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Reproduction > Week 2- STI's > Flashcards

Week 2- STI's Flashcards

1
Q 
Q1.The most common bacterial STI is: 
Genital Warts 
Gonorrhoea  
Chlamydia  
Herpes
A

Chlamydia

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2
Q 
Q2.Profuse mucopurulent discharge from the penis and painful urination are more commonly symptoms of: 
Herpes 
HPV 
Syphilis 
Gonorrhoea
A

Gonorrhoea

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3
Q 
Q3.A chancre develops during which stage of syphilis. 
Primary 
Latent 
Tertiary  
Secondary
A

Primary

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4
Q 
Q4.Which of these infections can lead to pelvic inflammatory disease in women. 
Syphilis 
HPV 
Chlamydia  
HIV
A

Chlamydia

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5
Q 
Q5.This STI is known as the "great imitator" because its symptoms resemble those of other infections. 
HIV 
Syphilis  
HPV 
Gonorrhoea
A

Syphilis

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6
Q 
Q6.The vaccine for HPV is currently recommended in (HIV negative) females of which age: 
11-13 
40+ 
9 - 26  
25 - 35
A

11-13

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7
Q

Q7.Viral shedding is higher with which type of Genital Herpes simplex virus
Type 1
Type 2

A

Type 2

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8
Q

What sort of bacterium is chlamydia?

A

Gram negative bacterium

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9
Q

How is chlamydia transmitted?

A

Vaginal, oral or anal sex.

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10
Q

People who have chlamydia can experience complications, one commonly being pelvic inflammatory disease. True or false?

A

True

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11
Q

What can pelvic inflammatory disease increase the risk of?

A

Ectopic pregnancy

Carries a risk of tubal factor infertility

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12
Q

What is the presentation of chlamydia in women?

A

Intermenstrual or post coital bleeding (after sex)

Signs of upper genital tract infection- lower abdominal pain, dyspareunia (pain during sex), mucopurulent cervicitis

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13
Q

What is the presentation of chlamydia in men?

A 
Urethral discharge
Dysuria (pain on urination)
Urethritis 
Epidymo-orchitis (swelling and pain in both testicles)
Proctitis
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14
Q

What complications can you have with chlamydia?

A 
Pelvic inflammatory disease
Tubal damage (ectopic pregnancy)
Chronic pelvic pain
Transmission to the neonate
Adult conjunctivitis 
Sexually acquired reactive arthritis 
Fitz-Hugh-Curtis syndrome
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15
Q

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?

A

Look for chlamydia to rule out sexually acquired reactive arthritis.

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16
Q

What is LGV?

A

A disease of the lymphatics and lymph nodes caused by specific serovars of chlamydia (L1-L3).

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17
Q

Who is likely to get LGV?

A

Men who have sex with men (MSM)

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18
Q

Symptoms of LGV?

A

Rectal pain, discharge and bleeding

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19
Q

Other STI’s are associated with LGV. True or false?

A

True- high risk of concurrent STI’s.

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20
Q

When would you test for chlamydia?

A

14 days after suspected exposure

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21
Q

What test would you use to diagnose chlamydia?

A

NAAT
Vulvovaginal swab for females
First void urine in males

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22
Q

If you suspect LGV alongside chlamydia, what extra swab would you do?

A

Rectal swab

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23
Q

How do you treat chlamydia?

A

1G of azithromycin stat

or

doxycycline 100mg BD for a week.

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24
Q

Describe gonorrhoea (gram stain etc)?

A

Gram negative intracellular diplococcus.

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25
Q

What are the common primary sites of infection for gonorrhoea?

A

Mucous membranes of the urethra, endocervix, rectum and pharynx

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26
Q

What is the incubation period for gonorrhoea?

A

2-5 days.

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27
Q

How does gonorrhoea present in males?

A

Very few (<10%) are asymptomatic
Urethral discharge
Dysuria
Rectal and pharyngeal infections are most likely asymptomatic.

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28
Q

How does gonorrhoea present in females?

A

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.

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29
Q

What complications can gonorrhoea cause? Split into lower genital tract and upper genital tract

A 
Lower genital tract-
Periurethral abscess
Rectal abscess
Barthonititis
Tysonitis
Epidydimitis 
Urethral stricture
Upper genital tract
Endometriosis
PID
Hydrosalpinx
Infertility
Ectopic pregnancy
Prostatitis
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30
Q

How do you diagnose gonorrhoea?

A

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)

31
Q

Treatment of gonorrhoea?

A

Ceftriaxone 500mg IM and (co-treatment for chlamydia) 1G azithromycin.

32
Q

Would you test to see if the patient is cured in gonorrhoea?

A

YES.

33
Q

Describe the advantages and disadvantages of each method for diagnosis of gonorrhoea

A

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.

