STIs causing anogenital lesions Flashcards
Viral causes? - 3
Bacterial causes? - 1
Genital warts
Genital herpes
Molluscum contagiosum
Syphilis
Genital Warts:
What HPV viruses cause it? - 2
Are they painful?
What can be done if a clinical diagnosis is not certain?
Management:
- What topical options are available? - P, I
- What can be done to remove them apart from surgery?
What is a potential complication which could be life-threatening?
6 & 11
No, they are painless
Biopsy
Podophyllotoxin cream
Imiquimod cream
Cytotherapy
Squamous cell carcinoma - cervical or anal
Molluscum Contagiosum:
Pathogen?
How is it spread? What about in adults?
How does the rash look?
How may the rash spread?
How long can the rash last?
Management - 3
Molluscum Contagiosum virus
Direct contact or contaminated objects
Sex
Pearly
Skin coloured papules
Central dimple
Auto-infection - itching and touching
2 yrs
Avoid scratching
Emollients
No time of school needed
Genital herpes:
What HSV causes it?
What usually precedes the beginning of symptoms?
Signs and symptoms:
- Systemic
- Where do they get lymphadenopathy?
- What urinary symptoms do they have?
Where does HSV hide before reactivation?
HSV 1
HSV 2**** = more commonly
Subclinical or sensory nerve prodrome SO TINGLING
Fever
Irritable
Miserable
THEY HAVE A FLU LIKE PRODROME
Inguinal lymphadenopathy
Dysuria Discharge Tenesmus ===== In severe
Peripheral nerves
Genital herpes:
Why can a symptomatic episode cause confusion and distress in long-term relationships?
Investigations:
- What is done with the swab taken at the base of the ulcer?
Management:
- Whar antiviral is used? For how long?
- What can they be given for the pain?
- What is done if it is severe/recurrent?
- What can be done to prevent transmission?
It can present yrs after the first infection
Aciclovir 5 days PO
Topical lidocaine gel
Continous aciclovir
Use condoms
Long term antivirals for partners
Genital herpes:
Complications:
- Neurological - 3
Meningitis
Encephalitis
Neuralgia
Syphilis:
What pathogen causes this?
What group of patients is it common in?
How is it transmitted? - 4
Primary syphilis:
- What is the lesion it causes called?
- Is the lesion hard or soft?
- Is it painful?
- What do you find near the infection site?
- Where can they get lesions?
How long do they take to heal?
Men who have sex with men
Treponema Pallidum
Sexual
Accidental inoculation - healthcare workers - lack of hand hygiene
Blood borne - needle sharing/transfusion
Chancre:
- Painless
- Hard
Lymphadenopathy - inguinal
Genitals, mouth, skin, or rectum
2-8 wks
Syphilis - Secondary syphilis:
- How long after the primary infection (chancre) does it occur?
Rash:
- Type?
- Where?
- What unusual rash location does this rash appear on?
Flu-like symptoms:
- What are some?
- What organs become enlarged?
Condylomata lata:
- What is it?
- Where?
How long does it take to resolve?
6 wks - 6 months after the chancre
Maculopapular rash
Generalised including PALMS and SOLES
Headache
Myalgia
Arthralgia
Lymphadenopathy
Splenomegaly
Hepatitis
Alopecia
Highly-infectious wart-like lesions on genitals - moist - look up
3-6 wks
Syphilis - Latent Syphilis:
Early latent syphilis:
- What does latent syphilis mean?
Under how many years is it classed as early?
- How can it be treated?
- Why can it infect other people during this time?
Late latent syphilis:
- Over how many years is it classed as late latent?
Tertiary syphilis:
- How long does it take for 3* syphilis to develop?
AORTA:
- They get aortic aneurysms and aortic regurg. Why does this happen?
Neurosyphilis:
- This is known as ASEPTIC MENINGITIS.
- What type of patient does it tend to occur in?
Ocular syphilis:
- What part of the eye becomes inflamed causing red eye?
- Is it painful?
- How does it affect their vision?
Immunosuppressed
Asymptomatic infection following untreated or unrecognised primary and secondary syphilis
< 2 yrs
Single dose of Penicillin
Risk of sexual and vertical transmission if left untreated. ============================== >2 yrs ============================== From 2 - 20 yrs
Aortitis
Focal neurological deficits
Seizures
Psychiatric symptoms
Argyll-Robertson pupil
Uveitis
Painful
Floaters
Flashing lights
Part of the posterior compartment
Syphilis - Investigations:
Primary syphilis needs DIRECT DETECTION:
- What is done to the ulcers?
PCR and Dark field microscopy - What does they bacteria look like under the dark field microscope?
Tests for Treponema Pallidum:
- RPR is used. What does it stand for?
- What does it test for?
- Is it specific or non-specific?
- Remain +ve for the rest of life
Knowing all this, what is this test therefore used for clinically?
Non-Trepnoemal Tests:
- How are these tests used clinically?
Determines exposure to syphilis in the past
Swabs and PCR
Spiral bacteria - green coloured
=================
Rapid Plasma Reagin (RPR) test
Detects NON-SPECIFIC antibodies that your body produces while fighting infection
Blood test used for screening
Determines disease activity
Syphilis - Treatment:
BENZYLPENICILLIN IM single dose
How many doses is given for early S?
How many doses is given for late S?
What is they have ocular or neurosyphilis?
What should not be forgotten with syphilis being an STI?
Duration of Rx depends on the stage - follow guidelines
E - 1
L - 3x a week
10-14 days
Syphilis - Complications:
Gummatous syphilis:
- What is deposited in bone and cartilage which causes destruction?
- It causes a saddle nose. What does this mean?
Neurosyphilis:
- What neurodegenerative disease can it lead to?
- Tabes dorsalis also occurs. What does this mean?
What cardiovascular complications can occur? - RARE!!!
The nose looks like a saddle - usually happens as a baby
Granulomas
Dementia
Loss of the dorsal column
Fine touch, vibration, two-point discrimination, and proprioception (position) from the skin and joints.
Vasculitis
Stroke
Aortitis
Congenital syphilis:
What complications can occur during pregnancy?
Early C Syphilis:
- What organs become enlarged?
- They also get a RASH.
- SEVERE ANAEMIA + JAUNDICE
Late C Syphilis:
- What happens to their teeth?
- DEAFNESS
How is congenital syphilis prevented?
Miscarriage
Stillbirth
Prematurity
Hepatosplenomegaly
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Pegged teeth - look up
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Antenatal Screening
