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reproductive health > STIs > Flashcards

STIs Flashcards

1
Q

What is chlamydia

A

Chlamyidia trachomatis is gram negative bacteria. Intracellular organism - enters and replicates within cells, ruptures and spreads

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2
Q

Whast % of men anad women are asymptomatic with chlamydia

A

50% men
75% women

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3
Q

What are the aims of the National chlamydia screening programme

A

Screen every sexually active person under 25 years of age for chlamydia annually or when they change their sexual partner
Retested postivei cases in 3 months to make sure havent contracted chlamydia again

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4
Q

What is someone screened for basic in a GUM

A

Chalmydia
Gonorrhea
Syphilis - bloods
HIV - bloods

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5
Q

Swabs used in sexual health testing

A

Charcoal swabs
Nucleic acid amplification test (NAAT)

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6
Q

Which infections are NAAT swabs used for

A

Chalmydia
Gonorrhea

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7
Q

What investgiations do charcoal swabs allow

A

Microscopy
Culture
Sesnitiveits

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8
Q

What is the medium of NAAT swabs called

A

Amies transport medium

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9
Q

What can charcoal swabs confimr

A

Bacterial vaginosis
Candidiases
Gonorrhea
Trichomonas vaginalis
Group B strep

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10
Q

Where does gonorrhea swab have to be from

A

endocervical swab

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11
Q

Where does tichomonas swab have to be from

A

Posterior fornix

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12
Q

What can be used for endocervical swabs and high vaginal swabs

A

Charcoal swabs

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13
Q

What do NAAT swabs test for

A

DNA or RNA of oranfism

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14
Q

What can a NAAT be perfomred on

A

Endocervical swab
Vulvovaginal swab
First catch urine sample
men - urine, urethral swab
Rectum, pharyngeal

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15
Q

When gonorrhea sus on NAAT test what further investigations do

A

Cahrcoal swab for microscopy, culture and sensitivities

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16
Q

Chlamydia presentation woman

A

Mostly asymptomatic
Abnormal vaginal discharge
Pelvic pain
Abnormal vaginal bleeding (intermenstrual or postcoital)
Dyspareunia
Dysuria

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17
Q

How does chalmydia present in men

A

Urethral discharge or discomfort
Painful urination (dysuria)
Epidydymo-orchitis
Reactive arthritis

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18
Q

When is rectal chlamydia and lymphogranuloma venreum worth considering

A

Anorectal symptoms eg discomfort, discharge, bleeding and cahnge in bowel habits

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19
Q

Examination findings chlamydai

A

Pelvic or abdominal tenderness
Cercical motion tnederness - cervical excitation
Inflamed cervix - cervicitis
Purulent discharge

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20
Q

What swabs can be taken to diagnose chlamydia

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)
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21
Q

First line management chalmydia

A

Doxycylcine 100mg twice a day for 7 dyas

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21
Q

First line management chalmydia

A

Doxycylcine 100mg twice a day for 7 dyas

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22
Q

Why has azithromycin become alternative medication for chlamydia

A

Mycoplasma genitalium resistance
Less effective for rectal chlamydia

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23
Q

What is doxycycline contraindicated in?

A

Pregnnacy
Breast feeding

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24
Q

Chalmydia treatments for pregnant or breast feeding women

A
  • 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
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25
Q

When is a test of cure for chlamydia done

A

Rectal chlamydia
Pregnancy
Persisiting symptoms

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26
Q

Further management than medical for chlamydia

A

Refrain from sex for 7 dyas - reduce risk reinfection
Refer to GUM - contact racing and notifying sexual partners
Test for and treat any other STIs
Future protection advice
Safegurading issues

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27
Q

Complications from chlamydia

A

PID
Chronic pelvic pain
Infertility
Ectopic pregnancy
Epididymo-orchitis
Conjunctivirits
Lymphogranuloma venereum
Reactive arthritis
WHY

