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Gwen - Reproductive Medicine (Obs, Gyn, Breast) > STIs > Flashcards

STIs Flashcards

1
Q

What is the definition of sexually transmitted infection?

A

The main mode of transmission of the organism is through sexual contact

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2
Q

What is the definition of sexually transmitted disease?

A

A disease caused by a sexually transmitted infection e.g. pelvic inflammatory disease

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3
Q

What is a sexually transmissible infection?

A

Disease can be transmitted by sexual contact, but it is not its main mode of transmission

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4
Q

What are different forms of sexual contact?

A
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5
Q

High risk groups for STIs

A

Age <25

Children of teenage mothers

Sex workers

MDM

Travellers from areas of high IV prevelance and their sexual partners

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6
Q

What are infective causes of vaginal discharge?

A
  • Candida albicans
  • Trichomonas vaginalis
  • BActerial vaginosis
  • Neisseria gonorrhoae
  • Chlamydia trachomatis
  • HSV
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7
Q

What are non-infective causes of vaginal discharge?

A
  • Cervical polyps
  • Neoplasms
  • Retained products - tampons
  • Chemical irritation
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8
Q

What are infectious causes of urethral discharge?

A
  • Nesseiria gonorrhoae
  • Chlamydia trachomatis
  • Mycoplasma genetalium
  • Ureaplasma urealyticum
  • Trichomonas vaginalis
  • HSV
  • HPV
  • UTI
  • Reponema Pallidum - meatal chancre
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9
Q

What are non-infective causes of urethral discharge?

A
  • Physical/chemical trauma
  • Urethral stricture
  • Nonspecific
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10
Q

What are infective causes of genital ulceration?

A
  • Sypillis - primary chancre, secondary mucous patches, tertiary gumma
  • Chanroid
  • Lymphogranuloma venereum
  • Donovanosis
  • HSV - Primary, recurrent
  • HZV
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11
Q

What are non-infective causes of genital ulceration?

A
  • Behcet’s syndrome
  • Toxic epidermal necrolysis
  • SJS
  • CArcinoma
  • Trauma
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12
Q

What are the main symptoms that can occur in STIs?

A
  • Dyspareunia
  • Vaginal/urethral discharge
  • Ulceration
  • Pain
  • Itch
  • Malodour
  • Genital swelling
  • Eye symptoms
  • Dysuria
  • Haematuria
  • Abdominal pain
  • Systemic symptoms - Skin rash, joint pain, malaise, lymphadenopathy,fever
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13
Q

What things would you want to ask about in a full sexual history?

A
  • PC/HPC
  • Past sexual history
  • Menstrual history
  • Gynae history
  • Obstetric history
  • PMH
  • Medications + Allergies
  • Social history
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14
Q

What would you want to ask about in a menstrual history?

A

MR FLOPPI DIC

  • Menopause
  • Regularity
  • Flow
  • Odd bleeding - Post-coital, Post-menopausal, Intermenstrual
  • Dysmenorrhoea
  • Initiation - menarche
  • Cycle - days on/days off
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15
Q

What would you want to ask about in the gynae history section of a sexual history?

A
  • Previous gynaecological disease +/- treatment
  • Last smear - date and result
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16
Q

What would you want to ask about in past sexual history?

A
  • Last sexual contact?
  • Casual/regular partner - how long for?
  • Consensual?
  • Male or female?
  • Types of sex involved - anal, vaginal, oral, multiple partners
  • Contraception used - condoms and/or other
  • Nationality of contact
  • Any other partners
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17
Q

What would you want to ask about in the obstetric section of the history when taking a full sexual history?

A
  • Contraception being used?
  • Current pregnancy/unsure?
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18
Q

What specific questions could you ask about HIV to identify positive risk factors for infection?

