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Clinical Pathology > 50 - HIV and STIs > Flashcards

50 - HIV and STIs Flashcards

1
Q

in utero transmission

A

Trans placental

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2
Q

Peri-natal transmission

A

Passage through infected birth canal

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3
Q

Eye mucous membrane transmission

A

Conjunctivitis

Keratitis

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4
Q

Gonorrhoea - disease causing organism

A

Neisseria gonorrhoeae

Gram –ve coccus

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5
Q

Gonorrhoea - pathogensis

A

Pili on cell surface become virulent.

Ability to attach to mucosal epithelial cells

Primarily infect columnar/cuboidal epithelium

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6
Q

Gonorrhoea - where? incubation?

A

GU tract, rectum, oropharynx

2-5 days incubation

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7
Q

Gonorrhoea - presentation

A

60% women are asymptomatic

Urethral discharge

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8
Q

Gonorrhoea - local complications

A

Lots of -itis

Metastatic: disseminated gonococcal infection (DGI)

Bacteraemia, arthritis, dermatitis (meningitis)

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9
Q

Gonorrhoea - microscopy

A 
Urethral swab (male)
Endocervical (not high vaginal).

Culture created and tested for resistance.

PCR sometimes too

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10
Q

Gonorrhoea - treatment

A

B-lactams
Cephalosporins
Fluoroquinolones

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11
Q

Chlamydia - incubation, name type

A

Types D-K
1-2 weeks incubation period

Type of non-gonococcal urethritis

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12
Q

Chlamydia - diagnosis

A

NAAT for chlamydia

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13
Q

Chlamydia - target cells

A

Squamocolumnar epithelial cells of endocervix

Also, conjunctiva, urethra and rectum for M+F

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14
Q

Chlamydia - presentation

A

Often asymptomatic (f>M)

Urethritis - less purulent discharge then gonococcal

Cervicitis - mucopurulent

May have dysuria/frequency

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15
Q

Chlamydia - complications

A 
PID (pelvic inflammatory disease (9.5% w/o Rx)
Tubal infertility (10.6%), ectopic pregnancy, chronic pain

Epididymitis (2%)

Neonatal + infant get conjunctivitis + infant pneumonia

Conjunctivitis
Reiter’s syndrome: arthritis, conjunctivitis, urethritis, skin lesions

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16
Q

Chlamydia - diagnosis

A

Histology
Cell culture

NAAT (superseded EIA)
99.7%

Serology

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17
Q

Chlamydia - treatment

A

Azithromycin
Doxycycline

Paediatric: conjunctivitis, pneumonia, erythromycin (14 days)

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18
Q

HPV - why important

A

12 high risk types are causally associated with cancer

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19
Q

HPV 6,11

A

90% genital warts

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20
Q

HPV 16, 18

A

Cervical carcinomas

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21
Q

Gardasil

A

Vaccine for HPV 6, 11, 16, 18

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22
Q

Genital herpes -

A

Double stranded DNA viruses

HSV-2 more common in women than man

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23
Q

Genital herpes - presentation

A

Pain, itching, dysuria, vaginal/urethral discharge

Bilateral vesicles / ulcers with viral shedding

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24
Q

Genital herpes - pathogenesis

A

Latency - sensory neuron cells (sacral nerve ganglia)

Reactivated by: local trauma, menstruation, stress

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25
Q

Genital herpes - diagnosis

A

Clinical
PCR (HSV 1 or 2)
Histology

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26
Q

Genital herpes - treatment

A

Acyclovir (primary or recurrence)

If frequent consider suppression

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27
Q

Genital herpes - complications

A 
Dissemination
Meningitis
Encephalitis
Sacral nerve parasthesiae
Urinary retention
28
Q

Syphilis - caused by

A

Spirochaete, Treponema pallidum

29
Q

Syphilis - pathogenesis

A

Penetrates intact mucous membranes, disseminated within days via lymphatics/bloodstream

30
Q

Syphilis - histology

A

Obliterative endarteritis (microvascular compromised)

31
Q

Syphilis - incubation time

A

21 days

32
Q

Syphilis - primary chancre

A

Site of inoculation, painless indurated lesion

Heals spontaneously within 3-6 weeks

33
Q

Syphilis - secondary chancre

A

2-8 weeks post onset

34
Q

Syphilis - clinical presentation

A

Skin - rash, condylomata lata, mucous patches

Constitutional symptoms - fever, malaise, weight loss

Generalised lymphadenopathy

CNS involvement (40%), headache, meningismus

35
Q

Syphilis - prognosis and treatment

A

Spontaneous resolution 3-12 weeks

Latent: no clinical manifetation, positive serology

W/o treatment: 30% will develop late w/ tertiary syphilis

36
Q

Syphilis - tertiary

A

Neurosyphilis - meningovascular (hemiplegia, seizures)

Parenchymatous - paresis of cortex - personality, argyll robertson pupils

Tabes dorsalis - spinal cord - demyelinisation of cord, lightening pain in legs, loss of position/vibratory sense