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28
Q

Pregnancy related coomplications chlamydia

A

Preterm
PROM
LBW
PP endometritis
Neonatal infection - conjunctivitis and pneumonia

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29
Q

What is lymphogranuloma venereum, who mostly gets it

A

Affects lymphoid tissue around site chlamydia
Men who have sex with men

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30
Q

What stages does LGV occur in

A

Primary - painless ulcer (primmary lesion)
Secondary - lymphadenitits - swelling, inflammation + pain of inguinal or femoral lymph nodes
Tertiary - Proctitiscolitis -> anal pain, change in habit, tenesmus, discharge

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31
Q

Treatemnet for LGV

A

Doxycycline 100mg twice daily for 21 days is the first-line treatment
Erythromycin, azithromycin and ofloxacin are alternatives.

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32
Q

How does chalmydial conjunctivitis present

A

Chronic erythema, irritationa nd discharge>2 weeks
Most are unilateral

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33
Q

How does chalmydial conjunctivitis present

A

Chronic erythema, irritationa nd discharge>2 weeks
Most are unilateral

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34
Q

What is gonorrhoea

A

Gram negative diplococcus bacteria infects mucous membranes with columnar epithelium - endocervix, urethra, rectum, conjunctiva and pharynx
Spreads via mucous secretions

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35
Q

How does gonorrhea present female

A

symptomatic 50% of women
Odourles spurulent discharge, green or yellow
Dysuria
Pelvic pain

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36
Q

How does gonorrhea present male

A

in 90% of men symptomatic
Odourless purulent discharge, green or yellow
Dysuria
Testicular pain or swelling - epididymo-orchitis

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37
Q

How else can gonorrhea present

A

Rectal - discomfort, discharge, may be asymptomatic
Pharyngeal - sore throat or asymptomatic
Prostatitis - perineal pain, urinary symptoms, prostate tenderness on exam
Conjunctivitis - erythema, purulent dischaege

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37
Q

How else can gonorrhea present

A

Rectal - discomfort, discharge, may be asymptomatic
Pharyngeal - sore throat or asymptomatic
Prostatitis - perineal pain, urinary symptoms, prostate tenderness on exam
Conjunctivitis - erythema, purulent dischaege

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38
Q

How disagnose gonorrhea

A

NATT - nendocervical, vulvovaginal or urethral swabs, first catch urine sample
Rectal and pharyngeal swabs -MSM, risk factors (sex in those areas), infections
Endocervical swab - charcoal

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39
Q

What need to do before starting anitbiotics for chlamydia

A

Endocervical charcoal swab for microscopy, culture and antibiotic sensitivities

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40
Q

Management of gonorrhoea

A

GUM clinic referr - coordinate test, treat and contact tracing
Medication depends on sensiticities

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41
Q

What is first line for uncomplicated fonorrhoea if sensitivities are known vs unknown

A

Single dose IM ceftriacone = 1g - unknown
Signle dose oral ciprofloxacin 500mg if snesiticeities KNOWN

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42
Q

Why do all patients with gonorrhea have a follow up test of cure

A

High levels of antibiotic resistance

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43
Q

When do test of cure gonorrhea

A

72 hours after treatment for culture
7 dyas after treatment - RNA NATT
14 days - DNA NATT

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44
Q

Complications of gonorrhea

A

PID
Chronic inflammatory pain
Infertility
Epidiymo-orchitis
Prostatitis
Conjuncitivits
Urethral strictures
Disseminated gonococcal infection
Skin lesions
Fitz-Hugh-Curtis syndrome
Septic arthritis
Endocarditis

