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MD1 - Reproduction Block > 3. Sexually Transmissible Infections > Flashcards

3. Sexually Transmissible Infections Flashcards

(39 cards)

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1
Q

What infections are transmitted via the Oral-genital contact?

A
  • Chlamydia, Gonorrhoea, HSV, Syphilis, HPV
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2
Q

What infections are transmitted via the Anilingus?

A
  • Amoeba, Cryptosporidia, Giardia, Shigella. HAV
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3
Q

What are the routes of transmission of STI?

A
  • Oral-genital contact - Vaginal intercourse - Anal intercourse - Anilingus
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4
Q

What should you ask about a patient coming in with an STI?

A
  • Partners
    • M/F
    • Number/monogamous
  • Pregnancy prevention?
  • Protection from STI
    • How do you protect against STI and HIV
  • Practices
    • Vaginal, Oral anal
  • Past history of ST
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5
Q

What are the possible causes for discharge?

A
  • Gonorrhea
  • Chlamydia
  • Trichomonas - Frothy green-yellow discharge
  • Bacterial vaginosis - White-grey fishy smell (polymicrobial growth)
  • Candidasis - Cottge cheese (not sexually transmitted)
  • Mycoplasma genitalium
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6
Q

What are the possible causes for STI ulcer?

A
  • HSC
  • Syphillis
  • Chancroid
  • LGV
  • Granuloma inguinale
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7
Q

What are the clinical patterns of STI?

A
  1. Discharge
  2. Ulcer
  3. Pelvic inflammatory disease
  4. Dermatological
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8
Q

What are the diagnostic tools for STI?

A
  • Microscopy
    • Vaginal fluid, gram stain
  • Culture
  • Serology
    • Syphilis, HIV
  • Nucleic acid ampification test
    • Geonorhea, Chlamydia, M.Genitallium
    • Urine, Uretheral, vaginal, cervical swabs.
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9
Q

What are the features of Nisseria gonorrhoeae?

A
  • Gram negative diplococci
  • Adhere to columnar epithelial cells
    • Produce various toxins and immune modulators that help them survive. Also modify surfae protein to hide from immune system.
  • Incubation period: 2-7 days
  • Asymptomatic infection in females (80%)
  • Males - Urethrtis (10%)
  • Increasing antibiotic resistance
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10
Q

What can happen if Gonorrhoea is left untreated?

A

If left untreated dissemination (0.5-3%) could cause

  • Arthritis
  • Macrulopapular rash
  • Meningitis
  • Endocarditis
  • Epididymitis
  • Peri-hepatitis (Fitz-Hugh-Curtis syndrome)
    • Adhesion of liver capsule to abdominal cavity wall
  • Increased risk post menses
  • Violin string adhesion
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11
Q

If Gonorrhoea is left untreated and lead to Pelvic Iflammatory disease what are the sequalae?

A
  • Tubal scarring
  • Infertility (10-20%)
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12
Q

What happens if babies are born with Gonno infected moms?

A

Neonatal gonococcal opthalmia

  • Gross purulent conjunctivitis
  • Day 2-5 of life –> Perforation and blindness
  • Mild disease indistinghuishble from other causes of conjunctivitis

Treatment

  • Cefotaxime IV
  • Topical antibiotic not required
  • Irrigate eyes regularly
  • Treat mother + sexual contacts
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13
Q

What diagnostic specimens are used for Gonno?

A

Cervical swab into charcoal transport

Male urethral swabs

urine

Other specimens: conjunctiva, pharynx, skin lesions, anal, CSF, blood, synovial fluid.

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14
Q

What laboratory investigations can be used to diagnose Gonno?

A
  • Non-selective: Chocolate blood agar in CO2
  • Selective: Thayer-Martin agarTM
    • Colistin (GN), Vancomycin (GP), nystatin (fungi)
  • Culture for antibiotic sensitivies
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15
Q

What is nucleic amplification tests and what is it used for?

A

Use genital (cervial or vaginal) swabs or first void urine.

Used to detect Gonno

Combined Chlamydia and Nisseria detection (Chlamydia co-infection in 50%)

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16
Q

What are the treatments for Gonno?

Study These Flashcards
A

Use high dose, single dose IV

Azithromycin 1g (Chlamydia)

and

Ceftriazone 500mg (IM/IV) (Gonno)

Ciproflaxacin 500mg oral if sensitive

Amoxicillin 3g + Probenecid 1g oral

17
Q

How do you prevent Gonno?

Study These Flashcards
A
  • Barrier contraception
  • Contact tracing
  • Vaccine???
18
Q

What are the features of Chlamydia infection?

Study These Flashcards
A
  • Most common STI (2-20%)
    • Females: Cervicitis
    • Male: Urethritis
    • [Anus, Conjunctivitis]
    • Frequently asymptomatic
  • Obligate intracellular parasite
  • Infects Columnar epithelium
    • Infects young female adults
  • Serovars
    • D-K: Genital Infection
    • L 1-3: Lymphogranuloma venerum (LGV)
    • A-C: Ocular infection (Trachoma)
  • 48-72 hours life cycle
  • Elementary bodies: infectious, non-replicating, hardy
  • Retriculate bodies: Metabolically actve, replicate
19
Q

What is the life cycle of Chlamydia?

