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GUM > STIs > Flashcards

STIs Flashcards

1
Q

What STIs cause itch as their main symptom?

A

Scabies
Pubic lice
Trichomonas
Candida (not STI)

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2
Q

Does HSV recur?

A

Yes
HSVI 50% chance of recurrence evry 12-18months
HSVII 3-4 times a year

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3
Q

Main symptoms & signs of HSV

A

Burning sensation, tenderness, urethritis, dysuria

Erythema-> vesicles-> ulcers and pustiles-> scabbing

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4
Q

Diagnosis of HSV?

A

HSV NAATS from base of lesion

From clinical appearance

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5
Q

Treatment of HSV

A

Aciclovir 2-400mg 5DS PO 10days
Saline bathing, instillagel
Recurrent-> prophylactic aciclovir

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6
Q

Complications of HSV

A

Viral meningitis
Neonatal infection
-> encephalitis (6% mortality, 70% morbidity)
->dissemination (30% mortality)

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7
Q

What can be done to limit vertical transmission of HSV?

A

If 1st episode HSV in 3rd trimester, PO aciclovir 400mg TDS until delivery

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8
Q

Describe HPV

A 
Human papilloma virus
30 types
16&18 oncogenic
6&11 genital warts
80% people are exposed, usually a 6 month infection
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9
Q

How can you describe warts?

A

Keratinised/non keratinised
Mucosal
Internal/satellite

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10
Q

Treatment of genital warts

A
  • Podophyllotoxin 0.15% cream causing local tissue necrosis, only for non-keratinised warts, teratogenic
  • Imiquimod 5% cream, stimulates immune system, all types of wart, not in pregnancy
  • Cryotherapy, liquid nitrogen freezing
  • Excision
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11
Q

What is the HPV vaccine?

A

Now quadrivalent, oldest females are now 26. Heterosexual men are benefiting from herd immunity. However HIV+ve homosexual men have no coverage and are at risk of anal cancer.

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12
Q

What are molluscum?

A

Molluscum contagiosum
• Benign epidermal eruptions
• Pox virus
• Children (face, neck, trunk, limbs)
• Sexual infection (young adults, genitals, pubic region, upper thighs, buttocks)
• Severe ‘giant’ in HIV+ve
• Can become secondarily infected with staph
• Regress spontaneously in months
• Warn about autoinoculation, wart creams are not licensed for MC

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13
Q

What is N. gonorrhoea? Symptoms?

A
  • Gram negative diplococcus, intracellular
  • Infects mucous membranes
  • Causes dysuria, discharge (urethral and vaginal), proctitis, pharyngitis and conjunctivitis
  • Can ascend to cause PID / epididymitis
  • Can disseminate (Fever, rash, arthritis)
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14
Q

What can N. gonorrhoea do in pregnancy?

A

IUGR, prematurity, PROM in pregnancy

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15
Q

How is N. gonorrhoea diagnosed?

A

NAAT, culture, microscopy if urethritis (shows >5 pus cells with segmented nuclei and diplococci)

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16
Q

Treatment of Gonorrhoea?

A

Check local guidelines due to resistance (ceftriaxone + azithromycin)
No sex for a week after treatment
Test of cure

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17
Q

What is chlamydia trachomatis?

A
  • Very common (5% of population)
  • Serovars A-L (D-L genital)
  • Very small, intracellular bacteria, cannot be seen by light microscopy
  • Incubation 7-21 days
  • Causes dysuria, discharge (urethral and vaginal), proctitis, pharyngitis and conjunctivitis but majority are asymptomatic
  • Can cause PID, infertility and ectopic pregnancy, miscarriage, prematurity
18
Q

What is PID?

A

Pelvic inflammatory disease
Chlamydia causes PID in 10-30% if untreated (fever, pelvic pain, adnexal tenderness, cervical excitation)
1 episode of PID-> 21% tubal infertility rate, 2 episodes 75% tubal infertility

19
Q

Chlamydia in pregnancy?

A

50% vertical transmission if untreated in pregnancy (neonatal conjunctivitis and pneumonitis, amnionitis)

20
Q

Diagnosis of chlamydia?

A

Nucleic acid amplification test (NAAT) from anal swabs/self taken vulvovaginal swabs or first catch urine

21
Q

Treatment of chlamydia?

A

DOXYCYCLINE 100mg BD 7days or ERYTHROMICIN BD 14days + test of cure in pregnancy

22
Q

Symptoms of mycoplasma genitalium?

