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Clinical Pathology > 50 - HIV and STIs > Flashcards

50 - HIV and STIs Flashcards

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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
Genital herpes - diagnosis
Clinical PCR (HSV 1 or 2) Histology
26
Genital herpes - treatment
Acyclovir (primary or recurrence) If frequent consider suppression
27
Genital herpes - complications
``` Dissemination Meningitis Encephalitis Sacral nerve parasthesiae Urinary retention ```
28
Syphilis - caused by
Spirochaete, Treponema pallidum
29
Syphilis - pathogenesis
Penetrates intact mucous membranes, disseminated within days via lymphatics/bloodstream
30
Syphilis - histology
Obliterative endarteritis (microvascular compromised)
31
Syphilis - incubation time
21 days
32
Syphilis - primary chancre
Site of inoculation, painless indurated lesion Heals spontaneously within 3-6 weeks
33
Syphilis - secondary chancre
2-8 weeks post onset
34
Syphilis - clinical presentation
Skin - rash, condylomata lata, mucous patches Constitutional symptoms - fever, malaise, weight loss Generalised lymphadenopathy CNS involvement (40%), headache, meningismus
35
Syphilis - prognosis and treatment
Spontaneous resolution 3-12 weeks Latent: no clinical manifetation, positive serology W/o treatment: 30% will develop late w/ tertiary syphilis
36
Syphilis - tertiary
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
Argyll robertson pupils
Accommodate to near vision Don't react to light
38
Syphilis - neonates
Early signs: snuffles, rash, hepatosplenomegaly Late: frontal bosses, saddle nose, sabre shins. Hutchinson's incisors
39
Syphilis - diagnosis
Lack of culture Direct detection by darkfield microscopy PCR more sensitive than microscopy
40
Syphilis - indirect tests
Serology - specific: anti-treponemal antibodies Non-specific: reaginic antibodies vs lipoidal antigens
41
Syphilis - treatment
Penicillin Length/route IM IV Jarish-Herxheimer rxn: commonest in 2* syphilis, fever, chills, myalgia, hypersensitivity rxn, self-limiting Alternatives: amoxicillin, ceftriaxone, doxycycline
42
Trichomoniasis - causative organism
Trichomonas vaginalis Protozoa - lacks mitochondria
43
Trichomoniasis - clinical presentation
Profuse greenish frothy vaginal discharge Mucosal inflammation Males may have urethritis but usually asymptomatic
44
Trichomoniasis - diagnosis
Microscopy/culture (high vaginal swab)
45
Trichomoniasis - treatment
Metronidazole
46
Bacterial (anaerobic) vaginosis (BV) -
Reduced vaginal lactobacilli Increased gardnerella vaginalis & anaerobes
47
Bacterial (anaerobic) vaginosis (BV) - clinical presentation
Watery discharge +ve KOH test (fishy odour) Vaginal pH >4.5 Clue cells on microscopy
48
Bacterial (anaerobic) vaginosis (BV) - treatment
Amoxycillin Topical clindamycin
49
Candidiasis - two types
Thrush | Balanitis
50
Candidiasis - risk factors
Oral contraceptives, poorly controlled diabetes Antibiotics - inhibition of normal flora
51
Candidiasis - clinical presentation
Vulval, vaginal and penile erythema w/ itching and irritation Classically: thick/adherent discharge and white plaques Maculopapular & fissuring lesions
52
Candidiasis - investigations
Microscopy (10% KOH) Culture
53
Candidiasis - causative agent
Candida albians 85% cases - more susceptible but low risk of recurrence
54
Candidiasis - uncomplicated
C albicans Topical - clo-trimazole (Canesten) Fluconazole: single 150mg oral dose
55
Candidiasis - complicated
Treatment for 10-14 days Consider partner treatment Long term suppressive if freq.
56
HIV - causative organism
Retrovirus - possesses reverse transcriptase script converts viral RNA into linear DNA which is incorporated into host genome error prone so high mutability rate
57
HIV - why causative organism so hard to fight
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
HIV - transmission routes
Sexual- genital or colonic mucosa Infected fluid - blood Mother to infant
59
HIV - how does it gain entry?
Viral glycoprotein gp120 Interacts w/ CD4 and chemokine receptor for virion to gain entry
60
HIV - WHO classification
Stage 1 - CD4 >500 cells/uL Stage 2 - 349-499 Stage 3 - 200-349 (adv. HIV) Stage 4
61
HIV - primary infection clinical presentation
Acute retroviral syndrome - fever, pharyngitis, lymphadenopathy, rash Asymptomatic Early: pulm TB, persistent oral candidiasis, chronic diarrhoea, persistent fever, severe bacterial infections
62
HIV - AIDS clinical presentation
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
HIV - diagnosis
25% undiagnosed Universal testing - GUM clinics w/ TB or lymphoma. Also antenatal
64
HIV - investigations
Antibody testing PCR - detects viral nucleic acid + copy #, genotypic mutations conferring drug resistance
65
HIV - treatment (drug types used)
Nucleoside reverse transcriptase inhibitors Non-nucleoside reverse transcriptase inhibitors Protease inhibitors (ritonavir) Viral entry inhibitors Integrase strand transfer inhibitors
66
HIV - treatment (methods)
Combinations Highly active antiretroviral therapy (HAART) Guidelines Prophylaxis vs opportunistic infections

Clinical Pathology (65 decks)

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