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nagasaki flashcard extravaganza > STIs > Flashcards

STIs Flashcards

1
Q

Complications of chancroid?

A

Gangrenous phagedenic ulceration and phimosis may occur. When phimosis heals, the mucosal tissues contract and may be susceptible to trauma, thereby increasing the risk of HIV transmission.

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2
Q

Types of Donovanosis

A

Ulcerogranulomatous: non tender, fleshly beefy-red ulcers
Hypertrophic: verrucous-like with a raised irregular edge, sometimes completely dry
Necrotic: foul-smelling ulcer causing tissue destruction
Sclerotic: fibrous and tissue scarring

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3
Q

Type lesions for donovanosis

A

Clinical appearances in men
The usual sites of infection are the prepuce, coronal sulcus, frenulum and glans.

Clinical appearances in women
The usual sites of infection are the labia minora and fourchette. More rarely, the vaginal wall and cervix can be affected

Often large vegetating masses
“walnut” appearance
Beefy red

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4
Q

Extragenital manifestations of donovanosis

A

Oral
Rarely liver or bone via blood spread

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5
Q

Complications of donovanosis

A

Stenosis of urethra, vagina and anus
Genital elephantiasis
Neoplastic changes
Depression

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6
Q

Commonest cause of SARA

A

CT

Other: GC, MGEN, Shigella, Salmonella, campylobacter, HIV, parvovirus,

Strep important non STI cause but common in younger population

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7
Q

How many SARA cases are HLAB27 positive and how much does it increase your risk?

A

50%
x 50

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8
Q

Eye manifestations of syphilis

A

Secondary: chorioretinitis and uveitis
Tertiary Syphilis:
Optic atrophy
Congenital infection: bilateral interstitial keratitis in over 90% of cases with congenitally acquired infection.

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9
Q

Incubation of HSV

A

2-5 days

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10
Q

Incubation of syphilis

A

9-90 days

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11
Q

Commonest oncogenic HPV types

A

16, 18

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12
Q

Causes of biological false positives in STS?

A

SLE, PWID, leprosy, > 60, CLD

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13
Q

Difference between GC and CT conjunctivitis in neonate?

A

GC > purulent, more oedema, CT > likely haemorrhagic

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14
Q

sensitivity of microscopy to diagnose trichomonas in women with discharge

A

as low as 45–60% in women

lower in men

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15
Q

When to refer candidal vulvovaginitis for specialist input

A

Unclear diagnosis
No improvement despite tx
Immunocompromised patient
Systemic treatment needed

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16
Q

What type of micro-organism are yeasts and what is special about them?

A

eukaryotic
unicellular
fungi
Can develop multicellular characteristics by forming pseudohyphae and biofilms

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17
Q

Mode of transmission of genital warts

A

Most often - sexual contact

Also - perinatally and auto-inoculation from hands

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18
Q

incubation period for genital warts?

A

Variable
Generally 3 weeks to 8 months
Can be as long as 18 months

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19
Q

What are the serious complications of vertical transmission of HPV to a neonate

A

Only serious, rare complication
= recurrent respiratory papillomatosis in the infant
Occurs in about 4:100,000 births

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20
Q

Symptoms of secondary Syphilis

A

rash - Maculopapular (70%) papular (12%), macular (10%) rash can be on palms and soles (spares load bearing areas)- not usually itchy can cause alopecia generalised lymphadenopathy. mucous patches (buccal, lingual and genital) condylomata lata - warm, moist areas Less common: hepatitis; glomerulonephritis, splenomegaly, 1–2% develop neurological complications

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21
Q

% of syphilis which has a second 2ndary stage?

A

25%
More likely in HIV

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22
Q

Examination required for symptomatic late syphilis disease clinical examination

A

clinical examination as indicated, with attention to: - Skin - Musculoskeletal system (congenital) - Cardiovascular system (for signs of aortic regurgitation) - Nervous system (general paresis: dysarthria, hypotonia, intention tremor, and reflex abnormalities; Tabes dorsalis: pupil abnormalities, impaired reflexes, impaired vibration and joint position sense, sensory ataxia and optic atrophy)

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23
Q

What proportion of sexual contacts of infectious syphilis develop the disease

A

1/3 of sexual contacts of infectious syphilis will develop the disease (transmission rates of 10–60% are cited)

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24
Q

At what stage of pregnancy is vertical transmission of syphilis most likely to occur?

