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Year 2 Medicine > Sexually Transmitted Diseases > Flashcards

Sexually Transmitted Diseases Flashcards

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1
Q

Who gets STIs?

  • … having sex… BUT the risk groups are:
    • Young age (
    • Frequent partner change, high no. lifetime partners, C… (simultaneous partners)
    • … orientation
    • E… for some STIs
    • Residence in …/d…
    • Use of non … …
    • History of …
A
  • ANYONE having sex… BUT the risk groups are:
    • Young age (<20 years) - lower age at 1st intercourse, ‘coitarche’
    • Frequent partner change, high no. lifetime partners, concurrency (simultaneous partners)
    • Sexual orientation
    • Ethnicity for some STIs
    • Residence in inner city/ deprivation
    • Use of non barrier contraception
    • History of previous STI
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2
Q

Coitarche means …

A

The first sexual intercourse

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3
Q

Does age at first intercourse (coitarche) affect rate of STI?

A

Yes - lower age = more likely

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4
Q

Is early age intercourse associated with poor subsequent sexual health?

A

Yes

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5
Q

Young people and STIs

  • Behaviourally more vulnerable to STI acquisition
    • Why? (5)
A
  • Behaviourally more vulnerable to STI acquisition
    • higher numbers of sexual partners / partners change
    • greater numbers of concurrent partners
    • yet to develop skills and confidence to use condoms, negotiate safe sex
    • more risk-taking behaviour/ experimentation
    • poor awareness contraception
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6
Q

What does this image show?

A

A normal cervix

  • Cervical ectropion – transformation zone – changing from columnar epithelium to squamous epithelium
  • Chlamydia and gonorrhoea infect columnar epithelium
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7
Q

Chlamydia and gonorrhoea infect where? (Cervix)

A

Chlamydia and gonorrhoea infect columnar epithelium

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8
Q

Percentage of all STIs occuring in young adults (16-24)

  • 16-24 year olds only make up …% of population
  • BUT - STI proportion in this age is much … (e.g. chlamydia …-…% is among this age)
A
  • 16-24 year olds only make up 12% of population
  • BUT - STI proportion in this age is much higher (e.g. chlamydia 55-75% is among this age)
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9
Q

Rates of chlamydia diagnoses by gender and age - England,2019

A
  • Males tend to go for younger females so disproportion with gender
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10
Q

Rates of chlamydia diagnoses by gender and age - England,2019

A
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11
Q

The earlier intercourse occurs, the higher the proportion:

  • Express … they had not …
  • Report being … or … willing than their partner
    • …% men and …% women express … they had not …
A
  • Express regret they had not waited longer
  • Report being more or less willing than their partner
    • 20% men and 42% women express regret they had not waited longer
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12
Q

Early intercourse - associated with vulnerabilities:

  • leaving home / not living with parents before … years
  • leaving … early
  • family … & …
  • lack of … relationships
  • those whose main source of information on sex was not .. or ..
A
  • leaving home / not living with parents before 16 years
  • leaving school early
  • family disruption & disadvantage
  • lack of nurturing relationships
  • those whose main source of information on sex was not school or parents
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13
Q

Where do young people get information? (regarding sex)

  • Parents? School? Books? Internet??
  • …% daily searches access porn sites
  • Most common Google search term: “…”
  • Unintended exposure reported by …% of 15-17yo while searching or checking e-mails
  • Intended viewing - …% teenagers view porn regularly; 1:… every day
A
  • Parents? School? Books? Internet??
  • 25% daily searches access porn sites
  • Most common Google search term: “sex”
  • Unintended exposure reported by 70% of 15-17yo while searching or checking e-mails
  • Intended viewing - 58% teenagers view porn regularly; 1:10 every day
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14
Q

…% teenagers view porn regularly; 1:… every day

A

58% teenagers view porn regularly; 1:10 every day

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15
Q

Negative aspects? - associated with porn

  • Unrealistic … & …
  • …-image / performance …
  • Lack of … / boundaries – hardcore material becomes … / normalised
  • Ethical issues: … of women, … blurred
  • Lack of … use: reduced risk perception, need to practice safe sex
A
  • Unrealistic nature & expectations
  • Self-image / performance anxiety
  • Lack of censorship / boundaries – hardcore material becomes addictive / normalised
  • Ethical issues: exploitation of women, consent blurred
  • Lack of condom use: reduced risk perception, need to practice safe sex
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16
Q