CVS - aortic regurg, saccular aneurysm

Late benign syphilis - non-specific granulomatous rxn

37
Q

Argyll robertson pupils

A

Accommodate to near vision

Don’t react to light

38
Q

Syphilis - neonates

A

Early signs: snuffles, rash, hepatosplenomegaly

Late: frontal bosses, saddle nose, sabre shins. Hutchinson’s incisors

39
Q

Syphilis - diagnosis

A

Lack of culture
Direct detection by darkfield microscopy

PCR more sensitive than microscopy

40
Q

Syphilis - indirect tests

A

Serology - specific: anti-treponemal antibodies

Non-specific: reaginic antibodies vs lipoidal antigens

41
Q

Syphilis - treatment

A

Penicillin
Length/route IM IV

Jarish-Herxheimer rxn: commonest in 2* syphilis, fever, chills, myalgia, hypersensitivity rxn, self-limiting

Alternatives: amoxicillin, ceftriaxone, doxycycline

42
Q

Trichomoniasis - causative organism

A

Trichomonas vaginalis

Protozoa - lacks mitochondria

43
Q

Trichomoniasis - clinical presentation

A

Profuse greenish frothy vaginal discharge

Mucosal inflammation

Males may have urethritis but usually asymptomatic

44
Q

Trichomoniasis - diagnosis

A

Microscopy/culture (high vaginal swab)

45
Q

Trichomoniasis - treatment

A

Metronidazole

46
Q

Bacterial (anaerobic) vaginosis (BV) -

A

Reduced vaginal lactobacilli

Increased gardnerella vaginalis & anaerobes

47
Q

Bacterial (anaerobic) vaginosis (BV) - clinical presentation

A

Watery discharge
+ve KOH test (fishy odour)

Vaginal pH >4.5
Clue cells on microscopy

48
Q

Bacterial (anaerobic) vaginosis (BV) - treatment

A

Amoxycillin

Topical clindamycin

49
Q

Candidiasis - two types

A

Thrush

Balanitis

50
Q

Candidiasis - risk factors

A

Oral contraceptives, poorly controlled diabetes

Antibiotics - inhibition of normal flora

51
Q

Candidiasis - clinical presentation

A

Vulval, vaginal and penile erythema w/ itching and irritation

Classically: thick/adherent discharge and white plaques

Maculopapular & fissuring lesions

52
Q

Candidiasis - investigations

A

Microscopy (10% KOH)

Culture

53
Q

Candidiasis - causative agent

A

Candida albians 85% cases - more susceptible but low risk of recurrence

54
Q

Candidiasis - uncomplicated

A

C albicans
Topical - clo-trimazole (Canesten)
Fluconazole: single 150mg oral dose

55
Q

Candidiasis - complicated

A

Treatment for 10-14 days

Consider partner treatment

Long term suppressive if freq.

56
Q

HIV - causative organism

A

Retrovirus - possesses reverse transcriptase script

converts viral RNA into linear DNA which is incorporated into host genome

error prone so high mutability rate

57
Q

HIV - why causative organism so hard to fight

A

RNA-based means survival advantage with great genetic diversity

DNA intermediary - latent and can incorporate into host genome

CD4/macrophage tropic - reduction of host immune response

58
Q

HIV - transmission routes

A

Sexual- genital or colonic mucosa

Infected fluid - blood

Mother to infant

59
Q

HIV - how does it gain entry?

A

Viral glycoprotein gp120

Interacts w/ CD4 and chemokine receptor for virion to gain entry

60
Q

HIV - WHO classification

A

Stage 1 - CD4 >500 cells/uL
Stage 2 - 349-499
Stage 3 - 200-349 (adv. HIV)
Stage 4

61
Q

HIV - primary infection clinical presentation

A

Acute retroviral syndrome - fever, pharyngitis, lymphadenopathy, rash

Asymptomatic

Early: pulm TB, persistent oral candidiasis, chronic diarrhoea, persistent fever, severe bacterial infections

62
Q

HIV - AIDS clinical presentation

A

HIV wasting syndrome (HIV encephalopathy)

Oesophageal candidiasis
Pneumocystis jirovecii pneumonia
CMV
CNS toxoplasmosis
Progressive multifocal leukoencephalopathy (PML)
Extra-pulm TB
Disseminated non-TB mycobacterial disease
Chronic cryptosporidiosis
Kaposi's sarcoma, lymphoma
63
Q

HIV - diagnosis

A

25% undiagnosed

Universal testing - GUM clinics w/ TB or lymphoma. Also antenatal

64
Q

HIV - investigations

A

Antibody testing

PCR - detects viral nucleic acid + copy #, genotypic mutations conferring drug resistance

65
Q

HIV - treatment (drug types used)

A

Nucleoside reverse transcriptase inhibitors

Non-nucleoside reverse transcriptase inhibitors

Protease inhibitors (ritonavir)

Viral entry inhibitors

Integrase strand transfer inhibitors

66
Q

HIV - treatment (methods)

A

Combinations
Highly active antiretroviral therapy (HAART)

Guidelines

Prophylaxis vs opportunistic infections

Clinical Pathology (65 decks)

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