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GOSH > STIs part 2 (HIV syphilis) > Flashcards

STIs part 2 (HIV syphilis) Flashcards

1
Q

what are genital warts caused by?

A
  • sexually transmitted HPV subtype 6 and 11

- (occasionally 16 and 18 but associated with malignant potential)

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2
Q

who is most likely to get florid lesions in genital warts?

A
  • DM
  • pregnancy
  • OCP
  • smoking
  • immunosuppression
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3
Q

what is the incubation period for genital warts?

what do genital warts look like?

how do they feel on palpation?

A
  • up to 8 months
  • pink papular lesions, single or multiple, keratotic or plaques
  • multiple raised papillomatous lesions, feel hard to touch and are irregular
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4
Q

what investigations would you perform for genital warts?

A
  • biopsy atypical lesions
  • cervical smear and cytology
  • colposcopy and biopsy cervical lesions
  • STI screen
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5
Q

how can genital warts be managed?

A
  • ablation (<6 and keratinised)
  • immune modulation (imiquimod cream)
  • surgical:
    curettage, excision
  • advice on cervical smears and eliminating sexual contacts
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6
Q

how might vaginal warts affect pregnancy?

what are the complications of vaginal warts?

A
  • consider LSCS only if large vaginal introitus lesions

- infection of confluent lesions, CIN, cervical carcinoma

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7
Q

what organism is syphilis caused by?

who is most at risk?

A
  • treponema pallidum

- re-emerged in MSM, many with HIV

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8
Q

how does primary stage syphilis present?

A
  • chancre- at site inoculation, small painless ulcer, indurated with exudate
  • may be on anal margin, tonsils, lips or nipples
  • incubation period a few weeks
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9
Q

how does secondary stage represent?

A
  • widespread maculopapular rash, palms, soles, generalised
  • mouth ulcers
  • alopecia
  • systemic symptoms: headaches, malaise, fever, meningitis, CN nerve dysfunction
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10
Q

how does tertiary stage present?

A
  • neurosyphilis (dementia, meningeal involvement)
  • cardiovascular symptoms
  • latent stage: positive blood test, no symptoms
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11
Q

what investigations would you do?

A
  • take sample from open skin lesions to do microscopy
  • serology
  • syphilis PCR
  • STI screen, especially HIV
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12
Q

what is the management of syphilis?

neurosyphilis?

A
  • benzathine penicillin 2.4g IM

- procaine benzylpenicillin, 750mg for 10 days

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13
Q

what are the complications of syphilis in pregnancy?

A
  • pregnant women with untreated syphilis 70-100% infants infected
  • 1/3 chance of stillbirth if infected
  • growth problems up to 2 years
  • all pregnant women with positive serology should be treated for syphilis
  • outcome depends on gestational age infection acquired
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14
Q

what is the pathology of HIV?

A
  • kills CD-4 cells
  • HIV 1 most common
  • reverse transcriptase RNA inserted into DNA and causes latent infection
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15
Q

what is the normal CD4 range?

what is the timecourse of HIV?

A
  • 500-1500

- infection, seroconversion (acute illness), asymptomatic, HIV related illness, AIDS , death

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16
Q

what happens in seroconversion in HIV?

A
  • initial massive proliferation of viral load, body can not cope and drops CD4
  • body recovers and makes more CD4 cells
  • HIV RNA conc increases, CD4 conc decreases, then they become symptomatic
17
Q

what are the risk factors to ask about?

A
  • sex worker
  • MSM
  • unprotected sex with foreign people
  • IVDU
18
Q

what are the symptoms of seroconversion?

A
  • occurs 2-6 weeks after exposure
  • only 60% of people get it
  • glandular fever like symptoms:
  • sore throat
  • fever
  • lymphadenopathy, malaise and lethargy, arthralgia/myalgia
  • rash (maculopapular on trunk)
  • ulcers on mouth and penis
19
Q

What would make you think HIV in a patient presenting with another problem?

A
  • atypical
  • severe
  • recurrent
20
Q

what are the aids related malignancies?

A
  • Kaposi sarcoma
  • non-hodgkins lymphoma
  • invasive cervical carcinoma
  • (all NHL patients should be screened for HIV)

10% of them will get a malignancy

21
Q

what are the bacterial conditions which are AIDS defining in people with HIV?

fungal?

A
  • TB
  • recurrent pneumonia
  • salmonella septicaemia
  • mycobacterium avid complex (MAC)
  • candidiasis (oesophageal, bronchial, tracheal, lungs)
  • pneumocystis pneumonia
22
Q

what viral infections are associated with it?

parasitic infections associated with it?

A
  • CMV (retinitis, liver, spleen, glands)
  • HSV
  • cerebral toxoplasmosis
  • cryptosporidiosis
  • leishmaniasis
23
Q

What is HAART?

A
  • the use of at least 3 anti- HIV drugs from at least 2 different drug classes
  • two nucleoside reverse transcriptase inhibitors (NRTIs)
  • one non nucleoside reverse transcriptase inhibitor (NNRTIs)
24
Q

what is the aim with viral load?

what may affect viral load coming down?

A
  • it should be kept below 50
  • monitor treatment to make sure it is coming down
  • compliance,over 95% of people who are 100% compliant will have an undetectable viral load
25
Q

what is an adverse side effect of HAART?

There are interactions between many steroids and HAART, which one does not have an adverse reaction with ritonavir?

A
  • Cushings disease

- beclomethasone (other cause cushings)

26
Q

what common drug does ritonavir/ cobiscistat interact with?

what does rilpivirine interact with?

A
  • CYP3A4 pathway (simvastatin)
  • causes rhabdomyolysis
  • PPIs contraindicated
27
Q

what may happen to HAART in drug interactions?

A
  • causes decreased conc allowing the virus to replicate with low drug levels, leading to drug resistance
28
Q

when should HAART be offered in the UK?

what is the guidance on who should be tested for HIV?

A
  • CD4 <350 (before AIDS) and treatment minimises risk of transmission
  • all people with an STI
  • all people with risk >1 in 1000
  • anyone in high risk groups
  • all patients with clinical indicator disease
29
Q

What are they looking for in an HIV blood test?

A
  • blood test takes 2 weeks to come back
  • (tests for antibody and antigen)
  • antibody takes 4 weeks to develop
30
Q

what other test can be done in HIV?

A
  • point of care testing

- measure viral load

31
Q

name 2 NRTIs?

A
  • zidovudine/ lamivudine/ tenofovir
32
Q

when should you start HAART in pregnancy?

what is the disadvantage of starting HAART?

A
  • any CD4 count, to reduce transmission

- on it for the rest of your life, co-pharmacy, side effects

33
Q

what are the most common side effects of HAART?

why?

A
  • bone marrow suppression
  • kidney and liver toxicity
  • insulin resistance
  • interferes with metabolic pathways by affecting mitochondrial activity
34
Q

what are the drug interactions of HAART?

A
  • all p450 interacting drugs
35
Q

what does the viral load have to be for the mother to have a normal delivery?

what does the baby get?

what other precaution must be taken?

A
  • <50
  • give neonatal PEP for 4 weeks
  • no breastfeeding
36
Q

when should PEP be given?

what else can be done for prevention?

A
  • anyone who has had sex with a high risk person in last 72 hours
  • PreP
  • male circumcision in 60% of cases

GOSH (18 decks)

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