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45
Q

What is gonorrhea ass with in neonate

A

Conjunctivitis (opthalmia neonatorum)
Contracted from mother in birth

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46
Q

Why is gonococcal conjunctivitis a medical emergency

A

Ass with sepsis, perforation of eye and blindness

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47
Q

What is disseminated gonococcal infection

A

Complciation of untreated gonorrhea, bacteria spread to skin and joints

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48
Q

Presentation of GDI

A

Various non specific skin lesions
Polyarthralgia - joint aches and pains
Migratory polyarthritis - arthritis moves between joints
Tenosynovitis
Systemic symptoms eg fever and fatigue

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49
Q

WHat is mycoplasma genitalum

A

Bacteria that causes non gonococcal urethrisit

50
Q

What are there high lveles of resitstance to in gonorrhea

A

Ciprofloxacin
Azithromycin

51
Q

Presnetation of mycoplasma genitalium

A

Urethritis
Epididymitis
Cerviciits
Endometritits
PID
Reactive arthritis
Preterm delivery in pregnancy
Tubal infertility
v similar to chlamydia and may be co-infection

52
Q

Why are traditional culutreus not helpful in isolating MG

A

V slow growing organism
Use NAAT

53
Q

Samples recomended for MG

A

First urine samples in morning - men
Vaginal swabs - can be self taken - women

54
Q

What things need to do when positive for MG

A

Check for macrolide resistance
Test of cure after treatemnt

55
Q

Uncomplicated MG genital infection 1st line

A

Doxycycline 100mg twice daily for 7 dyas then (not in pregnancy)
Axithromycin 1g stat then 500mg ince a dya for 2 dyas - UNLESS macrolide resisitace

56
Q

What is an alternative/complicated infection treatment of MG

A

Moxiflacin

57
Q

What is trichomonas

A

Protozoan - single celled organism w flagella (4 at front one at back)
Urethra in men + women, vagina aswell

58
Q

What can trichomonas increase the risk of

A

Contracting HIV by damaging vaginal mucosa
Bacterial vaginaosis
Cervical cancer
Pelvic inflammatory disease
Pregnancy related complications eg preterm

59
Q

Symptoms of trichomonas

A

50% none
Non specific if do
Vaginal dishcarge - frothy and yellow green + fishy
Itching
Dysurai
Dyspareunia
Balanitis (glans inflammation)

60
Q

Examination of cervix appearance in trichomonas

A

Strawberry cervix - colpitis macularis
Cervicitis caused - tiny haemorrhages across surface

61
Q

pH trichomonas

A

> 4,5

62
Q

Diagnosis of trichomonas

A

Charcoal swab + microscopy from prost fornix vagina - behind cervix
Self taken vaginal swab also used
Urethral swab or first catch urine in men

63
Q

Treatment of trichomonas

A

Metronidazole

64
Q

Where does herpes become latent after initial infection

A

Sensory nerve ganglia
Cold sores - trigeminal nerve
Genital - sacral nerve

65
Q

How is herpes simplex spread

A

Direct contact with affected mucous membranes or viral shedding in mucous secretions
Can be spread asymptomatically - more common in first 12 months infection

66
Q

When does herpes present

A

Asymptomatic or develop months or years after when latent virus reactivated
Normally initial infection symptoms appear within 2 weeks, most severe, then recurrent are milder
Symptoms last 3 weeks primary infection

67
Q

Signs and symptoms of genital herpes

A

Ulcers or blistering lesions
Neuro[athic pain - tingling, burning, shooting
Flu-like symptoms - fatigue, headahce
Dysuria
Inguinal lymphadenopathy

68
Q

Diagnosis of gential herpes

A

Cna be clinical
Viral pCR confirm

69
Q

Treatment for genital herpes

A

Aciclovir

70
Q

Additional conservative treatments for herpes

A

Varciciclovir, famciclovir
Paracetemol
Topical lidocaine 2% gel
Clean w warm salt water
Vaseline
Additional oral fluids
Wear loose clothing
Avoid intercourse with symptoms

71
Q

What is the main pregnancy risk with genital herpes infection

A

Neonatal herpes simplex virus infection contracted in labour and delivery
High morbidity and mortality

