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Repro > STIs > Flashcards

STIs Flashcards

1
Q

What is the most common bacterial STI?

A

Chlamydia Trachomatis

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2
Q

Which serovars are responsible for anogenital CT infection?

A

D-K

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3
Q

Which cell type does CT infect?

A

Columnar epithelium at mucosal sites

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4
Q

What is the typical male presentation of chlamydia?

A

Milky urethral discharge
Dysuria
Abdominal pain
Signs of urethritis or proctitis

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5
Q

What is the typical female presentation of chlamydia?

A

Irregular bleeding
Abdominal pain
Signs of cervicitis or proctitis
NB on discharge - poor predictive power on its own, but commonly reported.

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6
Q

How is chlamydia diagnosed?

A

NAAT 14 days following episode of risk
Male - first pass urine (hold for one hour)
Female - HVS or VVS

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7
Q

What is the first and second line management for uncomplicated CT infection?

A
  1. Doxycycline 100mg BD for 7 days

2. Azithromycin 1g single dose followed by 2 days of 1 x 500 mg doses

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8
Q

What are the complications of chlamydia?

A 
Pelvic Inflammatory Disease- which can lead to ectopic pregnancy or tubal factor infertility 
Fitz-Hugh-Curtis 
Conjunctivitis 
Reactive Arthritis 
Reiter's Syndrome

“Can’t pee, can’t see, can’t climb a tree”

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9
Q

What is the treatment for complicated chlamydia infection?

A

Ceftriaxone 1g IM (GC cover), Doxycycline 100mg BD for 14 days (CT cover), and metronidazole 400mg BD x 14 days (anaerobe cover)

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10
Q

What organism causes Lymphogranuloma Venereum?

A

Chlamydia Trachomatis serovars L1-3

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11
Q

What are the symptoms of LGV?

A

Rectal pain, discharge and bleeding

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12
Q

Who is most at risk for LGV?

A

MSM

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13
Q

What are the gram stain characteristics of Chlamydia Trachomatis?

A

Does not gram stain as no peptidoglycan in the cell wal

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14
Q

What is the causative organism of gonorrhoea?

A

Neisseria Gonorrhoeae

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15
Q

What are the gram stain characteristics of Neisseria gonorrhoeae?

A

Gram-negative diplococcus (look like 2 kidney beans facing each other) which are easily phagocytosed therefore seen intracellularly

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16
Q

What is the typical presentation of a GC infection?

A

Male - purulent urethral discharge
Female - endocervical discharge 50%, irregular bleeding and external dysuria

NB pharyngeal and rectal cases are typically asymptomatic

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17
Q

How is GC infection diagnosed?

A

NAAT test
Microscopy used if symptomatic
Culture can be done if microscopy is +ve

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18
Q

What is the first and second-line management for GC infection?

A
  1. Ceftriaxone 1g IM
  2. Cefixime 400mg oral plus Azithromycin 2g

Test of cure for all patients

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19
Q

What are the possible complications of gonorrhea?

A

Lower tract - bartholinitis, tysonitis, periurethral abscess, rectal abscess, epidiymitis, urethral stricture

Upper tract - endometritis, PID, hydrosalpinx, infertility, ectopic pregnancy, postatitis

20
Q

What is the DDx for genital ulceration?

A 
Viral - HSV, VZV, EBV, HIV, syphilis 
Crohn's 
Fixed drug eruption
Tropical STI 
Self harm 
Stevens Johnsons 
Lichen sclerosis 
Candida 
Behcet's
21
Q

What is the diagnostic test for genital herpes?

A

Viral swab for HSV

22
Q

How does genital herpes present at each different stage?

A

Primary - blistering ulcerations, flu-like prodrome, pain, external dysuria, vaginal or urethral discharge, local lymphadenopathy

Recurrent - unilateral, small blisters/ulcers, minimal systemic symptoms, pain is mild (can be described as tingling or itch)

23
Q

Viral shedding occurs more frequently in HSV-1 or HSV-2?

A

HSV-2

24
Q

When is viral shedding most likely to occur?

A

In the first year of infection

In people with frequent recurrences

25
Q

What is the management for genital herpes?

A

Analgesia
Lidocaine 5% ointment
Antivirals within 5 days

26
Q

What must be done if a pregnant woman presents with genital herpes?

A

Ix with HSV type-specific serology and NAAT to identify if primary or recurrent - if HSV type-specific if negative but NAAT is positive, then it is most likely primary and therefore there is high risk of neonatal herpes

27
Q

HSV is an enveloped virus containing _______ stranded _______.

A

HSV is an enveloped virus containing double stranded DNA.

28
Q

Where in the body does HSV reside?

A

sacral root ganglion

29
Q

What organism causes Syphilis?

A

Treponema Pallidum (subspecifc pallidum)

30
Q

What is the mode of transmission of syphilis?

A

Sexual contact or trans-placental

31
Q

What are the different stages of syphilis infection?

A

Primary - <6weeks
Secondary - 6 weeks - 6 months
Early latent - < 2 years since exposure or last negative serology, asymptomatic
Late latent - > 2 years from known exposure of last negative serology, asymptomatic
Tertiary - 20-40 years later

32
Q

What is the typical presentation of primary syphilis?

A

Painless chancre (may have pain) usually genital, sometimes with non-tender local lymphadenopathy

33
Q

What is the typical presentation of secondary syphilis?

A

Macular, follicular, or papular rash which includes the palms and soles.
May also present with lesions on mucous membranes, generalised lymphadenopathy, fever, sore throat, malaise, anterior uveitis, cranial nerve lesions, condylomata lata

34
Q

What are the complications associated with tertiary syphilis?

A

CVD e.g. aortic regurgitation

Stroke

35
Q

How is syphilis diagnosed?

A

Gold top serological testing - ELISA/EIA

If this is positive then also follow up with TPPA and non-treponemal test (RPR).

36
Q

What is the treatment for early syphilis infection?

A

2.4 MU Benzathine penicillin IM (stat)

37
Q

What is the treatment for late syphilis infection?

A

2.4 MU Benzathine penicillin IM weekly for 3/52

38
Q

What follow up testing should be done in syphilis?

A

Follow up RPR should be repeated until titer decreased fourfold (should be 3-6 months)

39
Q

Syphilis EIA was reactive, RPR was reactive, but TPPA was non-reactive - what does this suggest?

A

Very early infection

40
Q

Syphilis EIA is reactive, RPR is non-reactive, TPPA is reactive - what does this suggest?

A

Previous syphilis infection i.e. either treated, or late latent. Must confirm that patient has been treated. EIA and TPPA remain positive for life following infection.

41
Q

What is the DDx for genital lumps?

A 
Genital warts (HPV)
Skin tags 
Molluscum contagiosum 
Spots of Fordyce 
Pearly penile papules
42
Q

Which genotypes of anogenital HPV are considered low risk?

A

6, 11, 42, 43, 44

43
Q

Which genotypes of HPV are considered high risk? Why are they high risk?

A

16 (most oncogenic), 18, 31, 33, 35, 45, 52 and 58

High risk as cause cellular dysplasia (oncogenic)

44
Q

Which genotypes of HPV are covered by the vaccination?

A

6, 11, 16 and 18

New vaccine also 31, 33, 45, 52 and 58

45
Q

Which genotypes are most commonly associated with anogenital warts?

A

6 and 11

46
Q

What are the treatment options in anogenital warts?

A

Podophyllotoxin (Condyline)
Imiquimod (Aldara)
Cryotherapy
Electrocautery

47
Q

What is the treatment for pubic lice?

A

Malathion lotion

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