A

T. pallidum readily crosses the placenta vertical transmission can occur at any stage of pregnancy.

transmission risk is greatest in early syphilis

more common in 2nd and 3rd T

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25
Q

Timeframe for primary syphilitic chancre to resolve

A

ulcers resolve over 3–8 weeks

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26
Q

% of syphilis patients who develop neurosyphilis?

A

1–2% of patients with secondary syphilis develop neurological complications These typically include acute meningitis - (headache, neck stiffness, photophobia, nausea) cranial nerve palsies Eye involvement - uveitis, optic neuropathy, interstitial keratitis, retinal involvement

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27
Q

Time frame for developing tertiary syphilis?

A

Around 20–40 years after initial infection

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28
Q

% of untreated syphilis who develop tertiary?

A

1/3

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29
Q

Types of tertiary syphilis?

A

Gummatous disease (15%) - Cardiovascular (10%) - Late neurological complications (7%)

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30
Q

What is gummatous syphilis?

A

Granulomatous lesions with central necrosis Most often affect skin and bones. Rapidly resolve with treatment

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31
Q

Proportion of patients who become symptomatic with cardiovascular tertiary syphilis

A

10%

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32
Q

Symptoms of cardiovascular tertiary syphilis

A

Aortitis - Ascending aorta - substernal pain
Aortic regurgitation
Heart failure coronary
ostial stenosis a
Angina
Aneurysm.

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33
Q

Timeframe for developing Meningovascular syphilis

A

Typically 5–10 years after infection (may be earlier) Prodrome may occur in the weeks/months prior to stroke

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34
Q

Types of neuro-syphilis

A

Meningovascular Parenchymous
General paresis
Tabes dorsalis
Asymptomatic

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35
Q

Symptoms of Meningovascular syphilis

A

Focal arteritis
Infectious arteritis may result in ischaemic stroke (middle cerebral artery territory most commonly affected)
Meningeal inflammation signs dependent on site of vascular insult
Occasional prodrome; headache, emotional lability, insomnia

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36
Q

Symptoms of neurosyphilis causing general paresis

A

Progressive dementia Initial forgetfulness
Personality change
Seizures and hemiparesis may occur (late)
Emotional lability
Psychosis

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37
Q

Cause of symptoms from neurosyphilis causing general paresis

A

cortical neuronal loss

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38
Q

Cause of symptoms from neurosyphilis causing tabes dorsalis

A

Inflammation of spinal dorsal column / nerve roots

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39
Q

Which symptoms of neurosyphilis are caused by the loss of the dorsal columns?

A

absent reflexes absent joint position sense absent vibration sense

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40
Q

what are the 2 divisions of congenital syphilis?

A

early (diagnosed in the first two years of life) late (presenting after two years)

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41
Q

What proportion of infants with congenital syphilis are asymptomatic at birth?

A

2/3

42
Q

Signs of Late congenital syphilis

A

interstitial keratitis
Clutton’s joints
Hutchinson’s incisors
mulberry molars
high palatal arch
rhagades (peri-oral fissures)
sensineural deafness
frontal bossing
short maxilla
protuberance of mandible
saddlenose deformity
sterno-clavicular thickening
paroxysmal cold haemoglobinuria
neurological involvement (intellectual disability, cranial nerve palsies)

43
Q

Endemic treponemes

A

yaws (T. pallidum pertenue) - warm equatorial regions
bejel ( T. pallidum endemicum) - Middle East, Africa
pinta (T. pallidum carateum) - South America

All cause positive treponemal serology

44
Q

what is the VDRL test?

