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REPRODUCTION > Microbiology and STIs > Flashcards

Microbiology and STIs Flashcards

1
Q

Give examples of bacterial STIs

A

Chlamydia

Gonorrhoea

Syphilis

Mycoplasma genitalium

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2
Q

Give examples of viral STIs

A

Human papilloma virus

Herpes simplex virus

Hepatitis

HIV

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3
Q

Describe normal vaginal flora

A

Acidic environment

Lactobacillus predominates

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4
Q

Why are full STI screens done?

A

Co-infections are common, if a patient is ar risk of an STI, they are at risk of all STIs

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5
Q

Is candida an STI?

A

NO

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6
Q

What is the most common cause of candida?

A

Candida Albicans

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7
Q

Non-albicans candida is more common in which group of patients?

A

Immunosuppressed

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8
Q

What are some of the predisposing factors to getting candida?

A

Recent antibiotic treatment

Pregnancy

High oestrogen levels

Poorly controlled diabetes

Immunosuppression

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9
Q

How does candida present?

A

Intensely itchy

White vaginal discharge

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10
Q

How is candida diagnosed?

A

Self taken vulvovaginal swab

or clinician takes endocervical swab

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11
Q

What is the treatment for candida?

A

Clotrimazole

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12
Q

Is bacterial vaginosis an STI?

A

No - but it is more common in people who are sexually active

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13
Q

What is bacterial vaginosis?

A

Imbalance of bacteria in the vagina - anaerobes take over, turning the normally acidic environment alkaline

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14
Q

How does bacterial vaginosis present?

A

Foul smelling discharge

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15
Q

What are some of the possible consequences of bacterial vaginosis?

A

Increased rates of endometriosis

Increased risk of preterm delivery and infections in pregnancy

Increased risk of acquiring HIV

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16
Q

What is the treatment for bacterial vaginosis?

A

Oral metronidazole

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17
Q

Do you need to treat the partners of patients with bacterial vaginosis?

A

No

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18
Q

What is the organism which causes chlamydia?

A

Chlamydia trachomatis

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19
Q

Which sex is chlamydia more common in?

A

More common in women than men

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20
Q

What is the most common STI in the UK?

A

Chlamydia

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21
Q

Which STI is caused by an obligate intracellular bacteria which doesn’t stain with gram stain?

A

Chlamydia trachomatis

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22
Q

Which of the serological groupings of chlamydia is responsible for causing genital infection?

A

Serovars D-K

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23
Q

Lymphogranuloma venereum is a serovar of chlamydia. How does it present?

A

Diagnosed in MSM

Rectal pain, discharge and bleeding

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24
Q

Irregular bleeding is the red flag for which STI?

A

Chlamydia

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25
Q

How does chlamydia present in female patients?

A

Dyspareunia

Lower abdominal pain

Oozing vaginal discharge

Intermenstrual or postcoital bleeding

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26
Q

How does chlamydia present in male patients?

A

Milky urethral discharge

Dysuria

Urethritis

Epididymo-orchitis

Proctitis

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27
Q

What are some of the possible complications of chlamydia?

A

Tubal infertility

Reiter’s syndrome

Conjunctivitis

Fitz-Hugh-Curtis Syndrome (Perihepatitis)

Chronic pelvic pain

Ectopic pregnancy

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28
Q

What STI might be the cause of red eye in an infant?

A

Chlamydia

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29
Q

Transmission of chlamydia to neonates can cause what?

A

Conjunctivitis

Pneumonia

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30
Q

Which STI accounts for 50% of pelvic inflammatory disease?

A

Chlamydia

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31
Q

How is chlamydia diagnosed?

A

Test 14 days following exposure

NAAT or PCR
- Vulvovaginal swab (women), first void urine (men)

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32
Q

What is the treatment for chlamydia?

A

Doxycycline PO 7 days

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33
Q

Which STI is more common in men than women?

A

Gonorrhoea

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34
Q

What is the organism which causes gonorrhoea?

