STIs Flashcards
Name 3 bacterial STIs
Chlamydia
Gonorrhoea
Syphillis
4 viral STIs
HPV
Herpes Simplex
Hepatitis
HIV
3 Parasitic STIs
Trichomonas Vaginalis
Crabs (Pubic Lice)
Scabies
The main mode of transmission is human-human. Which STI can have some inanimate sources?
T vaginalis
What factors affect the infectiousness of the index case?
Concentration and phenotype of the organism
Susceptibility of the sexual partner
Resistance of the host
Classic catchphrase
Immunity is —-, reinfections are ——, vaccine development is ———
Immunity is rare, reinfections common and vaccine development difficult (Hep B and HPV)
Which bacteria predominate in the healthy vagina?
Lactobacillis spp.
What do Lactobacillis spp produce?
Lactic acid +- hydrogen peroxide (they suppress growth of other bacteria)
What bacteria is part of a normal vagina and would only be of worry if picked up on the swab of a pregnant lady?
Group B beta-haemolytic streptococcus
What bacteria is only worrying in the vagina if symptomatic?
Candida spp
What is the normal pH of the vagina?
PH 4-4.5
What two bacteria cause urethritis?
Gonorrhoea
Chlamydia
What greatly increases the probability of HIV acquisition?
Genital Ulcers
What does candida look like?
Creamy white discharge with redness
What is the most common type of candida?
Candida-albicans
Predisposing factors to candida
Recent antibiotic therapy
high oestrogen levels
diabetes (if poorly controlled)
Immunocomprimised
With repeated treatment albicans die as they are less resistant and —- ——– which are resistant to treatment grow
non-albicans
What type of infection in candida?
fungus
How do you diagnose candida?
Vaginal swab for culture
Is candida itchy?
INTENSELY ITCHY
Treatment for candida
Topical Clotrimazole (oral fluconazole?)
What does this describe- The vagina is not inflamed, itch is rare, vagina pH is more alkaline
Bacterial vaginosis
Describe the discharge bacterial vaginosis
Fishy smelling, white homogenous, may contain frothy bubbles
In bacterial vaginosis what is seen on wet mount?
Clue cells
Bacterial vaginosis is an STI TRUE/FALSE
FALSE
Treatment of bacterial vaginosis
Metronidazole (or clindamycin cream)
What are the 5 places that Chlamydia/Gonorrhoea can infect?
Urethra Rectum Throat Eyes Endocervix
What is the commonest STI in the UK?
Chlamydia
Which organism does not stain with the gram stain as no peptidoglycan in the cell wall (but if it did it would be gram negative)?
Chlamydia
What are the 3 serological subgrouping of Chlamydia
Serovars A-C –> Trachoma (eye infection-not STI)
Serovars D-K –> genital infection
Serovars L1-L3 –> LGV
What does gonorrhoea look like on microscopy?
Two kidney beans facing each other
Treatment of Gonorrhoea
IM Ceftriaxone (2nd line - Cefixime oral)
Test of cure is recommended in all STI cases TRUE/FALSE
FALSE- only recommended in gonorrhoea due to concerns of resistance
What is the incubation period of urethral infections of gonorrhoea in men?
Usually short (2-5 days)
Treatment of chlamydia
Uncomplicated- Doxycycline
Complicated- Azithromycin
Presentation of chlamydia
-Pain when peeing
-Unusual discharge (mild, watery)
WOMEN
-Pain in tummy
-Bleeding after sex/between periods
MEN
-Pain/swelling in testicles
Complications of Chlamydia
PID
Reactive arthritis
Epididoymo-orchitis
What are the three main components of reactive arthritis (formerly known as Reiters syndrome)
Urethritis
Conjunctivitis
Seronegative arthritis
Where is there a lot of genetic exchange of resistance within……
the pharynx
Presentation of gonorrhoea
Thick green/yellow discharge
Pain when urinating
Bleeding between periods
What proportion of people with gonorrhoea are asymptomatic?
10% Men
50% Women
If someone presents with Chlamydia/ Gonorrhoea how do you diagnose them?
