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Preclerkship > STIs > Flashcards

STIs Flashcards

1
Q

Most commonly diagnosed bacterial STI

A

Chlamydia

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2
Q

Chlamydia/gonorrhoea primarily affect individuals of what age?

A

Women 15-24

Men 20-29

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3
Q

Syphilis most affects

A

MSM
Sex workers/clients
Peope in endemic regions

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4
Q

70% of adults will have at least one genital __ infection in their life

A

HPV

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5
Q

Relationship between spermicidal lubricated condoms and STIs?

A

Nonoxynol-9 distrupts mucosal lining –> increased infection/transmission of STIs. NEVER use rectally

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6
Q

List reportable STIs in Canada (6)

A 
Chlamydia & Gonorrhea
Chancroid
Syphilis
Hepatitis B
HIV

Some jurisdictions

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7
Q

Why shouldn’t cervical specimens be taken from prepubertal girls?

A

STIs involve VAGINA not cervix

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8
Q

Endocervical samples used for which 2 common STIs?

Exocervical samples used for which 2 common STIs?

A

Endo: Chlamydia, gonorrhoea
Exo: HSV, HPV

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9
Q

Full names for chlamydia & gonorrhea

A

Chlamydia trachomatis, Neisseria gonorrhoeae

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10
Q

What less-invasive exams are available for Chlamydia & gonorrhea

A

First-catch urine (ideally haven’t peed 2 hours before)

Vaginal specimen can be SELF-administered

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11
Q

List 6 types of tests that can be done for C & G

A 
Endocervical sample
Vaginal sample / urethral sample (women/men)
First-catch urine
Rectal 
Pharyngeal
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12
Q

Chlamydia & gonorrhea are associated with what 6 “syndromes”?

A 
Asymptomatic
Urethritis
Cervicitis
Epididymitis
PID
Intestinal/enteric syndromes
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13
Q

4 symptoms of PID

A

Lower abdominal pain
Deep dyspareunia
Abnormal bleeding
Fever

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14
Q

3 bimanual exam findings of PID

A

Cervical motion tenderness
Adenexal tenderness
Adenexal masses

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15
Q

HPV can cause precancerous/cancerous lesions in what areas?

A

Mouth/oropharynx/larynx
Cervix/vagina/vulva
Penis
Anus

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16
Q

Tranmission modes of HPV

A

Receptive/penetrative vaginal/anal/oral sex

Also non-penetrative sexual activity

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17
Q

Nonsexual behaviour that increases risk of HPV?

A

Smoking

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18
Q

What 2 types of HPV are linked to 70% of cervical cancers?

A 
Type 16 (50%)
Type 18 (20%)
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19
Q

Which HPV types are “low-risk”, associated w/ 90% of anogenital warts?

A

Types 6 & 11

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20
Q

What 3 HPV vaccines are approved in Canada?

A

Cervarix: protect against Type 16/18
Gardasil: Types 16/18 & 6/11
Gardasil 9: same as above but additonal 5 cancer-causing types (31, 33, 45, 52, 58)

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21
Q

Do you need to perform C/S if active HPV warts during delivery?

A

No, unless significant bleeding risk or obstructing birth canal

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22
Q

Goal of HPV treatment

A

Topic, for symptom relief (does NOT prevent transmission/recurrence), pt may forgo treatment

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23
Q

How can internal HPV warts be treated?

A

Trichloroacetic acid
Cryotherapy
Electrosurgery
Surgical excision

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24
Q

Clinian-performed HPV treatments

A

Podophyllin (not as good as patient-applied phodophyllotoxin)
TCA
Cryotherapy
Surgical excision or electrosurgery

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25
Q

What is the only HPV treatment safe during pregnancy

A

Trichloroacetic acid

26
Q

What is a significant public health issue wrt treating gonnorhoea, and what do we do because of this?

A

AB resistance
Do NOT use penicillin/tetracyclines/quinolones
Notify PH after treatment failures

27
Q

Patients treated for gonorrhoea should abstain from sex for __ days after completion of treatment & asymptomatic

A

3 days

28
Q

Gonnorrhea infections incubate for ___ days and are often ____

A

2-7

Often asymptomatic

29
Q

What is disseminated gonococcal infection?

A

Gonorrhea can spread tematogenously (<1% of cases) –> arthritis, dermatitis; pericarditis/endocarditis/meningitis/perihepatitis rare

30
Q

Major sequelae of gonorrhea in women (6)

A

PID
Infertility, ectopic pregnancy, chronic pelvic pain
Reactive arthritis, disseminated gonococcal infection

31
Q

Major sequelae of gonorrhea in men (4)

A

Epididymo-orchitis
Reactive arthritis
Disseminated gonococcal infection
(infertility rare but can occur)

32
Q

What is reactive arthritis? 2 other names?

