STIs and GUM other infections Flashcards
Chlamydia is caused by and what kind of organism is it?
Chlamydia trachomatis
Obligate intracellular bacteria
Symptoms of chlamydia?
Mostly asymptomatic
or white, cloudy watery discharge, pain/bleeding in sex/urination
Which serological groups cause genital infections in chlamydia?
Serovars D-K
Investigation of chlamydia?
14 DAYS AFTER
Men- first pass urine
Women- HVS or vulvovaginal swab
For NAAT or PCR
Treatment of chlamydia?
Doxycycline 100mg bd PO x 7 days
What causes gonorrhoea?
Neisseria gonorrhoeae (gram -ve diplococcus)
Symptoms of gonorrhoea?
2-5 DAYS AFTER
Asymptomatic
or purulent discharge, burning/pain on urination
Investigation of gonorrhoea?
Men- first pass urine
Women- HVS or vulvovaginal swab
or rectal swab
For NAAT or PCR
Treatment of gonorrhoea?
IM ceftriaxone 500mg + TEST OF CURE at 2 weeks
What causes syphilis and incubation period?
Treponema pallidum (spirochaete)
Incubation= 9-90 days
Primary syphilis infection?
Painless chancre
Secondary syphilis infection?
“snail track” mouth ulcers, palm/sole rash, flu-like, lymphadenopathy
What comes after the secondary infection in syphilis?
Latent phase- no symptoms
What happens in the late stage of syphilis?
CV and neurovascular complications
Diagnosis of syphilis?
Swab for PCR
Serology
- TPPA, TPHA, IgM + IgG ELISA
Treatment of syphilis?
Injectable long-acting penicillin (Benzathine)
What are genital herpes caused by and incubation period?
HSV 1 +2
Incubation= 3-6 days
Symptoms of genital herpes?
Shallow ulcers and excruciating pain, local lymphadenopathy, fever, myalgia
Diagnosis of genital herpes?
Swab of deroofed blister for PCR
Why can genital herpes reoccur?
Stay dormant in root ganglia
Subsequent episodes shorter + less painful
Treatment of genital herpes?
Aciclovir 400mg tds x 7 days
What is genital warts caused by and incubation period?
HPV 6 + 11
Incubation= 3 weeks-9 months (ave. 3 months)
Treatment of genital warts?
Cryotherapy
Podophyllotoxin cream
Electrocautery
Symptoms of public lice?
Itching and visible eggs
Treatment of pubic lice?
Malathion lotion
Symptoms of trichomonas vaginalis (parasite)?
Vaginal discharge, irritation
Investigation of trichomonas vaginalis?
HSV for microscopy
Treatment of trichomonas vaginalis?
Metronidazole PO
What kind of virus is HIV and what does it target?
HIV- retrovirus (reverse transcriptase for replication)
Targets CD4+ receptors
Causes DYSFUNCTIONAL AND UNREGULATED immune system
HIV causes susceptibility to…
Viral infections
Fungal infections
Mycobacterial infections
Infection-induced cancers
What is a normal CD4 T helper cell count?
500-1600 cells/mm3
How is the HIV virus transmitted?
Through mucosa- rectal, buccal, cervical
Average life expectancy of HIV without treatment?
9-11 years
What is the predominant bacteria in the vaginal and what do they produce?
Lactobacillus ssp.
Lactic acid and hydrogen peroxide
What is the average pH of the vagina?
4-4.5
Other organisms present in vagina?
Strep viridans
Group B strep
Candida spp.
What is vaginal thrush caused by?
Candida albicans (only a problem if symptomatic)
Symptoms of thrush?
Female- Itchy, white vaginal discharge
Male- spotty penile rash
Predisposing factors to candida infection?
Recent antibiotics
High oestrogen (pregnancy, contraceptives)
Poorly controlled diabetes
Immunocompromised
Treatment of thrush?
Topical co-trimoxazole
Recurrent oropharyngeal candida may be a sign of?
HIV/immunosuppression
Bacterial vaginosis is more common in?
Sexually active people
What commonly causes BV?
Gardnerella vaginalis +/- anaerobes
Symptoms of BV?
Thin, watery, fish-smelling discharge
can use whiff test to increase odour
What does BV increase the risk of?