Main messages to get across to young people - Sex

A
  • Don’t rush into it – avoid peer pressure
  • Use condoms with all new partners
  • Get a STI screen when you have a new partner
  • Sort out contraception
  • Avoid overlapping sexual relationships
  • GBM* should also get vaccinated for hepatitis A/B and HPV & consider HIV PrEP (Gay and Bisexual Men)
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17
Q

Gay, bisexual and other men who have sex with men (MSM) are … likely to be diagnosed with bacterial STIs than other men

A
  • Gay, bisexual and other men who have sex with men (MSM) are more likely to be diagnosed with bacterial STIs than other men
  • Over the last decade, there has been a steady increase in the number of new STI diagnoses among MSM. Gonorrhoea has increased from 4,938 diagnoses in 2010 to 33,853 in 2019.
  • MSM account for most syphilis and gonorrhoea diagnoses in men.
  • Numbers of HIV diagnoses have been decreasing since 2015 largely due to the scale up of a combination of HIV prevention methods
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18
Q

Rates of gonorrhoea diagnoses by Gender and Age - England 2019

A
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19
Q

Rates of STI diagnoses by ethnic group amongst males: England, 2019

A
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20
Q

Rates of STI diagnoses by ethnic group amongst females: England, 2019

A
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21
Q
  • The rate of gonorrhoea in BME people is …x that of the general population
  • For trichomoniasis, the rate in BME people is …x that of the general population
A
  • The rate of gonorrhoea in BME people is 4x that of the general population
  • For trichomoniasis, the rate in BME people is 9x that of the general population
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22
Q

Sexual networks & core groups

  • Definition of a “core group”
    • ..-… of the population – high …
A
  • Definition of a “core group”
    • sub-group of the population – high turnover
    • not a static entity
    • highly sexually active individuals
    • high prevalence of infection
    • reservoirs of infection
    • high frequency of transmission
  • Effective control at the population level based on targeting core groups
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23
Q

Effective control at the population level based on targeting … … (Sexually Transmitted Infections/Diseases)

A

Effective control at the population level based on targeting core groups (Sexually Transmitted Infections/Diseases)

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24
Q

Rates of STI diagnoses by index of multiple deprivation quintile: England, 2019

  • Rates of STI diagnoses were highest among those living in the .. … areas of England.
A

Rates of STI diagnoses were highest among those living in the most deprived areas of England.