A

AKA Reiter Syndrome, oculo-urethro-synovial syndrome
“can’t see, can’t pee, can’t bend my knee”
Postinfectious autoimmune process after STIs, postenteric infection (e.g. traveller’s diarrhea)

33
Q

General treatment for gonorrhea

A 
Combo therapy (AB resistance + co-infection with chlamydia common)
Cephalosporin (cefixime, ceftriaxone) + Azithromycin
34
Q

What type of AB therapy for gonorrhea preferred?

A

Directly observed single-dose therapy

35
Q

How would you treat Neonates born to mother w/ untreated gonorrhea OR with symptoms

A

Cephalosporine (don’t co-treat for chlamydia w/out positive test)

36
Q

Trace-back period for reporting chlamydia/Gonorrhea

A

60 days (or last partner if no partner in last 60 days)

37
Q

Nucleic acid tests need to wait how long after treatment before testing again? Why?

A

2-3 weeks (false-positives from dead organisms)

38
Q

What is lymphogranuloma vereneum? (LGV)

A

Disease caused by L1/L2/L3 serotype of C trachomatis

Invades lymph –> chronic swelling –> scarring, systemic symptoms

39
Q

Transmission of Chlamydia

A

Vaginal, anal ,oral

Vertical transmission

40
Q

Incubation period of Chlamydia

A

usualky 2-3 wks, up to 6 weeks

41
Q

50% of males and 70% of females with chlamydia are…

A

Asymptomatic

42
Q

Pregnant women are routinely screened at initial prenatal visit for…

A

HIV, HBV, syphilis, and (if <25 or risk factors) chlamydia & gonorrhea

43
Q

Chlamydia may cause cervicitis characterized by

A

Friability of the os

44
Q

Complications of untreated chlamydia

A

PID, ectopic pregnancy, infertility, CPP
Epididymo-orchitis
Reactive arthritis

45
Q

Annual screening for C trachomatic recommended in..

A

<25 yo

gbMSM, transgender populations

46
Q

Testing for asymptomatic chlamydia in males and females?

A

First-void urine in either

Female: also vaginal swab (can be self-admin) or cervical swab are options

47
Q

Additional tests for chlamydia that can be done in patients with symptoms?

A

Swabs: urethral, rectal, pharyngeal, conjunctival, lesion (in addition to vaginal/cervical/FVU)

48
Q

Treatment indications for chlamydia

A

1) Positive test for chlamydia
2) Positive test for gonorrhea
3) Suspected if compatible syndrome or partner has STI

49
Q

After chlamydia treatment, how long do you need to wait before you can have unprotected sex again?

A

End of multi-dose treatment

7 days after single-dose treatment

50
Q

When do you need to test for cures for C/G?

A

Persistent symptoms, non-ideal treatment regime, prepubertal/pregnant, suspected non-adherence

51
Q

Preferred treatment for non-pregnant/non-lactating adults with chlamydia?

A

Doxycycline (BID for 7 days) = tetracycline

Azithromyzin (single dose, more compliance) = macrolide

52
Q

Paps:

Benign-appearing endometrial cells are only reported in women ___ and require evaluation in ____

A

45+ yo

Postmenopausal women

53
Q

Types of glandular cell abnormalities on Pap

A

Atypical glandular cells
AGC, favor neoplastic (suggestive but not specific of adenocarcinoma)
Endocervical adenocarcinoma in situ
Adenocarcinoma

54
Q

What is the current Ontario recommended Pap schedule?

A

25+ yo, every 3 years (if negative)

Stop at 70yo if negative cytology for previous 10 years

55
Q

Squamous cervical cytologic abnormalities on Paps are called ____. 2 types?

A

CSIL = cervical squamous intraepithelial lesions

LSIS (low grade) or HSIL (high-grade)

56
Q

LSIS on Pap, especially in young women, is usually ____

A

a transient HPV infection

57
Q

LSIL cervical cytologic specimens that contain a few cells that are suspicious for but not diagnostic of
HSIL are reported as

A

atypical squamous cells, cannot exclude a high-grade squamous intraepithelial
lesion (ASC-H)

58
Q

LSIL (Bethesda system) corresponds to Cervical Intraepithelial Neoplasia (CIN) what?

A

CIN I

59
Q

HSIL = CIN ?

A

CIN II/III

60
Q

What is the next stage after HSIL/CIN III?

A

Invasive squamous cell carcinoma

61
Q

Cytologic abnormalities must be further evaluated using…

A

Colposcopy, potentially biopsy

62
Q

For ASCUS or LSIS, the next step is

A

Repeat cytology in 6 months (if same or worse then refer to colposcopy)

Preclerkship (25 decks)

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