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Repro and Sexual Health > STIs > Flashcards

STIs Flashcards

1
Q

most common STI in the UK?

A

chlamydia

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2
Q

describe chlamydia bacteria

A

gram -ve obligate intracellular bacterium

vaginal, oral or anal transmission

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3
Q

chlamydia pathogenesis?

A

unclear

mucosal epithelial cells are primary target, bacteria replicates within vacuole in cytoplasm of host cell

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4
Q

risk of pelvic inflammatory disease in chlamydia?

A

9%

- risk of ectopic pregnancy

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5
Q

how does chlamydia present in females?

A 
often asymptomatic
post coital or intermenstrual bleeding
lower abdominal pain
dyspareunia
mucopurulent cervicitis
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6
Q

how does chlamydia present in males?

A 
urethral discharge
dysuria 
urethritis
epididymo-orchitis
proctitis (LGV)
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7
Q

potential complications of chlamydia?

A 
PID
reactive arthritis (urethritis, uveitis, arthritis)
conjuntivitis (more in babies)
Fitz-hugh curtis syndrome (perihepatitis)
transmission to neonate
tubal damage
ectopic pregnancy
chronic pelvic pain
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8
Q

advice in chlamydia testing?

A

stop testing for chlamydia in women >25 with discharge (more likely to be candida)
do test women who have had chlamydia in the past year
- 1 in 5 become reinfected within 10 months

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9
Q

serovars L1-L3 of chlamydia?

A 
lymphogranuloma verenum (LGV)
type of chlamydia more common in MSM and tropical regions
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10
Q

features of serovars L1-L3?

A

rectal pain
discharge
bleeding
high risk of concurrent STIs

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11
Q

how is chlamydia diagnosed?

A

test 14 days after exposure
do NAAT
- vulvovaginal swab in females (self taken)
- first pass urine in males (self taken)
- ass rectal swab if receptive anal intercourse

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12
Q

how is chalmydia treated?

A

most commonly used doxycyline 100mg BD for 7 days

can still use single 1g dose of azithromycin followed by 500mg daily for next 2 days but not used as much (resistance)

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13
Q

what is mycoplasma genitalium?

A

emerging STI
associated with non-gonococcal urethritis and PID
- if treatment fails for either of these then test for mycoplasma genitalium

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14
Q

how is mycoplasma genitalium tested?

A

NAAT (same sites as chlamydia)

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15
Q

ghonoorhoea bacteria?

A

gram -ve intracellular diplococcus

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16
Q

primary sites of infection in gonorrhoea?

A

mucous membranes of urethra, endocervix, rectum and pharynx

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17
Q

incubation of gonorrhoea?

A

urehtral infection in men = 2-5 days

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18
Q

in which direction is gonorrhoea most likely to be transmitted?

A

more likely in male to female

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19
Q

how does gonorrhoea present in males?

A 
only <10% are asymptomatic 
green/yellow purulent urethral discharge
dysuria
pharyngeal/rectal infections
- mostly asymptomatic
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20
Q

how does gonorrhoea present in females?

A

up to 50% are asymptomatic
increased/altered vaginal discharge (in 40%)
dysuria
pelvic pain (<5%)
pharyngeal and rectal infection are usually asymptomatic

21
Q

potential complications in gonorrhoea?

A 
barthonlinitis 
tysonitis
periurethral abscess
rectal abscess
epididymitis
urethral stricture
endometritis
PID
hydrosalpinx
infertility
ectopic pregnancy
prostatitis
22
Q

how is gonorrhoea diagnosed?

A 
NAAT screening test
microscopy (if symptomatic)
- more sensitive in urethral vs endocervical
culture (if micro +ve or contact of GC)
- gives antibiotic sensitivity
23
Q

how is gonorrhoea treated?

A

1st line = ceftriaxone 1g IM
2nd line = cefixime 400mg and azithromycin 2g oral (only if IM injection is contraindicated or refused by patient)
always test for cure after 2 weeks in patient
- check all sites where they had a positive swab

24
Q

3 classifications of genital herpes presentations?

A

primary infection
non-primary first episode (have already been exposed but first symptomatic presentation)
recurrent infection

25
Q

incubation period for primary infection genital herpes?