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25
_GMC guidance - Genital Examination_ * Offer a ... * Explain to patient why examination is ... & what it will ... * Give patient ... * Obtain patient’s ... before the examination * ... if patient asks you to * Keep discussion ... - avoid unnecessary comments
* Offer a **chaperone** * Explain to patient why examination is **necessary** & what it will **involve** * Give patient **privacy** to undress & dress * Obtain patient’s **permission** before the examination * **Discontinue** if patient asks you to * Keep discussion **relevant** - avoid unnecessary comments
26
_Female genital examination_ * Inspect ... area, ... & ... area * Look between ... ... * Inspect & ... ... region * Leg ... - allow better ... * ... examination (use water as lubricant-gels can interfere with tests) * ... examination (if indicated)
* Inspect **pubic** area, **vulva** & **perianal** area * Look between **skin** folds * Inspect & **palpate** **inguinal** region * **Leg** rests - allow better **visualisation** * **Speculum** examination (use water as lubricant-gels can interfere with tests) * **Bimanual** examination (if indicated)
27
Female genital examination – can you name A-M?
* A - **mons pubis** * B - **clitoral hood and anterior fourchette** * C - **clitoris** * D - **vestibule** * E - **anus** * F - **labia majora** * G - **labia minora** * H - **urethra** * I - **hymen / hymenal remnants** * J - **introitus** * K - **bartholins glands** * L – **posterior fourchette** * M – **perineum**
28
_Male genital examination – can you name the anatomy_
* S – shaft * F – foreskin * COS – coronal sulcus * G – glans * M – meatus * Fr – frenulum * GC – glans corona - corona of glans (we don’t use this term much – GC in sexual health usually means gonococcus or gonorrhoea!)
29
_Male genital examination_ * Inspect ... area, ... region * Inspect ... & ... area * ... scrotal contents – note presence of testes, any lumps/ tenderness * Inspect penis - record whether ... - if not inspect under ... * Particular attention to coronal ..., F... & M.. * Note presence of urethral ...
* Inspect **pubic** area, **inguinal** region * Inspect **scrotum** & **perianal** area * **Palpate** scrotal contents – note presence of testes, any lumps/ tenderness * Inspect penis - record whether **circumcised** - if not inspect under **foreskin** * Particular attention to coronal **sulcus**, **frenulum** & **meatus** * Note presence of urethral **discharge**
30
What are Pearly penile papules?
* Pearly penile papules are small dome-shaped to thread-like skin-coloured bumps that are typically located on the sulcus or corona of the glans penis. * normal - sometimes more prominent in some than others - no removal
31
Genital appearances - Enlarged sebaceous glands and Epidermoid cysts are often mistaken for ... by patient
Genital appearances - Enlarged sebaceous glands and Epidermoid cysts are often mistaken for **infection** by patient - they are considered cosmetic (NHS)
32
Malignant melanoma can be found on the ...
genitals
33
Psoriasis can also be found on the ...
genital area
34
Tinea cruris – a dermatophyte (...) infection - can be found on the ...
35
pruritic papules on genitals - check the ... - what might it be?
check hands - might be scabies
36
_Bacterial/protozoal vs. viral STIs_
37
Bacterial / protozoal \* STI's include ... (4)
Chlamydia, gonorrhoea, syphilis, TV\* (trichomonas vaginalis)
38
Chlamydia, gonorrhoea, syphilis, TV\* are all what kind of STI? (viral or bacterial/protozoal?)
Bacterial/protozoal STI
39
Viral STI's include ... (4)
Herpes, warts, HIV, hepatitis
40
Herpes, warts, HIV, hepatitis are all what kind of STI? (Viral or Bacterial/Protozoal?)
Viral STI's
41
_Features of Viral STI's, such as Herpes, Warts, HIV and hepatitis_ * many ... of infection * ... presentation * diagnostic tests may be ... * ... treatment only * often ...-... * ... reservoirs
* many **unaware** of infection * **delayed** presentation * diagnostic tests may be **unreliable** * **symptomatic** treatment only * often **life-long** * **expanding** reservoirs
42
_Features of Bacterial/Protozoal STI's, such as Chlamydia, gonorrhoea, syphilis, TV (Trichromonas vaginalis):_ * more often ... symptoms * ... presentation * ... diagnosis * ... treatment available * c... * reservoirs can be ...
* more often **florid** symptoms * **early** presentation * **rapid** diagnosis * **effective** treatment available * **curative** * reservoirs can be **controlled**
43
Which out of bacterial/protozoal or viral STI's can be treated?
Bacterial/protozoal - viral is symptomatic treatment only
44
People with ... STI's may be unaware of infection
Viral (Herpes, warts, HIV, hepatitis)
45
_Gonorrhoea: microscopic_ * typical gram-... intracellular diplo... * microscopic examination of a smear of ... exudate (men) of ... secretions (women)
* typical gram-**negative** intracellular diplo**cocci** * microscopic examination of a smear of **urethral** exudate (men) of **endocervical** secretions (women)
46
_Primary syphilis_ * how long after contact? * red mark -\> raised spot -\> ... at the site of contact * Enlarged ... ... in the groin/neck * Heals within ...-... weeks
* **weeks after contact (9-90 days)** * red mark -\> raised spot -\> **ulcer** at the site of contact * Enlarged **lymph nodes** in the groin/neck * Heals within **1-3** weeks (with or without treatment)
47
_Secondary syphilis_ * ..-.. weeks after primary stage - lasts for ..-.. weeks * Systemic dissemination - millions spirochaetes * ...-like illness, headache, lymphadenopathy * ... ulcers - “snail track” painless * Condylomata lata - white/grey lumps in moist areas * A... * ... resolution with effective treatment * Particularly suspect if rash involves ... & ...
