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Flashcards in Sexually transmitted infections Deck (128):
1

what is the most common STI in the UK?

Chlamydia

2

what are the different types of chlamydia infections?

serotypes A - C - ocular infections - get into eye fluid and causes conjunctivitis

serotypes D-K - genitourinary infections

L1 to L3 - lymphogranuloma venereum (LGV) - emerging infection in men who have sex with men and can cause proctitis

3

how is chlamydia infection transmitted?

unprotected vaginal, oral or anal sex
from mother to baby through delivery

4

what is the pathophysiology of chlamydia infection

C.Trachomatis enters the host cell as an elementary body (infectious form) and then becomes a reticular body, the non-infectious form capable of replication

following replication (by binary fission), the reticular bodies form back into elementary bodies and then cell ruptures to release them.

this cases inflammation and tissue damage.

5

what type of organism is chlamydia?

Chlamydia Trachomatis is a obligate intracellular gram negative bacteria.

6

what are the risk factors for chlamydia infection?

<25 yrs
sexually active e.g. recent change in partner, no. of partners
partner with chlamydia
co-infection with another STI
non barrier methods of contraception

7

what is the typical incubation period for chlamydia?

7-21 days (from infection to symptoms

8

what are the clinical features of chlamydia in women?

majority are asymptomatic - especially in lower genital tract

dysuria
dyspareunia
vaginal discharge
post coital and intermenstrual bleeding
lower abdominal pain
pelvic inflammatory disease - mild to moderate symptoms

signs:
- pelvic tenderness
- mucopurulent endocervical discharge
- cervical excitation
- cervicitis

9

what are clinical features of chlamydia in men?

urethritis - dysuria and urethral discharge
epididymo-orchitis - testicular pain

signs:
- epididymal tenderness
- mucopurlent discharge

majority asymptomatic

10

other than typical genitourinary symptoms of chlamydia what other clinical features are there?

conjunctivitis
can infect rectum - discomfort and discharge
can infect pharynx - no symptoms

11

how is chlamydia infection investigated?

women: vulvovaginal swab (first choice), endocervical swab, first pass urine sample

men: first pas urine sample (first choice), urethral swab

use NAAT on specimen

patients are recommended to have a full STI screen, if you have one STI, you are at risk of others and presentation is similar

contact tracing is required.

there is also a national chlamydia screening programme is England for those <25

12

how is chlamydia managed?

Abx treatment for uncomplicated urogenital chlamydia infection:
- Doxycycline 100mg twice daily 7 days
- OR Azithromycin 1g single dose

if above are contraindicated an alternative is erythromycin or ofloxacin

advice: avoid sexual contact and oral sex until treatment is complete (7 days after Azithromycin)

13

should we test chlamydia patients for cure after treatment?

not usually required unless suspected poor compliance, symptoms are persistent or pregnant.

if <25yrs, repeat testing is recommended 3 months after treatment

14

what are the complications of chlamydia in women?

salpingitis and/or endometritis which can lead to PID
PID can lead to perihepatitis (Fitz Hugh Curtis syndrome)
increased risk of ectopic pregnancy
increased risk of infertility

reactive arthritis and reiters syndrome

15

what are the complications of chlamydia in men?

infection can spread to epididymitis or epididymoorchitis causing testes to become painful and swollen - if left untreated can affect fertility

reactive arthritis and reiters syndrome

16

What risks does chlamydia in pregnancy have?

increased risk of premature delivery with low birth weight
increased risk of miscarriage and still birth
if child contracts it they will get neonatal chlamydial conjunctivitis (5-12 days after birth) and possibly develop pneumonia (1 to 3 months after birth)

17

how are pregnant women and neonates treated for chlamydia?

pregnant women - Abx but doxycycline and ofloxacin are contraindicated. therefore use azithromycin/erythromycin

neonates - oral erythromycin

18

what is the second most common STI in the UK after Chlamydia?

Gonorrhoea

19

what type of organism causes Gonorrhoea?

gram negative diplococci
Neisseria Gonorrhoea

20

how is gonorrhoea transmitted?

oral or vaginal or anal sex that's unprotected
vertical transmission from mother to child

21

describe the pathogenesis of gonorrhoea?

the bacteria adheres to mucous membranes of uterus, urethra, cervix, fallopian tubes, ovaries, eyes, testes and throat.

it invades the host cell (intracellular)
causes neutrophils to migrate - abscess forms
it has surface proteins that bind receptors on immune cells to inhibit them.

22

what are the risk factors for gonorrhoea infection?

<25 yrs
Men who have sex with men
multiple sexual partners
previous gonorrhoea infection
high density urban areas

23

what are the clinical features of gonorrhoea in a females?

dysuria
dyspareunia
abnormal vaginal discharge - thin watery yellow/green
lower abdominal pain

signs: mucopurulent endocervical discharge, pelvic tenderness, easily induced cervical bleeding

24

what is the incubation period for gonorrhoea?

