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Exam - M - Reproduction System (Megan and Rachel) > STIs > Flashcards

STIs Flashcards

1
Q

what pathogen causes gonorrhoea

A

Neisseria gonorrhoeae

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2
Q

what type of tissues can gonorrhoeae affect

A

mucous membranes with columnar epithelium

Commonly - cervix, urethra, anus, throat.

Common in children - lining of eyes.

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3
Q

what are risk factors for gonorrhoeae

A

young
sexually active
multiple partners
MSM

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4
Q

what is the incubation period for gonorrhoea

A

usually 5-6 days

can range from 2-14 days

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5
Q

how does gonorrhoea present in women

A 
most have no symptoms 
vaginal discharge (odourless, can be green or yellow) 
dysuria 
intermenstrual/post coital bleeding
pelvic pain
pharyngeal/rectal infection
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6
Q

how does gonorrhoea present in men

A

thick yellow discharge
rectal infection - usually asymptomatic, can cause discomfort and discharge
pharyngeal infection - usually asymptomatic, can cause sore throat
testicular pain/swelling
more likely to be symptomatic

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7
Q

what are complications of gonorrhoea

A 
acute monoarthritis usually in elbow or shoulder 
disseminated gonococcal infection 
women - pelvic inflammatory disease
men - epididymitis
infertility
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8
Q

what investigations could you do for gonorrhoea

A

nucleic acid amplification testing - optimum
swabs - rectal and pharyngeal for MSM
urine sample for men
endocervical/urethral swab for microscopy, culture, abx sensitivities
gram stained smear in symptomatic people

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9
Q

how do you treat gonorrhoea

A

ceftriaxone 1g IM if sensitivities not known
oral ciprofloxacin if sensitivities known
follow up NAAT testing
- test of cure at 1 weeks
- test of reinfection at 3 months
give advice
test for other STIs

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10
Q

what pathogen causes chlamydia

A

chlamydia trachomatis serovars D to K

most common STI in UK

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11
Q

how does chlamydia present in women

A 
over 80% are asymptomatic 
increased vaginal discharge 
dysuria 
intermenstrual/post-coital bleeding 
conjunctivitis 
pelvic pain 
painful sex - dyspareunia
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12
Q

how does chlamydia present in men

A

urethral discharge/discomfort
dysuria
epididmyo-orchitis
reactive arthritis

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13
Q

what are complications of chlamydia

A

men - epididymitis
women - ectopic pregnancy, pelvic pain, infertility
both - reactive arthritis, reiter’s syndrome

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14
Q

what investigations could you do for chlamydia

A

NAATs from swabs from cervix, urethra, rectum

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15
Q

how do you manage chlamydia

A

doxycycline 100mg 2x a day for 7 days
or oral azithromycin 1g if pregnant
test for reinfection at 3-12 months
dont do an earlier test of cure unless symptoms persist
need to trace sexual partners
avoid intercourse until treatment is complete

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16
Q

what is genital herpes caused by

A

herpes simplex virus 1 and 2

HSV-2 associated with genital herpes and is a co-factor in HIV transmissionHSV-1 with cold sores

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17
Q

how does genital herpes present

A

ulcers or blistering lesions in genital area
neuropathic pain in back, pelvis, legs
flu like symptoms
dysuria
80% asymptomatic
symptoms recur but are less severe in recurrent episodes

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18
Q

what are complications of genital herpes

A

autonomic neuropathy (urinary retention)
neonatal infection
secondary infection

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19
Q

what is the incubation time for herpes

A

5 days - months

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20
Q

what investigations could you do for genital herpes

A

swab the lesion, send to PCR

ask about contacts

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21
Q

how do you manage genital herpes

A

aciclovir
lidocaine ointment

for infrequent recurrences aciclovir 1.2g once daily until symptoms go

for frequent reoccurences give aciclovir 400mg 2x daily until symptoms stop

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22
Q

what is trichomoniasis caused by

A

trichomonas vaginalis (parasite)

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23
Q

what are symptoms of trichomoniasis

A 
men are usually asymptomatic 
10-30% of women are asymptomatic 
profuse vaginal discharge - greenish frothy and foul smelling - fishy
vulvitis
itch
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24
Q

what are complications of trichomoniasis

A

miscarrige
preterm labour
increased risk of HIV, cervical cancer, pelvic inflammatory disease, bacterial vaginosis

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25
Q

what investigations could you do for trichomoniasis

A

PCR of vaginal swab
microscopy of vaginal discharge
NAAT
culture

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26
Q

how do you treat trichomoniasis

A

metronidazole 400mg 2x/day for 5 days or 2g single dose

partner tracing + avoid intercourse until treatment is completed

27
Q

what causes anogenital warts

A

human papilloma virus types 6 and 11

28
Q

what are symptoms of anogenital warts

A

lumps

sometimes itching and bleeding

29
Q

what are complications of anogenital warts

A

neonatal laryngeal papillomatosis

30
Q

how do you treat anogenital warts

A 
podophyllotoxin 
imiquimod 
cyrotherapy 
diathermy 
scissor removal
31
Q

what is syphilis caused by

A

treponema pallidum

bacteria that gets into body through mucous membranes or skin.

