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REPRODUCTION & GYNAECOLOGY > STIs > Flashcards

STIs Flashcards

1
Q

What is the most common bacterial STI?

A

Chlamydia

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2
Q

Are more males or females with chlamydia infection asymptomatic?

A

More women are asymptomatic
=> 70-80% of women
=> 50% of men

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3
Q

Through what types of sex is chlamydia transmitted?

A

Vaginal, oral or anal sex

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4
Q

The highest incidence of chlamydia is in what age group?

A

20-24 years (♂+♀)

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5
Q

What complication of chlamydia infection can cause FURTHER complications in females?

A
  • Pelvic inflammatory disease (PID)
  • PID increases risk of ectopic pregnancy ten
  • PID also carries risk of tubal factor infertility (15-20%).
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6
Q

If females ARE symptomatic, then how do they present with chlamydia?

A
  • Post coital or intermenstrual bleeding
  • Lower abdominal pain
  • Dyspareunia (painful sex)
  • Mucopurulent cervicitis
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7
Q

If males are symptomatic with chlamydia, then how do they present?

A
  • Urethral discharge
  • Dysuria
  • Urethritis
  • Epididymo-orchitis
  • Proctitis (infl. of rectal lining)
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8
Q

What are the various complications of chlamydia infection?

A
  • PID
  • reactive arthritis
  • abdominal “piano string” like adhesions
  • conjunctivitis
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9
Q

What patient group is it important to test when considering chlamydia infection?

A
  • women who have had CT in past year

as 1 in 5 treated women become re-infected within 10 months after initial treatment

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10
Q

What can the L1-3 serovars of chlamydia potentially cause?

A

LGV - Lymphogranuloma Venereum

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11
Q

LGV is more common in what group?

A

Men who have sex with men (MSM)

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12
Q

What symptoms would make you consider LGV due to chlamydia?

A
  • Rectal pain
  • discharge
  • bleeding
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13
Q

There is a high risk of other STI infections with LGV frmo chlamydia. TRUE/FALSE?

A

TRUE - other STIs = high risk

(67% HIV)

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14
Q

What tests are used to diagnose chlamydia and how soon can these be done?

A
  • Test 14 days following exposure
  • NAAT
    females (vulvovaginal swab)
    males (first void urine)
  • Test sites of sexual contact (oral, vaginal, rectal)
    e. g. If MSM add rectal swab
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15
Q

How is chlamydia now treated?

A

Doxycycline 100mg BD x 1 week

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16
Q

How was chlamydia previously treated and why has this changed?

A

Single dose azithromycin

  • changed due to increasing macrolide resistance against Mycoplasma Genitalium
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17
Q

What symptoms/other conditions are associated with Mycoplasma Genitalium?

A
  • Non Gonococcal Urethritis (15-25%)

- PID

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18
Q

Patients carrying Mycoplasma Genitalium are often asymptomatic. TRUE/FALSE?

A

TRUE

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19
Q

How is Mycoplasma Genitalium tested for and diagnosed?

A

NAAT test (same sample sites as chlamydia)

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20
Q

What are the primary infection sites in Gonorrhoea?

A 
- mucous membranes 
=> urethra
=> endocervix
=> rectum
=> pharynx.
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21
Q

What is the typical incubation period of gonorrhoea?

A

2-5 days

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22
Q

A male partner is more likely to pass chlamydia to a female partner than vice versa. TRUE/FALSE?

A

TRUE

50-90% transmission from male -> female

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23
Q

What age groups have the highest incidence of gonorrhoea?

A

MALE - 20-24

FEMALE - <20

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24
Q

How do males usually present with symptoms of gonorrhoea?

A
  • *MOST = SYMPTOMATIC** (Asymptomatic <10%)
  • Urethral discharge – >80%
  • Dysuria
  • Pharyngeal/rectal infections – mostly asymptomatic
25
Q

What sex is diagnosed more with chlamydia and what sex is diagnosed more with gonorrhoea?

A

chlamydia - more females diagnosed

gonorrhoea - more males diagnosed

26
Q

Which sex is more likely to experience complications of gonorrhoea?

A

Females (3% vs <1% in males)

27
Q

How is gonorrhoea tested and diagnosed?

A
  • NAATs
  • Microscopy ( If symptomatic)
    • Urethral
    • Endocervical (less sensitive)
  • Culture
    • Urethral
    • Endocervical
28
Q

How is gonorrhoea treated?

A

1st: Ceftriaxone 1G IM
2nd: Cefixime 400 mg oral (If IM injection = contra-indicated/ refused)

After 2 wks do Test of cure in all patients

29
Q

What is the difference between Primary infection, Non- primary first episode and Recurrent infection with regards to genital herpes?

A

Primary - never been exposed to virus before, no Ab formed

Non-Primary First Ep - first symptomatic episode but Ab already present

Recurrent - latent infection causes episodes to reoccur

30
Q

What is the normal incubation period for a genital herpes infection?

