Week 2 - C - Sexually Transmitted Infections Flashcards
The most common bacterial STI is: 1. Genital Warts 2. Gonorrhoea 3. Chlamydia 4. Herpes
3 - chlamydia
Q2.Profuse mucopurulent discharge from the penis and painful urination are more commonly symptoms of: 1. Herpes 2. HPV 3. Syphilis 4. Gonorrhoea
4 - Gonorrhoea
Q3.A chancre develops during which stage of syphilis. 1. Primary 2. Latent 3. Tertiary 4. Secondary
- Primary
Q4.Which of these infections can lead to pelvic inflammatory disease in women. 1. Syphilis 2. HPV 3. Chlamydia 4. HIV
3 - Chlamydia
Q5.This STI is known as the “great imitator” because its symptoms resemble those of other infections. 1. HIV 2. Syphilis 3. HPV 4. Gonorrhoea
2 - Syphilis
Q6.The vaccine for HPV is currently recommended in (HIV negative) females of which age: 1. 11-13 2. 40+ 3. 9 - 26 4. 25 - 35
- 11-13 year old females
What HPV strains does the HPV vaccine protect against? WHat is the HPV vaccine known as?
Protects against strains 6,11,16,18 Known as gardasil
Q7.Viral shedding is higher with which type of Genital Herpes simplex virus 1. Type 1 2. Type 2
- Viral shedding is more common in Type 2 herpes (HHV 2(human herpes virus 2))
What is the most commonly reported STI in clinics today?
Most commonly reported STI in clinics is chamydia trachomatis
Chamydia has a high asymptomatic rate What percentage of women are asymptomatic? What percentage of men are asymptomatic? What are the two most common symptoms of chalmydia if patient is symptomatic?
70% of women are asymptomatic 50% of men are asymptomatic If patient is symptomatic can have a watery discharge from the urethra and pain on urination In women also get intermenstrual or post coital bleeding
If chlamydia is left untreated , what can it cause?
If left untreated can lead to pelvic inflammatory disease - this is due to the chalmydia spreading to the womb, fallopian tubes and ovaries
What other STI is a big cause of PID? What can PID cause in realtion to pregnancy?
Gonorrhea In relation to pregnancy, infertility and ectopic pregnancy
What is the transmission pattern of chlamydia? What type of bacterium is it?
CT can be transmitted vaginally orally or anally It is a gram negative bacterium
Why does chalmydia not stain on gram staining? What age group is the highest incidence of chlamydia? What does incidence mean?
It does not stain well as it contains no peptidoglycan in the cell wall and therefore cannot retain the gram stain The highest incidence is at ages 20-40 years old Incidence means the number of new cases of a disease over the number at risk of having the disease
As stated, those with chlamydia have a risk of developing pelvic inflammatory disease What percentage of those with CT infection develop PID? As stated PID can cause etopic pregnancy and tubal factor infertility What percentgae are the risks fo both of these increased by if having PID?
9% of those with a chlamydia infection develop PID The risk of ectopic pregnancy increases ten fold in those with PID And PID carries a risk of 15-20% for tubal factor infertility
Why can PID lead to ectopic pregnancy or tubal factor infertility?
This is because pelvic inflammatory disease scars the tissue in the fallopian tubes (potenitally uterus and ovaries)
What are the symptoms of pelvic inflammatory disease in men and women?
In women PID - pain around pelvis or lower abdomen, fever, heavy and painful periods, dysparenuia, vaginal discharge PID is confined to women as it is a disease of he uterus, fallopian tubes and ovaries therefore men cannot have symptoms as they do not have these reproductive organs
Name more symptoms of CT in women and men? What is mucopurulent cervicitis a sign of? WHat is epididymo-orchitis?
Women - intermenstrual bleeding, post coital bleeding, lower abdominal pain and dysparaneuia Mucopurlent cervicitis - sign of pelvic inflammatory disease in women (can also be a sign of gonorrhea) Men Urethral discharge Epididymo orchitis - inflammation of epididymis and testis Proctitis
What is proctitis? What CT serovars can cause proctitis? What is the treatment of proctitis when cause by chlamydia?
Proctitis is inflammation of the lining of the rectum - can present with the continuous urge to defecate CT starins L1-L3 can cause this - lymphogranuloma venereum Treat with 3 weeks of doxcycline
Name some complications of chlamydia trachomatis (including neonate coomplications) What is the arthritis condition that can occur with chamydia or gonorrhea infection?
