HIV, Sexually Transmitted Diseases and Tropical Infections

Question 1

what are the 6 methods of contracting an STD?

Answer 1

Direct inoculation
Trauma
IVDU
Fomites
Ingestion
Sexual/genital secretions

Question 2

what are the risk factors for contracting an STD?

Answer 2

<25 years old
several sexual partners
Non condom use
Gay men
History of STI
Large urban areas
social deprivation
Black ethnicity

Question 3

how is rectal gonorrhoea spread?

Answer 3

direct contact of mucosal surface
anal sex
transmucosal spread
fomite

Question 4

what are the symptoms of rectal gonorrhoea?

Answer 4

short incubation (5-10 days)
lower abdo pain
diarrhoea
rectal bleeding
anal discharge
tenesmus
maybe assoc symptoms - urethral/vaginal discharge, dysuria

Question 5

what will appear on proctoscopy in rectal gonorrhoea?

Answer 5

inflamed mucosae

purulent exudate

Question 6

what are the possible complications of rectal gonorrhoea?

Answer 6

abscess formation

Increased HIV risk

Question 7

Who is chlamydia more common in?

Answer 7

females

Gay Men

Question 8

how is chlamydia spread?

Answer 8

transmucosal spread
fomite
anal sex
(same as gonorrhoea)

Question 9

what is the most common location for chlamydia in gay men?

Answer 9

confined to rectum

Question 10

what are the symptoms of rectal Chlamydia?

Answer 10

70% asymptomatic
milder than gonorrhoea
anal discomfort/itch and discharge

Question 11

how is rectal chlamydia diagnosed?

Answer 11

proctoscopy

gram stain rectal swab

Question 12

how is chlamydia treated?

Answer 12

azithromycin (single dose)
doxycycline (1 week)
Test for cure after 6 weeks

Question 13

how does primary syphilis present?

Answer 13

solitary painless ulcer

Question 14

how does secondary syphilis present?

Answer 14

mucosal patches and ulcers
mouth, anogenital, rectal
Condylomata lata
Systemic inflammation
Hepatitis

Question 15

how is herpes simplex virus spread?

Answer 15

ano-genital

oro-anal

Question 16

where does herpes simplex virus usually affect?

Answer 16

peri-anal mucosa

may extend into rectum

Question 17

what is the most common type of herpes simplex virus?

Answer 17

HSV2

Question 18

what are the symptoms of herpes simplex virus?

Answer 18

pain
ulcers
painful defaecation
bleeding
mucus
viraemic symptoms

Question 19

how is human papillomavirus spread?

Answer 19

ano-genital

oro-anal

Question 20

what are the types of HPV?

Answer 20

HPV 6, 11, 16, 18

Question 21

what are the symptoms of HPV?

Answer 21

anal warts
can extend into rectum
increasing prevalence of anal cancers and Acute interstitial nephritis (in MSM and HIV+)

Question 22

What groups is Lymphogranuloma venereum associated with?

Answer 22

MSM (often HIV+)
Group sex
Drug use
Syphilis
Hep C

Question 23

what are the clinical features of lymphogranuloma venereum?

Answer 23

primary (3-30 days) = ulcer
Secondary (3-6/12) = inguinal syndrome, ano-rectal syndrome
Tertiary = strictures, fistulae and genital elephantiais

Question 24

who gets tested for LGV?

Answer 24

MSM with haemorrhagic proctitis
HIV + MSM with rectal chlamydia
Failed chlamydia test of cure
Contact of LGV

Question 25

what are LGV patients also tested for?

Answer 25

HIV
Hepatitis C
Syphilis

Question 26

what is the largest immune compartment in the body?

Answer 26

gut associated lymphoid tissue

Question 27

where are most mucosal lymphocytes?

Answer 27

rectum
foreskin
cervico-vagina

Question 28

what does HIV infection do to the GI tract?

Answer 28

tract in constant state of physiological inflammation
dense clustering of lymphocytes (cell-cell transmission)
Depletion of gut associated lymphoid tissue

Question 29

what are the clinical results of GALT loss?

Answer 29

unknown
HIV enteropathies
Opportunistic infection
Persistent immune activation - microbial translocation
Accelerated immunosenescence

Question 30

how might STIs present, generally?

Answer 30

peri-anal pathology
Proctitis
Proctocolitis
Hepato-biliary problems