STIs 2 Flashcards
commonest bacteria STI
chlamydia
mocopurulent discharge from the penis and painful urination is what
gonorrhoea
chancre develops at what stage of syphilis
primary
which infection leads to PID in women
chlamydia
which STI is known as the great imitator because its symptoms resemble other infections
syphilis
when is the HPV vaccine recommended for females
11-13
viral shedding is higher with which type of genital herpes simplex virus
HSV 2
chlamycida - GS
transmission
age
GN bacterium
vaginal, oral, anal
20-24s
pathogenesis of chlamydia
unclear
chlamydia can cause PID in 50%
PID increases risk of ectopic preg by 10% and carries a risk of tubal factor infertility of 15-20%
presentation of chlamydia in a female
post coital or inter menstrual bleeding
lower abd pain
dyspareunia
mucopurulent cervicitis
male presentation of chlamydia
urethral discharge
dysuria
urethritis
epididymis-orchitis
cx of chlamydia
PID
tubal damage
chronic pelvic pain
tranmission to neonate (17% conjunctivitis, 20% pneumonia)
adult conjunctivitis - occaisionally
sexually acquired reactive arthritis /reiters - commoner in men
Fitz - high - curtis syndrome (perihepatitis)
dx and rx of chlamydia
test 14 days following exposure
NAAT - females (vulvovaginal swab), males - first void urine
MSM - add real swab if receptive anal sex
azithromycin 1g stat
doxycycline 100mg BD x 1 week if rectal chlamydia
gonorrhoea GS
sites of infection
GN intracellular diplococcus
mucous membranes of urethra, endocervix, rectum and pharynx
incubation/transmission of G
incubation period of urethral infection in men is shorter (2-5days)
20% of risk from infected women to male partner
50-90% risk from infected man to female partner
presentation in males - G
asymp in less than 10%
urethal discharge - purulent and green/yellow
dysuria
pharyngeal/rectal infections which are mostly asymp
females presentation - G
asymp in almost 50%
increased/altered vaginal discharge in 40%
dysuria
pelvic pain in <5%
pharyngeal and rectal infection are usually asymp
cx of G
3% in females and <1% in males
lower genital trat - bartholinitis, tysonitis, periurethral anscess, rectal abscess, epididymitis, urethral stricture
upper genital tract - endometritis, PID, hydrosalpinx, infertility, ectopic pregnancy, prostatitis
cx of G
3% in females and <1% in males
lower genital trat - bartholinitis, tysonitis, periurethral anscess, rectal abscess, epididymitis, urethral stricture
upper genital tract - endometritis, PID, hydrosalpinx, infertility, ectopic pregnancy, prostatitis
dx of G
microscopy - urethral 90-95% sensitivity, endocervical 37-50% sensitivity
culture >95% sensitivity (male urethra), 80-92% sensative (female endocx)
NAATs>96% sensitiivty (both in symp and asymp)
rx of G
ceftriaxone 500mg IM 1st line
cefixime 400mg PO - if IM injection contra indicated or refused
azithromycin 1g given regardless of chlamydia result
test of cure in all px
genital herpes pattern
primary infection
non primary first episode
recurrent infection
GH primary infection incub
duration
symptoms
3-6 days
14-21 days
blistering and ulceration of the external genitalia pain external dysuria vaginal or urethral discharge local lymphadenopathy fever and myalgia
recurrent episodes GH
more common with what
mis dx as what
symptoms
more common with HSV2
thrush
unilateral small blisters and ulcers, minimal systemic symptoms
resolves within 5-7 days
management of GH
swab base of ulcer for HSV PCR oral acyclovir consider topical lidocaine if painful saline bathing analgesia
viral shedding common with which type
when
who
reduced by what
following HSV 2 is commoner than for HSV 1
more frequent in the first year of infection
more individuals with frequent recurrences
reduced by suppressive therapy
HPV is the commonest what
life time risk of acquiring it
viral STI in the UK
80%
HPV genotypes total certain low risk high risk
> 170
40 infect anogenital epithelium
6, 11, 42, 43, 44
16, 18, 31, 33, 35, 45, 51, 52, 66
HPV transmission
incub
80% of the population are exposed
10% harbour detectable infection
1% develop anogentail warts
likely to have acquired form asymp partner
incub 3 weeks to 9 months
HPV immunology
spontaneous clearance of warts 20-34%
clearance with treatment 60%
persistence despite treatment 20%
anogenital warts caused by which type of HPV
> 90% by 6/11
HPV treatment
podophyllotoxin (wart icon) - cytotoxic, not licensed for extra genital warts
iminquimod - immune modifier, for all anogenital warts
cryotherapy - cytolytic can require repeat treatments
electrocautery
HPV vaccination
MSM and HIV+ included
syphillis transmission
classification
sexual contact, transplacental/during birth, blood transfusions, non sexual contact
congenital, acquired
acquired syphilis types of infections
early have primary, secondary and early latent
late non infectious have late latent and tertiary
primary syphilis incub period
lesion
sites
other signs
9-90 days (mean of 21days)
lesions - primary chancre - painless, appear at site of inoculation
sites are genital 90% of the time
non tender local lymphadenopathy
secondary syphilis
incub period
signs
6 weeks - 6 months
skin - macular, follicular/pustular rash on palms and soles
lesions of mucous membranes
generalised lymphadenopathy
patchy alopecia
condylomata lata (most infectious lesion in syphilis)
dx of syphilis
demonstration of trepnonema palladium from lesions of infected LNs - dark field microscopy, PSCR
serological testing - detects AB to pathogenic treponemes
serological testing in syphilis
non-treponema - VDRL, RPR (rapid plasma reagin)
treponema - TPPA, ELISA/EIA (screening test), INNO-LIA, FTA abs
rx and follow up in syphilis
early - 2.4 MU benzathine penicillin x1
late 2.4 MU benzathine pencilline x3
until RPA is negative to serofast
tires should decrease fourfold by 3-6 months in early
serological relate/reinfection if titres increase by fourfold
