Week 2- STI's Flashcards
Q1.The most common bacterial STI is: Genital Warts Gonorrhoea Chlamydia Herpes
Chlamydia
Q2.Profuse mucopurulent discharge from the penis and painful urination are more commonly symptoms of: Herpes HPV Syphilis Gonorrhoea
Gonorrhoea
Q3.A chancre develops during which stage of syphilis. Primary Latent Tertiary Secondary
Primary
Q4.Which of these infections can lead to pelvic inflammatory disease in women. Syphilis HPV Chlamydia HIV
Chlamydia
Q5.This STI is known as the "great imitator" because its symptoms resemble those of other infections. HIV Syphilis HPV Gonorrhoea
Syphilis
Q6.The vaccine for HPV is currently recommended in (HIV negative) females of which age: 11-13 40+ 9 - 26 25 - 35
11-13
Q7.Viral shedding is higher with which type of Genital Herpes simplex virus
Type 1
Type 2
Type 2
What sort of bacterium is chlamydia?
Gram negative bacterium
How is chlamydia transmitted?
Vaginal, oral or anal sex.
People who have chlamydia can experience complications, one commonly being pelvic inflammatory disease. True or false?
True
What can pelvic inflammatory disease increase the risk of?
Ectopic pregnancy
Carries a risk of tubal factor infertility
What is the presentation of chlamydia in women?
Intermenstrual or post coital bleeding (after sex)
Signs of upper genital tract infection- lower abdominal pain, dyspareunia (pain during sex), mucopurulent cervicitis
What is the presentation of chlamydia in men?
Urethral discharge Dysuria (pain on urination) Urethritis Epidymo-orchitis (swelling and pain in both testicles) Proctitis
What complications can you have with chlamydia?
Pelvic inflammatory disease Tubal damage (ectopic pregnancy) Chronic pelvic pain Transmission to the neonate Adult conjunctivitis Sexually acquired reactive arthritis Fitz-Hugh-Curtis syndrome
A 24 year old man comes in with pain in his knee joint. The pain started recently and feels stiff in nature. What test should you do?
Look for chlamydia to rule out sexually acquired reactive arthritis.
What is LGV?
A disease of the lymphatics and lymph nodes caused by specific serovars of chlamydia (L1-L3).
Who is likely to get LGV?
Men who have sex with men (MSM)
Symptoms of LGV?
Rectal pain, discharge and bleeding
Other STI’s are associated with LGV. True or false?
True- high risk of concurrent STI’s.
When would you test for chlamydia?
14 days after suspected exposure
What test would you use to diagnose chlamydia?
NAAT
Vulvovaginal swab for females
First void urine in males
If you suspect LGV alongside chlamydia, what extra swab would you do?
Rectal swab
How do you treat chlamydia?
1G of azithromycin stat
or
doxycycline 100mg BD for a week.
Describe gonorrhoea (gram stain etc)?
Gram negative intracellular diplococcus.
What are the common primary sites of infection for gonorrhoea?
Mucous membranes of the urethra, endocervix, rectum and pharynx
What is the incubation period for gonorrhoea?
2-5 days.
How does gonorrhoea present in males?
Very few (<10%) are asymptomatic
Urethral discharge
Dysuria
Rectal and pharyngeal infections are most likely asymptomatic.
How does gonorrhoea present in females?
Up to 50% are asymptomatic
Increased/altered vaginal discharge
Dysuria
Pelvic pain (less than 5% of people get this)
Pharyngeal and rectal infection usually asymptomatic.
What complications can gonorrhoea cause? Split into lower genital tract and upper genital tract
Lower genital tract- Periurethral abscess Rectal abscess Barthonititis Tysonitis Epidydimitis Urethral stricture
Upper genital tract Endometriosis PID Hydrosalpinx Infertility Ectopic pregnancy Prostatitis
How do you diagnose gonorrhoea?
Microscopy- urethral- 90-95% sensitive. However endocervical 35-50%
Culture- >95% sensitive in male urethra
80-92% sensitive in female
NAAT- >96% sensitivity (both for symptomatic and asymptomatic)
Treatment of gonorrhoea?
Ceftriaxone 500mg IM and (co-treatment for chlamydia) 1G azithromycin.
Would you test to see if the patient is cured in gonorrhoea?
YES.
Describe the advantages and disadvantages of each method for diagnosis of gonorrhoea
Microscopy-advantage- timely treatment
Disadvantage- invasive treatment. Low sensitivity. Requires confirmation.