32
Q

how does syphilis present (stages)

A

incubation period of 21 days
primary - chancre (painless ulcer)
secondary - systemic symptoms, maculopapular rash, condylomata lata, fever, lymphadenopathy, alopecia, oral lesions
latent stage - symptoms resolve but patient is still infected (early latent stage is within 2 years of initial infection, late latent stage is after 2 yrs)
tertiary - can happen many years after initial infection, gummas develop, can have CVS and neuro complications
neurosyphilis - infection involves CNS

33
Q

what are complications of syphilis

A

neurosyphilis
CN palsies
cardiac or aortal involvement
congenital syphilis

34
Q

what investigations could you do in syphilis

A

serology for TP IgGEIA, TPPA, RPR

samples from infection site can be sent for dark field microscopy, PCR

35
Q

how do you treat syphilis

A

under 2years with no neuro invovement - IM benzathine penicillin or doxycycline 100mg bd 2wks
if late stage (over 2yrs) with no neuro invovement - IM benzathine penicillin for 3wks, doxycycline 100mg bd 28dys
screen for other STIs

36
Q

what is genital candidiasis caused by

A

candidia albicans (thrush)

37
Q

what are risk factors for genital candidiasis (thrush)

A

increased oestrogen
poorly controlled diabetes
immunosuppressants
broad-spectrum antibiotics

38
Q

how does genital candidaisis present

A

itch
burning
thick white discharge
dyspareunia

39
Q

what investigations can you do for genital candidiasis

A

test vaginal pH - usually <4.5, if its >4.5 consider trichomonas
swab for microscopy and culture

40
Q

how can you manage genital candidiasis

A

antifungal cream or pessary - clotrimazole
if severe oral fluconazole
condoms will not be as effective for 5 days after so alternative contraception is needed

41
Q

what are risk factors for genital candidiasis

A

pregnant
antibiotic therapy
DM
immunosuppressed

42
Q

what causes bacterial vaginosis

A

overgrowth of bacteria in the vagina

43
Q

how does bacterial vaginosis present

A

thin white fishy smelling discharge
like megans xx

no itch or pain

44
Q

what investigations could you do for bacterial vaginosis

A

gram stain to examine vaginal flora

45
Q

how do you manage bacterial vaginosis

A

oral or PV metronidazole

PV clindamycin

46
Q

What are the signs and symptoms of neurosyphilis?

A
  • Argyll- robertson pupil
  • headache
  • dementia
  • tabes dorsalis (lots of presentations)
  • paralysis
  • sensory impairment
47
Q

What is the feature of argyle’s Robertsons pupil?

A
  • pupil changes for accommodation but DOESNT change in reaction to light
48
Q

What is HIV?

A

Human immunodeficiency virus.

49
Q

What is AIDS?

A

Acquired immunodeficiency syndrome - it occurs when HIV progresses and the person becomes immunodeficient.

50
Q

What is the pathophysiology of HIV?

A

It enters the body and destroys CD4 T-helper cells.
(these are the cells that trigger the body’s response to an infection)
It can take up to 3 months for antibodies to be made

51
Q

What are the signs and symptoms of HIV?

A

A flu like illness for the first few weeks (fever and body aches).

Asymptomatic after this until immunodeficient

52
Q

How is HIV transmitted?

A
  • Anal or vaginal sex
  • from mother to baby either during pregnancy, birth or breast feeding (vertical transmission)
  • mucous membrane, blood or open wound exposed to infected blood or bodily fluids
53
Q

What is the pathophysiology of AIDS?

A

When the CD4 T-helper cells have dropped so low that opportunistic infections can occur.

54
Q

What are examples of AIDS defining illnesses?

A
  • tuberculosis
  • candidiasis
  • lymphomas
  • cytomegalovirus
  • kaposis sarcoma
  • pneumocystitis pneumonia
55
Q

When should repeat testing be done in HIV?

A

3 months after the initial contact with the virus, as this is when antibodies will have developed by.

56
Q

When is HIV screened for?

A

When pregnant as routine.

57
Q

What are the normal and AIDS levels of CD4?

A

Normal = 500-1200 cells/mm3

End stage HIV/AIDS = <200cells/mm3

58
Q

What is an undetectable Viral load?

A

When the HIV RNA is under 50-100 copies/ml.

It can be in the hundreds of thousands in untreated patients.

59
Q

What is the treatment for HIV?

A
  1. ART - antiretroviral therapy (offered to everyone with HIV regardless of CD4 count or viral load)
  2. Two NRTI’s -tenofovir and emtricitabine
  3. HAART
  4. prophylactic co -trimoxazole (if CD4<200)
60
Q

How should HIV patients be treated when they have an infection?

A

If they have normal CD4 and undetectable viral load, they should be treated like non-HIV patients.

Make sure to check drug interactions with their HIV medications.

61
Q

What are women with HIV at increased risk of?

A

HPV - cervical cancer

they receive yearly smears

62
Q

What vaccines should HIV patients avoid?

A

Live vaccines.

63
Q

What are mothers with HIV advised against?

A

Breastfeeding

even with undetectable viral load they can pass on HIV to baby

64
Q

What is the prophylaxis therapy for contact with HIV?

A

Must be within 72hrs of contact

ART therapy - Truvada and raltegravir for 28 days

Exam - M - Reproduction System (Megan and Rachel) (45 decks)

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