The ulcers typically have a sharply defined, ragged, undermined border.

A

Chancroid
(Haemophilus ducreyi)
- tropical disease

43
Q

Stage 1: small painless pustule which later forms an ulcer

Stage 2: painful inguinal lymphadenopathy

Stage 3: proctocolitis

A

Lymphogranuloma venereum (LGV)

  • caused by Chlamydia trachomatis.
44
Q

Treatment of lymphgranuloma venereum

A

doxycycline

(same tx as for chlamydia)

45
Q

What organism causes syphilis

A

Treponema pallidum
(spirochaete)

46
Q

Incubation period in syphilis

A

9-90 days

47
Q

Features of PRIMARY syphilis

A
  • chancre
  • local, non-tender lymphadenopathy
48
Q

Why may the typical syphilis chancre not be visible in females

A

lesion may be on the cervix

49
Q

Typical features of SECONDARY syphilis (6-10 weeks post infection)

A

systemic symptoms:
- fevers
- lymphadenopathy
- rash on trunk, palms, soles
- buccal ‘snail track’ ulcers
- condylomata lata (painless, warty lesions on the genitalia )

50
Q

Typical features of TERTIARY syphilis

A
  • gummas (granulomatous lesions of the skin and bones)
  • ascending aortic aneurysms
  • paralysis
  • spinal cord degeneration
  • Argyll-Robertson pupil
51
Q

Features of congenital syphilis

A
  • blunted upper incisor teeth (Hutchinson’s teeth), ‘mulberry’ molars
  • rhagades (linear scars at the angle of the mouth)
  • keratitis
  • saber shins
  • saddle nose
  • deafness
52
Q

Investigation for syphilis

A

non-treponemal test + treponemal test

53
Q

Describe how non-treponemal tests work

A
  • reactivity of serum from infected patients to a cardiolipin-cholesterol-lecithin antigen

examples include:
- rapid plasma reagin (RPR)
- Venereal Disease Research Laboratory (VDRL)

54
Q

Give examples of treponemal tests for syphilis

A

TP-EIA (T. pallidum enzyme immunoassay)

TPHA (T. pallidum HaemAgglutination test)

  • these are qualitative => results are either ‘reactive’ or ‘non-reactive’
55
Q

Causes of false positive non-treponemal tests

A

pregnancy
SLE, anti-phospholipid syndrome
TB
leprosy
malaria
HIV

56
Q

Positive non-treponemal test + positive treponemal test

A

active syphilis infection

57
Q

Positive non-treponemal test + negative treponemal test

A

false-positive result e.g. due to pregnancy or SLE

58
Q

Negative non-treponemal test + positive treponemal test

A

successfully treated syphilis

59
Q

Management of syphilis

A

IM benzylpenicillin
(or doxycycline)

60
Q

How do we monitor response to syphilis treatment?

A

Monitor non-treponemal titres

61
Q

Fever, rash, tachycardia after the first dose of antibiotic in syphilis

A

Jarisch-Herxheimer reaction

62
Q

What type of organism is trichomonas vaginalis

A

highly motile, flagellated protozoan parasite

63
Q

Features of trichomonas infection

A
  • offensive yellow/green discharge
  • vulvovaginitis
  • strawberry cervix
  • vaginal pH > 4.5
  • men usually asymptomatic but may cause urethritis
64
Q

Investigation findings in trichomonas infection

A

microscopy of a wet mount shows motile trophozoites

65
Q

Treatment of trichomonas

A

oral metronidazole for 5-7 days

66
Q
A

MRCP Infectious Diseases (73 decks)

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