10- Sexually transmitted disease (bacterial) Flashcards

Question

Nucleic acid amplification tests (NAAT)

Answer 1

- check directly for the DNA or RNA of the organism. - NAAT testing is used to test specifically for **chlamydia and gonorrhoea**. -They are not useful for other pelvic infections (except where specifically testing for Mycoplasma genitalium).

Answer 2

In women, a NAAT test can be performed on a **vulvovaginal** swab (a self-taken lower vaginal swab), an **endocervical** swab or a first-catch urine sample. The order of preference is : - endocervical - vulvovaginal - urine.

Answer 3

In men, a NAAT test can be performed on a first-catch urine sample or a urethral swab. It is worth noting that the NAAT swabs will specify on the packet whether the swabs are for endocervical, vulvovaginal or urethral use. A specific kit is used for first-catch urine NATT testing. Rectal and pharyngeal NAAT swabs can also be taken to diagnose chlamydia in the rectum and throat. Consider these swabs where anal or oral sex has occurred. Where gonorrhoea is suspected or demonstrated on a NAAT test, an endocervical charcoal swab is required for microscopy, culture and sensitivities.

Answer 4

* Pelvic or abdominal tenderness * Cervical motion tenderness (cervical excitation) * Inflamed cervix (cervicitis) * Purulent discharge

Answer 5

Nucleic acid amplification tests (NAAT) are used to diagnose chlamydia. This can involve a: * Vulvovaginal swab * Endocervical swab * First-catch urine sample (in women or men) * Urethral swab in men * Rectal swab (after anal sex) * Pharyngeal swab (after oral sex)

Answer 6

doxycycline 100mg twice a day for 7 day

Answer 7

- Azithromycin 1g stat then 500mg once a day for 2 days - Erythromycin 500mg four times daily for 7 days - Erythromycin 500mg twice daily for 14 days - Amoxicillin 500mg three times daily for 7 days

Answer 8

A test of cure is not routinely recommended. However, a test of cure should be used for rectal cases of chlamydia, in pregnancy and where symptoms persist.

Answer 9

- Abstain from sex for seven days of treatment of all partners to reduce the risk of re-infection - Refer all patients to genitourinary medicine (GUM) for contact tracing and notification of sexual partners - Test for and treat any other sexually transmitted infections - Provide advice about ways to prevent future infection - Consider safeguarding issues and sexual abuse in children and young people

Answer 10

**There are a large number of complications from infection with chlamydia:** * Pelvic inflammatory disease * Chronic pelvic pain * Infertility * Ectopic pregnancy * Epididymo-orchitis * Conjunctivitis * Lymphogranuloma venereum * Reactive arthritis * **Pregnancy-related complications include: ** * Preterm delivery * Premature rupture of membranes * Low birth weight * Postpartum endometritis * Neonatal infection (conjunctivitis and pneumonia) *

Answer 11

Lymphogranuloma venereum (LGV) is a condition affecting the lymphoid tissue around the site of infection with chlamydia. It most commonly occurs in men who have sex with men (MSM). LGV occurs in three stages: 1) The primary stage involves a painless ulcer (primary lesion). This typically occurs on the penis in men, vaginal wall in women or rectum after anal sex. 2) The secondary stage involves lymphadenitis. This is swelling, inflammation and pain in the lymph nodes infected with the bacteria. The inguinal or femoral lymph nodes may be affected. 3) The tertiary stage involves inflammation of the rectum (proctitis) and anus. Proctocolitis leads to anal pain, change in bowel habit, tenesmus and discharge. Tenesmus is a feeling of needing to empty the bowels, even after completing a bowel motion. **Mangement **Doxycycline 100mg twice daily for 21 days is the first-line treatment for LGV recommended by BASHH. Erythromycin, azithromycin and ofloxacin are alternatives.

Answer 12

Chlamydia can infect the conjunctiva of the eye. Conjunctival infection is usually as a result of sexual activity, when genital fluid comes in contact with the eye, for example, through hand-to-eye spread. It presents with chronic erythema, irritation and discharge lasting more than two weeks. Most cases are unilateral. Chlamydial conjunctivitis occurs more frequently in young adults. It can also affect neonates with mothers infected with chlamydia. Gonococcal conjunctivitis is a crucial differential diagnosis and should be tested.

