STIs Flashcards
what is the peak age range that chlamydia is diagnosed?
18-27
what is the peak age range that gonorrhoea is diagnosed at?
for women it is similar to chlamydia ie 17-21 but for men it is 21-33
what are the full names for the bacteria that cause chlamydia and gonorrhoea?
Chylamydia trachomatis
Neisseria gonorrhoeae
which parts of the body do chlamydia and gonorrhoea affect in the adult?
urethra endocervical canal rectum pharynx conjunctivia
which parts of the body does chlamydia and gonorrhoea affect in the neonate?
conjunctiva atypical pneumonia (specifically chlamydia)
how does CT and GC present in men?
dysuria (painful or difficult urination)
urethral discharge
what percentage of people are asymptomatic with GC and CT?
gonorrhoea - 10%(M), 50% (W)
chlamydia - 50% (M), 70% (W)
so chlamydia is more likely to be asymptomatic
gonorrhoea is more likely to be asymptomatic in women
what are the complications of chlamydia in men?
epididymo-orchitis
reactive arthritis
how does CT and GC present in women?
discharge
menstrual irregularity
dysuria
what are the complications of CT and GC in women?
pelvic inflammatory disease which leads to:
• tubal factor infertility
• ectopic pregnancy
• chronic pelvic pain
neonatal transmission that causes opthalmia neonatorum or atypical pneumonia on CT
Fitz Hugh Curtis syndrome - liver capsule inflammation leading to the creation of adhesions = peri-hepatitis
How is chlamydia diagnosed?
Nucleic Acid Amplification Tests (NAAT) obtained by vaginal swab (best option), endocervical swab, first void urine in women and first void urine in men (best option for men)
how is chlamydia treated?
• partner management
• test for other STIs
• azithromycin 1 gram stat or Doxycycline 100mg bd for 7 days
• Erythromycin 500mg bd for 14 days or Azithromycin 1 gram stat in pregnancy (as can’t use tetracyclines in pregnancy eg doxycycline)
review the pt 3 months after treatment
how is gonorrhoea diagnosed?
there are more ways to diagnose gonorrhoea than chlamydia:
• microscopy of smears on selective media of genital secretions from the male urethra, endocervical swab, rectum
• culture on selective medium to ensure that it is N. gonorrhoea and not N. meningitidis etc
• sensitivity testing
• Nucleic Acid Amplification Tests (NAAT)
what does gonorrhoea look like under microscopy?
gram negative diplococci within the cytoplasm of polymorphs
how is gonorrhoea treated?
partner notification
test for other STIs
Continuous surveillance of antibiotic sensitivity
Ceftriaxone (a cephalosporin) 500mg IMI WITH Azithromycin 1 gram orally stat
why is partner notification important in CT and GC?
- Prevent re-infection of index patient
* Prevent complications in asymptomatic contacts
which is more common chlamydia or gonorrhoea?
chlamydia (C comes before G)
which has more common asymptomatic carriage GC or CT?
chlamydia
which of GC or CT has more florid presentation?
gonorrhoea
which of GC and CT is more common in recent partner change rather than an established relationship?
gonorrhoea
what is the organism that causes syphilis?
Treponema pallidum
what is early infectious syphilis?
within 2 years of infection there are three types: •primary •secondary •Early latent
what is late syphilis?
over 2 years since infection there are 4 types: •late latent •CNS •CVS •gummatous
what should you suspect if you find a genital ulcer?
Any genital ulcer is syphilis until proved otherwise
Why is gonorrhoea more common in men?
due to MSM
Which has a shorter incubation period, GC or CT?
gonorrhoea
for which of gonorrhoea and chlamydia are you less likely to present with complications and why?
gonorrhoea as it presents with symptoms and less likely to be asymptomatic so pts are more likely to seek medical help for gonorrhoea
why is chlamydia hard to grow in artificial media?
it is INTRACEULLULAR
which of gonorrhoea and chlamydia imply recent partner change?
gonorrhoea
how and when does opthalmia neonatorum present?
12-24 hours after delivery
large amount of oedema, discharge
give two causes of genital ulcers
syphilis
herpes simplex
why would someone develop early latent syphilis?
if their syphilis was not treated when they had the primary and secondary stage
give examples of presentations of CNS syphilis
dementia
strokes
tabes dorsalis
what is tabes dorsalis?
demyelination of the dorsal column tracts that normally are involved in fine touch, vibration and proprioception
leads to weakness,diminished reflexes,paresthesias, joint damage due to loss of proprioception
give an example of presentations of CVS syphilis
Syphilitic aortitis leading to aortic anyeurism and heart failure
what is gummatous syphilis?
fibrotic ulcers on any part of the body
is syphilis more common in men or equal incidence between men and women?
more common between men due to MSM transmission
what are the features of primary syphilis?
generalised systemic infection before primary chancre
primary chancre - in genital skin, nipples or mouth
incubation period 3-5 weeks (9-90 days)
affects regional lymph nodes 1-2 weeks after the primary chancre if not treated
heals without scarring after 4-8 weeks
painless (or less painful than herpes)
what are the features of secondary syphilis?
onset is 6-8 weeks after initial infection
primary chancre may be present at the same time, or may have no history of primary chancre
most common presentation is a rash - all over the body including palms and soles
mucous membrane lesions, lymphadenopathy, alopecia, hoarseness, bone pain, hepatitis, nephrotic syndrome, meningitis etc
how is syphilis transmitted to an unborn child?
transplacental transmission
what is the transmission rate of syphilis that is primary/secondary and early latency?
primary/secondary - 90%
early latency - 40%
how is syphilis diagnosed?
- early moist lesions - soft warts, can collect fluid from these and do microscopy
- SEROLOGY - is maintstay though
- rash can confirm or refute diagnosis
what are the different types of serological tests for syphilis?
screening enzyme immunoassay
confirmatory tests for a positive screening result is the treponema pallidum particle agglutination test TPPA
to see how active the disease is do: non-treponemal test VDRL or RPR
what is the treatment and management of syphilis?
penicillin by injection
follow up pt
partner notification
