Overview of different conditions Flashcards
1
Q
What is the most common STI in the UK?
A
Chlamydia trachomatis
2
Q
What % of a) women and b) men are asymptomatic when they have chlamydia?
A
a) 80%
b) 50%
3
Q
6 symptoms of chlamydia in women?
A
1) Post coital/ intermenstural bleeding
2) Abdominal pain
3) Dysuria
4) Dysparaunia
5) Purulent vaginal discharge
6) Proctitis
4
Q
4 symptoms of chlamydia in men?
A
1) urethral discharge
2) dysuria
3) testicular/ epididymal pain
4) can cause proctitis
5
Q
3 signs of chlamydia in women
A
1) Cervictitis with mucopurulent discharge
2) cervical contact bleeding
3) adenexal tenderness and cervical motion tenderness
6
Q
2 signs of chlamydia in men
A
1) Urethral discharge
2) Local complications eg epididmytis
7
Q
3 extra-gential complications of chlamydia
A
Proctitis
Pharyngitis
Conjunctivitis
8
Q
5 complications of chlamydia that affect women
A
1) PID
2) ectopic pregnancy
3) tubal infertility
4) sexually acquired reactive arthritis
5) peri hepatitis (fitz hugh curtis syndrome)
9
Q
2 complications of chlamydia that affect men
A
1) epididymitis
2) SARA
10
Q
What is the gold standard test for chlamydia
A
Nucleic acid amplification testing (NAAT)
11
Q
How long should a swab be rotated for in the urine/ vaginal/ cervical to test for chlamydia
A
10-15 secs
12
Q
When would microscopy be indicated in diagnosing chlamydia?
A
Non-specific urethritis/ identification of polymorphic nucleocytes
13
Q
When should patients be tested for chlamydia
A
Any time but if they have had UPSI in last 2 weeks should be advised to test after the 2 week window
14
Q
Recommended tx for chlamydia?
A
Azizthromycin 1g stat
Doxycycline 100mg BD for 7 days
15
Q
What pregnancy complications is chalmydial infection associated with?
A
- Low birth weight
- Post-partum endometritis
- Neonatal conjuctivitis
- Neonatal pneumonitis
16
Q
Who is it essential to contact after diagnosis with chlamydia
A
- All partners in last 3 months or previous partner is longer
- Current partner
17
Q
Is neisseria gonorrhoea gram positive or gram negative
A
Negative
18
Q
Can gonnorrhoea be transmitted non-sexually in adults
A
No
19
Q
How does peri-natal transmission present in the neonate
A
Eye infection, presenting in first week of life
20
Q
In what % of women is gonnorhoea asymptomatic?
A
50%
21
Q
What symptoms may women with gonnorhoea present with?
A
- Increased or altered discharge
- Lower abdominal pain
- Dysuria
- Inter-menstrual bleeding
22
Q
What is the most common presentation of gonnorhoea in men and what % of men is it seen in?
A
Mucopurulent discharge
80%
23
Q
4 symptoms of gonnorhoea in men
A
Mucopurulent discharge
Dysuria
Anal discharge
Perianal/ anal pain
24
Q
Signs of gonnorhea in women
A
Mucopurulent discharge
Cervical contact bleeding
25
Signs of gonnorhoea in men
Urethral discharge
| Epididymal pain/ swelling
26
What complications of gonnorhea can be seen in women and men?
```
Dissemination infection by haematogenous spread
Septicaemia
Arthritis
Tenosynovitis
Skin lesions
```
27
What complications of gonnorhoea can be seen in men?
Epididymitis
| Prostatitis
28
What do guidelines currently suggest for testing gonnorhoea
NAAT
29
When should microscopy be used to test for gonnorhoea
Symptomatic men
30
Is microscopy definitive in diagnosing gonnorhoea
No- must also do NAAT and cultures
31
What is the current UK guidelines for uncomplicated gonnorhoea infection
Ceftriaxone 500mg IM stat
| Azizthromycin 1g PO stat
32
How long should a gonnorhoea patient be advised to abstain from sexual intercourse
1 week after treatment and until sexual partner has been treated
33
What type of organism is implicated in trichomonas vaginalis infection
Flagellated protozoan
34
Transmission of what virus is enhanced by trichomonas vaginalis infection
HIV
35
Clinical features of TV (5)
- Vaginal/ urethral discharge
- Vulva itching
- Dysuria
- Offensive odour
- Strawberry cervix (2%)
36
What 2 testing methods are there for TV?? Which is gold standard
Microscopy
| Culture--> gold standard
37
What is drug treatment of TV?
Metronidazole (tinidazole)
38
How long must you abstain from sex with TV?
7 days/ until partners are treated
39
What is candidiasis?
Acute inflammatory dermatitis of the vulva and vagina due to the mucosal invasion of commensal yeast species
40
Most common species implicated in candidiasis?
Candida albicans
41
What 4 things are associated with candidiasis?
- Vaginal douching
- Antibiotics
- Tight fitting, synthetic clothing
- Perfumed soaps
42
Signs and symptoms of candidiasis?