A

Venereal Diseases Research Laboratory (VDRL) carbon antigen test = non specific test anti-cardiolipin antibodies

45
Q

Classification of Treponemal antibody tests

A

Non-specific tests (cardiolipin, lipoidal, reagin, non- treponemal): VDRL / RPR test.
Specific (treponemal) tests: EIA, CLIA, TPHA, TPPA, FTA-abs, T. pallidum immunoblot

46
Q

what are the primary screening tests for syphilis?

A

Primary screening tests 1st = Treponemal test - TPPA or EIA/CLIA (preferably a test that detects both IgG and IgM

47
Q

What initial RPR level indicates active syphilis?

A

Initial RPR/VDRL titre >16 usually indicates active disease and the need for treatment, RPR titre <16 does not exclude active infection

48
Q

What is the prozone phenomenon?

A

an immunologic phenomenon which causes a false negative syphilis result
The effectiveness of antibodies to form immune complexes stops increasing with greater concentrations and decreases with extremely high concentrations

49
Q

How can the prozone phenomenon be avoided

A

Any negative test on undiluted sera should be repeated on diluted sera

50
Q

Why is a longer duration of treatment given in late syphilis?

A

On the basis of more slowly dividing treponemes

51
Q

What are the potential adverse pregnancy outcomes relating to syphilis?

A

fetal infection usually occurs in 2nd / 3rd trimesters

(But can occur as early as 8–9wk gest)

Polyhydramnios

Miscarriage / stillbirth

Pre-term labour

Fetal hydrops

placental oedema

Congential syphilis

52
Q

What ultrasound features may suggest fetal syphilis infection

A

Non- immune hydrops
Hepatosplenomegaly

53
Q

What is the risk of a Jarisch-Herxheimer reaction during pregnancy

A

Theoretical increased risk of spontaneous and iatrogenic pre-term delivery and fetal demise
May experience uterine contractions - resolve within 24h. Seem secondary to development of fever.
Decelerations may occur - usually resolve without early delivery being required
Occurs same frequency as non-pregnant
Tx: supportive care

54
Q

How common is congenital syphilis?

A

Congenital syphilis is uncommon in the UK
Approximately 10 cases reported annually.

55
Q

What is the Jarisch-Herxheimer reaction

A

Jarisch-Herxheimer reaction = An acute febrile illness headache, myalgia, chills, rigours

Resolves within 24 hours.

Common in early syphilis

Usually not clinically significant

unless neurological/ ophthalmic involvement or in pregnancy when it may cause fetal distress

56
Q

How is syphilis treatment failure determined

A

Treatment failure is characterised by:

Four-fold or greater increase in non-treponemal test titre.
Recurrence of signs or symptoms
Re-infection excluded

57
Q

what is hutchinsons triad?

A

interstitial keratitis

hutchinsons incisors

deafness

58
Q

After treatment of syphilis what serology results would raise suspicion of inadequate treatment or re-infection?

A

Failure to achieve 4x drop in RPR by 6m

Failure to achieve an 8x drop in RPR by 12m

A significant increase in RPR

Persisting RPR >16 is rarely seen in correctly treated syphilis

59
Q

Complications of chlamydia

A

PID

endometritis /salpingitis

tubal infertility

Ectopic pregnancy

Fitz-Hugh-Curtis syndrome = peri-hepatitis

Neonatal or adult conjunctivitis

Neonatal pneumonia

Sexually acquired reactive arthritis

Epididymo-orchitis (may be associated with male sub-fertility)

60
Q

What is Fitz-Hughes-Curtis?

A

Perihepatitis. Usually chlamydia/other STI
May lead to hepatic adhesions (“guitar strings”) to peritoneum
Does not ordinarily affect LFTs
CT - capsule enhances
Treat as PID

61
Q

What complications of gonorrhoea infection may occur?

A

epididymo-orchitis

prostatitis

pelvic inflammatory disease (PID)

Haematogenous dissemination - skin lesions, arthralgia, arthritis and tenosynovitis

62
Q

In what % of cases with NGU is neither chlamydia nor mycoplasma detected ?

