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Week 7 - Clinical Microbiology & Infections 2 > Sexually Transmitted Diseases > Flashcards

Sexually Transmitted Diseases Flashcards

1
Q

Who should consider taking a sexual history/performing sexual health screen from? [9]

A

Anyone presenting with symptoms of:

  1. Vaginitis
  2. Urethritis
  3. Epididymo-orchitis
  4. Pelvic inflammatory disease
  5. Proctitis
  6. Ulcer/lumps on genitals
  7. Possible syphilis (esp. rash (look at hands/feet))
  8. Possible HIV seroconversion
  9. Asymptomatic patients (in certain settings)
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2
Q

What are the typical presenting symptoms of vaginitis? [3]

A
  1. change in discharge
  2. dysuria
  3. change in menstrual bleeding
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3
Q

What are the typical presenting symptoms of urethritis? [3]

A
  1. penile discharge
  2. dysuria
  3. meatal discomfort
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4
Q

What are the typical presenting symptoms of epididymo-orchitis? [2]

A

painful, swollen testicle

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5
Q

What are the typical presenting symptoms of pelvic inflammatory disease? [4]

A
  1. pelvic pain
  2. fever
  3. change in discharge
  4. dyspareunia
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6
Q

What are the typical presenting symptoms of proctitis? [3]

A
  1. rectal discharge
  2. rectal pain
  3. rectal bleeding
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7
Q

What is the standard “sexual health screen”? [3]

A
  1. Chlamydia and gonorrhoea (NAAT test)
  2. Syphilis and HIV (blood test - big EDTA bottle)
  3. Note: screen may be altered based on symptoms, risk, gender non-congruence etc.
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8
Q

Who is at higher risk of gonorrhoea (in terms of epidemiology)? [3]

A
  1. Men who have sex with men (MSM)
  2. Afro-Caribbean
  3. Urban areas with deprivation
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9
Q

What is the microbiological cause of gonorrhoea, what body parts does it infect and how does it spread within the body? [3]

A
  1. Bacterial → gram negative diplococcus N. gonnorhoeae
  2. Infects mucous membranes of urethra, endocervix, rectum, pharynx and conjunctiva
  3. Inoculation through secretions from one mucous membrane to another
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10
Q

What are the typical signs & symptoms of gonorrhoea under the following headings…? [11]

  1. male urethra [2]
  2. women endocervix/urethra [4]
  3. pharynx [1]
  4. rectum [1]
  5. anus [3]
A
  1. Male urethra >90% symptomatic
    • Urethral discharge
    • Dysuria
    • 2-5 days after exposure
  2. Women (endocervix/urethra)
    • 50% asymptomatic
    • Change in discharge
    • Abdominal/pelvic pain
    • Dysuria
    • Altered bleeding is rare
  3. Pharynx
    • Usually asymptomatic
  4. Rectum
    • Usually asymptomatic
  5. Anal discharge, pain or discomfort
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11
Q

What investigations are used to diagnose gonorrhoea? [3]

A
  1. NAAT testing (main investigation used)
    • Male → urine
    • Female → self-taken vaginal swab
    • High sensitivity & specificity
  2. Other investigations that can be done (but not usually)
    • Urethral sample microscopy
      • Gram negative diplococci seen
    • Culture plate
      • To test drug resistance
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12
Q

How do you treat gonorrhoea? [2]

A
  1. Ceftriaxone lg 1M stat
  2. (or ciprofloxacin if sensitive)
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13
Q

What are the potential complications of gonorrhoea? [5]

A
  1. Epididymo-orchitis
  2. Prostatitis
  3. Pelvic Inflammatory disease
  4. Disseminated gonococcal infection
    • Rare in UK
    • Usually affects skin and joints
  5. Resistance
    • 48.6% resistant to at least 1 antibiotic
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14
Q

What is chlamydia? [1]

A

most common bacterial STI in UK

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15
Q

What are the risk factors for chlamydia? [3]

A
  1. <25yo
  2. New sexual partner or >1 partner in 12/12
  3. Inconsistent condom use
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16
Q

What are the typical signs & symptoms of chlamydia under the following headings? [14]