A
  • Have you ever had a partner whom is known to be HIV positive?
  • Have you ever had sex with a bisexual man/engaged in male homosexual activity?
  • Have you ever had sex with someone abroad, or who was born in a different country?
  • Have you ever injected drugs?
  • Are you aware of any of your previous partners having ever injected drugs?
  • Have you ever paid someone for sex, or been paid for sex?
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19
Q

What is the following?

A

Balanitis - specifically candida balanitis

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20
Q

What is the following?

A

Genital ulcer - think of infectinve and non-infective causes

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21
Q

What is the following?

A

Genital warts - specifically HPV warts

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22
Q

What is the causative organism of gonorrhoea?

A

Neisseria gonorrhoeae

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23
Q

What is the general incubation period of neisseria gonorrhoea?

A

Usually 5-6 days - can be 2 days - 2 weeks

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24
Q

What sex does gonorrhoea occur in most commonly?

A

Men - often in MSM

(Least common, most serious)

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25
Q

What are symtpoms of gonorrhoea in men?

A

10% asymptomatic

  • Thick profuse yellow discharge
  • Dysuria
  • Pharyngeal/rectal infection
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26
Q

What are symptoms of gonorrhoea in women?

A

>50% asymptomatic:

  • Vaginal discharge
  • Dysuria
  • Intermenstrual/post-coital bleeding
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27
Q

What investigations would you consider doing if you suspected gonorrhoea?

A
  • NAAT testing on samples obtained as follows:
    • Women - a vulvovaginal swab (which may be self-taken)
    • Men - first pass urine

Sites sampled for swabs should be mucosal sites associated with symptoms, and sites related to the type of sexual activity reported.

  • Urethral/endo-cerival swab for gram stain
  • Blood culture
  • Join aspiration and microscopy if dissmentinated infection suspected
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28
Q

What is NAAT?

A

Nucleic acid amplification test

A technique utilized to detect a particular nucleic acid, virus, or bacteria which acts as a pathogen in blood, tissue, urine. Amplification is done using PCR or ligase chain reaction

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29
Q

What might you see on urinalysis in someone with gonorrhoea?

A

Positive leukocyte esterase

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30
Q

What gram-type is gonorrhoea?

A

Intracellular gram-negative diplococci

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31
Q

Why might you do imaging in someone with gonorrhoea?

A

Look for features of PID - inflammatory changes of fallopian tubes and ovaries, abnormal fluid collection

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32
Q

How would you treat confirmed gonorrhoea?

A
  • Ceftriaxone 500mg IM once plus Azithromycin 1g Oral
  • Add doxycycline +/- metranidazole if complicated
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33
Q

When is metranidazole added to treatment of gonorrhoea?

A

If there is a history of sexual assault/abuse

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34
Q

What complications can occur in men with gonorrhoea?

A
  • Epididymitis, prostatitis
  • Acute mononeuritis
  • Disseminated gonococcal infection
  • Acute monoarthritis
  • Reiter’s syndrome
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35
Q

What complications can occur in women with gonorrohoea?

A
  • PID
  • Bartholin’s Abscess
  • Peri-heptitis
  • Disseminated gonoccocal disease
  • Acute Mononeuritis
  • Reiter’s syndrome
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36
Q

What is disseminated gonococcal disease?

A

Bacteremic spread of the sexually transmitted pathogen, Neisseria gonorrhoeae, which can lead to a variety of clinical symptoms and signs, such as arthritis or arthralgias, tenosynovitis, and multiple skin lesions

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37
Q

How should you follow-up someone with gonococcal infection?

A

Test of cure at 2 weeks and test of reinfection at 3 months

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38
Q

What organism causes chlamydia infection?

A

Chlamydia trachomatis serovars D to K

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39
Q

How does chlamydia present in women?

A

Asymptomatic - 80%

  • Vaginal discharge
  • Dysuria
  • Intermenstrual/post-coital bleeding
  • Dyspareunia
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40
Q

What proportion of women are asymptomatic with chlamydia infection?

A

80%

(Most common, least serious - although leading cause of infertility in UK)

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41
Q

How can chlamydia present in men?