2-5 days

25

what are the clinical features of gonorrhoea in men?

dysuria
mucopurulent urethral discharge

signs: discharge and epididymal tenderness

26

what symptom would you get in gonorrhoea infection of rectum or pharynx?

rectum: discharge, pain/discomfort or asymptomatic

pharynx - asymptomatic

27

how would you investigate gonorrhoea?

men:
urethral swab/ meatus swab = microscopy and culture
first pass urine - NAAT

women:
endocervical / vaginal swab - NAAT
endocervical / urethral swab - microscopy and culture

NAAT will provide dual testing for gonorrhoea and chlamydia

full STI screen for anyone with symptoms because of symptoms overlapping and same risk factors

28

how can gonorrhoea be treated?

IM ceftriaxone 500mg and single dose of oral azithromycin 1g
no need to await test results if symptoms are indicative

educate about safe sex
contact tracing
follow up to test for cure

29

when should you admit a gonorrhoea patient to hospital?

systemic symptoms = malaise, joint pain, fever and rash. this may be indicative of disseminated gonorrhoea infection which could potentially result in meningitis

30

what are the complications of gonorrhoea?

women: PID, infertility, ectopic pregnancy and chronic pelvic pain

men: spread from urethra to testes and cause epididymo-orchitis which is painful but rarely causes infertility. also Prostatitis

disseminated gonococcal infection - joint pain, rash, meningitis

31

what are the issues of gonorrhoea infection in pregnancy ?

perinatal mortality
premature labour
early fetal membrane rupture
spontaneous abortion

vertical transmission and cause neonatal gonococcal conjunctivitis (eye pain, redness and discharge)

32

how can gonorrhoea in pregnancy be treated?

same as non-pregnancy
can give neonate prophylactic Abx

33

what is pelvic inflammatory disease?

infection of the upper genital tract in females which affects uterus, fallopian tubes and ovaries, caused by infective organisms ascending from the lower genital tract

34

what is the pathophysiology behind PID?

infections such as chlamydia and gonorrhoea (chlamydia being most common) spread from the vagina and cervix to infect the endometrium, fallopian tubes, ovaries and peritoneum causing inflammation.

some microbes Ecoli and bacteriodes do not cause PID but enhance the infection.

other factors that cause it is instrumentation to the cervix e.g. insertion of coil, gynae surgery, termination of pregnancy

35

in PID what is the typically path of spread of infection?

cervicitis
endometritis
salpingitis

36

what are the risk factors for PID?

sexually active
non barrier contraception
multiple sexual partners
age 15-24
previous PID
history of STI

immunosuppression

low socioeconomic class
low education

37

what are the clinical features of PID?

can be asymptomatic

lower abdominal pain
deep dyspareunia
post coital bleeding
menstrual abnormalities - IMB, menorrhagia , dysmenorrhoea
dysuria
abnormal vaginal discharge

more advanced: severe pain, fever , N&V

38

what is found on vaginal examination of someone with PID?

tenderness of uterus/adnexae or cervical excitation
may be mass in lower abdomen
abnormal vaginal discharge

39

what are the differentials for PID?

ruptured ovarian cyst
endometriosis
ectopic pregnancy
UTI
appendicitis
malignancy
pelvic abscess

40

what investigations should be performed for PID?

endocervical swabs - test for gonorrhoea and chlamydia via NAAT

high vaginal swabs - trichomonas vaginalis and bacterial vaginosis

HIV and syphilis screen too

urine dipstick to exclude UTI
pregnancy test

transvaginal USS - if severe and uncertain diagnosis

laparoscopy - severe cases and uncertain diagnosis = gold standard because it allows you to observe the inflammatory changes

41

what is the CDC criteria for PID?

minimal criteria:
- lower abdominal tenderness
- uterine/adnexal tenderness
- cervical motion tenderness

additional criteria:
- temperature >38.3
- abnormal cervical or vaginal mucopurulent discharge
- white blood cells on microscopy of vaginal secretions
- raised ESR/CRP
- lab results of gonorrhoea, chlamydia or trachomatis

definitive diagnosis:
- histopathological findings of endometritis on endometrial biopsy
- laparoscopic findings consistent with PID
- transvaginal USS or MRI show thickened filled tubes.

42

how is PID managed?

14 day course of broad spec Abx before results of swabs
- doxycycline, IM ceftriaxone and oral metronidazole

analgesia
avoid sex
contact tracing from last 6 months and give them doxycycline

43

how is PID treated in pregnancy?

Ofloxacin and metronidazole
cant give doxycycline in pregnancy

44

when should PID be admitted to hospital?

pregnant - risk of ectopic
severe symptoms
signs of pelvic peritonitis
unresponsibe to Abx or need of IV

45

what are the prevention strategies

primary: education, adverts
secondary: screen at risk population
tertiary - treat people to reduce spread and complication

46

what are the complications of PID?

increases chance of ectopic pregnancy and infertility due to scaring of the fallopian tubes and loss of ciliary function and adhesions

tubo-ovarian abscess

chronic pelvic pain

Fitz Hugh Curtis syndrome

peritonitis
periappendicitis

47

what is Fitz-hugh Curtis syndrome? include symptoms

perihepatitis - spread of PID into peritoneum and then around liver
causes RUQ pain, worse on laughing and coughing
mainly by chlamydia but rare

48

what is the laparoscopic finding in fitz hugh Curtis syndrome?