A

Neisseria gonorrhoea

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35
Q

Which STI is caused by a gram negative intracellular diplococcus?

A

Gonorrhoea

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36
Q

How does gonorrhoea present in female patients?

A

Pelvic pain

Vaginal discharge

Intermenstrual or postcoital bleeding

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37
Q

How does gonorrhoea present in males?

A

Urethral discharge

Dysuria

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38
Q

What are some of the possible complications of gonorrhoea?

A

Tubal infertility

PID

Ectopic pregnancy

Bartholinitis

Tysonitis

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39
Q

How is gonorrhoea diagnosed?

A

Swabs for culture or NAAT

40
Q

What is the first line treatment for gonorrhoea?

A

IM ceftriaxone

41
Q

What is the second line treatment for gonorrhoea?

A

Cefixime PO

42
Q

Which STI is particularly associated with rising incidence of antibiotic resistance?

A

Gonorrhoea

43
Q

What is the name of the emerging sexually transmitted bacterial infection which involves asymptomatic carriage and is associated with non-gonococcal urethritis and PID?

A

Mycoplasma genitalium

44
Q

What causes genital herpes?

A

Herpes simplex virus type 1 and type 2

45
Q

How is genital herpes transmitted?

A

Genital to genital contact or oropharyngeal to genital contact

46
Q

What are the symptoms of genital herpes?

A

Very painful blistering and ulceration of the external genitalia

Dysuria

Vaginal/ urethral discharge and discharge from the lesions themselves

Local lymphadenopathy

Fever and myalgia

47
Q

What is the risk if someone presents in the 3rd trimester of pregnancy with genital herpes?

A

Neonatal herpes

48
Q

How do you diagnose genital herpes?

A

Swabs of the deroofed blisters for PCR

49
Q

What is the treatment for genital herpes?

A

Aciclovir PO

Analgesia or topical lidocaine

Saline bathing

50
Q

What causes genital warts?

A

Human papilloma virus (HPV)

51
Q

What is the most common viral STI in the UK?

A

HPV

52
Q

Which STI has the typical ‘cauliflower appearance’?

A

Genital warts

53
Q

Which types of HPV are associated with anogenital warts?

A

HPV 6 and 11

54
Q

Which types of HPV are associated with cancer?

A

HPV 16 and 18

55
Q

How is HPV managed?

A

May clear spontaneously

Topical podophylin (wart icon)

Cryotherapy with liquid nitrogen

56
Q

Who gets the HPV vaccine?

A

Girls aged 11-13

MSM

57
Q

What bacteria causes syphilis?

A

Treponema pallidum

58
Q

How can syphilis be transmitted?

A

Sexual contact

Trans-placental/ during birth

Blood transfusions

59
Q

How does primary syphilis present?

A

Chancre (painless ulcer) at the site of inoculation

Non tender local lymphadenopathy

60
Q

How might secondary syphilis present?

A

Snail track ulcers in the mouth

Pustular rash on the palms and soles

Patchy alopecia

Condylomata lata

Generalised lymphadenopathy

61
Q

How might late stage syphilis present?

A

Cardiovascular or neurovascular complications

e.g aortic aneurysms

62
Q

How is syphilis diagnosed?

A

PCR (swabs)

Specific and non-specific serological tests

63
Q

What are the specific serological screening tests for syphilis?

A

EIA, TPHA and TPPA

64
Q

What are the non-specific serological screening tests for syphilis?

A

CDRL

RPR

65
Q

How is syphilis treated?

A

Long-acting IM penicillin

66
Q

What is trichomonas vaginalis and how is it treated?

A

Parasite causing STI

Oral metronidazole

67
Q

What is the treatment for pubic lice?

A

Malathion lotion

68
Q

How may proctitis present?

which may occur with STIs in MSM

A

Bloody diarrhoea

Feeling of fullness in the rectum

69
Q

What is the treatment for acute bacterial prostatitis?