A

Asymptomatic > 70%

  • Slight watery discharge
  • Dysuria
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42
Q

What is the consistency of urethral discharge produced in chlamydial infection?

A

Watery discharge

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43
Q

What is the consistency of urethral discharge produced in gonococcal infection?

A

Thick yellow discharge

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44
Q

How would you test for chlamydia infection?

A

NAAT for diagnosis of smaples collected as follows:

  • Women
    • Swabs - urethra, vagina, cervix, rectum
    • First void urine
  • Men
    • First void urine
    • Urethral swab
  • Both
    • ​Rectal swabs if symptomatic
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45
Q

How would you manage someone with chlamydia?

A

Azithromycin 1g PO

Doxyxycine if rectal infection (CI pregnancy)

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46
Q

What are complications of chlamydia in women?

A
  • Pelvic inflammatory disease and hence:
    • ectopic preganncy
    • infertility
  • Reactive arthritis/reier’s syndrome
  • Cervical cancer
  • Perihepatitis (Fitz-Hugh-Curtis syndrome)
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47
Q

What are complications of chlamydia in men?

A
  • Epididymitis
  • Reactive arthritis
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48
Q

What complications can occur in neonates with chlamydia?

A
  • Chlamydia pneumonia
  • Opthalmia neonatorum - conjunctivis
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49
Q

What are features of reiter’s syndrome

A

Can’t see, can’t pee, pain in the knee

  • Urethritis/cervicitis
  • Conjunctivitis
  • Arthritis
50
Q

What age group does chlamydia usually affect?

A

<25 years + sexually active

51
Q

What is the average incubation period of chlamydia trachomatis?

A

7-21 days

52
Q

What gram-type is chalmydia trachomatis?

A

Gram-negative

53
Q

What herpes viruses cause genital herpes?

A

HSV 1 + 2

54
Q

Typical follow up chlamydia

A

Test for reinfection at 3-21 months. Earlier test not needed unless symptoms persist.

55
Q

How does HSV infection present?

A

80% - no symptoms

  • Monthly/annual buring/itching then blistering rash then tender ulceration
    • Genital
    • Oral
  • Tender inguinal nodes
  • Flu-like symptoms
  • Urethral discharge
  • Proctitis
  • Dysuria
56
Q

Why is HIV ragarded as a risk factor for clinical presentation of HSV disease?

A

Increases risk of reactivation and infection

57
Q

What is the pathogenesis of herpes infection?

A

Virus initially breaks mucosal barrier/skin. It then replicates in the epidermis, and infects sensory/autonomic nerve endings and travels by retrograde axonal transport to sensory ganglia. It then enters a latent state, which allows the virus to evade the immune system

Reactivation of the virus occurs when it travels by anterograde transport to mucosal/cutaneous surface

58
Q

What clinical presentation of herpes does HSV 1 cause?

A

Mainly oral herpes

59
Q

What clinical presentation of herpes does HSV2 cause?

A

Mainly genital herpes

60
Q

How would you diagnose herpes?

A

Clinical impression (grouped vesilces/papules = burst forming shallow ulcers)

Swab - viral culture, HSV PCR, IgG assay

61
Q

How would you manage someone with HSV infection?

A
  • Pain relief - Topical lidocaine, paracetamol/ibuprofen
  • Antivirals - Aciclovir/Valaciclovir/Famciclovir
    • Primary outbreak - aciclovir 400mg 5 dats
    • Infrequent recurrences - aciclovire 1.2g daily until symptoms gone
    • Frequent recurrences - aciclovir 400bd as supression
  • Counselling - recurrence, implications for sexual partners (avoid sex if symptomatic)
62
Q

How does HSV affect pregnancy?

A

Delivery by caesarean section if priary HSV is contraindicated after 34 weeks within last 6 weeks of pregnancy.

SLight increase in risk of miscarriage in first trimester.

63
Q

What are complications of HSV infection?

