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STIs Flashcards

1
Q

What is the most commonly reported bacterial STI in sexual health clinics?

A

Chlamydia = 70-80% of women and 50% men are asymptomatic

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2
Q

What causes chlamydia?

A

Gram negative obligate intracellular bacterium = very small and stain poorly

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3
Q

What are the modes of transmission for chlamydia?

A

Vaginal, oral, anal

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4
Q

What age group has the highest incidence of chlamydia?

A

Age 20-24

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5
Q

How common is PID as a result of chlamydial infection?

A

9% of women with chlamydia will go on to develop PID = 10x increase in ectopic pregnancy and 15-20% risk of tubal factor infertility with PID

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6
Q

What is the prognosis of chlamydia?

A

Some can clear infection naturally = good TH1 and gamma interferon
Abnormal host immune response confers damage

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7
Q

What is the primary target of chlamydia?

A

Mucosal epithelial cells = replicates within vacuole

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8
Q

What is the presentation of chlamydia in females?

A

Post-coital or intermenstrual bleeding, lower abdominal pain, dyspareunia, mucopurulent cervicitis

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9
Q

What is the presentation of chlamydia in males?

A

Urethral discharge, dysuria, urethritis, proctitis, epididymo-orchitis

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10
Q

What are some complications of chlamydia?

A

PID = chlamydia causes 50% of cases
Tubal damage, chronic pelvic pain, adult conjunctivitis
Reiter’s syndrome = more common in men
Transmission to neonate, Fitz-Hugh-Curtis syndrome

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11
Q

Who should be tested for chlamydia?

A

Stop testing in women >age 25 with vaginal discharge

Test women who have had chlamydia in past year

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12
Q

How common is reinfection with chlamydia?

A

1 in 5 women with diagnosed and treated with chlamydia are likely to become re-infected within 10 months after initial treatment

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13
Q

What is LGV?

A

Serovars of chlamydia trachomitis (L1-L3) = common in male/male sex

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14
Q

What are some features of LGV?

A

High risk of concurrent STIs = 67% have HIV

Symptoms = rectal pain, discharge, bleeding

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15
Q

How is chlamydia diagnosed?

A

Test 14 days following exposure

Nucleic acid amplification test = vulvovaginal swab for females and first void urine in males

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16
Q

What swabs should be added when testing for chlamydia if male/male receptive anal sex?

A

Add rectal swab

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17
Q

How is chlamydia treated?

A

Doxycycline 100mg twice daily for 1 week

Azithromycin 1g starting followed by 500mg daily for 2 days

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18
Q

What is mycoplasma genitalium?

A

Emerging sexually transmitted pathogen = associated with non-gonococcal urethritis and PID

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19
Q

What are some features of mycoplasma genitalium?

A

Prevalence of 1-2% of population
Asymptomatic carriage
Tested for using nucleic acid amplification
High levels of macrolide estimated at 40%

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20
Q

What causes gonorrohea?

A

Gram negative intracellular diplococcus

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21
Q

What are the primary sites of gonorrhoea infection?

A

Mucous membranes of urethra, endocervix, rectum and pharynx

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22
Q

What is the incubation period for urethral gonorrhoea in men?

A

Short incubation = 2-5 days

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23
Q

What is the risk of spreading gonorrhoea to a partner?

A

20% risk from infected woman to uninfected male

50-90% risk from infected man to uninfected female

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24
Q

What is the presentation of gonorrhoea in men?

A

Asymptomatic in <= 10% = pharyngeal and rectal infections usually asymptomatic
Urethral discharge in >80%
Dysuria

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25
Q

What is the presentation of gonorrhoea in women?

A

Asymptomatic in up to 50% = pharyngeal and rectal infections usually asymptomatic
Increased or altered vaginal discharge in 40%
Dysuria and pelvic pain (<5%)

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26
Q

How common are complications from gonorrhoea?

A

Occur in 3% of females and <1% of males

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27
Q

What are some lower genital tract complications of gonorrohea?

A

Bartholinitis, tysonitis, periurethral abscess, rectal abscess, epididymitis, urethral stricture

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28
Q

What are some upper genital tract complications of gonorrhoea?

A

Endometritis, PID, hydrosalpinx, infertility, ectopic pregnancy, prostatitis

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29
Q

What tests can be done for diagnosing gonorrhoea?

A

Nucleic acid amplification test = >96% sensitivity

Microscopy and culture

30
Q

When is microscopy done for gonorrhoea?

A

Symptomatic testing = urethral has 90-95% sensitivity, endocervical has 37-50% sensitivity

31
Q

When is culture done for gonorrhoea?

A

If microscopy positive or if contact of case = urethral has >95% sensitivity, endocervical has 80-92% sensitivity

32
Q

What is the treatment of gonorrhoea?

A

First line = IM ceftriaxone 500mg

Second line = oral cefixime 400mg (only if IM contraindicated or refused)

33
Q

When do you do test of cure for gonorrhoea?

A

After two weeks of treatment

34
Q

What kind of infections may cause genital herpes?

A

Primary infection, non-primary first episode, recurrent infection

35
Q

How long does genital herpes last for?

A

Incubation period of 3-6 days

Duration of 14-21 days

36
Q

What are the symptoms of genital herpes?

A

Blistering and ulceration of external genitalia, pain, external dysuria, vaginal/urethral discharge, local lymphadenopathy, fever, myalgia

37
Q

What are some features of recurrent episodes of genital herpes?