A

Incubation - 3-6 days

31
Q

How long does the first symptomatic attack of genital herpes normally last?

A

Duration - 14-21 days (usually the longest and most severe exposure)

32
Q

What symptoms are common in genital herpes?

A
  • Blistering/ulceration of external genitalia
  • Pain
  • External dysuria
  • Vaginal or urethral discharge
  • Local lymphadenopathy
  • Fever and myalgia (flu-like illness)
33
Q

What is genital herpes often overlooked or misdiagnosed as?

A

Thrush

- due to itching and discharge

34
Q

Recurrent episodes are more common with what HSV type?

A
  • HSV-2

- Recurrent episode = minimal systemic symptoms, resolves within 5-7 days (shorter than initial)

35
Q

How is genital herpes diagnosed?

A
  • Swab base of ulcer for HSV PCR
36
Q

How is genital herpes treated and how are discomforting symptoms treated?

A
  • Oral antivirals (Aciclovir 400mg TDS x 5/7)
  • Topical Lidocaine 5% ointment if very painful
  • Saline bathing
37
Q

Is viral shedding of genital herpes higher for HSV type 1 or 2?

A

Type 2

- and this is most frequent in first year of infection

38
Q

Why is it important to work out if a pregnant female has had genital herpes prior to the existing episode?

A

If she has had previous epsiode and developed Ab then these will have crossed placenta to immunise baby

  • If NOT then baby is at risk of neonatal herpes during birth
39
Q

What is the most common viral STI in the UK?

A

HPV (genital warts)

40
Q

What subtypes of HPV are covered in the current quadrivalent vaccine?

A

Low risk - 6,11 (cause anogenital warts)

High Risk - 16,18 (cause cancers)

41
Q

How many HPV subtypes will be included in the new vaccine?

A

Nanovalent Vaccine => 9 strains

including 4 current strains + 31, 33, 45, 52, 58

42
Q

What strains of HPV would cause palmar and plantar warts?

A

Types 1 and 2

43
Q

Transmission of HPV is likely to have been acquired from an asymptomatic partner. TRUE/FALSE?

A

TRUE
Subclinical disease = common on all anogenital sites
=> patients may not know they carry the disease

44
Q

What is the typical incubation period of HPV?

A

Between 3 weeks to 9 months

45
Q

Multiple HPV subtypes can be transmitted at the same time. TRUE/FALSE?

46
Q

Describe the outcomes of HPV with (or without) treatments

A 
Spontaneous clearance (no Tx) = 20-34%
Clearance with treatment = 60%
Persistence despite treatment = 20%
47
Q

Describe the typical appearance of anogenital warts

A

“cauliflower like”

- may be pedunculated => hang from a narrow connection to skin

48
Q

What treatments are available for genital warts?

A

Podophyllotoxin (Warticon)
- Cytotoxic

Imiquimod
- immune modifier

Cryotherapy

Electrocautery/ minor surgical procedure

49
Q

Who is eligible for the HPV vaccine?

A
  • Girls aged 11-13
  • Men who have sex with men (high uptake of vaccine)
  • will also eventually be rolled out to teenage boys
50
Q

What type of organism is syphilis and how is it transmitted?

A

Spirochete organism

Transmitted via:

  • Sexual contact
  • Trans-placental/during birth (=> deemed as congenital)
  • Blood transfusions
  • Non-sexual contact – healthcare workers
51
Q

What is the incubation period of PRIMARY syphilis?

A

Between 9-90 days (mean of 21 days)

52
Q

What is the primary lesion in syphilis called?

A

Chancre (painless lesion)

- at site of inoculation (90% genital, 10% extra-genital)

53
Q

What is the typical incubation period of SECONDARY syphilis?

A

6 wks to 6 months

54
Q

How does secondary syphilis normally present?

A

“the great imitator”
- disseminated infection => presents EVERYWHERE

  • Skin (rash on palms + soles)
  • Lesions of mucous membranes
  • Lymphadenopathy
  • Alopecia
  • Condylomata Lata (highly infectious lesion in syphilis)
55
Q

How is syphilis tested and diagnosed?

A

Dark Field Microscopy
PCR (polymerase chain reaction)
Serological Testing

56
Q

What serological test are specific to Treponema (syphilis)?

A

TPPA (Treponemal Pallidum Particle Agglutination)

ELISA/EIA (Enzyme Immunoassay) SCREENING TEST

57
Q

What serological tests are not syphilis specific but give an indication of inflammation and therefore infection?

A

VDRL (Venereal Disease Research Laboratory)

RPR (Rapid Plasma Reagin)

58
Q

What treatment is used in both early and late stage syphilis?

A

Long acting Penicillin inj.

more doses req’d in late syphilis

59
Q

How should you follow up syphilis serology after treatment and what would indicate reinfection?

A
  • Check RPR until negative
  • Titres should decrease by 3-6 months in early syphilis.
  • Relapse/reinfection if titres increase by fourfold

REPRODUCTION & GYNAECOLOGY (58 decks)

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