Pelvic inflammatory disease Tubal factor infertility and ectopic pregnacy Proctitis Neonates - conjunctivits and chamydophila pneumonaie Reiter;s artritis (reactive arthritis) - uveitis, urethrieits, arthriits (cant see, cant pee, cant climb a tree)
Young person diagnosed with bilateral conjunctiviits - diagnosis? What is the treatment of the bilateral conjunctiviits?
This is usually chamydial conjunctivitiis Treat with topical oxytetracycline
A rare complication of pelvic inflammatory disease due to chlamyida trachomatis involves liver capsule inflammation leading to the formation of adhesions between the parietal peritoneum and the liver WHat are these adhesions known as and what is this disease knwon as?
The adhesions are known as violin sting adhesions and this complication is known as Fitz-Hugh Curtiz syndrome
In fitz high curtiz syndrome, what is the appropritate treatment? (want coverage of both chlamydia and gonorrhea) What are the symptoms of this conditon and which gender is affected?
The major symptom and signs include an acute onset of right upper quadrant (RUQ) abdominal pain aggravated by breathing, coughing or laughing, which may be referred to the right shoulder. Sometimes can have a mucopurlent cervicitis Only affects women Want IM ceftriaxone and oral azithromycin - covers both
What area in scotland has the greatest rates of chlamydia? (both male and female)
Tayside
Chamydia serovars, what does each group of serovars cause Chamydia serovars A-C? Chlamydia serovars D-K? Chlamydia serovars L1-L3?
A-c - trachoma - eye infection D-K - genital infection (including PID) L1-L3 - lymphogranuloma venereum - complicated chlamydia trachomatis
Who is lymphogranuloma venereum (LGV) mainly diagnosed in? What are the symptoms? What is the treatment?
Mainly diagnosed in men who have sex with men (MSM) Symptoms - rectal bleeding, pain and discharge Tx - 3 weeks of doxycycline
LGV infections have a high recurrence rate What percentage of those with LGV infections also have HIV?
67% also have a co HIV infection
When is chlamydia trachomatis tested for following exposure? How is it tested for? (male) and (both self adminsited and clinican for female) How long should patient not have voided urine for? What about MSM?
Tested for 14 days following exposure NAAT testing (nucleic acid amplifcication testing) - carrie dout by taking a vaulvovaginal swab (self adminsitered in females) or an endocervical swab (clinician using a speculum to open vagina) Take first void urine in males who are suspected with chlamydia trachomatis - patient should not have voided for at least one hour Add rectal swab in MSM if receptive anal intercourse
What is the preferred test for chlamydia in an asymptomatic female?
VVS (vulvovaginal swab) NAAT test would be the test of choice
What is the treatment for chlamydia?
Oral azithromycin 1G stat or Oral doxycycline 100mg BD for 7 days
When is a test for cure carried out in chlamydia?
Not normally carried out Test for cure carried out in pregnant women 3 weeks post treatment and the same if rectal chlamydial infection
What type of bacteria is gonorrhea? What bacteria causes gonorrhea?
The is a gram negative intracellular diplococci Caused by neisseria gonorrhea
What are the primary sites of infection in gonorrhea?
The primary sites of infection are the mucous membranes ie Mucous membranes of urethra, endocervic, rectum and pharynx
The incubation period of urethral infection in men is usually short (2-5 days) When do results for gonorrhea come back?Is gonorrhea more likely to be passed on from infected man to women or infected women to man?
Results for gonorrhea come back at the same times as chlamydia as dual NAAT testing is carried out - so 14 days More likely for a man to pass it on to a women
Which gender is chalmydia more common in? Which gender is gonorrhea more common in?
Chamydia is more common in women Gonorrhea is more common in men
What is the presentation of gonorrhea infection in males? WHat percentage is asymptomatic?
Urethral discharge in greater than 80% Dysuria - painful urination Pharngeal/rectal infections are usually asympomtatic 10% of patients are asymptomatic
What is the presentation of gonococcal infection in females? What percentage are aysmpotmatic?
Increased/altered vaginal discharge Dysuria Pelvic pain Asymptomatic in up to 50%
What percentage of males and females are aysmptomatic for chalmydia and gonorrhea infections? What percentage of PID cases does chlamydia account for?
Chlamydia Males - 50% Females - 70% Gonorrhea Males - 10% Females - 50% Chlamydia accounts or 50% of PID cases
What glands present in the labia can become inflamed usually due to a gonococcal infection if it is STI related?
This would be Bartholin’s glands - can present as an abscess if infected
What is the function of Bartholin;s glands Which gland in the male are they homologous to?
Function of bartholins glands is to secrete mucous to lubricate the vagina Homologous to the bulbourethral (Cowper’s) glands in the male
How is gonorrhea diagnosed?