A

30%–80%

63
Q

What % of patients with NGU may be caused by Herpes simplex viruses (1 and 2)?

A

uncommon cause of NGU Approx 2%–3%

64
Q

what are the less common organisms that have been reported as causes of NGU?

A

Epstein Barr Virus

Neisseria meningitidis

Haemophilus sp

Candida sp

Bacterial vaginosis associated bacteria

65
Q

What is the smallest known self-replicating bacterium?

A

M Gen!

66
Q

Classical appearance of a chancroid ulcer

A

Ragged undermined edge grey or yellow base bleeds when touched. painful single or multiple
Nodes usually appear at the same time - can be bubos

67
Q

What are the usual sites of chancroid infection in women?

A

Labia minora - fourchette. Uncommon = vaginal wall and cervix

68
Q

Which extragenital sites can chancroid manifest in?

A

Rare - fingers - breasts - inner thighs

69
Q

Clinical variants of chancroid

A

giant phagadenic ulcers
dwarf chancroid (similar to herpes)
follicular chancroid
single painless ulcers (like syphilis)

70
Q

What proportion of patients with chancroid have painful inguinal lymphadenopathy

A

50% of male cases less common in women

71
Q

What are the three stages of LGV

A

Primary lesion
Secondary lesions, lymphadenitis or lymphadenopathy or bubo
Tertiary stage or the genito-anorectal syndrome

72
Q

Presentation of LGV proctitis

A

Haemorrhagic proctitis = primary manifestation rectal pain anorectal bleeding mucoid and/or haemopurulent rectal discharge tenesmus constipation symptoms of lower GI inflammation Some report fever / malaise

73
Q

What proportion of rectal LGV cases are asymptomatic

A

95%

74
Q

what secondary lesions may arise from LGV infection?

A

Tender inguinal / femoral lymphadenopathy lymph node chain may become matted periadenitis
bubo formation
Buboes may ulcerate and discharge pus +/- create chronic fistulae. s
Systemic spread associated with fever / arthritis / pneumonitis / perihepatitis
Reactive arthritis

75
Q

Features of the tertiary stage of LGV

A

proctitis proctocolitis mimicking Crohn’s disease fistulae strictures chronic granulomatous disfiguring fibrosis and scarring

76
Q

Long term complications of LGV

A

destruction of lymph nodes may cause genital lymphoedema (elephantiasis) persistent suppuration pyoderma association with rectal cancer reported

77
Q

Commonest cause of PID

A

Chlamydia = commonest identified cause

Other organisms commonly found which may be implicated
Gardnerella vaginalis
anaerobes (including Prevotella, Atopobium, Leptotrichia) Mycoplasma genitalium

Pathogen negative PID is common

78
Q

What % of men with mumps develop epididymo-orchitis

A

up to 40% of post-pubertal males

79
Q

What is the timeframe for surgery for testicular torsion

A

testicular salvage surgery IS REQUIRED WITHIN 6 HOURS becomes decreasingly likely with time

80
Q

Symptoms of mumps

A

headache
fever
characteristic unilateral / bilateral parotid swelling
7-10 days later - unilateral testicular swelling
+/- epididymitis

81
Q

Complications of epididymo-orchitis

A

More common in uropathogen related epididymo-orchitis than STI causes
* Reactive hydrocoele
* Abscess formation
* Infarction of the testicle
* Infertility - poorly understood relationship

Mumps epididymo-orchitis can lead to testicular atrophy.

82
Q

Test for confirming diagnosis of mumps epididymo-orchitis

A

mumps IgM / IgG serology

83
Q

Differential diagnosis in suspected epididymo-orchitis which does not improve with antibiotics

A

testicular ischaemia / infarction
testicular / epididymal tumour
alternative infectious aetiologies - TB, mumps or rarer infective cause
non-infective causes
progression to an abscess

84
Q

What is the mean duration of first episode of SARA

A

4­ - 6 months
followed by full recovery

50% have recurrent episodes at variable intervals

85
Q

% risk of neonatal herpes following vaginal birth during an episode of primary HSV

A

41%

86
Q

Which type of neonatal herpes has the best prognosis?