* **2-6** weeks after 10 stage - lasts for **2-4** weeks * Systemic dissemination - millions spirochaetes * **Flu**-like illness, headache, lymphadenopathy * **Mouth** ulcers - “snail track” painless * Condylomata lata - white/grey lumps in moist areas * Arthritis * **Rapid** resolution with effective treatment * Particularly suspect if rash involves **palms** & **soles**
48
Secondary syphilis occurs how many weeks after primary stage?
2-6 weeks
49
Secondary syphilis lasts for how long?
2-4 weeks
50
If infection (Rash) involves palms and soles, what STIs are suspected? (what is the differential diagnoses?)
HIV and Secondary Syphilis (main) also non STI - pityriasis rosea (no herald patch)
51
Secondary syphilis involves the ... and ...
palms and soles
52
_Trichomonas vaginalis_ * ... cell protozoan parasite * Infects ... & ... * d.., d... * Causes ... discharge, “... cervix” * Diagnosed by seeing ... organisms on microscopy * Responds well to ...
* **Single** cell protozoan parasite * Infects **vagina** & **urethra** * **Dysuria, discharge** * Causes **frothy** discharge, “**strawberry** cervix” * Diagnosed by seeing **motile** organisms on microscopy * Responds well to **metronidazole**
53
Trichomonas vaginalis responds well to ...
Responds well to **metronidazole**
54
Trichomonas vaginalis causes what kind of discharge?
Causes **frothy** discharge, “**strawberry** cervix”
55
Viral STI's are ...
HIV, hepatitis, HPV, herpes
56
_Genital warts_ * How common? * What virus? * Type ... and Type ... in 90% * What types are related to cervical cancer?
* **Extremely common** * **Human papilloma virus (HPV)** * Type **6 & 11** in 90% * Vs types **16 & 18, 31, 33** etc. (cervical cancer)
57
HPV types 16 & 18, 31, 33 etc can cause what type of cancer?
**Cervical** cancer
58
What HPV types can cause cervical cancer?
16, 18, 31, 33
59
What are the most common HPV types? (90% of cases)
6 and 11
60
_Number of anogenital warts (first episode) diagnoses by sexual risk: England, 2015 to 2019_
61
Introduction of vaccine for HPV (Australian data)
62
_Molluscum contagiosum_ * What are they?
* Molluscum contagiosum is an infection caused by a poxvirus (molluscum contagiosum virus). The result of the infection is usually a benign, mild skin disease characterized by lesions (growths) that may appear anywhere on the body. * common in kids - not STI related
63
_Herpes simplex type 1 & 2_ * Symptoms * painful ..., ..., vaginal ... * ... symptoms e.g. fever and myalgia (more common in first occurrence) * recurrences generally ... severe * Signs * blistering & ... (+/- cervix/rectum) * painful inguinal lymphadenopathy * heals after ...-... days
* Symptoms * painful **ulceration, dysuria, vaginal discharge** * **systemic** symptoms e.g. fever and myalgia (more common in first occurrence) * recurrences generally **less** severe * Signs * blistering & **ulceration** (+/- cervix/rectum) * painful inguinal lymphadenopathy * heals after **5-14 days**
64
What are the symptoms of Herpes Simplex T1 and T2?
Painful ulceration, dysuria, vaginal discharge - possibly systemic symptoms also (fever, myalgia - more common in first occurence)
65
Herpes Simplex T1 and T2 heals after ... - ... days
**5-14 days**
66
Only 1:... people aware they have herpes (...%)
Only 1:**5** people aware they have herpes (**20**%)
67
* Oral HSV: usually type ... * Genital HSV: ...% type 1, ...% type 2
* Oral HSV: usually type **1** * Genital HSV: **50**% type 1, **50**% type 2
68
_Non-Sexually Transmitted Infections_ * What 2 infections are there?
* Candida / thrush * Bacterial vaginosis
69
_Candida / thrush_ * f... infection * not an ... * symptoms (3) * ... rash in males * treatment is ... ...
* **fungal** * not an **STI** * **itching, discharge, swelling** * **papular** rash in males * treatment is **topical antifungals**
70
_Bacterial vaginosis_ * symptoms - discharge / “...” odour * imbalance of vaginal ... * overgrowth of ... * often result of ... / ...etc. * responds to ...
* discharge / “**fishy**” odour * imbalance of vaginal **flora** * overgrowth of **anaerobes** * often result of **over-washing / bubble baths etc.** * responds to **metronidazole**
71
_Complications of STIs_
72
_Complications of Chlamydia / gonorrhoea_
* PID, epididymitis, infertility, chronic pain, seronegative arthritis +/- urethritis and conjunctivitis
73
_Complications of HPV / warts_
* cervical cancer, anal/vulval/penile intraepithelial neoplasia (AIN/VIN/PIN)
74
_Complications of Bacterial vaginosis and Trichomonas vaginalis_
* miscarriage, early labour, low-birth weight (pregnant)
75
_Complications of Syphilis_
* dementia, cardiac abnormalities etc etc - tertiary stage progression
76
_Complications of Hepatitis B, hepatitis C_
* cirrhosis, liver cancer
77
_Complications of HIV_
* opportunistic infections, lymphoma, non-AIDS malignancies
78
Most STIs increase the risk of ... transmission
Most STIs increase the risk of HIV transmission
79
_Summary of STI's_
* Rates of STIs are increasing because of changing behaviour, communication, globalisation * Certain groups are more vulnerable to STIs due to links with core groups through sexual networks * Patients may present with ‘normal anatomy’ or non-STI pathology * Differences between bacterial vs viral infections * Serious complications therefore correct diagnosis & prompt treatment essential

Year 2 Medicine (162 decks)

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