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Sexual Health > STIs 2 > Flashcards

STIs 2 Flashcards

1
Q

Which individuals are at increased risk of HIV?

A

MSM
IVDU
People from areas of the world where heterosexual HIV infection is endemic
blood/blood products/organ recipient between 1975-85
occupational and medical exposure via invasive procedures in unsterile conditions

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2
Q

What does a white curd like vaginal discharge suggest?

A

Candida

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3
Q

What does a watery/malodourous vaginal discharge suggest?

A

BV or TV

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4
Q

What does a mucopurulent vaginal discharge suggest?

A

Gonorrhoea

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5
Q

What does a white/clear vaginal discharge suggest?

A

Chlamydia/NSU

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6
Q

Which conditions is dysuria associated with?

A

chlamydia
gonorrhoea
TV
HSV

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7
Q

Which STD cause IBD/PCB?

A

CT and GC

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8
Q

Which STD causes genital ulcers?

A

Herpes simplex virus is the commonest cause in the UK
consider: primary syphillis (1ary painless chancre), traums, bacterial infection, carcinoma and tropical ulcer disease (LGV)

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9
Q

Which STDs are associated with lymphadenopathy?

A

HSV

HIV

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10
Q

What causes balanitis?

A

Inflammation of the glans can be caused by:

Candida/anaerobic bacteria

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11
Q

Which STDs cause epidymo-orchitis?

A

Swelling and tenderness of testes/epididymis
caused by:
CT, GC
or Gram -ve organisms

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12
Q

Which STDs cause pelvic pain and dyspareunia?

A

may suggest PID caused by CT, GC or anaerobes

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13
Q

What type of tests are used for gonorrhoea, and their sensitivity/specificity?

A

Microscopy - cervical (50%) and male urethral (95%)
NAAT - endocervical/urethral (95%), female urine samples (30-60%)
Culture - Gran -ve diplococci, oxidase +ve, utilises glucose. Antibiotic suseptibility - penicillinase activity or antibiotic discs on pure culture (85-95%)

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14
Q

Which samples are collected for chlamydia testing?

A

Urine and urethrel in men

Vaginal/cervical (rotate for 10-20s)

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15
Q

What tests are used to identify chlamydia?

A

Microscopy - PMNs
NAAT (97-98%)
Culture - expensive, labour intensive and time consuming and very few labs offer service. low sensitivity (75%) but can be 100% specific
EIA - easier than culture and more sensitive (but still only 70%) - may give false +ves so confirmation of +ve results essential
Direct Fluoroscence Ab (DFA) - monoclonal Ab binds to C.trachominits, identified using fluroroscence microscope

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16
Q

What tests are used to diagnose TV?

A

Remember TV -> vaginitis and green discharge
STD

Test:
Wet slide microscopy - motile protozoan and flagellae, associated with pH >4.5 (92% - sensitvity)

CULTURE is GOLD STANDARD, but it is difficult and time consuming - direct inoccula

17
Q

What tests are used to diagnose candida?

A

Microscopy - Gram stained vaginal smear - PSEUDOHYPHAE and BUDDING YEAST (SPORES)

Culture: Direct innoculation on Sabouraud’s medium or into transport media - it is also commensal so results interpreted alongside clinical details

18
Q

What tests are used to diagnose bacterial vaginosis?v

A

Vaginal pH > 5.5 hence alteration of bacterial flora +/- overgrowth e.g. Gardnerella vaginalis, Mycoplasma hominis, peptostreptococci, Mobiluncus and anaerobes e.g Bacteria species with too few lactobacilli (protective microbiota of female genitalia)

MICROSCOPY: Gram stained vaginal smear examined using Hay/Ison criteria:
GRADE 1: Normal - Lactobacillus morphocytes predominate
GRADE 2: Intermediate - Mixed flora, some Lactobacilli present but Gardenella or Mobiluncus morphocytes present
GRADE 3: BV - Mainly Gardenella +/- Mobiluncus morphocytes. Few or absent lactobacilli

19
Q

What tests are used for Herpes Simplex Virus?

A

Direct Identification of Virus:
Direct staining, IMF, cell culture or PCR culture is GOLD STANDARD ( can distinguish HSV 1 & 2)
Culture is slow and costly (100% specificity)
PCR detects HSV DNA and is faster, more sensitive and less risk of contamination, compared with culture
IMF is less sensitive/specific than culture and is not recommended

Serology:
detects specific Ab (97% sensitivity, 98% specificity)
not used routinely - difficult to interpret significance of +ve result

20
Q

What tests are used for HIV Serology?

A

Antibody tests:
EIA test (100% sensitivity) - no false negatives
All +ves confirmed using 1-2 other tests - Western blotting or EIA with higher specificity
Each lab has a testing algorithm
Always remember window period when interpreting results

Anitgen test: p24 antigen - useful in diagnosing 1ary infection as it is positive before Ab production

NAAT: Detect RNA
Quantitative tests - ‘viral load test’ - commonly used to monitor treatment
Can give false positives at low levels - not used for screening as not sensitive enough and also difficult, time consuming and costly
useful in diagnosing primary infection, as very high viral loads prior to Ab production

21
Q

What tests are used for Hep A?

A

IgM AB: +ve in acute Hep A - start to appear 3-4 weeks following infection
IgG Ab: produced later on, used to detect past infection and indicates immunity
Lab tends to measure total Ab unless acute infection is suspected

22
Q

What tests are used for Hep B?

A

Hep B Surface Antigen (HBsAg) - FIRST TO BECOME POSITIVE during infection, remains positive in chronic disease (HbsAg +ve > 6m)

IgM Hep B core antibody (anti-HBc): FIRST ANTIBODY detected shortly after HbsAg

IgG anti-HBc: signifies PREVIOUS INFECTION and is used to detect natural immunity

Hep B Surface Antibody (anti-HBs): The only Ab produced after vaccination as the vaccine contains surface Ag, used to check immunity following vaccination

Hep B e Antigen (HbeAg): presence of indicates high infectivity

23
Q

What is the first thing to become during acute Hep B infection?

A

HbsAg

24
Q

What is the first antibody to become positive in acute Hep B infection?

A

anti-Hbc

25
Q

Which antigen or antibody signifies previous infection?

A

IgG anti-HBc

26
Q

Which antibody is produced following Hep B vaccination?

A

Anti-HbS

27
Q

Which antigen or antibody suggests presence of high infectivity?

A

HbeAg

28
Q

What test is used for Hep C infection diagnosis?

A

Antibody test

If +ve -> specialist referral - RNA test, LFTs and further Mx

29
Q

Who is most at risk of Hep C infection?

A

IVDU
HIV +VE pts
partner Hep C +ve
blood transfusion

30
Q

What are the 2 main types of resistance produced by Neisseria gonorrhoae?

A

PPNG (Pencillinase producing NG) - 5%

CMRNG (Chromosomal resistant NG) - 3.6%

31
Q

When treating N.gonorrhoea what rate of resistance to antibiotics should be looked for and what should be done?

A

> 5%

need to change treatment!

Sexual Health (3 decks)

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