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GOSH > STIs > Flashcards

STIs Flashcards

1
Q

what is trichomonas vaginalis caused by?

what is elicited in the history?

A
  • anaerobic protozoan
  • asymptomatic (especially in men)
  • profuse, offensive greenish/grey, frothy discharge
  • vaginal and vulval irritation
  • superficial dyspareunia
  • dysuria
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2
Q

what would you see on examination of trichomonas?

A
  • erythematous punctuate appearance cervix (strawberry cervix)
  • vaginal discharge and vulval erythema
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3
Q

what are the diagnostic investigations for trichomonas? (3)

A
  • vaginal pH >5.0
  • HVS for direct microscopy and culture in a trichomonas medium
  • trichomonads are seen on saline wet-mount (pathognomonic)
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4
Q

what STIs can be detected in a high vaginal swab?

endocervical swab?

blood tests?

A
  • BV, candida albicans
  • chlamydia and gonorrhoea
  • blood tests for HIV, syphilis and hepatitis B (abundance of leukocytes)
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5
Q

what is the treatment for trichomonas?

what complications are there?

A
  • metronidazole (200mg PO)
  • PID
  • premature delivery, PROM etc
  • SEs of Tx (flushing, headache, nausea, etc)
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6
Q

what is the most common adverse side effect of chlamydia?

what percentage of people are asymptomatic ?

A
  • PID (accounts for 50% of cases of PID)

- 60-80%

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7
Q

what are symptoms in males and females of chlamydia?

A
  • vulval irritation
  • superficial/ deep dyspareunia
  • dysuria and frequency
  • vaginal discharge
  • PCB, IMB
  • abdo pain, fever

male:

  • urethritis
  • unilateral testicular pain
  • dysuria
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8
Q

what may be seen on examination in chlamydia?

A
  • copious mucous vaginal discharge
  • pain
  • induration
  • speculum shows cervicitis, friable contact bleeding.
  • PID, adnexal tenderness, cervical motion tenderness, abdo tenderness
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9
Q

what investigations would you do for chlamydia in males, then females?

A

males:
- first void urine (NAATs)
- swab urethra from discharge (CT and GN)
- MSU if UTI

females:
- endocervical swab (NAATs)
- VVS (NAATs, red)
- HVS (TV, BS, candida, gonorrhoea)
- urine dip and MSU

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10
Q

what is the management of chlamydia?

A
  • azithromycin stat
  • doxycycline
  • erythromycin
  • avoid intercourse for 7 days after completion treatment, contact tracing.
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11
Q

what are the complications of chlamydia?

neonatal complications?

A
  • PID
  • seronegative arthritis
  • Reiters syndrome
  • fitz- hugh- curtis syndrome
  • pregnancy problems
  • neonatal pneumonia
  • ophthalmitis, pneumonia
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12
Q

what can PID cause?

A
  • tubal infertility, Acute PID results in tubal blockage in 15% of cases following 1st episode, 40% following 2nd
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13
Q

what percentage of men and women are symptomatic following gonorrhoea infection?

what is the incubation period?

A
  • 50% of women, 90% of men

- 2-10 days

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14
Q

what are the symptoms of gonorrhoea in women?

men?

A
  • purulent, offensive vaginal discharge
  • deep dyspareunia
  • IMB, PCB, menorrhagia

men:
- urethral dysfunction (discharge, dysuria)
- epididymal tenderness/ swelling
- balanitis

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15
Q

what are the complications of gonorrhoea?

A
  • local spread: bartolinitis, skenitis
  • ascending spread:
    salpingitis, fever, malaise, rash
  • septicaemia, infection of rectum, fits Hugh-curtis syndrome
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16
Q

what can be found on pelvic exam?

A
  • white/ yellow purulent discharge
  • abscess (urethral or bartholins)
  • uterine tenderness, adnexal tenderness, cervical excitation
17
Q

what would gonorrhoea look like under microscope?

what investigations would you do?

A
  • gram -ve diplococci
  • EC swab (NAATs)
  • VVS (NAATs)
  • urethral, rectal and pharyngeal swabs
  • microscopy and culture of swab will identify n.gonorrhoea and antibiotic sensitivity
18
Q

what is the management of gonorrhoea?

A
  • ceftriaxone 500mg and azithromycin 1g
19
Q

what are the neonatal complications of gonorrhoea?

A
  • neonatal ophthalmia (presents 2-7 days after birth with severe bilateral conjunctivitis, chemosis and lid oedema
20
Q

what is more common HSV1 or 2?

what would you obtain from a history

A
  • equally as common
  • extensive sore genital ulceration
  • can be systemic “flu-like”
  • dysuria
  • discharge
  • neuropathic pain in buttocks/ genitals
21
Q

what do the lesions look like in hsv?

A
  • vesicles that burst leaving superficial tender ulceration with erythematous halo and grey/white exudate
22
Q

how do recurrent infections compare with initial infections in HSV?

what might be a trigger for reactivation?

A
  • shorter and less severe, last 3-5 days, cause unilateral lesions
  • trauma, stress, menstruation
23
Q

what is the difference in reactivation between HSV 1 and 2?

A
  • HSV 2 has 4-6 outbreaks a year

- HSV 1 limited to once per annum

24
Q

when are you most infectious in HSV?

what prodromal symptom may alert you of it coming on?

A
  • during viral shedding and symptoms

- neuralgia pain down legs and buttocks

25
Q

what investigations would you perform?

A
  • swab ulcer vesicular fluid for PCR (HSV and syphilis)

- STI screen (NAAT’s urine, bloods HIV and Hep B, syphilis)

26
Q

what is the management of HSV?

A
  • primary episodes 400mg TDS for 5 days
  • topical/ oral analgesia
  • recurrent episodes are self limiting, use saline baths and analgesia
27
Q

what do you do if a mother gets herpes in 1st/2nd trimester?

what do you do in 3rd trimester acquisition?

A
  • daily suppressive acyclovir from 36 weeks
  • 1st episode associated with first trimester miscarriage
  • takes 6 weeks for pregnant women to develop Ab’s in response to HSV and protect neonate
  • offer C section if present delivery or within 6 weeks of birth
  • Give IV acyclovir

GOSH (18 decks)

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