Swab- Men (1st void early morning urine), Women (Vaginal swab)
Then NAAT –> Tests for both organisms in one test
How does LGV present?
Rectal pain
Discharge
Bleeding
LGV rectally has identical histology with what?
Crohns
Treatment of LGV
3 week course of doxycycline
What is proctitis?
Inflammation of the lining of the rectum
Presentation of acute bacterial prostatitis
Symptoms of UTI
Pain (lower abdomen pain/back/perineal pain)
Tender prostate on examination
Acute bacterial prostatitis can be caused by different things in younger v older men
Young- Chlamydia/Gonorrhoea
Older- UTI
Treatment of acute bacterial prostatitis
Ciprofloxacin 28 days
What is the bacterium that causes syphillis?
Treponema pallidum
As treponema palladium does not stain on gram stain what does the diagnosis depend on?
PCR test
What are the 4 stages of syphillis infection
Primary lesion
Secondary stage
Latent stage
Late stage syphillis
What is the primary lesion of syphillis
Chancre
Organism multiplies at the inoculation sites
Chance is painful TRUE/FALSE
TRUE
Painless, non-tender lymphadenopathy
What is the secondary stage of syhpillis?
Large numbers of bacteria circulating in blood with multiple manifestations at different sites
What is the most highly infectious lesion in syphillis?
Condylomata Lata
What is late stage syphillis?
Cardiovascular or neurovsacular complications many years later
What is the screening test for syphillis?
Combined IgG and IgM ELISA
IgM ELISA is a marker of….
Recurrent, untreated infection (of syphillis)
TPPA and VDRL are marker are…
Untreated active infection (of syphillis)
What are the specific serology used in Syphillis?
Combined IgG and IgM ELISA
TPPA
TRUE/FALSE TPPA remains positive for life
TRUE, therefore not useful for monitoring
What are the non specific serology used in syphillis?
VDRL
RPR
What is non-specific serology good/bad for
Useful for mentoring response to therapy (usually decline and can become negative after successful treatment)
Indicate tissue inflammation, may be false positive
Treatment of syphillis
Penecillin
Which two serology stay positive for life in syphillis?
IgG
TPPA
Which serology becomes negative after treatment?
IgM
VDRL
If syphillis but penicillin allergic what do you do
Penecillin desensitisation
Penecillin has a very —- rate of replication
slow
What is the cause of Genital Herpes?
HSV
What are the two types of HSV that can cause genital herpes?
HSV type 1 (also cause cold sores)
HSV type 2 (more common)
Presentation of genital herpes
Blistering/ulcerating pain Extreme dysuria Discharge Lymphadenopathy Fever
In genital herpes there can be exquisitely painful multiple small vesicles. What specifically causes this?
Inflammation at nerve endings
TRUE/FALSE
HSV2 viral shedding more than HSV1
TRUE
What is the best test for HSV carriage between recurrences?
There is no good test. PSYCH
Treatment of genital herpes
aciclovir + lignocaine
What is the Ddx you need to consider when there is a vanishing and recurring rash
Most likely HSV
Shingles (rare)
Are recurrent episodes more common with HSV-1 or HSV-2
HSV-2
What causes genital warts?
HPV
What is the most common viral STI in the UK?
HPV
What types of HPV are the most common causes of anogenital warts
HPV6 and HPV11
TRUE/FALSE Subclinic disease is common in genital warts
TRUE ( likely to have acquired HPOV from an asymptomatic partner)
What is the incubation period of genital warts?
3wks-9months
Who is able to get the HPV vaccination?
Girls 11-13years
MSM <45
Treatment for genital warts
Podophyllotoxin (Warticon)
Imiquimod
Cryotherapy
Electrocautery
Presentation of trichomonas vaginalis
Yellowish/green vaginal discharge frothy
Itching
Soreness
(IN FEMALES)
Diagnosis for trichomonas vaginalis
HVS for microscopy
Treatment of trichomonas vaginalis
Oral metronidazole
How are pubic lice acquired?
Close genital skin contact
What actually causes the itching with pubic lice?
Lice bites skin and feed on skin which causes itching in pubic area
Treatment for pubic lice
Malathion lotion
