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STIs Flashcards

1
Q

What is the most common bacterial STI?

A

Chlamydia

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2
Q

Profuse mucopurulent discharge from the penis and painful urination are most commonly symptoms of what STI?

A

Gonorrhoea

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3
Q

During which stage of syphilis does a chancre develop?

A

Primary

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4
Q

Which STI can lead to pelvic inflammatory disease in women?

A

Chlamydia

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5
Q

Which STI is known as the great imitator?

A

Syphilis

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6
Q

At what age is the HPV vaccine recommended for females?

A

11-13yo

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7
Q

Which type of genital HSV has a higher level of viral shedding?

A

Type 2

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8
Q

What type of organism is chlamydia?

A

Gram -ve bacteria

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9
Q

How is chlamydia transmitted?

A

Vaginal
Oral
Anal

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10
Q

What age group has the highest incidence of chlamydia?

A

20-24yo (M+F)

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11
Q

By how much does an episode of PID increase the risk of ectopic pregnancy by?

A

10x

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12
Q

What risk of tubal factor infertility does an episode of PID carry?

A

15-20%

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13
Q

How does chlamydia present in females?

A

Post coital or intermenstrual bleeding
Lower abdo pain
Dyspareunia
Mucopurulent cervicitis

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14
Q

How does chlamydia present in males?

A

Urethral discharge
Dysuria
Urethritis
Epididymo-orchitis

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15
Q

What are some complications of chlamydia?

A

PID (50% of cases)
Tubal damage
Chronic pelvic pain
Transmission to neonate
Adult conjunctivitis
Sexually acquired reactive arthritis/Reiter’s syndrome
Fitz-Hugh-Curtis Syndrome (perihepatitis)

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16
Q

How is chlamydia diagnosed?

A

Test 14 days following exposure
NAAT- females (vulvovaginal swab), males (first void urine)
MSM (rectal swab if receptive anal intercourse)

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17
Q

How is chlamydia treated?

A

Azithromycin 1g stat

Doxycycline 100mg BD x 1wk

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18
Q

What type of organism is gonorrhoea?

A

Gram -ve intracellular diplococcus

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19
Q

Where are the primary sites of infection of gonorrhoea?

A 
Mucous membranes of: 
urethra
endocervix
rectum
pharynx
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20
Q

What is the incubation period of urethral gonorrhoea infection in men?

A

Short: 2-5 days

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21
Q

What is the transmission risk of gonorrhoea from an infected woman to male partner?

A

20%

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22
Q

What is the transmission risk of gonorrhoea from an infected man to female partner?

A

50-90%

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23
Q

How does gonorrhoea present in males?

A

Asymptomatic in =<10%
Urethral discharge >80%
Dysuria
Pharyngeal/rectal infections mostly asymptomatic

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24
Q

How does gonorrhoea present in females?

A

Asymptomatic (up to 50%)
Increased/altered vaginal discharge (40%)
Dysuria
Pelvic pain (<5%)
Pharyngeal/rectal infections mostly asymptomatic

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25
Q

What are the lower genital tract complications of gonorrhoea?

A 
Bartholinitis
Tysonitis
Periurethral abscess
Rectal abscess
Epididymitis
Urethral stricture
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26
Q

What are the upper genital tract complications of gonorrhoea?

A 
Endometritis
PID
Hydrosalpinx
Infertility
Ectopic pregnancy
Prostatitis
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27
Q

How is gonorrhoea diagnosed through microscopy?

A

Urethral 90-95% sensitivity

Endocervical 37-50% sensitivity

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28
Q

How is gonorrhoea diagnosed through culture?

A

> 95% sensitivity (male urethra)

80-92% sensitivity (female endocx)

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29
Q

How is gonorrhoea diagnosed through NAATs?

A

> 96% sensitivity (both symptomatic + asymptomatic)

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30
Q

What is the first line treatment of gonorrhoea?

A

Ceftriaxone 500mg IM

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31
Q

What is the second line treatment of gonorrhoea?

A

Ceftriaxone 400mg oral (only if IM contraindicated or refused)

32
Q

What is the co-treatment of gonorrhoea?

A 
Azithromycin 1g (regardless of chlamydia result) given at same time as gonorrhoea treatment
Test of cure in all patients
33
Q

What is the incubation and duration of the primary infection of genital herpes?

A

Incubation 3-6 days

Duration 14-21 days

34
Q

What are the symptoms and signs of the primary infection of genital herpes?

A 
Blistering and ulceration of the external genitalia 
Pain
External dysuria
Vaginal or urethral discharge
Local lymphadenopathy
Fever and myalgia (prodrome)
35
Q

Which HSV, 1 or 2, has more recurrent episodes?

A

2

36
Q

What are the recurrent episodes of HSV often misdiagnosed as?

A

Thrush

37
Q

Describe recurrent episodes of HSV

A

Usually unilateral, small blisters and ulcers

Minimal systemic symptoms, resolves within 5-7 days

38
Q

How should HSV recurrent episodes be managed?