- Vulval itch and soreness
- Vaginal discharge- white and curd like
- Erythema and oedema
- Superficial dyspareunia
43
Where would you swab to investigate candidiasis
Anterior fornix
44
What investigations would you run in a symptomatic patient with suspected candidiasis
Vaginal swab for microscopy and culture
45
An example of a topic cream to treat candidiasis?
Clotrimazole
46
An example of a tablet to treat candidiasis?
Fluconazole
47
What is the most common cause of abnormal vaginal discharge?
Bacterial vaginosis
48
Is pH higher or lower in BV
Higher
49
Risk factors for bacterial vaginosis
- Vaginal douching
- Receptive oral sex
- Recent change in sex partner
- Smoking
- STI
50
Signs and symptoms of BV (2)
- Offensive thin white discharge
| - Fishy odour typically after SI
51
What investigations would you do in suspected symptomatic BV
Vaginal swab for microscopy
52
What cells are you looking for in swab for BV
Clue cells
53
What criteria is used in the swab for BV
Hays/ Ison
54
What would you see on a normal vaginal microscopy
Lactobacillus morphotypes predominate
55
What would you see on a grade 2/ intermediate vaginal swab?
Mixed flora
Some lactobacilli
Gardnella or Moboluncus morphotypes also present
56
What would you see on a grade 3/ BV swab?
Gardnerella+/ Mobiluncus morphocytes
| Few or absent lactobacilli
57
What antibiotics are used to treat BV
- Metronidazole or
| - Clindamycin
58
What characterises non-specific urethritis (NSU)
Dysuria +/- discharge +/- urinary frequency
59
What is the most common cause of NSU in younger men
Ascending infection
60
Common causative organisms in NSU in younger men?
N. Gonorrhoeae
C. Trachomatis
Mycoplasmas/ Ureaplasmas
Trochomonas vaginalis
61
Most common way that NSU is aquired
Sexually
62
What would you suspect if you saw sterile pyruria in a man with urinary symptoms
NSU
63
Should you test asymptomatic people for NSU
No
64
What tests should be undertaken if you suspect NSU (4)
- Urethral smear for gram stain
- Urethral culture for N. Gonnorhoea
- NAAT for GC and CT
- Urinalysis
65
Complications of NSU in men (4)
- Epididymo-orchitis
- Sub-fertility
- Reiter's syndrome
- Prostatitis
66
How would treat an uncomplicated first presentation of NSU
- Doxycyline, 100mg BD for 7 days
- Azithromyicine 1g STAT PO
- Ofloxacin 200mg BD/ 400mg OD for 7 days
67
How would you treat recurrent/ complicated NSU
* Doxycycline 100mg BD for 7 days PLUS metronidazole 400mg BD for 5 days
* Azithromycin 500mg STAT then 250mg OD for 4 days PLUS metronidazole 400mg BD for 5 days
68
Which virus is the usual cause of oro-labial herpes
HSV-1
69
What is now the most common cause of genital herpes in the UK
HSV-1
70
Which virus type mainly causes recurrent anogenital symptoms
HSV-2
71
How is HSV transmitted
Close physical contact: sexual or oro-genital
72
When can HSV be transmitted
When an already infected individual is shedding
73
When is an HSV virus shedding?
- Sporadic
| - Not necessary in association with symptoms flare
74
What % of patients develop symptoms of HSV upon first transmission?
1/3
75
How long does an untreated episode of genital last
3 weeks
76
5 symptoms of herpes virus?
- Febrile illness
- Dysuria/ frequency
- Painful inguinal lymphadenopathy
- Tingling/ neuropathic pain in genital area/ buttocks/legs
- Genital blisters, ulcers, fissures
77
How long does a febrile illness associated with HSV last?
5-7 days
78
3 complications of HSV?
- Acute urinary retention
- Constipation
- Aseptic meningitis
79
If complications of HSV occur when are they mos tlikely to
In first episode
80
Are recurrent episodes of HSV usually mild or severe
Mild
81
How long does it normally take for a recurrent episode of HSV to resolve
3-4 days
82
Symptoms of a recurrent episode of HSV
- Neuropathic prodome in genital area/ buttocks
| - Erythema/ blisters
83
What 5 things increase the risk of symptomatic recurrences of herpes
- Young (<20)
- Have a severe first episode
- If recurrence is within 3 months of first episode
- Who have a genital type 2 infection
- HIV/ immunosuppresant
84
Where do you take swabs in HSV
From the lesions if symptomatic
85
What is the gold standard for identifying herpes
PCR culture
86
Pros and cons of culture in HSV diagnosis
Slow but very specific
87
What is the purpose of serology in herpes
Detects type specific antibodies
88
When should you commence treatment for first episode of herpes?
Within 5 days of lesions develop// new lesions still forming// systemic symptoms still present
89
What is the recommended 5 day regimens for herpes?
Aciclovir- 400mg TDS
| Valaciclovir 500mg BD
90
Do anti-virals alter the natural history of herpes
No
91
True or false: recurrent episodes are usually self limiting
True
92
When would you suggest suppresive therapy to prevent herpes recurrences
- Patients with 6 or more episodes per year
| - Patients with prolonged episodes (>4 days)
93
What group of viruses calls genital warts
Human papillomavius (HPV)
94
90% of genital warts are called by strains;
6 and 11
95
Do women with genital warts need more frequent cervical smears
No
96
How is HPV passed
Close physical contact, almost always genital- genital
97
Can you transmit HPV when you don't have warts
Yes
98
5 symptoms of signs of genital warts?
