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Case 23 - Infertility > STIs > Flashcards

STIs Flashcards

1
Q

STI syndromes

A

Genital discharge
Genital warts/ulcers
Pelvic pain
Sexually transmitted and blood-borne viruses

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2
Q

Risk factors

A 
Young age
No barrier contraception
Non-regular sexual relationships
Men who have sex with men
IV drug use
African origin
Social deprivation
Sex workers
Poor access to advice and treatment of STIs
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3
Q

Determinants of risky sexual behaviour

A

Individual factors - low self esteem, lack of skills and knowledge of risks of unsafe sex
External influences - peer pressure, attitudes and prejudices of society
Service provision - accessibility of sexual health services and/or lack of resources such as condoms

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4
Q

NAATs lab investigation

A

Nucleic acid amplification testing
Rely on detection of DNA
Used for Chlamydia and N.gonnorhoea
PCR can also be used for herpes

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5
Q

Microscopy, culture and sensitivity lab investigation

A

For N.gonorrhoeae, candida, bacterial vaginosis (BV), trichomonas vaginalis

Charcoal swab the medium used for gonoccoi (but also useful for transporting other organisms)

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6
Q

Blood test lab investigation

A

Syphilis, HIV, hepatitis

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7
Q

Chlamydia trachomatis - symptoms and complications

A

Obligate, intracellular, Gram -ve
Symptoms include discharge, tenderness, infertility in women, Relter’s syndrome (arthritis, cervicitis, urethritis, conjunctivitis), proctitis (inflamm of inner rectum), pharyngitis, perihepatitis (upper abdom pain)

Complicatios include PID (if symptomatic then infertility, ectopic preg, chronic pelvic pain, sexually acquired reactive arthritis, epididymo-orchitis, peri-hepatitis

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8
Q

Neonatal chlamydia

A

Manifests as conjuctivitis 5-12 days after birth or pneumonia 1-3 months

treat with oral erythromycin

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9
Q

Chlamydia investigations and treatment

A

Women - VVS swab taken
Men - first catch urine (FCU)
Extra genital sites - rectal/pharyngeal

Treatment - doxy 100mg bd for 7 days
Avoid sexual contact for duration of tx, partner notification

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10
Q

LGV

A

Lymphogranuloma venerum
Caused by one of three invasive serovars of chlamydia trachomatis
Presents as solitary genital lesion, proctitis, lymphadanopathy
Tx - doxy

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11
Q

Neisseria gonnorrhoeae bacteria

A

Gram -ve
Intracellular diplococcus
Humans only host
Infects epithelial cells of mucous membrane of GU tract or rectum
Development of localised infection with pus production
Possible asymptomatic carriage in women

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12
Q

Gonorrhoea symptoms

A

Penile urethral infection (90% symptomatic), discharge
Female urethral infection - dysuria +/- frequency
Endocervical infection - 50% increased/altered vaginal discharge, 25% lower abdom pain, occasionally inter-menstrual bleeding
Rectal - mostly asymptomatic but can present with anal discharge/pain/discomfort
Pharyngeal - mostly asymptomatic but can present with sore throat

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13
Q

Gonorrhoea lab diagnosis

A

Light microscopy of gram-stained genital specimens to look for gram -ve diplococci
NAAT - can use urine or swabs
PMN in urethral pus

men - first pass urine
women - Vulvo-vaginal swab
MSM - rectal and pharyngeal swabs as routine

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14
Q

Gonorrhoea tx

A

One of following:
Ceftriaxone 1g IM
Cipro 500mg orally

Most strains respond to ceftriaxone
Doxy also given to pts who have concomitant chlamydial infection

Partner notification - all partners within preceding two weeks

Partner tx - if >14d after exposure test and tx if +ve, if <14d then clinical risk assessment +/- abx

Test of cure - NAAT if asymptomatic

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15
Q

Bacterial vaginosis

A

Most common cause of abnormal vaginal discharge in women of child bearing age
Overgrowth of lactobacilli
RF’s - black ethnicity, receptive cunnilingus
Presentation - offensive fishy odour without itch/irritation
Diagnosis - microscopy
Tx - metronidazole

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16
Q

Thrush/candida albicans

A

Acute dermatitis of vulva/vagina caused by invasion of commensal yeasts
Presents as itch, vulval pain, superficial dyspareunia, curd like white vaginal discharge

Diagnosis is either clinical or microscopy

Tx is topical clotrimazole, beware use with condoms

17
Q

Treponema pallidum/syphilis

A

Primary - hard genital or oral ulcer at site of infection after about 3 weeks (asymptomatic for up to 24 weeks)

Secondary - red maculopapular rash anywhere plus pale moist papules in urogenital region and mouth

Tertiary - degeneration of nervous system, aneurysms and granulomatous lesions in liver, skin and bones in about 40% of patients

18
Q

Congenital syphilis

A

Placental transfer after 10-15 weeks of pregnancy
Infection can cause death or spontaneous abortion of foetus
Survivors develop secondary syphilis symptoms

19
Q

Syphilis diagnosis

A

From lesions or infected lymph nodes in early syphilis
Dark field microscopy
Direct fluorescent antibody (DFA) test
NAAT
EIA - can be for IgM for early infection or IgG - the latter becomes +ve at 5w or both

20
Q

Syphilis tx

A

Benzathine penicillin Im single dose if early
If late then IM weekly for three weeks
Neurosyphilis - procaine penicillin IM olus probenecid or benpen

21
Q

HPV

A

Induces hyperplastic epithelial lesions
Types exhibit tissue/cell specificity
1-6 month incubation period

Types have varying potential to cause malignancy - cervical carcinoma, urogenital warts, laryngeal papillomas, common/flat and plantar warts

Virus can be seen on colonoscopy after staining
Tx with podophyllum, cryo, laser and surgery

22
Q

HPV vaccine

A

Two killed vaccines available - Cervarix and Gardasil

Given to girls aged 12-13 to immunise them before become sexually active

23
Q

Herpes simplex virus

A

HSV type 1 - affects oral region and causes cold sores
HSV type 2 - associated with genital infection (penis, anus, vagina)

However both can infect mouth and/or genitals due to oral sex or autoinoculation

Commonly asymptomatic but still shedding virus and infectious

24
Q

Genital herpes

A

Transmission occurs easily by sexual contact or during birth

Neonatal infection may result in disseminated infection often involving CNS

25
Q

Genital herpes - primary infection or recurrence

A

Primary prevention -febrile flu like prodrome, tingling neuropathic pain in genital area, extensive bilateral crops of painful blisters, tender lymph nodes, local oedema, discharge, dysuria. Tx with saline bathing, local anasethetics and 5d course of aciclovir

recurrence - latent following first infection, periodic reactivation. Episodes shorter but quite often get recurrence after first one

26
Q

HSV diagnosis

A

Clinical appearance
Viral culture
DNA detection using NAAT of a swab from base of ulcer
May take up to 12w to become antibody positive after primary infection

Case 23 - Infertility (3 decks)

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