A

Dysuria , Discharge, upper genital tract infection, proctitis
Similar problems to chlamydia
Hard to find so use NAATS

23
Q

What is syphilis?

A
  • Caused by Treponema pallidum
  • Spirochete bacterium

1º:Painless chancre, regional lymphadenopathy (9-90 days)

2º: Mucosal lesions, rash, lymphadenopathy, meningitis, iritis, palms and soles (3 months)

Latent: Asymptommatic

3º: CVS: aortic aneurysm, aortic regurg, gummatous syphilis. Neuro: tabes dorsalis, stroke, general paresis, dementia

24
Q

Risk populations for syphilis?

A

Homosexual men, HIV+ve, sexual contact from endemic area, tissue donation

25
Q

Diagnosis and treatment of syphilis

A

PCR/serology, dark field microscopy

IM benzathine penicillin

26
Q

What is Trichomonas vaginalis?

A
  • Found in urethra/vagina
  • Flagellated protozoan parasite
  • Dysuria/urinary frequency
  • Frothy yellow discharge
  • Offensive odour
27
Q

Treatment of trichomonas vaginalis?

A

Metronidazole 400mg BD 5-7days

Contact trace partners back 4/52 & treat them regardless of test results

28
Q

What causes chancroid?

A

Haemophilus ducreyi

29
Q

What is LGV?

A
  • Lymphogranulum venereum
  • Chlamydia trachomatis L1, 2, 3
  • Causes inflamed lymphatics, scarring and tightening
  • Has been mistaken for ‘apple coring’ colorectal cancer
30
Q

What is donavanosis?

A
  • Papau New Guinea

* Klebsiella granulomatosis

31
Q

Diagnosis of trichomonas vaginalis?

A
  • Wet film microscopy:40-60% sensitivity
  • Point of care test (POCT): 80-94% sensitivity, ready in 15-30mins, risk of false positive
  • Culture: can also use in men
  • NAAT: 88-97% sensitivity, can also use in men, new ‘gold standard’
  • Cervical cytology – need to confirm diagnosis
32
Q

Trichomonas vaginalis and pregnancy?

A

Associated with preterm delivery, low birth weight and post-partum sepsis
Vertical transmission in 5%

33
Q

Describe pubic lice

A

Large pincers to cling onto thick body hair
3 stages:
Nit (white oval egg attached to hair base, 10-50 laid per louse)
Nymph (Hatches in 7 days, migrates to hair base)
The adult (1-2mm grey/brown, 3 pairs of legs, can move 10cm a day)
If nits are above hair base, this shows how long they’ve been there

34
Q

Public lice are commoner when?

A
  • Commoner in the cooler months
  • Commoner in MSM
  • Needs skin-skin contact (or occasionally sharing underwear)
35
Q

Symptoms of pubic lice and sites

A
  • Thighs, perineum, trunk, abdomen, axillary hair
  • Eyebrows, eyelashes (rarely scalp)

Intense irritation, movement noticed
Blue macules, black spots, lice and nits

36
Q

Treatment of pubic lice

A
  • Malathion 0.5%
  • Permethrin 1% (pregnancy)
  • Lotions better than shampoos
  • Body hair treated and left for 12 hrs
  • New linin
  • Repeat after 1 week
  • Full STI screen
37
Q

Describe scabies

A
  • Parasitic mite
  • Life span 4-6 weeks
  • Female burrows into the skin, lays its eggs (1-3/day)
  • Feeds on lymph and lysed tissue
  • Larvae hatch and mature over 10 days
  • 8 legs
  • Can’t see with the naked eye
  • Spread with skin to skin contact, frequently sexually transmission
  • Sporadic outbreaks in families/institutions
38
Q

Symptoms of scabies

A
  • Hypersensitivity reaction
  • Pruritus (worse at night)
  • Symmetrical eczematous looking lesions (hands, genital, elbow, nipple area
  • Burrows (fine channels)
  • Indurated nodules
  • May be secondary bacterial infection
39
Q

Management of scabies?

A
  • Permethrin 5%
  • Malathion 0.5%
  • Apply from neck down and leave for 12hrs
  • Repeat a week later
  • Irritation may last several week after treatment
  • Treat sexual partner and household contacts
40
Q

Describe Norwegian scabies

A
  • Same mite
  • Found in people that are immunocompromised and elderly
  • Highly contagious
  • Thousands of mites
  • Extensive crusted lesions with hyperkeratotic scales
  • Less pruritic
  • Treatment is isolation and repeat applications
  • Oral Ivermectin if topical treatments don’t work

GUM (5 decks)

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