A

Ciprofloxacin

70
Q

What are the benefits of using NAATs?

A

Highly sensitive and specific

Can test for both gonorrhoea and chlamydia at the same time

71
Q

HIV is a retrovirus, what does this mean?

A

It uses the reverse transcriptase enzyme rather than the transcriptase enzyme

72
Q

What is the normal range of CD4 count?

A

> 500

73
Q

With what CD4 count is there risk of opportunistic infections?

A

<200

74
Q

What is the target site for HIV?

A

CD4 receptors

75
Q

How might primary HIV infection present?

A

Symptoms can be very vague;
Fever

Maculopapular rash

Myalgia

Pharyngitis

Headache

76
Q

What is the most common opportunistic infection in patients with HIV?

A

Pneumocystis pneumonia

caused by pneumocystis jiroveci

77
Q

What antibiotic is used to treat pneumocystis pneumonia, an opportunistic infection occurring in patients with HIV?

A

Co-trimoxazole

78
Q

What is immune reconstitution syndrome?

A

When HIV is treated and the immune system starts to recover, it can reveal an underlying infection such as TB which then becomes active

79
Q

What organism causes cerebral toxoplasmosis, an opportunistic infection which can occur in patients with HIV?

A

Toxoplasma gondii

80
Q

Multidermatomal or recurrent herpes zoster infections should make you consider what diagnosis?

A

HIV

81
Q

What is ‘slim’s disease’?

A

Cachexia due to HIV

82
Q

Name 3 AIDS related cancers

A

Kaposi’s sarcoma

Non-hodgkins lymphoma

Cervical cancer

83
Q

How can HIV affect the disease progression of psoriasis and rheumatoid arthritis?

A

Psoriasis is a CD8 mediated disease – in HIV there are high levels of CD8 – so psoriasis can get worse with HIV

Rheumatoid arthritis is a CD4 mediated disease – in HIV there are low levels of CD4 – so RA can get better with HIV

84
Q

Why are patients more likely to acquire HIV through anoreceptive sex?

A

The wall of the rectum is thinner than the vagina and anal penetration involves more trauma to tissues

85
Q

What factors can increase the risk of transmission of HIV?

A

Trauma

Genital ulceration

Concurrent STIs

86
Q

Which group of people are most likely to go undiagnosed with HIV?

A

Heterosexual men

Don’t have the typical risk factors and are less likely to present for care

87
Q

What tests can be done to detect HIV?

A

Viral load

p24 antigen

Antibody testing

Rapid HIV test (POCT)

Recent infection testing algorithm (RITA)

88
Q

What tests are done as the *mainstay of diagnosis for HIV?

A

Antibody testing and P24

89
Q

What is the highly active anti-retroviral therapy for HIV?

A

Combination of 3 drugs from at least 2 classes to which the virus is susceptible

90
Q

What secondary prevention methods should be offered to people with HIV?

A

Vaccines - Hep A/B, flu and HPV

Smoking cessation

91
Q

What are the rules/ guidance in terms of partner notification for patients with HIV?

A

Partner notification is VOLUNTARY

Doctors have a duty of care to their patient - they can advice PN but can’t force it

Exposing someone to the risk of transmission can be illegal in some circumstances in Scotland

92
Q

How can onward HIV transmission be prevented?

A

Condom use

HIV treatment

STI treatment

PN

Pre and post exposure prophylaxis

Change of sexual behaviours - e.g not receiving rectally

93
Q

When can a vaginal Vs a caesarean delivery be done in mothers with HIV?

A

Vaginal delivery if undetected viral load

Caesarean section if detected viral load

94
Q

What are the rules with breastfeeding in HIV +ve mothers?

A

Exclusive formula feeding for all babies born to HIV +ve mothers

95
Q

What is the whiff test and which condition is it used to identify?

A

10% potassium hydroxide is added to the vaginal discharge to produce a fish odour

Used to identify bacterial vaginosis

REPRODUCTION (12 decks)

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