A
  • Autonomic neuropathy (urinary retention)
  • Neonatal HSV
  • Secondary infection
  • Encephalitis/Meningitis
  • Keratitis/Keratoconjunctivitis
64
Q

Incubation period HSV

A

About 5 days to months. Some people never report symptpms.

65
Q

What is the causative organism of trichomoniasis?

A

Trichomonas Vaginalis

COmmon

66
Q

What are the symptoms of trichomoniasis in men?

A

Asymptomatic

67
Q

What are symptoms of trichomoniasis in women?

A

30% asymptomatic:

  • Profuse thin vaginal discharge - greenish, foul-smelling, frothy
  • Vulvitis - itching

“strawberry cervic” on speculum

68
Q

What investigations would you do if you suspected tichomoniasis?

A

High vaginal swab

  • Microscopy of wet preparation
  • NAAT testing
  • Note that no urine test yet so no test for men
69
Q

How would you manage someone with trichomoniasis?

A
  • Metronidazole
    • 400mg po bd for 5 days, or
    • 2g single dose.
70
Q

What are complications of trichomoniasis?

A
  • Miscarriage
  • Pre-term labour
71
Q

What is the main organism implicated in anogenital warts?

A

Human papilloma virus - 6 and 11

72
Q

How does HPV present?

A

Anogenital warts - occassionally itchy or painful. Texture of a small cauliflower.

73
Q

How would you manage anogenital warts?

A
  • Topical podophyllotoxin CI in pregnancy
  • Imiquimod CI pregnancy
  • Cryotherapy
  • Diathermy/Ablation
  • Scissor removal
74
Q

What organism causes syphillis?

A

Treponema pallidum

75
Q

What is the incubation period of treponema pallidum?

A

9-90 days until first chancre. But can be asymptomatic

76
Q

Describe the natural history of syphillis

A

Primary = local painless ulcer on trunk/face/palms/soles that results within 2-3 weeks

Secondary = 4-10 weeks post infection with general malaise, fever, generalised ymphadeonpathy etc

Tertiray = the neurovasculr, cardiovasular, gummatous complications. Occurs after a latent period of 2 or more years (when patient is non infectious). Gumma are characteristic lesions.

77
Q

What are features of primary syphillis?

A

Chancre

Begins as macule -> papule -> painless ulcer (chancre) with central slough and defined rolled edges

78
Q

What are features of secondary syphillis?

A

Dissemination 4-10 weeks after initial chancre:

  • Maculopapular rash - can be on palms and soles
  • Mucous patches
  • Condyloma lata
  • Fever
  • Headache
  • Myalgia
  • Lymphadenoapthy
  • Hepatitis
  • Patchy alopecia
79
Q

What could cause the following?

A

Secondary syphillis - maculopapular rash

80
Q

What could cause the following?

A

Secondary syphillis - mucous patches

81
Q

What could cause the following painless ulcer?

A

Primary syphillis - chancre

82
Q

What could cause the following?

A

Secondary syphillis - condyloma lata - pale, raised plaques

83
Q

What are features of tertiary syphillis?

A

Occurs 20-40 years after initial infection

  • Aseptic meningitis
  • Neurosyphillis - Seizures, Psychiatric symptoms, Focal neurological deficit
  • Tabes dorsalis
  • Gummatous syphillis
  • Cardiovascular syphillis

(v rare)

84
Q

What is tabes doralis?

A

Also known as syphilitic myelopathy, is a slow degeneration (specifically, demyelination) of the neural tracts primarily in the dorsal columns (posterior columns) of the spinal cord (the portion closest to the back of the body) & dorsal roots.

85
Q

What are argyle robertson pupils?

A

Characterised by:

  • Miosis (small pupils)
  • Absence of the pupillary light response
  • Brisk accommodation reaction
  • Bilateral involvement.
86
Q

What is the mechanism behind Argyll-Robertson pupils?

A

Caused by a pretectal lesion in the dorsal midbrain affecting the fibres of light reflex, which spare the fibres of the accommodation pathway that innervate the Edinger–Westphal nuclei

87
Q

What are features of tabes dorsalis?

