HIV testing Flashcards
RFs of HIV
MSM multiple partenrs history of STI hep B or C anal sex or sex clubs or chem sex female sexual contacts of MSM current or former partner with HIV IV drug use tattoos HIV positive mothers needlestick injury from HIV country prevalent prostiturtes rape.sexual assault
who are recommended to have a test for HIV
MSM female contacts IVDU Black african men and women born high risk countries DD partner with HIV
can someone with HIV treatment can have sex with someone who doesnt have
undetectable viral load for 6 months = untrasmissable
take meds properly
methods for HIV testing
1) venepuncture - highly sensitive and highly specific P24 Antigen HIV Antibody BEST TEST ELISA on blood or saliva
2) rapid point if care test and dried blood spot - comes back within 20 minutes
drawback - looks for ABs against HIV virus ABs take time to build up. delay in picking up the infection
not specific or sensitive
window period for HIV
high risk exposure
- 45 days days later for result
if initial test is negative for HIV
repeat test in a few weeks
what other tests would you offer in HIV patient
HEP B/C chlamydia gon syphillis HIVA HEP A viral load and CD4 count - offer hep B vaccination - HPV vaccination - upto age of 45 to - prevent warts adn cancer of genital skin - discuss PEPSE/PrEP (take one tablet daily to reduce risk of HIV acquisition) - discuss safe sec - Window Period testing - infectious period 45 days
where will you take swabs for HIV
oral
rectal
urine
window period for chlam or gonoe
takes 2 weeks
windown period for syphillis, hepB orC
12 weeks
hep C is 9 months
fequency of HIV testing
every 3 months - MSM
- USING pREp
Annual test for HIV is recommeded to who
commerucal sex workers
IVDU
hetero changin partner
Black african men
in which condition which will you recommend HIV testing
mononucleosis-like syndrome
recurrent bacterial pneumonia
recurrent or severe shingles
what is bacterial vaginosis
most common cause of abnormal vaginal discharge in women of reproductive age.
CAUSE
- imbalance of vaginal flora
- loss of lactobacilli that maintain acidic pH of vagina >4.5
Triggers
- sex
- menses
- receptive oral SI
- vaginal douching
- perfumed bath products
- change in sexual partners
- presence of STI
The most common organisms include Gardnerella vaginalis
presentation of bacterial vaginosis
Offensive, fishy-smelling vaginal discharge without soreness or irritation.
On examination, there is usually a thin layer of white discharge covering the vaginal wall.
Ix and diagnosis fro bacterial vaginosis
Hay-Ison criteria
Gram stain post fornix
0= no bacteria
1=normal
2= reduced lactobacilli plus mixed flora (intermediate)
3= few or absent lactobacilli and mixed flora, predom Gardnerella morphotypes
4=Gram positive Cocci dominate
Amsel’s criteria require at least three of the following for diagnosis:
- Homogeneous discharge as described above.
- Microscopy showing vaginal epithelial cells coated with a large number of bacilli (“clue cells”).
- Vaginal pH >4.5.
- Fishy odour on adding 10% potassium hydroxide to vaginal fluid. (WHIFF TEST)
Mx and complications of BV
General advice e.g. avoiding vaginal douching, use of shower gels.
Asymptomatic women usually do not need treatment, unless they are pregnant.
If symptomatic - oral metronidazole 400-500 mg bd for 5-7 days. Treatment of choice (and can be used in pregnancy).
complications
BV can increase the risk of acquiring and transmitting HIV and other STIs.
In pregnancy, BV is associated with various complications including preterm delivery, premature rupture of membranes and postpartum endometritis.
DDx
- chlamydia and gonorrhoea
- trichomonad vaginalis
- vaginal candidiasis
factors ass w vaginal candidiasis
diabetes mellitus recent antibiotics upto 3m before steroids - high oestrogen levels -> pregnancy, luteal phase, COCs immunosuppression: HIV
features of vaginal candidiasis
Mx
- ‘cottage cheese’, - non-offensive discharge
- vulvitis: superficial dyspareunia, dysuria
itch
Examination
vulval erythema, fissuring, satellite lesions may be seen, pH - 4
Ix
- swabs taken from high vaginal walls
- microscopy shows pores, pseudohyphae -> active then neutrophils too
Mx
1. fluconazole 150mg PO stat -> avoid in pregnancy/breastfeeding or clotrimazole pessary 500mg PV stat
PLUS clotrimazole 1% cream top BD for 2 weeks
recurrent vaginal candidiasis
4 or more episodes per year
compliance with previous treatment should be checked
confirm the diagnosis of candidiasis
high vaginal swab for microscopy and culture
consider a blood glucose test to exclude diabetes
exclude differential diagnoses such as lichen sclerosus
consider the use of an induction-maintenance regime
induction: oral fluconazole every 3 days for 3 doses
maintenance: oral fluconazole weekly for 6 months
CI - clotrimazole pessaries used
HIV Mx
antenatal care
- before pregnancy they have to take all their antiretroviral therapy
do blood test to check CD4 count
HIV obstetrics clinic
never been on therapy
- need to be started
- tenofovir
less than 50 CD4 before giving birth
during birth
>50 viral load C section -> give IV antiretrovirals zidovudine
<50 normal vaginal delivery
once u get baby wash the baby and cord clamp
postnatally
- really low viral load and compliant w therapy - baby has to be on one retroviral 2-4 weeks
high risk pregnancy 3-4 weeks
test HIV delivered, upon discharge,
Mum cant breastfeed
factors which reduce vertical transmission of HIV in pregnancy
- maternal antiretroviral therapy
- mode of delivery (caesarean section)
- vaginal delivery is recommended if viral load is less than 50 copies/ml at 36 weeks, otherwise caesarian section is recommended
a zidovudine infusion should be started four hours before beginning the caesarean section - neonatal antiretroviral therapy
- > zidovudine is usually administered orally to the neonate if maternal viral load is <50 copies/ml. Otherwise triple ART should be used. Therapy should be continued for 4-6 weeks.
- infant feeding (bottle feeding)
RFs of STI
aged under 25
>1 sexual partner in the last 12 months
new sexual partner
UPSI
Ix for STI
endocervical swab p wet mount - trichomonas
gram stain microscopy, culture -> BV/candida
vulvovaginal swab
- NAAT for N. gonorrhoeae
- C. Trachomatis
Other tests
- culture - endocervical culture