A 
incubation = 3-6 days
duration = 14-21 days
26
Q

features of symptomatic genital herpes?

A 
blistering and ulceration of external genitalia
extreme pain
external dysuria
vaginal or urethral discharge
local lymphadenopathy
fever and myalgia (prodrome)
27
Q

first episode vs recurrent episodes?

A

first usually worse

28
Q

features of recurrent episodes?

A

more common with HSV2
usually unilateral, small blisters and ulcers
minimal systemic symptoms, resolve within 5-7 days

29
Q

how is genital herpes investigated?

A

swab base of ulcer for HSV PCR

30
Q

how is genital herpes managed?

A

oral aciclovir 400mg 3 times daily for 5 days
consider topical lidocaine 5% ointment if very painful
saline bathing
analgesia

31
Q

HSV1 vs HSV2?

A

HSV2 has more attacks per year

viral shedding following HSV2 is consistently higher than HSV1

32
Q

how does viral shedding occur in herpes?

A

more frequent in first year of infection
more in individuals with frequent recurrences
reduced by suppressive therapy (aciclovir)

33
Q

special circumstances in herpes?

A

risk of neonatal transmission if first episode in 3rd trimester (within 6 weeks of EDD)

  • recurrent episode not as bad as foetus will have developed antibodies from mother
  • should inform O+G and review birth plan
34
Q

most common viral STI in UK?

A

HPV

35
Q

low risk vs high risk HPV?

A

low risk = 6, 11

high risk = 16, 18

36
Q

different clinical sequele in different types of HPV?

A

latent infection
anogenital warts (6 and 11)
palmar and plantar warts (1 and 2)
cellular dysplasia/intraepithelial neoplasia

37
Q

incubation period of HPV?

A

3 weeks to 9 months

- can have it for years asymptomatically then have symptoms in some cases

38
Q

how do warts clear in HPV?

A

20-34% clear spontaneously
60% clear with treatment
20% persist despite treatment

39
Q

how is HPV managed?

A 
podophyllotoxin (warticon)
- topical cytotoxic agent not licensed for extra genital warts but widely used
imiquimod (aldara)
- immune modifier
- 2nd line or first line in anal warts
cryotherapy
- cytolytic can require repeat treatments
electrocautery
40
Q

syphilis bacteria?

A

treponema pallidum (spirochete bacteria)

41
Q

how can syphilis be transmitted?

A

sexual contact
trans-placental/during birth
blood transfusions
non-sexual contact (healthcare workers)

42
Q

classification of syphilis?

A

congenital
- early infectious stage = primary, secondary and early latent phase
acquired
- late non-infectious stage = late latent and tertiary phase

43
Q

features of primary syphilis?

A 
9-90 day incubation (mean 21)
primary painless lesion (chancre) at site of inoculation 
90% are genital
10% extra-genital
non-tender lympahdenopathy
44
Q

features of secondary syphilis?

A

6 weeks - 6 month incubation
skin features (macular/follicular/pustular rash on hands and feet)
lesions of mucous membranes
generalized lympadenoathy
patchy alopecia
condylomata lata (most infectious lesion in syphilis, exudes a serum teeming with treponemes)

45
Q

diagnosis of syphilis?

A

demonstrate treponema pallidum from lesions or infected lymph nodes
- via dark field microscopy or PCR

serological testing - detects antibodies to pathogenic treponemes

46
Q

what serological tests are done for syphilis?

A

Non-specific

  • VDRL
  • RPR

specific

  • TPPA (treponema pallidum particle agglutination)
  • ELIZA/EIA (enzyme immunoassay - screening test)
  • INNO-LIA (line immunoassay)
  • FTA abs (fluorescent treponemal antibody absorbed)
47
Q

treatment and follow up in syphilis?

A

early syphilis
- 2.4 MU benzathine penicillin X 1
late syphilis
- 2.4 MU benzathine penicillin X 3

48
Q

syphilis follow up serologically?

A

continue until RPR is negative or serofast

  • titres should decrease fourfold by 3-6 months in early syphilis
  • relapse/reinfection defined as when titres increase fourfold

Repro and Sexual Health (63 decks)

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