STIs

Question 1

Most common STI

Answer 1

Chlamydia

Question 2

Impact of STI highest in

Answer 2

Heterosexuals under 25
MSM
Black ethnic minorities

Question 3

Largest STI diagnosis increase in MSM

Answer 3

Syphilis up 20%

Gonorrhoea up 22%

Question 4

Chlamydia Trachomatis

Answer 4

Obligate intracellular pathogen

Asymptomatic infection common

Question 5

Serovar

Answer 5

Distinct variation within species of bacteria or virus

Question 6

Chlamydia Serovars D-K

Answer 6

Most UTIs
Males- urethritis, epididymitis, prostatitis
Females- Cervicitis, PID, Fitz-Hugh Curtis
Neonate- conjunctivitis and pneumonia

Question 7

Chlamydia Servars L1-3

Answer 7

Lymphogranuloma venerum

–> buboes, proctitis (inflammation of lining of rectum)

Question 8

Chlamydia trachomatis complications

Answer 8

Reactive arthritis

Infertility

Question 9

Chlamydia trachomatis treatment

Answer 9

Doxycyline

Azithromycin

Question 10

Neisseria gonorrhoea- Males

Answer 10

Urethritis
Proctitis
Sore throat
Epididymitis
Prostatitis

Question 11

Neisseria gonorrhoea- Females

Answer 11

Cervicitis
PID
Peri-hepatitis
Septic abortion

Question 12

Neisseria gonorrhoea- Neonates

Answer 12

Conjunctivitis

Question 13

Neisseria gonorrhoea- complications

Answer 13

Septic arthritis
Blindness
Infertility
Septicaemia

Question 14

Neisseria gonorrhoea- management

Answer 14

Ceftriaxone

–> drug resistance increasing

Question 15

Genital warts

Answer 15

HPV
90% asymptomatic
Multiple sites
Some associated with carcinoma (16,18,31,33)
Increasing incidence ano-genital and oropharyngeal carcinoma
Vaccination

Question 16

Genital warts management

Answer 16

Topical podophyllotoxon
Imiquimod
Cryotherapy

Question 17

Herpes Simplex Virus 1 + 2

Answer 17

HSV-1 = Oral
HSV-2 = Genital
Primary infection
Latency
Reactivation

Question 18

Herpes simplex virus 1+2- management

Answer 18

Aciclovir
Famciclovir
Valaciclovir

Question 19

Syphilis bacteria

Answer 19

Treponema pallidum

Gram negative spirochete bacterium

Question 20

Treponema pallidum

Answer 20

Primary, secondary, latent, tertiary, congenital
Often asymptomatic in early stages
Diagnosis depends on serology

Question 21

Syphilis treatment

Answer 21

Penicillin

Doxycycline

Question 22

Primary Syphilis

Answer 22

Chancre (sore) usually single, painless
Dark ground positive
Lymphadenopathy
Serology may be negative
Infectious ++

Question 23

Secondary Syphilis

Answer 23

Rash
Fever
Lymphadenopathy
Condyloma lata
Serology positive
Infectious ++

Question 24

HIV Routine testing

Answer 24

GUM, Ante-natal, TOP, DDU

New registrations in GP and medical admissions in areas where high prevalence

Question 25

HIV Opportunistic testing of individuals at high risk

Answer 25

``` STI MSM HIV + partner IDU High prevalence country ```

Question 26

HIV Diagnostic testing with indicator clinical conditions

Answer 26

TB/lymphoma

Question 27

Primary HIV infection

Answer 27

Acute retroviral syndrome 75% patients develop symptoms within 2-6 weeks of infection Wide differential diagnosis- glandular fever, flu Increased viral replication Decreased CD4 count Time of high risk of transmission May be HIV antibody negative

Question 28

HIV antibody

Answer 28

Primary HIV infection may be HIV antibody negative HIV RNA/p24 antigen positive HIV antibody can take up to 3 months to become positive

Question 29

Primary HIV 1 infection Common features

Answer 29

``` Headache Lymphadenopathy Pharyngitis Nausea Oral/genital ulceration on occasion Rash Myalgia Fever Fatigue Weight loss Night sweats ```

Question 30

HIV causing disease

Answer 30

Infects CD4+ cells, macrophages and dendritic cells Acute (primary) HIV infection leads to massive CD4+ cell loss Chronic HIV infection associated with on-going CD4+ cell loss, decline in immune function and progressive immunosuppression

Question 31

HIV-associated disease- Direct HIV effect

Answer 31

Wasting Diarrhoea Neurological problems

Question 32

HIV-associated disease- Opportunistic infections

Answer 32

``` Viral Fungal Bacterial Mycobacterial Parasitic INFECTIONS ```

Question 33

HIV-associated disease- Malignancies

Answer 33

Kaposi's sarcoma- affects lining of blood vessels, often appears as skin lesions Lymphoma Carcinoma cervix

Question 34

CD4 count >500

Answer 34

Low risk HIV-related disease

Question 35

CD4 count 350-500

Answer 35

Symptomatic HIV disease possible

Question 36

CD4 count <200

Answer 36

Risk PCP, gut infections

Question 37

CD4 count <100

Answer 37

CMV, MAI, crypto, toxo, KS

Question 38

Aims of antiretroviral therapy

Answer 38

Suppression of HIV replication --> CD4 count recovery --> Immune reconstitution --> Long term reduced risk of morbidity and mortality

Question 39

Antiretroviral Therapy Principles

Answer 39

HAART= highly active antiretroviral therapy 6 classes of ARV drugs available Act during viral replication cycle to prevent production of new HIV particles Combination antiretroviral therapy always At least 3 drugs from at least two classes --> usually 2 NRTIS + NNRTI or PI Lifelong treatment Adherence vital for success --> resistance can develop quickly, and can be transmitted

Question 40

Antiretroviral therapy Drugs

Answer 40

At least 3 drugs from at least 2 classes | Usually 2 NRTIS + NNRTI or PI

Question 41

NRTI

Answer 41

Nucleoside Reverse transcriptase inhibitors Lamivudine Stops RNA synthesis

Question 42

NNRTI

Answer 42

Non-nucleoside reverse transcriptase inhibitors Nevirapine Stops RNA synthesis

Question 43

PI

Answer 43

Protease inhibitors Ritonavir Stops virus protein being cut up

Question 44

Types of antiretroviral drugs

Answer 44

``` Fusion inhibitor Co-receptor antagonist Nucleoside reverse transcriptase inhibitor Non-nucleoside RT inhibitor Integrase inhibitor Protease inhibitor ```

Question 45

Short term SEs HAART

Answer 45

``` Nausea/vomiting/headache Sleep disturbance (efavirenz) ```

Question 46

Long term SEs HAART

Answer 46

``` Lipodystrophy (NRTIs + PIs) Renal dysfunction (tenofovir) Peripheral neuropathy (d4T, AZT, DDI) Lactic acidosis- may be fatal (d4T, DDI) ```

Question 47

Problems with HAART

Answer 47

Long + short term side effects IRIS- paradoxical inflammatory reaction to pathogen Drug interactions Complex regimens/polypharmacy

Question 48

PEP/ PEPSE + PrEP

Answer 48

``` Indications --> High risk sexual exposure <72 hours --> Needlestick Available via virology/GUM/A+E PrEP- safe and efficacious ```

Question 49

HIV management pregnancy

Answer 49

Early HIV screening ARVT for mother- immediate + continued if low CD4, 2nd trimester + discontinued if high CD4 Elective C section- vaginal delivery possible if undetectable HIV load ARVT for infant No breastfeeding --> Reduced risk of transmission from 25 to less than 1%