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Bacterial STIs Flashcards

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1
Q

How long is the half life of azithromycin?

A

68 hours

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2
Q

What % of NGU is cause by M genitalium?

A

25%

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3
Q

What is the commonest cause of non STI PID?

A

Anaerobes-most commonly E coli

Often severe and in older women

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4
Q

Why should all PID regimens be effective against GC and CT?

A

Negative vulvovaginal tests don’t rule out upper reproductive tract infection

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5
Q

What is association between PID and anaerobes/BV?

A

Endometritis causes bleeding- which can provoke BS

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6
Q

Is metronidazole important in management of PID?

A

Abx regimes without metronidazole perform as well suggesting that anaerobes are less important in mild PID

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7
Q

Is test of cure required for Mycoplasma genitalium?

A

Yes - 5 weeks post treatment to ensure microbiological cure

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8
Q

Who do BASHH Recommend that we test for Mycoplasma genitalium?

A 
Recommend:
NGU
PID
Consider:
Cervicitis
Epidydimitis
Proctitis
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9
Q

What is recommended to manage GC if penicillin allergy?

A

3rd generation cephalosporins (cefixime and ceftriaxone show negligible cross allergy)

Gentamycin 240 mg IM + azithromycin 2g
Spectinomycin 2g IM +azithromycin 2g
Azithromycin 2g alone (high resistance)

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10
Q

What is recommended treatment of recurrent/persistent NGU?

A

If treated with doxycycline regimen first line:

Recommended
Azithromycin 1g stat then 500 mg once daily for the next 2 days,
PLUS metronidazole 400mg twice daily for five days

Azithromycin should be started within 2 weeks of finishing doxycycline. This is not necessary if the person has tested Mgen-negative.

NB patients should be advised to abstain from sexual intercourse until 14 days after the start of treatment and until symptoms have resolved.

If treated with azithromycin regimen first line:

Recommended

Moxifloxacin 400mg once daily for 10 days, PLUS metronidazole 400mg twice daily for five days

Alternative

Doxycycline 100mg twice daily for 7 days, plus metronidazole 400mg twice daily for five days

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11
Q

What is the treatment for 1st episode NGU?

A

Doxycycline 100mg twice daily for 7 days

Alternatives

Azithromycin 1g stat then 500mg once daily for the next 2 days

or
Ofloxacin 200mg twice daily, or 400mg once daily, for 7 days

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12
Q

How long should patients abstain from sex if being treated for NGU?

A

14 days after the start of treatment, and until symptoms have resolved.

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13
Q

Why should patients abstain from sex for 14 days after start of treatment for NGU?

A

This is likely to reduce the risk of selecting/inducing macrolide resistance if exposed to Mgen or Neisseria gonorrhoeae which would make these infections more difficult to treat.

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14
Q

What is the commonest cause of NGU?

A 
chlamydia 11-50%
M gen- 6-50%
Ureaplasma 11-26%
TV 1-20%
Adenovirus 2-4%
HSV 2-3%
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15
Q

What are the STI causes of neonatal conjunctivitis?

A

CT
GC
Group B beta haemolytic strep

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16
Q

What is the management of neonatal ophthalmia neonatorum cause by CT

A

50 mg/kg erythromycin orally
4 doses in 24 h
14 day course

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17
Q

What is the risk of neonatal ophthalmia neonatorum if mother has untreated CT and what are complications?

A

30-50% risk of vertical transmission
67% bilateral conjunctivitis
Corneal scarring is RARE

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18
Q

What is the risk of neonatal ophthalmia neonatorum if mother has untreated GC and what are complications?

A

30-40% risk of vertical transmission

Can lead to ulceration, corneal scarring, blindness

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19
Q

What is the management of neonatal ophthalmia neonatorum cause by GC

A

25-50mg /kg of Ceftriaxone IM/IV

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20
Q

Is GC and CT neonatal ophthalmia neonatorum a notifiable disease?

A

No - not since 2010

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21
Q

What is the commonest cause of neonatal ophthalmia neonatorum in the UK?

A

Chlamydia

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22
Q

what i’ll is the recommended antibiotic regime for SARA?

A

standard course of antibiotics for whichever STI is identified?

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23
Q

morphology of chlamydia?

A

Gram negative ovoid

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24
Q

Morphology of M genitalium?