Culture- advantage- allows antibiotic sensitivity and monitoring
Disadvantage- Invasive test- requires specific media and incubation
NAAT- advantage-non invasive. Less problems with transport
disadvantage-risk of false positive. Positive result should be confirmed by NAAT with different target.
What is meant by a genital herpes primary infection?
Never been infected with herpes before.
What is meant by a non-primary first episode in herpes infection?
Been exposed to the antigens before but not been infected.
What is the incubation period for herpes infection?
3-6 days.
How long does genital herpes last?
14-21 days
What symptoms do you get with genital herpes?
Blistering and ulcering at the external genitalia Pain External dysuria Vaginal or urethral discharge Local lymphadenopathy Fever and myalgia
Which type of herpes is recurrent episodes more likely to occur with?
HSV 2.
How does HSV type 2 present?
Usually misdiagnosed as thrush- mild anogenital tingling, burning or soreness.
Usually unilateral small blisters and ulcers.
Minimal systemic symptoms, resolves within 5-7 days.
How does HSV type 2 present?
Usually misdiagnosed as thrush- mild anogenital tingling, burning or soreness.
Usually unilateral small blisters and ulcers.
Do you experience systemic symptoms with HSV type 2?
Minimal systemic symptoms, resolves within 5-7 days.
How would you manage and treat herpes?
Swab base of ulcer for HSV PCR Give oral aciclovir Consider topical lignocaine 5% if extremely painful Analgesia Saline bathing
What is viral shedding?
When a virus has invaded a cell and reproduced and used up all of its energy etc, it exits the cell.
Which virus is more likely to carry out viral shedding?
HSV 2.
When is viral shedding more likely to occur?
In recurrences
In the first year of infection
Reduced by suppressive therapy.
Which special circumstances of infection with HSV are important to recognise?
In a pregnant individual- herpes in the neonates is rare but when it does happen its really serious.
Especially important if in 6 weeks of estimated delivery date.
Which types of HPV are low risk types?
6,11,42,43,44
Remember 6 and 11
Which HPV types are high risk types?
16,18,31,33,35,45,51,52,66
Remember 16 and 18
Which HPV type causes anogenital warts?
Likely 6 and 11.
Which HPV type causes palmar and plantar warts?
1 and 2.
How does HPV present?
Depends on the type however almost all present with latent infection.
Could also have-
-anogenital warts
-palmar and plantar warts
-cellular dysplasia/intraepithelial neoplasia.
What is the incubation period for HPV?
3 weeks to 9months.
Transmission of more than one type of HPV is common. True or false?
True- likely to come in groups.
Do you need to treat HPV?
20-34% clear without treatment
60% clear with treatment
20% persistent despite treatment.
How would you treat HPV?
1st line -Podophyllotoxin (warticon)
2nd line- imiquimod- or used first line in perianal warts
3rd line- cryotherapy
Who gets a HPV vaccination?
Girls 11-13
MSM
People living with HIV.
How is syphillis transmitted?
Sexual contact
Transplacental
Blood transfusions
Non-sexual contact- healthcare workers.
How can syphillis be classified?
Congenital
Acquired
What is meant by early latent syphillis?
Positive syphillis serology but no symptoms.
What is the incubation period of primary syphillis?
9-90 days.
What is the primary lesion known as? Is it painful?
Chancre. A painless ulcer
Where do the chancre appear?
At the site of inoculation.
What other symptoms will be shown in primary syphillis?
Non tender lymphadenopathy.
What is the incubation period of secondary syphillis?
6 weeks to 6 months.
What symptoms will be seen in secondary syphillis?
Skin lesions Lesions of mucous membranes Generalised lymphadenopathy Patchy alopecia Condylomata lata (a very infectious lesion that secretes vast amounts of treponema).
How do you diagnose syphillis?
Need to swab lesions
Dark field microscopy or PCR
Serological testing- detects antibody to pathogenic treponemes.
Which test is used for screening for syphillis?
ELISA/EIA test (enzyme immunoassay test)
If the screening test is positive, what further tests may be done in syphillis?
TPPA (treponema pallidum particle agglutination)
Which test monitors disease activity in syphillis?
RPR (rapid plasma reagin)
How would you treat early syphilis?
2.4MU benzathine penicillin x1
How would you treat late syphillis?
2.4MU benzathine penicillin x 3
Do you follow up syphillis treatment with further tests?
You carry on treating until RPR is negative or serofast.
Titres should decrease 4 fold by 3-6 months of treatment
There is a serological relapse if titres increase by four fold.