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Block 5 > STIs > Flashcards

STIs Flashcards

1
Q

What main drug classes has Neisseria Gonorrhoeae become resistant too?

A

Quinolones e.g. Ciprofloxacin
Beta-lactams due to penicillin-binding proteins
Macrolides e.g. Azithromycin

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2
Q

What are the main mechanisms of antibiotic resistance in Neisseria Gonorrhoeae?

A

Drug breakdown e.g. Penicillin resistance

Drug efflux causing multiple antibiotic resistance

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3
Q

What mediates the rapid spread of antibiotic resistance between strains of Neisseria Gonorrhoeae?

A

Plasmid and chromosome mediated

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4
Q

What are the principles of antimicrobial therapy for STIs?

A

Check national/local guidelines but:

  1. Right drug for patient by checking allergies/contraindications/interactions and organism using guidelines (BASHH) on empirical treatment until susceptibility known
  2. Right dose for patient due to weight/liver/renal function and for bacteria i.e. MIC
  3. Right time i.e. immediately
  4. Right duration: single dose can be effective and increases concordance and minimises side effecrs
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5
Q

How can you diagnose STIs microbiologically?

A
  1. M, C + S
  2. Detect with protein Ag or nucleic acid i.e. DNA/RNA (NAAT)
  3. Detect response to pathogen via Ab (serology)
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6
Q

What are the bacterial characteristics of gonorrhoea?

A

Gram -ve IC diplococci

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7
Q

What are the advantages and disadvantages of microscopy, culture and sensitivity testing?

A

Adv:

  • Rapid (result in clinic)
  • Gives antimicrobial susceptibility (2-3d after)
  • Useful for individual patient treatment and epidemiological surveillance

Disadv:

  • Less sensitive than NAAT
  • Requires skilled microscopist
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8
Q

What are the advantages and disadvantages of non-culture methods?

A

Adv:

  • 24-48hr result
  • High sensitivity and specificity
  • Combine with Chlamydia test

Disadv:

  • No antimicrobial susceptibility
  • Requires non-inhibitory specimen as body fluids such as urine may inhibit PCR so not suitable for normal swabs
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9
Q

What are the bacterial features of Chlamydia?

A

Obligate IC bacterium growing inside columnar epithelial cells

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10
Q

How do you diagnose Chlamydia?

A

It will not grow in cell free culture i.e. on an agar plate so needs a Nuclear Acid Amplification Test (NAAT) which can be >99% sensitive and specific

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11
Q

How do you diagnosis syphilis?

A

Culture not possible as Treponema Pallidum unculturable SO:

  • Microscopy with dark ground
  • Nucleic acid detection via PCR
  • Ab detection via serology
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12
Q

What are the advantages and disadvantages of syphilis microscopy diagnosis?

A

Adv:
- Specific

Disadv:

  • Low sensitivity
  • Only available primary syphilis
  • Skilled technician needed
  • Relies on good quality specimen
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13
Q

Why is nucleic acid detection of syphilis good?

A

High specificity in primary lesions and available in some sexual health clinics

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14
Q

Why is serology good for diagnosing syphilis?

A

Reacts to Ags so activity level demonstrated and it allows diagnosis of active syphilis

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15
Q

How is most syphilis diagnosed and why?

A

By Ab detection as serum IgM indicates recent infection whilst IgG stays +ve for months/years/life

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16
Q

What is PREP?

A

HIV prevention tablet - take 1 pill a day

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17
Q

How can STIs transmit through sexual contact?

A
  1. Oral/vaginal/anal/sex toys/douching

2. Skin/skin contact (e.g. HSV, molluscum, HPV)

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18
Q

What type of gonorrhoea is rising in incidence?

A

Extra-genital

19
Q

What cells at the back of throat house Chlamydia and Gonorrhoea?

A

Columnar epithelium

20
Q

How can STIs transmit through non-sexual contact?

A
  1. In utero (e.g. syphilis, BBV)
  2. Peripartum (e.g. Gonorrhoea, Chlamydia and BBV)
  3. Other BBV exposure via occupation, recreational drug use, blood/body fluid/tissue transfusion/transplant
21
Q

What are the principles of STI control?