- Genital lumps
- Irritation/ discomfort
- Bleeding
- Itching
- Hyper-pigmentation
99
What is the aim of treating HPV
Eradicate visible warts
100
How would you treat simple external genital warts
- Podophyllotoxin cream/ solution
| - Weekly cryotherapy if available
101
How would you treat cervical warts
Colposcopy
102
How would you treat oral warts
Cryotherapy
103
Is contact tracing necessary in genital warts
No
104
What organism causes syphilis
Treponema Pallidum subspecies pallidum
105
2 ways that syphilis can be transmitted
- Direct contact with an infectious lesion (SI)
| - Vertical transmission during pregnancy (via placenta)
106
In which group is syphilis most common
White MSM aged 25-34
107
What % of white MSM with syphilis also have HIV
40%
108
Incubation period of primary syphilis
21 days
109
What is the main thing you will see in primary syphilis
Chancre: a single ano-genital ulceration. Painless, indurated with clean base.
110
How long does it take for a chancre to resolve
3-8 weeks
111
What % of untreated syphilis will develop into secondary syphilis
25%
112
How long after an intial chancre does seconary syphilis typically occur
4-10 weeks
113
What rash may be seen in secondary syphilis
Widespread mucocutaneus, itchy, palms and soles, mucous patches
114
How long does it take for secondary syphilis to resolve
3-12 weeks
115
What % of patients will develop a recurrence of secondary syphilis in early latent stage
25%
116
When does latent syphilis occur
20-40 years after intiial infection
117
In what proportion of syphilis patients does latent/ teritiary disease occur
1/3
118
Diagnosis of syphilis is based on which 2 investigations`
1) Dark-field microscopy of swab from lesion to identify T. Pallidum
2) Serology (anti-treponemal IgM and IgG)
119
What is PID
Inflammation caused by an infection ascending from the endocervix
120
5 organisms commonly causing PID
- Chalmydia
- Gonnorhoea
- Anaerobes
- Mycoplasma
- Streptococci
121
What is the difference between acute and chronic PID
Acute <1 month
| Chronic >1 month
122
Risk factors of PID
```
<25
Recent partner change
Use of non-barrer contraception only
TOP
Recent IUD change
Recent miscarriage
```
123
Symptoms of PID
- Pelvic pain
- Deep dyspareunia
- Irregular periods
- Intermensutral/ post-coital bleeding
- Vaginal discharge
124
Signs of PID
- Cervical motion tenderness
| - Adnexal discomfort
125
Common long term consequences of PID
Chronic pelvic pain
Ectopic pregnancy
Infertility
126
Investigations for PID (3)
- Endocervical NAAT for GC and CT. Swab inserted inside cervical os and firmly rotated
- Endocervical swab for microscopy
- Urinalysis/ MSU/ pregnancy test
127
When would you do a pelvic us/ laparoscopy
Reserved for patients failin to respond to therapy
128
Outpatient tx for mild PID
Ceftriaxone 500mg IM STAT PLUS Doxycycline 100mg BD 14 days PLUS Metronidazole 400mg BD 14 days
Ofloxacin 400mg BD 14 days PLUS Metronidazole 400mg BD 14 days
129
When would you admit someone with suspected PID
- Diagnostic uncertainty
- Severe symptoms
- Presence of a tubo-ovarian abscess
- Immunodeficiency
- Inability to tolerate oral regimen
130
Is contact tracing necessary with PID
Current male partners/ recent sexual partners within 6 months of symptom onset can be traced even if no organism identified
131
What is epididymo-orchitis defined as
Pain, swelling and inflammation of epididymides +/- testicular inflammation triggered by an infectious agent
132
4 infectious agents related to epididymo-orchitis
- N.gonorrhoea
- C.Trachomatis
- E.coli
- M.Tuberculosis
133
When is chlaymidia most seen inrelation to epididymo-orchitis
<35
134
When is e.coli most seen in relation to epididymo-orchitis
structural urinary tract abnormality
135
Is epididymo-orchitis usually uni or bilateral?
Uni
136
Clinical features of epididymo-orchitis
- Scrotal pain
- Testicular pain
- Torsion
137
Complications of epididymo-orchitis?
Reactive hydrocele
Abscess formation
Infertility
138
Investigations for epididymo-orchitis
* First pass urine – CT/GC
* Midstream urinalysis – UTI, TB
* Serology – HIV, syphilis, mumps
* Doppler USS – Torsion
* Refer to urology - structural abnormalities
139
General advice for epididymo-orchitis
- Rest/ analgesia
- Abstain from SI
- If severe treat as inpatient with fluid/ electrolyte management
140
What is the recommended regimen for epididymo-orchitis if UTI likely cause
Ofloxacin 200mg PO BD 14 days
Ciprofloxacin 500mg PO BD 10 days