A

Flask shaped with narrow terminal rod

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25
Morphology of haemophilia ducreyi?
Shoals of fish Small gram negative coccobacillus in chains (Microscopy low sensitivity- PCR most sensitive 95%)
26
Morphology of klebsiella granulomatosis?
``` donovanosis Donavon bodies deep purple Wrights/giemsa stain Closed safety pin appearance Shiny halo around bacteria Bipolar inclusions in bacteria Cant do PCR/culture- not available ```
27
Morphology of GC?
Gram negative diplococci
28
Incubation of LGV?
3-30 days
29
What constitutional symptoms are associated with LGV?
Fever, arthritis, aseptic meningitis, hepatitis, pneumonia Erythema multiforme Erythema nodosum
30
What is tertiary LGV?
Anorectal syndrome Direct infection from AI Proctitis Anal discharge with bleeding, rectal pain, tenesmus, fever Chronic--> fistula, abscesses, strictures, scarring (saxophone penis)
31
Management of LGV?
Doxycycline 100mg po bd 21 days or Erythromycin 500mg ads 21 days
32
PN for LGV?
30 days from symptom onset Or 3/12 of asymptomatic (like CT) Epidemiological treatment Should be examined and tested for chlamydial infection and receive presumptive treatment with 21 days of doxycycline 100 mg twice daily or alternative regimen for the same duration
33
Does LGV require follow up
Patients should be followed up until symptoms resolve. Routine TOC not necessary if recommended regimen has been completed. If TOC is required it should be performed 2 weeks after completion of therapy.
34
Is routine LGV typing of symptomatic and asymptomatic Chlamydia infection at any site recommended?
Only in HIV-positive MSM
35
What are associations between LGV and HIV?
There is a strong association between LGV infection and established or incident HIV infection and with incident hepatitis C infection.
36
Who should be offered 3 monthly STI screen including HIV?
UAI with partner of unknown or serodiscord- ant HIV status over last 12 months >10 sexual partners, over last 12 months ``` Drug use (methamphetamine, inhaled nitrites) during sex over last six months ``` ``` Drug use (GBL, ketamine, other NPSs during sex over last six months) ``` Multiple or anonymous partners since last tested Any unprotected sexual contact (oral, genital or anal) with a new partner since last tested
37
Which infections tend to cause proctitis in MSM?
STIs - transmitted rectally through receptive anal intercourse or fomites (fingers, sex toys or other objects carrying these pathogens) or through oro-anal intercourse.
38
Which infections tend to cause enterocolitis in MSM?
Enteric pathogens, which are statutorily notifiable, tend to cause enterocolitis, although symptoms may overlap with those caused by STIs and there may be dual pathologies. Acquisition of enteric pathogens may be linked to travel or occur in outbreaks related to food in addition to person-to-person trans- mission (e.g. for norovirus) However, there is increasing evidence that a range of enteric infections may be transmitted during sex between men
39
What are the causes of sexually transmitted proctitis?
``` Neisseria gonorrhoeae Chlamydia trachomatis Genotypes D-K Genotypes L1-3 (LGV) Treponema pallidum Herpes simplex virus ```
40
What are causes of sexually transmitted enteric infections?
``` Shigella spp VTEC (verotoxin-producing Escherichia coli) Campylobacter spp. Salmonella spp. Entamoeba histolytica Cryptosporidium spp. Cytomegalovirus Giardia duodenalis Microsporidium spp. Hepatitis A ```
41
What are the symptoms of sexually transmitted enteric infections?
diarrhoea and/or dysentery | abdominal pain
42
What would be indicative of proctitis on microscopy?
>10 PMNL per high power field
43
What is treatment for proctitis?
Empirical therapy, in symptomatic men with proctitis in whom the rectal chlamydial status is unknown, should include LGV (which also effectively treats syphilitic proctitis) and gonorrhoea treatment
44
Which infections causing proctitis are notifiable?
Infectious bloody diarrhoea as a clinical syndrome is a notifiable infection and should be notified to the Local Authority Proper Officer
45
Which part of the bowel do enteric infections usually affect?
Typically affect the large bowel (the colon) and less commonly, the small bowel. Enteric infections are characterised by sudden onset of diarrhoea, with or without vomiting and are usually transient disorders due to enteric infection with viruses, bacteria or protozoa. Other symptoms include blood and/or mucous in the faeces (dysentery), and fever or malaise.
46
For ix of sexually transmitted enteric infections, when is microbiology recommended?
Microbiology examination of stool is recommended in all cases and is essential when the patient: * needs antibiotics. * is systemically unwell. * needs hospital admission. * has blood, mucous or pus in stool. * has diarrhoea after foreign travel. * is immunosuppressed
47
What can be used to treat diarrhoea in sexually transmitted enteric infection?
Antidiarrhoeal (or antimotility) drugs such as loper- amide are contraindicated for the management of infectious diarrhoea
48
What can be used to treat diarrhoea in sexually transmitted enteric infection?