  1. male urethra [4]
  2. women [6]
  3. pharynx [1]
  4. rectum [3]
A
  1. Male urethra
    • Majority asymptomatic
    • Discharge
    • Dysuria
    • Meatal discomfort (urethral dysfunction)
  2. Women
    • Most asymptomatic
    • Intermenstrual bleeding
    • Postcoital (PC) bleeding (bleeding after sex)
    • Cervicitis or contact bleeding
    • Change in discharge
    • Pelvic pain
  3. Pharynx
    • Usually asymptomatic
  4. Rectum
    • Usually asymptomatic
    • Can present with proctitis
    • Lymphogranuloma venereum (LGV) subtype often presents as proctitis
      • Can have lymphadenopathy/ulcer disease
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17
Q

What investigations are used to diagnose chlamydia? [1]

A
  1. NAAT testing
    • Same sample as gonorrhoea (urine in males/self-taken vaginal swab in women)
    • Too small for microscopy
18
Q

What is the treatment of chlamydia? [1]

A

doxycycline

19
Q

What are the potential complications of chlamydia? [2]

A
  1. Pelvic Inflammatory Disease (in women)
  2. Epididymo-orchitis (in men)
20
Q

What are the symptoms of Mycoplasma Genitalium?

A

Some people get symptoms of urethritis/PID

21
Q

What is the bacterial cause of syphillis? [1]

A

Gram negative spirochete called Treponema pallidum

22
Q

How long does it take for primary syphillis to present? [1]

A

9-90 days

23
Q

What is the typical clinical presentation of primary syphillis? [1]

A

Chancre

24
Q

What is a chancre? [1]

A

a painless ulcer (usually singular), that develops on the genitals

25
Q

How long does it take for secondary syphillis to present? [1]

A

3 months - 2 years

26
Q

What are the common clinical symptoms of secondary syphillis? [5]

A
  1. Usually generalised rash affecting palms and soles
  2. Muco-cutaneous lesions,
  3. Condylomata Iata
  4. Lymphadenopathy
  5. Fever
27
Q

What are the 3 typical clinical presentations of tertiary syphilis? [3]

A
  1. neurosyphilis
  2. cardiovascular syphilis
  3. gummatous syphilis
28
Q

What are the 3 features of cardiovascular syphilis? [3]

A
  1. aortic valve disease
  2. aortic aneurysm
  3. aortitis
29
Q

What is gummatous syphilis and what organs does it usually affect? [5]

A
  1. characterized by granulomatous lesions, called gummas, which are characterized by a centre of necrotic tissue with a rubbery texture.
  2. gummas principally form in the liver, bones, and testes but may affect any organ
30
Q

What is the treatment for syphilis? [1]

A

Benzathine penicillin

31
Q

What is the viral cause of ano-genital warts? [1]

A

Human papillomavirus (HPV) 6 and 11

32
Q

What are the treatment options for ano-genital warts? [3]

A
  1. Cryotherapy
  2. Topical treatments: podophyllotoxin/imiquimod
  3. Surgical excision (rarely required)
33
Q

What test is used to diagnose herpes simplex virus (HSV)? [1]

A

viral PCR swab

34
Q

What are the potential complications of HSV? [5]

A
  1. CNS infection
  2. balanitis
  3. proctitis
  4. urinary retention
  5. If 1st episode in pregnancy: risk of neonatal infection
35
Q

What is balanitis? [1]

A

inflammation of the glans penis and often the foreskin

36
Q

What is the treatment for HSV? [1]

A

Aciclovir

37
Q

What are the symptoms of trichomonas vaginalis in males & females? [9]

A
  • Up to half of male and female cases asymptomatic
  • Females
    1. Vaginal discharge
      • Classic: frothy, yellow
    2. Significant vulval itch
    3. Dysuria
    4. Offensive odour
    5. “Strawberry cervix” in 2%
    6. Urethritis
  • Males
    1. Usually asymptomatic
    2. Urethritis
38
Q

What is the treatment of trichomonas vaginalis? [1]

A

metronidazole

39
Q

What are the typical symptoms of scabies? [2]

A
  1. Itch, especially at night
    • Caused by mite excrement which triggers hypersensitivity reaction
  2. Burrows
    • Classically in web spaces, wrist, elbows, nipples
40
Q

What are the treatment options for scabies and what should you do with your clothes afterwards? [3]

A
  1. Permethrin 5% OR Malathion 0.5%
    • Wash off after 24 hours
  2. Wash contaminated clothes at 50°C
41
Q

How is phthirus pubis transmitted and where is it commonly found? [2]

A
  1. Transmitted by close bodily contact
  2. Live on course body hair (as opposed to head lice)
42
Q

What are the treatment of phthirus pubis?

A
  1. Malathion 0.5% OR
  2. Permethrin 1% cream

Week 7 - Clinical Microbiology & Infections 2 (16 decks)

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