If in the sexual and reproductive health clinic Swab for microscopy and culture for antibiotic sensitivity - urethra swabbed in males, endocervix swabbed in females GP Swab - urethra in males and can self admisiter vulvo-vaginal swab or clincian takes an endocervical swab and sent for NAAT testing (PCR is a form of NAAT testing)
WHich is more sensitive/specific between NAAT and microscopy? What does the image on the left show?
NAAT is more sensitive and specific but doesn’t allow for testing antibiotic sensitivities of the gonorrhea strain Image shows gram negative intracellular diplicocci - can see it is PiNk therefore negative
What is used for treatment of gonorrhea infections? What is given if pateint refuses IM treatment or it is contraindicated?
IM ceftriaxone + oral azithromycin (1g STAT) is given If patient cannot have IM treatment - then give oral cefixime
When is test of cure carried out in patients?
Test of cure is carried out in all patients with gonorrhea infection Carried out 2 weeks after normally but has to be 5 weeks if using NAAT testing as NAAT still identifies dead organsisms
17 year old male 6 day hx of urethral discharge and dysuria Last sex 10 days ago Sex with a male partner (casual) Oral and Anal sex (insertive and receptive) No condom used What swabs (from where) would be taken?
Swab urethra, pharnx and rectum for chlamydia and gonorrhea infection Also take first pass urine for chlamydia
Microscopy GNDC positive Culture and NAAT from all sites Urine and rectal GC and rectal Chlamydia What is the treatment for this patient?
Give patient IM ceftriazone and oral azithromycine Also give doxycycline as he has a rectal chamydia infection
What are the three different types of genital herpes infection?
Primary first episode Non-primary first episode Recurrent episode
What is the incubation and duration period of genital herpes for first episode? What are the symptoms?
Incubation period is 3-6 days with duration of symptoms lasting 14-21 days for primary infections Symptoms Blistering and ulceration of external genitalia Pain External dysuria LOcal lymphaenopathy
What symptoms can precede genital herpes symptoms?
Can get fever and myalgia and(sort of flu like illnesses) pre herpes symptoms
What herpes viruses cause genital herpes? Which causes oral herpes? WHat is HHV3, HHV4, HHV5, HHV8?
- HHV1and2 cause genital herpes
- HHV1 causes oral herpes
- HHV3 - Varicella Zoster virus
- HHV4 - Epstein Barr virus
- HHV5 - Human cytolomegalovirus
- HHV8 - kaposi’s sarcoma herpes virus
What herpes virus more often causes recurrent episodes? How long do these episodes tend to last and what are the symptoms?
HHV2 usually causes recurrent episodes The symptoms last for 5-7 days and are usually unilateral with small blisters and ulcers forming
How is genital herpes diagnosed? What is given as treatment? What ointment can be given if passing urine is too uncomfortable?
Genital herpes is diagnosed by deroofing and swabbing the base of ulcer/blister and send in viral transport medium for PCR Oral antiviral treatment - acicylovir is given as treatment LIdocaine ointment can be given to make urination more comfortable
https://s3.amazonaws.com/classconnection/403/flashcards/11907403/png/pjpgpngjpgpngjpg-1601277932E2758A8C4.png
Viral shedding is more common in HHV type 2 It is more common within first year of infection And is more common in individuals with recurrent infection
Neonatal herpes is a herpes infection in a newborn baby. It’s caused by the herpes simplex virus, a highly contagious virus that can cause cold sores and genital ulcers in adults. A newborn baby is at risk of catching herpes if the mother had genital herpes for the first time when?
Newborn babies is at a high risk of catching herpes if mother has genital herpes for the first time within the last 6 weesk of pregnancy as no antibodies against the herpes will have been formed
If you develop genital herpes for the first time during the third trimester (week 27 of the pregnancy until birth), particularly during the last six weeks of the pregnancy, the risk of passing the virus on to your baby is considerably higher. This is because you will not have time to develop protective antibodies to pass to your baby, and the virus can be passed to your baby before or during the birth. What can be done to help prevent tranmission of virus?
Can carry out a caesaren section and also take acicylovir
If you develop genital herpes for the first time during the third trimester (week 27 of the pregnancy until birth), particularly during the last six weeks of the pregnancy, the risk of passing the virus on to your baby is considerably higher. What is the risk of passing on the virus if a vaginal birth is carried out?
If you give birth vaginally, the risk of passing the virus on to your baby is around four in 10.
What is the most common viral STI? Lifetime risk of acquiring the infection is as high as 80%1
This is human papilloma virus (HPV)
There are greater than 170 types of HPV described Which HPV types cause palmar and plantar warts? Which HPV types cause anogenital warts? (ie greater than 90% of anogenital warts are cuased by which genotypes) Which HPV types cause cellular dysplasia and intraepithelial neoplasia?