Antidiarrhoeal (or antimotility) drugs such as loper- amide are contraindicated for the management of infectious diarrhoea
49
When might empirical treatment be recommended in sexually transmitted enteric infection?
Guided by microbiology advice based upon most likely aetiology, empirical rx may be considered when: • The patient is pyrexial (temperature >38C) • The stools are bloody • Diarrhoea lasts more than seven days • Co-morbidities (frailty, inflammatory bowel disease, immunocompromised state, e.g. advanced HIV infection, immunosuppressive agents, etc.) are present
50
Advice on preventing spread of sexually transmitted enteric infection?
Advise on hygiene • Advise to avoid return to work until 48 h after last episode of diarrhoea • For patients who work as food handlers or with people vulnerable to infections, return to work should be guided by local public health authorities
51
Advice on sexual practices to prevent spread of sexually transmitted enteric infection?
Wash hands, genitals and perianal skin before and after sexual activities such as intercourse, rimming, fingering or handling used condoms and sex toys. If possible, showering is advised as bacteria like Shigella may be present on other skin surfaces. * Use condoms for anal sex and latex gloves for digital penetration or fisting. Dental dams or a condom cut into a square to make a barrier for rimming. * Avoid sharing sex toys or douching equipment. * Avoid recommencing sexual contact until seven days after the last episode of diarrhoea.
52
Treatment of recurrent persistent NSU?
If had doxycycline first line: Azithromycin 1 g stat then 500 mg once daily for the next 2 days + metronidazole 400mg twice daily for five days Azithromycin should be given < 2 weeks of finishing doxycycline. (not necessary if the person has tested Mgen-negative.) NO SEX 14 days after the start of treatment and until symptoms have resolved. If had azithromycin as first line- Moxifloxacin 400mg od 10 days + metronidazole 400mg bd five days Alternative Doxycycline 100mg twice daily for 7 days, plus metronidazole 400mg twice daily for five day
53
What are the growth requirements for GC?
35-37 degrees PH 6.5-7.5 Atmosphere containing 5-7% Co2 Selective and enriched culture medium eg Thayer martin/modified New york city- supplemented with iron, essential AA, glucose and antimicrobials
54
Risk of transmission of GC men to women after 1 episode of sex?
60- 80% Decreased by 40% with condoms
55
Risk of transmission of GC women to men after 1 episode of sex?
20% Decreased by 75% with condoms
56
Risk of transmission of GC vertical?
Up to 30%
57
Spontaneous clearance of GC in pharynx?
100% at 12 weeks
58
How many men with GC have urethral discharge?
80%
59
How many men with GC are asymptomatic?
10%
60
How many women with GC have vaginal discharge?
50%
61
How many women with GC are asymptomatic?
50%
62
Urinary symptoms for GC urethral infection?
Dysuria but not frequency
63
Urinary symptoms for CT urethral infection?
Dysuria but not frequency
64
How many women with GC present with power abdominal pain?
25%
65
Does GC cause IMB or HMB?
Rarely
66
Infectious causes of proctocolitis?
Hepatitis A Campylobacter Salmonella Cryptosporidium
67
Treatment of crytosporidium?
Protozoa Fluids No proven effective method Paromycin, azithromycin and other abx- variable success
68
Example of a drug that should not be used with azithromycin?
Colchicine | Macrolide increases toxicity with colchicine
69
What is the incubation period for Donavonosis?
50 days
70
What is the incubation period for LGV?
3-30 days
71
What is the incubation period for primary sphilis?
9-90 days
72
What is the incubation period for Chancroid?
4-7 days
73
What is the incubation period for HSV?
3-14 days
74
Which STI causes gangrenous phagedenic ulceration
chancroid
75
Which STI causes complication rectal stricture
LGV
76
Which STI is associated with neoplastic changes?
Donavonosis
77
Which STI is caused by an RNA picornavirus?
Hepatitis A
78
Which STI is caused by a lentivirus?
HIV1
79
Which type of virus causes EBV?
DNA
80
Describe the type of virus causing HSV 1 or 2
neurotropic virus with a central DNA core
81
Describe the type of virus - CMV
largest DNA herpes virus
82
Risk factors for rectal LGV?
``` 20-30 yo Sex workers MSM (anal sex, fisting, enemas/sex toys) STIs Social deprivation ``` Tropical/subtropical (Africa, SE Asia, caribbean) Epidemic MSM UK, america, W Europe
83
PPV for chlamydia NAAT
If PPV >90% no need for confirmatory testing (NB if prevalence increases so does PPV If prevalence decreases, NPV increases)
84
Can PCR be taken from oral lesions for STS?
YES PCR can be used on oral or other lesions where commensal treponemes may also be present ( microscopy is not suitable for examining oral lesions due to the presence of commensal treponemes)
85
Treatment of steptococcus group A
Amoxicillin (on penicillin V) | Axithromycin (or clindamycin)
86
Treatment of steptococcus group B
Benzylpenicillin
87
GC culture medium/transport?
Transport bia amies/stuart or a CO2 producing medium | Transport kept at 4 degrees

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