Answer 13

- Neisseria gonorrhoeae is a gram-negative diplococcus bacteria. - It infects mucous membranes with a columnar epithelium, such as the endocervix in women, urethra, rectum, conjunctiva and pharynx. - It spreads via contact with mucous secretions from infected areas.

Answer 14

- young - sexually active - multiple parnters - having other STIs such as chlamydia and IV

Answer 15

There is a high level of antibiotic resistance to gonorrhoea. Traditionally ciprofloxacin or azithromycin was used to treat gonorrhoea. However, there are now high levels of resistance to these antibiotics.

Answer 16

* Odourless purulent discharge, possibly green or yellow * Dysuria * Pelvic pain

Answer 17

* Odourless purulent discharge, possibly green or yellow * Dysuria * Testicular pain or swelling (epididymo-orchitis)

Answer 18

may cause anal or rectal discomfort and discharge, but is often asymptomatic.

Answer 19

may cause a sore throat, but is often asymptomatic.

Answer 20

causes perineal pain, urinary symptoms and prostate tenderness on examination.

Answer 21

erythema and a purulent discharge.

Answer 22

1) NAAT 2) charcoal endocervical swab

Answer 23

is use to detect the RNA or DNA of gonorrhoea. Genital infection can be diagnosed with endocervical, vulvovaginal or urethral swabs, or in a first-catch urine sample. Rectal and pharyngeal swab are recommended in all men who have sex with men (MSM), and in those with risk factors (e.g. anal and oral sex) or symptoms of infection in these areas.

Answer 24

A standard charcoal endocervical swab should be taken for microscopy, culture and antibiotic sensitivities before initiating antibiotics. This is particularly important given the high rates of antibiotic resistance.

Answer 25

TOM TIP: It is worth remembering that NATT tests are used to check if a gonococcal infection is present or not by looking for gonococcal RNA or DNA. They do not provide any information about the specific bacteria and their antibiotic sensitivities and resistance. This is why a standard charcoal swab for microscopy, culture and sensitivities is so essential, to guide the choice of antibiotics to use in treatment.

Answer 26

* A single dose of intramuscular ceftriaxone 1g if the sensitivities are NOT known * A single dose of oral ciprofloxacin 500mg if the sensitivities ARE known

Answer 27

All patients should have a follow up “test of cure” given the high antibiotic resistance. This is with NAAT testing if they are asymptomatic, or cultures where they are symptomatic. BASHH recommend a test of cure at least: * * 72 hours after treatment for culture * 7 days after treatment for RNA NATT * 14 days after treatment for DNA NATT

Answer 28

* Abstain from sex for seven days of treatment of all partners to reduce the risk of re-infection * Test for and treat any other sexually transmitted infections * Provide advice about ways to prevent future infection * Consider safeguarding issues and sexual abuse in children and young people

Answer 29

* Pelvic inflammatory disease * Chronic pelvic pain * Infertility * Epididymo-orchitis (men) * Prostatitis (men) * Conjunctivitis * Urethral strictures * Disseminated gonococcal infection * Skin lesions * Fitz-Hugh-Curtis syndrome * Septic arthritis * Endocarditis

Answer 30

gonoccocal conjunctivitis- *ophthalmia neonatorum* - contracted during childbirth - emergency associated with sepsis, perforation of the ye and blindness

Answer 31

Disseminated gonococcal infection (GDI) is a complication of untreated gonococcal infection, where the bacteria spreads to the skin and joints. It causes: * Various non-specific skin lesions * Polyarthralgia (joint aches and pains) * Migratory polyarthritis (arthritis that moves between joints) * Tenosynovitis * Systemic symptoms such as fever and fatigue

Answer 32

- Trichomonas vaginalis is a type of parasite spread through sexual intercourse. - Trichomonas is classed as a **protozoan**, and is a single-celled organism with flagella. - Flagella are appendages stretching from the body, similar to limbs. Trichomonas has four flagella at the front and a single flagellum at the back, giving a characteristic appearance to the organism. The flagella are used for movement, attaching to tissues and causing damage. Trichomonas is spread through sexual activity and lives in the urethra of men and women and the vagina of women.