A 
Swab ulcer base for HSV PCR
Oral Aciclovir
Consider topical Lidocaine 5% ointment if v. painful
Saline bathing
Analgesia
39
Q

When is viral shedding more common?

A

HSV 2
More frequent in first year of infection
More in individuals with frequent recurrences
Reduced by suppressive therapy

40
Q

What is the most common viral STI?

A

HPV

41
Q

What are some of the associated clinical sequelae with different HPV genotypes?

A

Latent infection
Anogenital warts
Palmar and plantar warts
Cellular dysplasia/intraepithelial neoplasia

42
Q

What is the incubation period of HPV?

A

3 weeks to 9 months

43
Q

Where is subclinical disease common in HPV?

A

All anogenital sites

44
Q

Is transmission of more than one type common in HPV?

A

Yes

45
Q

What types of HPV cause >90% of anogenital warts?

A

6 and 11

46
Q

What is the treatment for HPV anogenital warts?

A

Podophyllotoxin (Warticon)
Imiquimod (Aldara)
Cryotherapy
Electrocautery

47
Q

Describe podophyllotoxin in wart treatment

A

Cytotoxic

Not licensed for extra genital warts (but widely used)

48
Q

Describe imiquimod in wart treatment?

A

Immune modifier

Can be used on all anogenital warts

49
Q

Other than 11-13yo girls, who currently gets the HPV vaccine?

A

MSM

People living with HIV

50
Q

How is syphilis usually transmitted?

A

Sexual contact
Trans-placental/during birth
Blood transfusions
Non-sexual contact - healthcare workers

51
Q

How is syphilis classified?

A

Congenital

Acquired

52
Q

What stages of acquired syphilis can lead to an infectious state?

A

Primary
Secondary
Early Latent

53
Q

What is the incubation period of primary syphilis?

A

9-90 days (mean 21)

54
Q

Where do the lesions of primary syphilis appear?

A

Site of inoculation

55
Q

What are the sites of inoculation of primary syphilis?

A

Genital 90%

Extra Genital 10%

56
Q

What is the incubation period of secondary syphilis?

A

6wks to 6/12

57
Q

What are some clinical features of secondary syphilis?

A

Skin (macular, follicular or pustular rash on palms + soles)
Lesions of mucous membranes
Generalised lymphadenopathy
Patchy alopecia
Condylomata Lata (most infectious lesion in syphilis)

58
Q

How is syphilis diagnosed?

A

Demonstration of Treponema Pallidum (lesions, infected LNs): dark field microscopy, PCR
Serological testing- detects antibody

59
Q

What are some non-treponemal serological tests?

A

VDRL (Venereal Disease Research Laboratory)

RPR (Rapid Plasma Reagin)

60
Q

What are some treponemal tests?

A

TPPA (Treponemal Pallidum Particle Agglutination)
ELISA/EIA (Enzyme Immunoassay) SCREENING TEST
INNO-LIA (Line immunoassay)
FTA abs (Fluorescent Treponemal Antibody absorbed)

61
Q

What is the treatment for early syphilis?

A

2.4 MU Benzathine penicillin x 1

62
Q

What is the treatment for late syphilis?

A

2.4 MU Benzathine penicillin x 3

63
Q

What is the serological follow up for syphilis?

A

Until RPR is -ve of serofast:
Titres should decrease fourfold by 3-6 months in early syphilis
There is serological relapse/reinfection if titres increase by fourfold

64
Q

What is the look back period for chlamydia?

A

Male urethral 4 weeks, any other 6 months

65
Q

What is the look back period for gonorrhoea?

A

Male urethral 2 weeks, any other 3 months

66
Q

What is the look back period for non-specific urethritis?

A

4 weeks

67
Q

What is the look back period for trichomonas vaginalis?

A

4 week

68
Q

What is the look back period for epididymitis?

A

As CT/GC or if -ve, 6 months

69
Q

What is the look back period for HIV?

A

3 months before -ve test, or before most likely time of infection

70
Q

What is the look back period for syphilis?

A

Primary 90 days
Seconary 2 years
Other 3 months before most recent -ve test

71
Q

What is partner notification not required for?

A

Warts
Herpes
Vaginal thrush
Bacterial vaginosis

72
Q

What constitutes rape?

A

Penetration of the vagina, anus or mouth by the penis without consent

73
Q

What invalidates sexual consent?

A

Incapacitated by alcohol or drugs
Incarcerated
Violence or threat of violence

74
Q

Describe female sterilisation

A 
Permanent
Laparoscopic
Fallopian tubes cut/tied/blocked
No reliance on hormones
Similar efficacy to Mirena IUS
75
Q

Are there any non-contraceptive benefits to female sterilisation?

A

No

76
Q

Describe the use of diaphragms as contraception

A 
Silicon diaphragm
Use with spermicidal gel
Use within 4 hours of insertion, stays in 6 hours after sex
Fitted by medic, user dependent
Does not prevent infections
77
Q

Who can use Caya diaphragms?

A

Users of the 65-80mm diaphragm

No medical fitting necessary

Reproduction (40 decks)

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