A

Disease localised to skin, eye and/or mouth (SEM)

30% of neonatal herpes infections

antiviral treatment means neurological and/or ocular morbidity is less than 2%

87
Q

What is the mortality rate and neurological morbidity rate from neonatal herpes of the local CNS

A

70% of all neonatal HSV, 60% have no SEM

6% mortality

70% - Neurological morbidity (may be lifelong)

Infants with local CNS disease often present late (generally between 10 days and 4 weeks of age)

88
Q

what may disseminated herpes present with

A

encephalitis
hepatitis
disseminated skin lesions

rare in adults
more common in pregnancy

high maternal mortality

89
Q

What is the recommended medication for treating uncomplicated gonorrhoea in neonates under 41 weeks

A

IV Cefotaxime
Expert paediatric advice is required regarding dosage

AVOID ceftriaxone under 41/40 weeks - risk precipitation in urine/lungs + hyperbole

90
Q

What is the recommended medication for treating uncomplicated gonorrhoea in neonates over 41 weeks postmenstrual age

A

Ceftriaxone 125mg IM STAT in children who weigh < 45kg

or Spectinomycin 40 mg/kg IM STAT [unreliable in pharyngeal infection]

91
Q

How does pharyngeal syphilis present?

A

Ulcer (1st) or mass (2nd/3rd)
Treated as per stage

92
Q

What does the histology of syphilis show?

A

Primary syphilis (primary chancre) demonstrates an acanthotic epidermis which erodes with time to become ulcerated. Under the ulcer bed there is typically a dense lymphocytic response, numerous plasma cells, and endothelial swelling .

Secondary syphilis exhibits considerable variability - The epidermis is often involved and shows a psoriasiform hyperplasia with superficial neutrophils There is also a lichenoid tissue reaction, epidermal apoptosis and exocytosis of neutrophils The dermis shows a superficial and deep chronic infiltrate which may resemble the changes of primary syphilis. There are numerous plasma cells in about 1/3 of cases and often endothelial swelling

Tertiary syphilis shows necrotising granulomatous inflammation. The organisms may be impossible to find with special stains and clinical correlation is often needed.

93
Q

What is the groove sign pathonomonic of?

A

LGV
Inguinal and femoral LN, creates groove between

94
Q

What are Clutton’s joints?

A

Congenital syphilis - symmetrical joint swelling seen in congenital syphilis. It most commonly affects the knees, presenting with synovitis and joint effusions (collections of fluid within the joint capsules) lasting up to a year.

95
Q

Recommended regimes for HSV in HIV

A

In advanced HIV double dose/extend course

1st episode 400mg ACV 5/day 7-10days
Val 500mg-1g BD
Famciclovir 500mg TDS
Therapy continued until all lesions re-epithialised

Normal therapy okay if immune competant

96
Q

Cause of false positive EIA?

A

False-positive result may be seen in certain acute or chronic infections (e.g., tuberculosis, hepatitis, malaria, early HIV infection), autoimmune diseases (e.g., systemic lupus, rheumatoid arthritis), injection drug use, pregnancy, and following vaccination (e.g., smallpox, MMR).

97
Q

What is Dubois sign?

A

Shortening of little finger in congenital syphilis

98
Q

Which treponemal test is positive first

A

EIA then TPPA

99
Q

Microscopic appearance of chancroid?

A

Gram-negative rods which may show the appearances of railroad lines or schools of fish

100
Q

Chancroid treatment

A

Erythro 500mg QDS 7/7 (SE); Azithro 1g STAT

101
Q

Donovanosis 1st line

A

Azithro 1g weekly; or azithro 500mg OD for 3/52

102
Q

What complications can arise from HSV infection?

A

Superinfection
Meningitis/encephalitis
Vertical transmission
Psychosexual
Neuropathic pain
Autonomic neuropathy eg urinary retention
Ophthalmic complications

nagasaki flashcard extravaganza (34 decks)

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