A
  • Dorsal column degeneration
  • Orthapaedic pain - Charcots joint
  • Reflexes - Areflexia and extensor plantars
  • Shooting pain
  • Argyll-robertson pupil
  • Locomotor ataxia
  • Impaired proprioception
  • Syphillis
88
Q

What are features of gummatous syphillis?

A

Destructive granulomata in skin, mucous membranes, bones, viscera

89
Q

What stage of syphillis is gummatous syphillis?

A

Tertiary syphillis

90
Q

What are features of cardiovascular syphillis?

A
  • Aortitis
  • Aortic regurgitation +/- aneurysm
91
Q

What are features of neurosyphillis?

A
  • Asymtpomatic neurosyphillus - postive CSF serology without symptoms ro signs
  • Meningovascular syphillus - subacute meningitis with CN palsies, GUMMA, paraperesis
  • General paresis of the insane - progressive dementia, brisk reflexes
  • Tabes dorsalis - lightening pains in legs, ataxia loss of reflexes, neuropathic (charcot’s) joint
  • Argyll robson pupuil
92
Q

What could cause the following?

A

Tertiary syphillis - gummatous syphillis

93
Q

What are features of early congenital syphillis?

A

Presentation before 2 years

  • Prematurity + IUGR
  • Hepatosplenomegaly
  • Nasal chondritis
  • Skin rash
  • Osteochondritis
  • Neuro symptoms - cranial nerve palsies, hydrocephalus
94
Q

What are features of late congenital syphillis?

A

Presentation after 2 years

  • Craniofacial abnormalities
  • Hutchison’s triad - hutchisons teeth, intersitial keratitis, CNVIII deafness
  • Neurosyphillis
  • Saber shins
  • Frontal bossing
  • Paroxysmal cold haemoglobinuria
95
Q

How would you investigate if you suspected syphillitic infection?

A
  • Bloods - TP IgG/IgM, TPPA, RPR
    • TP IgG/IgM
    • EIA = enzyme imune assay (remains life long in the presence of current or past infection) TREPONEMAL SPECIFIC
    • TPPA = T pallidum particle agglutination (remains life long in the presence of current or past infection) TREPONEMAL SPECIFIC
    • FTA-ABS (fluorescent antibody absorption) (remains life long in the presence of current or past infection) TREPONEMAL SPECIFIC
    • RPR = rapid plasma reagin test (correaltes with disease activity) TREPONEMA NON SPECIFIC
    • VDRL = venereal disease research lab test (marker of treatment efficaicy) NON TREPONEMAL SPECIFIC
  • Imaging - CXR, ECHO, CT/MRI
  • Other - swab + dark-field microscopy (FROM LESIONS)
96
Q

What type of organism is trepnema pallidum?

A

Coiled Spirochaete

97
Q

What is TPPA?

A

Serum T pallidum particle agglutinin

98
Q

What is RPR testing for syphillis testing?

A

Serum rapid plasma reagin test

Correlates with disease activity, and can also be used as a marker of treatment efficacy

99
Q

Why might you consider doing a CXR in someone with syphillis?

A

Cardiac abnormality

100
Q

Why might you do an ECHO in someone with syphillis?

A

Looking for cardiac abnormalityif suspected

101
Q

How would you manage someone with early syphillis (<2 years)?

A
  • Benzathine penicillin IM 2.4 MU
  • Consider Doxycycline 100mg Bd if allergic
102
Q

How would you manage late syphillis (>2 years)?

A
  • Benzathine penicillin 2.4MU im weekly for 3 doses
  • Consider Doxycycline 100mg bd po 28 days if allergic
103
Q

What is lymphogranuloma venerum?

A

A STD caused by the invasive serovars L1, L2, L2a or L3 of Chlamydia trachomatis

104
Q

What are features of lymphogranuloma venerum?