A 
More common with HSV-2
Often misdiagnosed as thrush 
Usually unilateral small blisters and ulcers
Minimal systemic symptoms
Resolves within 5-7 days
38
Q

What do you swab for diagnosing genital herpes?

A

Swab base of ulcer for HSV PCR

39
Q

What is the treatment for genital herpes?

A

Oral aciclovir 400mg 3x for five days a week
Consider topical lidocaine 5% ointment if very sore
Saline bathing and analgesia

40
Q

What are some features of viral shedding in genital herpes?

A

Higher in HSV2 and reduced by suppressive therapy
More frequent in 1st year of infection
More common in people with frequent recurrences

41
Q

When would you consider giving suppressive therapy for genital herpes?

A

If patient has 6 or more attacks per year

42
Q

How does genital herpes affect pregnancy?

A

50% risk of transmission if primary HSV
70% of babies have localised CNS or disseminated disease
Disseminated HSV more common in preterm infants

43
Q

What is the most common viral STI in the UK?

A

HPV = lifetime risk of up to 80%

44
Q

How many genotypes are there of HPV that could cause an STI?

A

> 40 genotypes that infect anogenital epithelium
Low risk = types 6, 11, 42, 43 and 44
High risk = types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and 68

45
Q

What are some types of infection that different HPV genotypes can cause?

A

Anogenital = types 6 and 11
Palmoplantar warts = types 1 and 2
Cellular dysplasia = type 16
Cervical, anal, penile, vulval and oropharyngeal = type 18

46
Q

What is the incubation period for HPV?

A

3 weeks up to 9 months

47
Q

What is the prognosis of HPV?

A

20-34% will clear spontaneously
60% clear with treatment
20% are treatment-resistant

48
Q

What causes over 90% of anogenital warts?

A

HPV types 6 and 11

49
Q

What are the treatments for HPV?

A

Imiquimod = can be used for all anogenital warts but not licensed for pregnancy
Podophyllotoxin = not for extra-anogenital use, not licensed for pregnancy
Cryotherapy and electrocautery

50
Q

Who is vaccinated against HPV?

A

Girls aged 11-13, adolescent boys, gay men

51
Q

What causes syphilis?

A

Treponema pallidum bacteria

52
Q

How is syphilis transmitted?

A

Through sexual contact, during birth, through placenta, via blood transfusion = classed as congenital or acquired

53
Q

What types of syphilis are infectious?

A 
Infectious = primary, secondary, early latent
Non-infectious = late latent, tertiary
54
Q

What is the incubation period of primary syphilis?

A

Incubation from 9-90 days = mean is 21 days

55
Q

What are the symptoms of primary syphilis?

A

Non-tender local lymphadenopathy

Lesion known as primary chancre = painless and at site of inoculation (90% are genital)

56
Q

What is the incubation period of secondary syphilis?

A

incubation of 6 weeks -6 months

57
Q

How may the skin be involved in secondary syphilis?

A

Macular, follicular or pustular palmoplantar rash

58
Q

What are the symptoms of secondary syphilis?

A

Rash, lesions of mucous membranes, generalised lymphadenopathy, patchy alopecia, condylomata lata

59
Q

What is condylomata lata?

A

Most highly infectious lesion of syphilis = exudes serum filled with treponemes

60
Q

How is syphilis diagnosed?

A

Samples from lesions or infected lymph nodes used for dark field microscopy or PCR
Serological testing for antibodies

61
Q

What are some serological tests done for syphilis?

A 
Non-treponemal = VDRL, RPR
Treponemal = TPPA, INNO-LIA, FTA abs
62
Q

What is the screening test done for syphilis?

A

ELISA enzyme immunoassay

63
Q

What is the treatment for syphilis?

A

Early syphilis = 2.4 MU benzathine penicillin x1

Late syphilis = 2.4 MU benzathine penicillin x3

64
Q

How long do you follow up syphilis patients for?

A

Until RPR is negative or serofast = titres should decrease by fourfold by 3-6 months in early syphilis

65
Q

When does syphilis relapse occur?

A

If titres increase by fourfold

66
Q

What STIs are tested for in an STI screen?

A

Gonorrhoea, chlamydia, syphilis and HIV

67
Q

What samples are taken for gonorrhoea and chlamydia?

A

Vulvovaginal swab = women
First pass urine sample = men
Rectal and throat swab = male/male sex, gonorrhoea on microscopy and gonorrhoea contacts

68
Q

What symptomatic sampling can be done for vaginal/urethral discharge?

A 
Cervical and urethral microscopy = gram stain
Vaginal microscopy (gram stain, wet prep) and narrow range pH
Amies swab = HVS culture and sensitivity
69
Q

When would you take an Amies swab?

A 
Recurrent or persistent discharge
Vaginitis of unknown cause 
Pregnant or post partum
Post gynaecological surgery or instrumentation
Signs and symptoms of PID
70
Q

How is PID treated?

A

Ceftriaxone 1g IM, doxycycline 100mg twice daily for two weeks and metronidazole 400mg twice daily for two weeks

71
Q

What are the serovars of chlamydia?

A 
A-B = endemic trachoma (ocular infections)
D-K = urethritis, PID, epididymo-orchitis, neonatal pneumonia and conjunctivitis
L1-3 = lymphogranuloma venereum
72
Q

How does gonorrhoea presentation vary depending on the site that is infected?

A 
Urethral = discharge in >90%, dysuria
Pharyngeal/rectal = mostly asymptomatic
Endocervical = discharge in 50%, irregular bleeding, external dysuria

Reproduction (62 decks)

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