STIs and GUM - Syphilis, HIV, Genital Herpes, Chlamydia, Gonorrhea, Genital warts, Bacterial Vaginosis, Thrush, Molluscum contagiosum Flashcards
Syphilis
-causative organism
-transmission
-pathophysiology
Treponema pallidum
Sexual contact - MSM
Blood transfusion/IVDU
Pregnancy transmission
Primary - 3wks post exposure
-single painless ulcer + local non-tender LN
Secondary - systemic spread in 6wks-6months
-symmetrical maculopapular rash - trunk, face, palms, soles
-constitutional symptoms
Early latent - confirmed infection without current clinical features
Tertiary/late syphilis - 2 years
-tabes dorsalis, GPI
-CV impacts
Syphilis
-investigation
-
Examination
-genital - chancre
-skin - mouth, palm, soles
-neuro, eye involvement
LP, CSF analysis if neuro involvement
GUM and sexual health screen
Serological tests
Non treponemal - active infection, but not specific for syphilis
Treponemal specific - AB positive for life
Syphilis
-management
-possible treatment reaction
GUM referral for 1st line treatment
-Benzathine benzylpenicillin (doxycycline alt)
Avoid all sexual contact unless
-diagnosis excluded
-successful treatment confirmed - 4fold decline in non-treponemal titre
Contact tracing and HIV testing
Jarisch-Herxheimer reaction - fever, rash, tachycardia after 1st Abx dose
-no treatment needed, can give IV paracetamol
Genital herpes
-causative organism
-presentation
-diagnosis
-management
-pregnancy
HSV1 - oral
HSV2 - genital
Painful genital ulceration
Tender inguinal LN
Dysuria => Urinary retention
Primary episode - headache, fever, tired
Gold standard - NAAT
HSV serology useful if recurrent genital ulceration of unknown cause
Conservative - saline bathing, analgesia, topical analgesia
Medication - PO aciclovir
Elective CS if primary attack at 28/40
HIV seroconversion
-pathophysiology
-presentation
-diagnosis
3-12wks post infection
Immune system is reacting to the presence of HIV => AB production
Glandular fever-like
-sore throat
-LN
-fatigue, myalgia, arthralgia
-diarrhoea
-maculopapular rash
Combination test - p24 AG + HIV AB
-repeated to confirm positive diagnosis
HIV asymptomatic
-testing
4wks post exposure - combination test
If negative, repeat at 12wks
HIV
-management
ART - combination decreases replication and resistance
-2 nucleoside reverse transcriptase inhibitors
-1 protease inhibitor or non-nucleoside reverse transcriptase inhibitor
HIV
-neurocomplications and CT findings
CD4 100-200
Toxoplasmosis - multiple ring enhancing lesions
-headache, confusion, drowsy
M - sulfadiazine + pyrimethamine
Progressive multifocal leukoencephalopathy - demyelination
-infection by JC virus
-subacute behavioural, speech, motor, visual changes
CD4 50-100
Primary CNS lymphoma - single homogenous solid enhancing lesions
-EBV
M - steroids, surgery/chemo/radiation
Cryptococcus - meningeal enhancement
-most common fungal CNS infection
-headache, fever, malaise, N/V, seizures, focal deficit
HIV
-pneumocystis jiroveci pneumonia
-presentation
-invetigations
-management
CD4 100-200
SOB, dry cough, fever, VERY FEW CHEST SIGNS
CXR
Can be normal
Bilateral interstitial pulmonary infiltrates
Exercise induced desaturation
Broncheolar lavage - PCP
Co-trimoxazole
Give prophylactic co-trimoxazole if CD4 U200
HIV
-Kaposi’s sarcoma
-causative organism
-presentation
-management
CD4 200-500
HHV8
Purple plaques on skin and mucosa
Ulceration
Resp involvement - massive hemoptysis + pleural effusion
RT + resection
Chlamydia
-presentation
-complications
-diagnosis
-management
MOST COMMON STI - gram negative
7-21days
Asymptomatic in most
Women - discharge, bleeding, dysuria, low abdo pain, menstrual disturbance
Men - urethral discharge, dysuria
GOLD STANDARD - NAAT
Women - vulvovaginal swab
Men - first void urine sample
Should be carried out 2wks after exposure
1st line - 7 day doxycycline
-if pregnant => azithromycin (1g STAT), erythromycin or amox
Contact tracing - treat then test
PID - chronic pelvic pain, FHC syndrome, infertility, ectopics
Endometritis
Transmission to neonate
Epididymitis
Incubation period of
-chlamydia
-gonorrhea
-HIV
-syphilis
-herpes
Gonorrhea - 2-5days
Chlamydia - 1-3wks
HIV seroconversion -3-12wks
Herpes - 3 days
Syphilis - 3wks
Gonorrhea
-presentation
-diagnosis
-management
-complications
G-ve diplococcus
2-5 days
Often asymptomatic
Women - vaginal dyscharge, menstrual disturbance, low abdo pain
Men - urethral discharge, dysuria
Rectal - discharge, itch, painful bowel mv
Pharyngeal - sore throat, dysphagia
GOLD STANDARD - NAAT
Women - vulvovaginal swab
Men - first void urine sample
If rectum, throat involvement - swab
Should be carried out 1wk after exposure
1st line - single IM ceftriaxone 1g
-if refused PO STAT cefixime 400mg + azithromycin 2g
If ceftriaxone resistant => STAT PO cipro 500mg
Local
-urethral structures, epididymitis, salpingitis => infertility
Disseminated
-tenosynovitis, polyarthritis, dermatitis
Genital warts
-causative organism
-presentation
-diagnosis
-management
HPV 6, 11
Small cauliflower-like rough lumps around vagina, penis, anus, perineum
May be
-painful, itchy, bleed
-dyspareunia, dysuria
Clinical diagnosis
1st line - TOP podophyllum, cryotherapy
2nd line - imiquimod (TOP cream)
Multiple non keratinised warts respond well to podophyllum
Solitary, keratinised respond well to cryotherapy
Often resistant to treatment
Recurrence common
Majority clear without intervention within 1-2 years
Bacterial vaginosis
-causative organism
-pathophysiology
-presentation
-investigations
-management
-complications in pregnancy
Overgrowth of gardnerella vaginalis => lactic acid production from aerobic lactobacilli falls, pH rises
Not STI but v common in sexually active women
Fishy offensive discharge
Thin, white, homogenous
Vagina pH 4.5+
Positive whiff test on addition of KOH
Microscopy - Clue cells
Asymptomatic - no treatment unless undergoing TOP
Symptomatic - PO metronidazole 5-7days
-alt TOP metronidazole or clindamycin
Pregnant + asymptomatic - discuss with obstetrician
Pregnant + symptomatic - PO metronidazole 5-7 days
Complications in pregnancy
-preterm labour
-low birth weight
-chorioamnionitis
-late miscarriageVa