72
Q

How are babies protected against HSV

A

Antibodies from mum after initial infection can cross placenta -> passive immunity

73
Q

How treat primary genital herpes before 28 weeks gestation

A

Aciclovir during intial
Prophylactic aciclovir from 36 weeks gestation onwards - reduce risk genital lesions during labour and delivery

74
Q

When is C section recommended for herpes in pregnant women

A

If symptomatic
If contracted after 28 weeks gestation
(not needed if contact before 28 weeks, its >6 weeks past infection and woman is asymptomatic)

75
Q

How treat gential herpes contracted after 28 weeks gestation

A

Aciclovir and immediate prophyactive gollow ip

76
Q

What risk does recurrent gnetial herpes in pregnancy present

A

low for passing on to neonate even if lesions present
Prophylactic aciclovir considered form 36 weeks to reduce symptoms for delivery

77
Q

What is HIV + types + what does it target

A

RNA retrovirus
HIV I most common, 2 rare outside west africa
CD4-T helper cells

78
Q

How HIV initially presents

A

Seroconversion flu like illness - within frew weeks infection
Then asymptomatic until progresses to immunodeficiecny -> AIDs defining illnesses and oportunistic infections

79
Q

How is HIV spread

A

Unprotexted anal, vaginal or roal sezual activity
Mother to child at any stage of pregnancy, birth or breastfeeding - vertical
Mucous membrane, blood or open wound exposure to infected blood or bodily fluids eg needle sharing, injuries or blood splashed in eye

80
Q

Examples of AIDs defining illnesses

A

Kaposis sarcoma
Pneumocysitis jirovecii oneumonia - PCP
Cytomegalovirus infection
Candidiasis - oesophageal, broncheal
Lymphomas
TB

81
Q

Who should be tested for HIV

A

Anyone with any risk factors
Need verbal consent documented to test

82
Q

Why need to repeat HIV antibody test in 3 months

A

Antibodies take 3 months to develop - may be negative on first test so need another if exposed to virus to confirm

83
Q

Tests for HIV

A

Antibody - can order at home and slef ample
p24 antigen testing - earlier + result
PCR testing for HIV RNA levels - gives viral load

84
Q

What is normal CD4 count

A

500-1200 cells/mm3

85
Q

What CD4 count is considered end stage HIV

A

<200 cells/mm3

86
Q

What does undetectable viral load mean

A

PCR - HIV RNA levels below labs recordable range eg 50-100 copies/ml

87
Q

treat HIV

A

Antiretroviral therapy = ART
Offered to anyone irrespective of CD4 count or viral load

88
Q

Starting regime HIV

A

two NRTIs eg tenofovir and emtrivitabine + thrid agent

89
Q

What does hiv treatment aim for

A

Normal CD4 count
Undectable viral load
Treat physical health problems

90
Q

What is HAART + classes

A

Highly active anti-retrovirus therapy
* Protease inhibitors (PIs)
* Integrase inhibitors (IIs)
* Nucleoside reverse transcriptase inhibitors (NRTIs)
* Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
* Entry inhibitors (EIs)

91
Q

What extra is given to people with a CD4 under 200

A

Prophylactic co-trimaxazole (septrin) to prevent against PCP

92
Q

What monitor HIV patients for

A

Cardiovascular risk factors and blood lipids - hgih risk of CVS disease

93
Q

What is required yearly in women with HIV and why

A

Cervical smears
Risk of HPV and cervical cancer

94
Q

What vaccines need and dont

A

Should be up to date
influenza, pneumococcal, hepatitis A and B, tetanus, diphtheria and polio vaccines.
Avoid live vaccines

95
Q

What advice about reproductive helath given

A

Condoms for vaginal and anal sex and dams for oral sex even when both partners HIV +
If viral load undetectable transmission through unprotexted sex unhheard of although not impossible - parnters should be reguarly tested