A

Remove reservoirs/sources
Treat other infections/sources of inflammation
Interrupt transmission
Increase host resistance

22
Q

What primary prevention exists for STIs?

A

Safe sexual behaviours inc. barrier contraceptive methods
Immunisation for HPV (warts), HBV and HAV
PrEP

23
Q

What secondary prevention exists for STIs?

A 
Detect via screening
Better access to SH services
Target info (e.g. 16-25s, MSM)
If 1 STI, look for others!
Prompt effective treatment
Partner notification (contact tracing)
24
Q

Where are we currently at with HIV/AIDs life expectancy?

A

It is better than that of a smoker

25
Q

What are typical clinical presentations of STIs?

A 
ASYMPTOMATIC
Urethritis
Discharge
Ulcerative genital lesions
PID
Epididymo-orchitis
Infestations
Warts
26
Q

What can happen to the female reproductive tract due to STIs?

A 
Vaginitis
Vulvitis
Cervicitis
Endometritis
Oophoritis
Salpingitis
27
Q

What can happen to the male reproductive tract due to STIs?

A 
Urethritis
Balanitis
Prostatitis
Proctitis
Epididymitis
28
Q

What differentials exist for urethritis?

A

Chlamydia Trachomatis
Neisseria Gonorrhoeae
Non-specific urethritis (NSU) e.g. Mycoplasma Genitalium or no organism found

29
Q

What differentials exist for vaginal discharge?

A

STI: Gonorrhoea, Chlamydia or Trichomonas

Non-STI: Candidiasis (thrush) or bacterial vaginosis

30
Q

What STI differentials exist for genital ulceration?

A

Herpes Simplex Virus (1 or 2)

Syphillis

31
Q

What non-STI differentials exist for genital ulceration?

A 
Aphthous 
Behcet's
Drug induced e.g. Foscarnet
Pemphigus
Lichen sclerosus
Lichen planus
Crohn's disease
Systemic sclerosis
Steven Johnsons syndrome
Allergy
Trauma
32
Q

What are the symptoms of primary syphilis?

A

Single or multiple primary chancres that are painless or painful but firm/round - sore lasts 3-6 weeks with or w/o treatment

33
Q

What are the symptoms of secondary syphilis?

A

Rashes classically on palms/soles, multiple sores on mucous membranes, fever lymphadenopathy, fatigue, neurosyphilis and hepatitis/glomerulonephritis/myelitis etc. anything with ‘itis’!

34
Q

What are the symptoms of latent syphilis?

A

Occurs asymptomatically is secondary syphilis is untreated and lasts 10-30 years potentially progressing to tertiary

35
Q

What are the symptoms of tertiary syphilis?

A

Although now rare classified by tabes dorsalis, general paralysis of insane (GPI) and dementia

36
Q

What can cause pelvic inflammatory disease (PID)?

A

STI
Non-STI
Coil

37
Q

What are the symptoms of pelvic inflammatory disease (PID)?

A 
Pain
Discharge
PV bleeding
Low abdo tenderness inc. RUQ
Cervical excitation
Endocervical pus
Chronic pelvic pain
Tubal infertility (or abscess)
Ectopic pregnancy
38
Q

What can causes epididymo-orchitis?

A

UTI e.g. E.Coli
STI e.g. Gonorrhoea/Chlamydia
Viral e.g. mumps
Rarely TB or Brucella

39
Q

What are the complications of epididymo-orchitis?

A

Scrotal abscess

Infertility

40
Q

What other STI presentations exist?

A

Infestation by scabies or pubic lice

Lumps and bumps e.g. genital warts or Molluscum Contagiosum

41
Q

What extra-genital/systemic manifestations of STI exist?

A

Red sclera
Rashes
Swellings and skin markings (Gonorrhoea)
SARA

42
Q

What STIs can manifest genitally and also systemically?

A 
Gonorrheal bacteraemia/arthritis
PID
Perihepatitis
2ndary/3ry syphilis
SARA
Herpes meningitis
Encephalitis
43
Q

What STIs present systemically but NOT genitally?

A

HIV

Hepatitis A, B and C

Block 5 (29 decks)

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