Answer 33

* Contracting HIV by damaging the vaginal mucosa * Bacterial vaginosis * Cervical cancer * Pelvic inflammatory disease * Pregnancy-related complications such as preterm delivery

Answer 34

50% asymptomatic * Vaginal discharge- frothy and yellow/green * Itching * Dysuria (painful urination) * Dyspareunia (painful sex) * Balanitis (inflammation to the glans penis)

Answer 35

* **“Strawberry cervix”** (also called colpitis macularis). A strawberry cervix is caused by inflammation (cervicitis) relating to the trichomonas infection. There are tiny haemorrhages across the surface of the cervix, giving the appearance of a strawberry. * * **Testing the vaginal pH** will reveal a raised ph (above 4.5), similar to bacterial vaginosis.

Answer 36

- charcoal swab with microscopy Women - swab from posterior fornix of the vagina Men - urethral swab or first catch urine

Answer 37

Metronidazole

Answer 38

caused by **Treponema pallidum** - spirochete shaped - STI - incubation period is 21 days on average**

Answer 39

* Oral, vaginal or anal sex involving direct contact with an infected area * Vertical transmission from mother to baby during pregnancy * Intravenous drug use * Blood transfusions and other transplants (although this is rare due to screening of blood products)

Answer 40

* primary * secondary * latent * tertiary * neurosyphillus

Answer 41

involves a painless ulcer called a chancre at the original site of infection (usually on the genitals). * A painless genital ulcer (chancre). This tends to resolve over 3 – 8 weeks. * Local lymphadenopathy

Answer 42

Secondary syphilis involves systemic symptoms, particularly of the skin and mucous membranes. These symptoms can resolve after 3 – 12 weeks and the patient can enter the latent stage Typically starts after the chancre has healed, with symptoms of: * Maculopapular rash * Condylomata lata (grey wart-like lesions around the genitals and anus) * Low-grade fever * Lymphadenopathy * Alopecia (localised hair loss) * Oral lesions**

Answer 43

Latent syphilis occurs after the secondary stage of syphilis, where symptoms disappear and the patient becomes asymptomatic despite still being infected. Early latent syphilis occurs within two years of the initial infection, and late latent syphilis occurs from two years after the initial infection onwards.

Answer 44

can occur many years after the initial infection and affect many organs of the body, particularly with the development of gummas and cardiovascular and neurological complications. * Gummatous lesions (gummas are granulomatous lesions that can affect the skin, organs and bones) * Aortic aneurysms * Neurosyphilis

Answer 45

occurs if the infection involves the central nervous system, presenting with neurological symptoms. * Headache * Altered behaviour * Dementia *** Tabes dorsalis **(demyelination affecting the spinal cord posterior columns) * Ocular syphilis (affecting the eyes) * Paralysis * Sensory impairment

Answer 46

It is a constricted pupil that accommodates when focusing on a near object but does not react to light. - They are often irregularly shaped. - It is commonly called a “prostitutes pupil” due to the relation to neurosyphilis and because “it accommodates but does not react“.

Answer 47

Antibody testing for antibodies to the T. pallidum bacteria can be used as a screening test for syphilis.

Answer 48

1) dark field microscopy 2) polymeradse chain reaction (PCR) 3) Rapid plasma reagin (RPR) and venreal diase research lab (VDRL) tests

Answer 49

non-specific but sensitive tests used to assess for active syphilis infection. These tests assess the quantity of antibodies being produced by the body to an infection with syphilis. A higher number indicates a greater chance of active disease. These tests involve introducing a sample of serum to a solution containing antigens and assessing the reaction. A more significant reaction suggests a higher quantity of antibodies. The tests are non-specific, meaning they often produce false-positive results. There is a skill to both performing and interpreting the results of these tests.

Answer 50

All patients should be managed and followed up by a specialist service, such as GUM. As with all sexually transmitted infections, patients need: * Antibiotics- benzyl penicillin IM * Full screening for other STIs * Advice about avoiding sexual activity until treated * Contact tracing * Prevention of future infections

Answer 51

mainly treated with macrolides

Answer 52

- Endemic in S and W Africa, India and Caribbean - European outbreak since 2003 ◦ MSM ◦ 80% HIV positive ◦ 14% HCV coinfection rate ◦ Predominantly L2b

10- Sexually transmitted disease (bacterial) Flashcards

(76 cards)