34
Q

What is meant by a genital herpes primary infection?

A

Never been infected with herpes before.

35
Q

What is meant by a non-primary first episode in herpes infection?

A

Been exposed to the antigens before but not been infected.

36
Q

What is the incubation period for herpes infection?

A

3-6 days.

37
Q

How long does genital herpes last?

A

14-21 days

38
Q

What symptoms do you get with genital herpes?

A 
Blistering and ulcering at the external genitalia 
Pain
External dysuria 
Vaginal or urethral discharge
Local lymphadenopathy
Fever and myalgia
39
Q

Which type of herpes is recurrent episodes more likely to occur with?

A

HSV 2.

40
Q

How does HSV type 2 present?

A

Usually misdiagnosed as thrush- mild anogenital tingling, burning or soreness.
Usually unilateral small blisters and ulcers.
Minimal systemic symptoms, resolves within 5-7 days.

41
Q

How does HSV type 2 present?

A

Usually misdiagnosed as thrush- mild anogenital tingling, burning or soreness.
Usually unilateral small blisters and ulcers.

42
Q

Do you experience systemic symptoms with HSV type 2?

A

Minimal systemic symptoms, resolves within 5-7 days.

43
Q

How would you manage and treat herpes?

A 
Swab base of ulcer for HSV PCR
Give oral aciclovir
Consider topical lignocaine 5% if extremely painful
Analgesia
Saline bathing
44
Q

What is viral shedding?

A

When a virus has invaded a cell and reproduced and used up all of its energy etc, it exits the cell.

45
Q

Which virus is more likely to carry out viral shedding?

A

HSV 2.

46
Q

When is viral shedding more likely to occur?

A

In recurrences
In the first year of infection
Reduced by suppressive therapy.

47
Q

Which special circumstances of infection with HSV are important to recognise?

A

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.

48
Q

Which types of HPV are low risk types?

A

6,11,42,43,44

Remember 6 and 11

49
Q

Which HPV types are high risk types?

A

16,18,31,33,35,45,51,52,66

Remember 16 and 18

50
Q

Which HPV type causes anogenital warts?

A

Likely 6 and 11.

51
Q

Which HPV type causes palmar and plantar warts?

A

1 and 2.

52
Q

How does HPV present?

A

Depends on the type however almost all present with latent infection.
Could also have-
-anogenital warts
-palmar and plantar warts
-cellular dysplasia/intraepithelial neoplasia.

53
Q

What is the incubation period for HPV?

A

3 weeks to 9months.

54
Q

Transmission of more than one type of HPV is common. True or false?

A

True- likely to come in groups.

55
Q

Do you need to treat HPV?

A

20-34% clear without treatment
60% clear with treatment
20% persistent despite treatment.

56
Q

How would you treat HPV?

A

1st line -Podophyllotoxin (warticon)
2nd line- imiquimod- or used first line in perianal warts
3rd line- cryotherapy

57
Q

Who gets a HPV vaccination?

A

Girls 11-13
MSM
People living with HIV.

58
Q

How is syphillis transmitted?

A

Sexual contact
Transplacental
Blood transfusions
Non-sexual contact- healthcare workers.

59
Q

How can syphillis be classified?

A

Congenital

Acquired

60
Q

What is meant by early latent syphillis?

A

Positive syphillis serology but no symptoms.

61
Q

What is the incubation period of primary syphillis?

A

9-90 days.

62
Q

What is the primary lesion known as? Is it painful?

A

Chancre. A painless ulcer

63
Q

Where do the chancre appear?

A

At the site of inoculation.

64
Q

What other symptoms will be shown in primary syphillis?

A

Non tender lymphadenopathy.

65
Q

What is the incubation period of secondary syphillis?

A

6 weeks to 6 months.

66
Q

What symptoms will be seen in secondary syphillis?

A 
Skin lesions
Lesions of mucous membranes
Generalised lymphadenopathy
Patchy alopecia
Condylomata lata (a very infectious lesion that secretes vast amounts of treponema).
67
Q

How do you diagnose syphillis?

A

Need to swab lesions
Dark field microscopy or PCR
Serological testing- detects antibody to pathogenic treponemes.

68
Q

Which test is used for screening for syphillis?

A

ELISA/EIA test (enzyme immunoassay test)

69
Q

If the screening test is positive, what further tests may be done in syphillis?

A

TPPA (treponema pallidum particle agglutination)

70
Q

Which test monitors disease activity in syphillis?

A

RPR (rapid plasma reagin)

71
Q

How would you treat early syphilis?

A

2.4MU benzathine penicillin x1

72
Q

How would you treat late syphillis?

A

2.4MU benzathine penicillin x 3

73
Q

Do you follow up syphillis treatment with further tests?

A

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.

Reproduction (34 decks)

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