Endometriosis, HIV contraction, premature labour
Treatment of BV?
Metronidazole PO for 7 days
Symptoms of acute bacterial prostatitis?
UTI symptoms, lower abdo /back/perineal/penile pain
Diagnosis of prostatitis?
Mid-stream urine sample for culture
Treatment of prostatitis?
Ciprofloxacin for 28 days
What can prostatitis lead to?
Chronic prostatitis- chronic pelvic pain syndrome
Symptoms of primary HIV infection?
2-4 weeks after transmission:
Fever, myalgia, maculopapular rash, pharyngitis, headache
What is an opportunistic infection?
Caused by pathogen that doesn’t normally cause disease in healthy individual
At what CD4 count do opportunistic infections occur?
<300 cells/mm3
2 opportunistic infections affecting the lungs in HIV?
Pneumocystis pneumonia
TB
What is pneumocystis pneumonia caused by and symptoms?
Pneumocystis jiroveci
SOB, dry cough, fever
Treatment of pneumocystis pneumonia?
High dose co-trimoxazole
Complications of chlamydia in women?
PID, tubal damage, chronic pelvic pain
Who is the HPV vaccination given to?
Girls 11- 13 years
MSM
Worried about genital herpes but asymptomatic?
Leaflet for symptoms and test only if symptoms
Gonorrhoea management in primary care?
Refer to sexual health for treatment, test of cure and contact tracing
A cause of cerebral abscesses in HIV?
Cerebral toxoplasmosis
Which STI shows clue cells?
Gardnerella vaginalis (bacterial vaginosis)
What is a cause of cerebral abscess in HIV patients?
Cerebral toxoplasmosis (toxoplasma gondii)
Cause of retinitis, colitis and oesophagitis in HIV patients?
CMV infection
Common skin infections in HIV patients?
Herpes zoster
Herpes simplex
HPV
What is progressive multifocal leukoencephalopathy (PML)?
In HIV patients- due to John Cunningham virus
focal neurology, personality change, confusion
Why can wasting occur in HIV patients?
Chronic immune activation
Anorexia
Malabsorption/diarrhoea
Hypogonadism
3 AIDs related cancers and what causes them?
Kaposi’s sarcoma (herpes 8 virus)
Non-Hodgkin’s Lymphoma (EBV)
Cervical cancer (HPV)
Where does Kaposi’s sarcoma occur?
Mostly skin, but can be ANYWHERE
Transmission methods of HIV?
Sexual
Parenteral (drug use, blood products)
Vertical (mother-to-child)- in-utero, delivery or breastfeeding
How can we prevent vertical transmission of HIV?
Mother’s viral load undetectable at birth
How is HIV diagnosed?
Venous sample for SEROLOGY
or
Fingerprick/saliva test for antibodies (rarer)
What tests do the labs carry out to confirm HIV? (4)
- HIV antibodies (IgM+IgG)- only after 3 months
- Antigen + antibody test (p24)
- Viral load (RNA)
- RITA
Approach to HIV management?
Stage infection Opportunistic infection prophylaxis + vaccinations STI screening Support Partner notification Prevent onward transmission
Aim of anti-retroviral therapy?
Reduce viral load to ZERO
What is the most common target for anti-retroviral therapy?
Integrase (inhibit function)
Can use combination of 3 drugs to treat- called HAART
What is the most important factor in preventing resistance against anti-retroviral therapy?
ADHERENCE
If given chance to breath, virus will select out resistant strains only
Better to STOP completely (by step-down)
Side effects of HAART (toxicity)?
Diarrhoea, N+V, rash/Steven’s Johnsons, psychosis, proximal tubulopathies, osteomalacia, anaemia, hepatitis
Methods to prevent transmission of HIV?
HAART (UNDETECTABLE=UNTRANSMITTABLE)
Condoms
Regular testing
Partner disclosure
What does mycoplasma genitalium cause and how is it diagnosed?
Urethritis
NAAT from swab or urine
Is transmission of gonorrhoea more common from an infected man or woman?
Infected man
Which type is HSV more commonly causes recurrence of genital herpes and has more viral shedding?
HSV 2
Which STI can cause neonatal conjunctivitis?
Chlamydia