HPV 1-4 cause palmar and plantar warts HPV tpes 6 and 11 account for >90% of anogenital warts HPV types 16 and 18 mainly cause cellular dysplasia and intraepithelial neoplasia - >80% of cervical cancers
Incubation period of HPV can last anywhere from 3 weeks to 9 months What is the average incubation period? The warts can clear, spontaenously, with treatment or be persistent despite treatment After what time limit if the warts havent cleared will it not be spontaneous?
Average incubation period of HPV is 3 months If the warts havent cleared by 3 months after presentation then they will not clear spontaneously and treatment will be required
20% of people with HPV genital warts will clear spontaneously (immune mechanisms come into play, when there is recognition by the body of the presence of HPV. However, this recognition is not perfect and result in clearance of only about 20% of anogenital warts) What percentage will clear with treatment and what percentage will be persistent despite treatment?
60% of patients warts will clear with treatment 20% of patients with warts will have persistent disease despite treatment Usually persistent warts occur in the immunocompromised
What is 1st and 2 line in the treatment of genital warts?
1st line - the cytotoxic therapy Podophyllotoxin (Warticon) 2nd line - Immune modifier - Inquimod
Who is the HPV vaccine available for?
HPV vaccine given in boys and girls aged 11-13 years of age The human papillomavirus (HPV) vaccine is now available in Scotland from sexual health and HIV clinics to MSM who are up to and including 45 years of age.
What bacterium causes syphilis? What are the different stages?
Caused by treponema pallidum Different stages are primary, secondary, latent and late stage syphilis (late stage is also referred to as tertiary)
Present in serology but no symptoms is when the early latent stage starts (infectious) Late latent stage is when non-infectious starts How long does the latent stage last in most people?
Latent stage usually lasts around 2 years
Incubation period is from 9-90 days (mean of 21 days) What is the lesion in primary syphilis known as?
This is a primary chancre - painless and occurs at the site of inoculation
How does secondary syphilis present? What is the highly infectious lesions seen in the secondary infectious stage of syphilis known as?
Secondary syphilis presents as palms and soles rash (dont usually get a rash on both), generalized lymphadenopathy, patchy alopecia Highly infectious state is known as condylomata lata
What is syphilis often referred to as?
It is often referred to as the great imitator
What are the techniques used to diagnose syphilis?
Dark field micrcoscopy - not done in Taydise PCR of the the swab taken from chancre or swab of rash Serology testing is carried out in the latent stage
What is the screening serological test carried out in the diagnosis of syphilis? What are the non serological tests that are used to monitor the progression of the syphilis?
Screening serological test - IgG and IgM ELISA test Non serological to monitor progression This is the VDRL and RPR tests (IgM test also becomes negative once syphilis has been treated)
What is given as treatment for syphilis?
Early sphyilis 2.4MU Benzathine penicilline (a form of benzylpenicillin) given IM - one week Late syphilis 2.4MU Benzathine penicillin given IM weekly for 3 weeks
What is the second line treatment for syphilis if the patient is pen allergic?
De-sensitized penicllin or Doxycycline
In the treatment of syphilis Titres should decrease fourfold by 3-6 months in early syphilis. Titres are measured at 3,6 and 12 months If the patient starts at 64 titres, what hsould it be by 6 months?
Titires measured of syphilis should have dropped below 16
Q1.The most common bacterial STI is? (What is the most common viral) Q2.Profuse mucopurulent discharge from the penis and painful urination are more commonly symptoms of? Q3.A chancre develops during which stage of syphilis? Q4.Which STI infections can lead to pelvic inflammatory disease in women? (give two)
- Chlamydia - HPV is the most common viral STI 2. Gonorrhea 3. Primary stage 4. Chlamydia (most common) and gonorrhea
Q5.This STI is known as the “great imitator” because its symptoms resemble those of other infections.? Q6.The vaccine for HPV is currently recommended for females (HIV negative) aged? (and what is the citeria for males) Q7.Viral shedding is higher with which type of Genital Herpes simplex virus ? Q8. WHat STIs can cause ulceration?
- Syphilis 6. Women aged 11-13 years of age (Given in SRH and HIV clinics to MSM aged up to and including 45 years old) 7. Commoner in Type 2 8. Syphilis, herpes simplex virus, and lymphongranuloma venereum (Chlaymida trachomatis serovars L1-L3)
What is the test that is virtually diagnostic of neurosyphilis?
This is where the patient has small irregular pupils that constrict to accommodation but not light - these are known as Argyll Robertson pupils (prostitute pupils - they accomodate but do no react (to light))