96
Q

How can conceive with HIV

A

If undetectable, naturally
Sperm washing
IVF

97
Q

What viral load allows a normal vaginal delviery with HIV

A

<50 copies/ml

98
Q

When is C section considered for delivery in HIV

A

Considered if >50
In all women >400 copies/ml

99
Q

What is given if viral load unknown or >1000 in delivery

A

IV zidovudine

100
Q

What is a low risk baby given prophylactivalyy if mothers HIV +

A

Zidovudine for 4 weeks

101
Q

What is high risk baby given after birth if HIV + mother

A

Zidovudine, lamivudine and nevirapine for 4 weeks

102
Q

What risk babies if mum HIV +

A

<50 = low
>50 = high
Viral load

103
Q

Can you breastfeed with HIV

A

Highly unrecommended - HIV can be transmitted in breastfeeding even if viral load undetectable

104
Q

WHat is the current PEP meds

A

ART - truvada (emtricitabine and tenofovir_ and raltegravir for 28 days

105
Q

Howeffective is PEP

A

more effective earlier done
Needs done befpre 72 hours after incident

106
Q

What do after PEP

A

Immediate test and test in 3 months to confirm negative
Abstain from unprotected sexual activity for 3 months until confirmed negative

107
Q

What is syphilis caused by

A

Treponema pallidum - spirochete - enters mucous membranes and disseminates
21 day incubation

108
Q

How is syphilis contracted

A

Oral,vaginal, anal sex
Vertical transmission
IV drug use
Blood transfusions and transplants

109
Q

Stages of syphilis

A

Primary - painless ulcer (chancre) at OG site
Secondary - systemic (skin + MM)
Latenet stage - asymtpomatic
Tertiray - many years later -> organs, gumma development, CVS + neuro
Neurosyphilis - CNS infection

110
Q

How long is secondary syphilis

A

3-12 weeks

111
Q

Early vs late latent syphilis

A

become asymptomatic before 2 years is early
After is late

112
Q

Primary syphilis presentation

A

Chancre - 3-8 week resolve
Local lymphadenopathy

113
Q

Symptoms of secondary syphilis

A

Maculopapular rash
Condylomata lata
Low grade fever
Lymphadenopathy
Alopecua
Oral lesions

114
Q

What are condylomata lata

A

Grey wart like lesions genitals and anus

115
Q

Key features of tertiary syphilis

A

Depends on organs effected how presents
Gummatous lesions
Aortic aneursysms
Neurosyphilis

116
Q

When does neurosyphilis occur

A

Can occur at any stage if reaches CNS

117
Q

Presentation of neurosyphilis

A

Headahce
Altered behaviour
Dementia
Tabes dorsalis (lose coordination)
Ocular syphilis
Paralysis
Snesory impairment

118
Q

What is tabes dorsalis

A

Demyelination affecting the spinal cord posterior columns

119
Q

What is the typical pupil finding in neurosyphilis

A

Argyll-robertsion pipil

120
Q

What is argyll robertson pupil

A

Constricted pupil accomodates when focusing on near object but doenst react to lught
Often irreguarly shaoed
Prostitutes pupil - syphilis + accomodates but doesnt react

121
Q

Diagnosis of syphilhis

A

Antibody testing for T.pallidum
Dark field microscopy
PCR

122
Q

Non specific but sensitive tests assess for active infection syphilis:

A

Rapid plasma ragin - RPR
venereal disease reaseach lab (VDRL)
Quantigy antibodies - greater chance active disease
Can be false positives

123
Q

Management of syphilis

A

GUM follow up
Full screening for other STIs
Advice about avoiding sexual activity til treated
Contact tracing
Prevention further infections

124
Q

Treatment for syphilis standard

A

Deep IM dose of benzathine benzylpenicillin

125
Q

Alternatives for syphilis treatment

A

Ceftriazone
Amoxicillin
Doxycycline

reproductive health (69 decks)

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