A

Painless papule/ulcer, which can be followed by:

  • Lymphadenopathy
  • Fever
  • Arthritis
  • Pneumonitis

Can also have haemorrhagic prostatitis

105
Q

What is chancroid?

A

A bacterial STD caused by infection with Haemophilus ducreyi. It is characterized by painful necrotizing genital ulcers that may be accompanied by inguinal lymphadenopathy

106
Q

What would you want to look for on examination of someone with an STI in a male?

A
  • Retract foreskin
  • Inpect urethral meatus
  • Scrotal contents/tenderness/swelling
107
Q

What might you look for on exmaination in a woman with a suspected STI?

A
  • Vulval examination
  • Speculum examination
  • Bimanual examination for adnexal tenderness
  • Palpate abdomen for masses
  • Consider PR exam - if anal symptoms
  • Inguinal lymph nodes
  • Oral mucosa
108
Q

What is pelvic inflammatory disease?

A

Results when infection ascend from the cervix or vagina into the upper genital tract. It includes endometritis, salpingitis, tubo-ovarian abscess and pelvic peritonitis.

Salpingitis is used interchangably with PID

109
Q

What are the most common causes of pelvic inflammatory disease?

A
  • Chlamydia (most common)
  • Gonorrhoea
  • Uterine instrumentation
  • Post-partum infection
110
Q

What are symptoms of PID?

A
  • Lower abdominal pain - usually bilateral
  • Increased vaginal discharge (cervicitis)
  • Heavy mesntrual bleeding (endometriosis)
  • Irregular bleeding
  • Postcoital bleeding
  • Deep dyspareunia

Suspect in any female with lower abdo pain with unusual cervical/vaginal discharge

111
Q

What are signs of PID?

A
  • Mucopurulent discharge from cervix with contact bleeding - cervicitis
  • Adnexal/suprapubic tenderness
  • Cervical motion tenderness
  • Pyrexia
  • Palpable adnexal mass

Cervical excitation

112
Q

How would you diagnose PID?

A

Clinical diagnosis mostly, but laparoscopy is the gold standard (only indicated if diagnosis is uncertain)

  • Bloods - FBC + CRP + Blood cultures (if unwell)
  • Other - swabs
113
Q
A
114
Q

What precautions may a woman who is pregnant with HSV have to take to protect her unborn child form HSV infection?

A
  • Delivery by C-section - if PRIMARY HSV infection contracted after 34 weeks (Risk of infecting baby is very high if delivered vaginally)
  • If primary infection > 2 months prior to delivery - vaginal delivery likely to be safe to baby as antibodies will have been passed on.
  • If patient has developed HSV in the first trimester - small risk of miscarriage
  • Aciclovir - generally is not advocated before 20 weeks.
115
Q

What are complications fo PID?

A
  • Tubo-ovarian abscess
  • Fitz-Hugh-Curtis syndrome - liver capsule inflammation with perihepatic adhesions
  • Recurrent PID
  • Ectopic pregnancy
  • Subfertility/infertility
  • Bilateral hydronephrosis
116
Q

How would you manage PID?

A
  • Admit if severe
  • Antibiotics - IM ceftriaxone/azithromycin + PO doxycycline + metranidazole
  • Drain abscess
  • Consider anti-emetics - if vomiting

There should be a low threshold for treatment

117
Q

What are some of the features of chronic PID?

A
  • Pelvic pain
  • Menorrhagia
  • Secondary dysmenorrhoea
  • Discharge
  • Deep dyspareunia
118
Q

Why can bilateral hydronephrosis occur as a complication of PID?

A

Due to local inflammation of the ureters - causes them to stenose and back up

119
Q

What STI’s are associated with Ftz-Hugh-Curtis syndrome?

A
  • C. Trochamatis
  • Can be in gonorrhoea
120
Q

What is the following?

A

Ftiz-Hugh-Curtis syndrome

Gwen - Reproductive Medicine (Obs, Gyn, Breast) (49 decks)

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