20
Q

What are the clinical findings of Chlamydia in men?

Study These Flashcards
A
  • Dysuria
  • Meatal erythema
  • Clear urethral discharge (may need to milk to produce discharge)
  • Testicular pain (Epididmo-orchitis)
  • Prostasis
21
Q

What are the clinical findings of Chlamydia in women?

Study These Flashcards
A
  • Cervitis, endometrisis/vaginal discharge
  • Urethritis/Dysuria
  • Irregular bleeding
  • Pelvic pain & dyspaeunia

Pelvic inflammatory disease

  • Acute and chronic
22
Q

What happens when Chlamydia invades the lymph node?

Study These Flashcards
A
  • LGV (Lymphogranuloma venereum)
  • Ulcerative genital lesion –> Suppurative inguinal lymphadenopathy with systemic Sx
  • Proto-colitis with strictures (MSM)
  • Endemic in Africa, India, SE Asia, South America
23
Q

What happens in Neonatal Chlamydia?

Study These Flashcards
A

50% Transmission

  • 25% conjunctivitis
  • 10% pneumonia

Colonization may persists

Conjunctivitis IP 2-28 days

Pneumonia IP 2-8 weeks

24
Q

What laboratory investigations are done for Chlamydia?

Study These Flashcards
A
  • Cervical/Urethral/Anal swab
  • Urine
  • Nucleic Acid detection
  • Culture not routine and requires cell culture techniques
  • Test of cure required
    • Post procedure
    • Prgnancy
25
What are the treatments for Chlamydia?
Azithromycin or Doxycycline * Contact trace partners * Doctor must be notified * Test of cure 4-6 weeks (If too early may still have trade DNA for up to 3 weeks) * Advise retset in 3 months
26
What are the features of *Trichomonas vaginalis ?*
* Flagellated protozoan * Frequently asymptomatic (67% asymptomatic) - Males more likely to be asymptomatic * Frothy, green-yellow vaginal discharge * ph \>5.0 * Cervical erythema & friability * Pruritis, dysuria, abdominal pain * Prevalence underestimated * Marker for high risk sexual activity * Genital inflammation --\> Increase risk for HIV acquisition * Associated with * Non-steady partner/Older partner * Marijuana use * High in Indegenous community
27
What laboratory testing can be done to test for Trichomonas vagnalis?
* High vaginal swab * Wet prep, microscopy - motile * Culture * Urine - PCR * Sometimes seen on PAP smear
28
What are the treatments for Trichomonas vaginalis?
Metronidazole 2g oral single dose Tinidazole 2m oral single dose Metronidazole 400mg Clindamycin cream
29
What are the stages of *Treponema palladium* (syphilis) infection?
Primary * Initial infection * Painless ulcer at site of inoculation * Takes 3 weeks, because bacteria takes a long time to replicate (33 hr) * This will heal up Secondary * 6-12 weeks later you get secondary symptoms * Spread via lymphatic * Generate rash, alopecia, hepatitis, generalized lymphadenopathy * Eventually heal Tertiary * If untreated organism stays for life and lead to damage of varous organs * Gumma - inflammatory reaction that can destroy joint, skin, aorta (aortitis), takes decades to develop * So you want to identify people at primary, secondary and tertiary.
30
What are the laboratory detection test for Syphilis (T. Palladium)
* Microscopy * Dark field * Serology * Non-treponemal test (VLRL, RPR) * Treponemal test (TPHA, EIHA, FTA-Abs)
31
What is the non-treponemal test (VLRL, RPR) test for T.Palladium testing?
* Antibodies to cellular lipids & lecithin (non-specific antigen) * Positive 4-8 weeks post infection * 70% positive within 2 weeks of chancre (painless ulcer) * 100% positive for secondary & latent infection * Useful for screening/monitoring therapy * Non-specific antibodies gradually disapere if respond to treament * Titrate to detect response to treatment * False positive reaction * CT disorder, viral infection (hepatitis, vaericella, EBV, measles) IVDU 10%, pregnancy * False negativ reaction * Prozone effect
32
What is the treponemal test eg. EIA, TPHA, TPPA, FTA-Abs testing?
* Positive slightly earlier * If RPR is also present it indicates persistent infection * positive for life * Immunoglotting and PCR
33
What are the features of Mycoplasma genitalium?
Slow growing, takes 2m to grow in culture. Mycoplasma deform in shape and don't have a cell wall. So can't gram stain. They form flask shape, pertuberanece is what they use to attach to columnar epithelium which they use to enter the cell. Antibiotic resistant Prevalence 3-5%
34
What does Mycoplasma genitalium cause?
* Urethritis in men * Cervicitis in women * Acute endometritis * PID post termination of pregnancy * Presists for 3-6 months * Preterm delivery * May presispose to HIV transmission
35
What is the treatment for Mycoplasma genitalium?
* Azithromycin 1gm * 85% efficacy * Moxifloxacin 400mg daily 7-10 days * Expensive
36
What are the indications for STI testing?
* Symptomatic patient investigation * Screening asymptomatic infeciton * Pre-pregnancy * Antenatal screening * Blood and organ donation * Contact tracing * Epidemiological surveillance
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MD1 - Reproduction Block (15 decks)

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