Violin string adhesions - due to peritoneum adhering to liver capsule

49

what type of virus is HIV?

single stranded RNA retrovirus

50

what is the pathophysiology of HIV?

HIV binds CD4 cells and is uptaken into these cells
the ssRNA genome is then reverse transcribed into DNA by reverse transcriptase
the dsDNA is then inserted into the host cell genome by enzyme integrase.
The host cell then goes onto transcribe and translate as normal but in doing so will produce viral RNA and proteins.
New virus particles can assemble and bud off
the never virus particle matures when the protease cleaves its proteins (after it has left host cell)

the host cell becomes stressed and damaged from this process and thus the virus kills CD4 T cells.

51

how can the changes in symptoms of HIV be explained? i.e. early on, then later

initially the virus rapidly replicates, killing lots of CD4 cells and thus making the individual feel ill - flu like symptoms.

eventually HIV antibodies are made and viral replication is kept low and number of CD4 cells remains stable - latent phase - asymptomatic

years later eventually immune system cant keep up and CD4 cells slowly reduce and without treatment it will lead to AIDS

52

how is HIV transmitted?

unprotected sex
sharing of injecting equipment
blood products, organ donation, artificial insemination
vertical - utero, birth, breastfeeding

more likely to catch it if viral load is higher (i.e. someone who is not being treated), already have an STI or breaks in skin

53

which groups of people are at risk?

men who have sex with men
IV drug users
high prevalence areas
having sex with a partner who has lived or recently travelled to Africa

54

what are the clinical features of the initial seroconversion illness?

fever
malaise
muscles aches
lymphadenopathy
maculopapular rash
N&V
pharyngitis

55

How does HIV present after latency?

weight loss
high temperatures
diarrhoea
frequent infections - candida/ HSV

56

name 4 AIDS defining illness's

Kaposi sarcoma
TB
Pneumocystis jiroveci pneumonia
non-hodgekins lymphoma

57

what investigations are carried out to diagnose HIV?

fourth generation test - first line
- ELISA - test for serum HIV Ab and p24 antigen
- Reliable after 4-6 weeks

58

how is HIV managed?

Highly active anti-retroviral therapy (HAART)
- includes nucleoside reverse transcriptase inhibitors (NRTIs), protease inhibitors and non-nucleoside reverse transcriptase inhibitors and integrase strand transfer inhibitors. All reduce viral replication and maturation
- e.g. Stribild or Atripla - each contain a combination of the different drugs

psychological support
contact tracing.

-

59

how effective is HAART?

- does not cure but reduced viral load to undetectable levels making prognosis excellent.
- life long treatment so compliance is key

60

what drugs can HIV medications interact with?

epileptic medication

61

how is HIV monitored?

CD4 count
HIV viral load
FBC, U&Es, urinalysis, LFTs

62

what is post exposure prophylaxis for HIV?

can be given up to 72 hours after exposure to lower risk of becoming infected.

PEP consists of 1 month of:
- Truvada (once a day)
- Raltegravir (twice a day)

63

what measures are taken to reduce HIV vertical transmission?

avoid breast feeding
antenatal anti-retroviral therapy during pregnancy and delivery
neonatal post exposure prophylaxis

64

what type of organism causes syphilis infection?

spirochete gram negative bacterium
Treponema pallidum

65

how does Treponema pallidum transmit?

motile bacterium enters through a break in skin or intact mucous membranes OR mother to fetus via the placenta and through infected blood products

66

describe the pathogenesis/ life cycle of treponema pallidum...

once contaminated new host the bacteria divides and forms a papule which ulcerates into infectious hard ulcers (chancre) form at the site of contact after an incubation period of 2-3 weeks

the first stage is acquired symptomatic syphilis = primary syphilis
If left untreated this develops into secondary syphilis where there is more systemic symptoms like malaise, rash etc
Next the latent phase occurs where the individual is asymptomatic
finally tertiary syphilis follows involving multiple organs including heart and nervous system - causes damage via obliterating arteritis which leads to endothelial cells proliferating and occluding the lumen of vessels and thus resulting in ischaemia

67

what are the risk factors for syphilis infection?

engaging in unprotected sex - especially with high risk partners
multiple sexual partners
MSM
HIV infection

68

how can the clinical features of syphilis be categorised?

can be categorised into congenital and acquired

symptomatic (primary, secondary, tertiary) and asymptomatic (latent)

69

what are the clinical features of primary syphilis ?

papules that ulcerate into hard chancres
chancres are painless, non itchy and typically develop 9-90days post infection on genital sites (penis, scrotum, anus, cervix, labia)
chancre are usually singular
chancre usually heal within 3-10 weeks with/without symptoms

70

what are the clinical features of secondary syphilis ?

skin rash - hand and soles of feet - not itchy or painful
malaise, fever, arthralgia, weight loss, headaches
painless lymphadenopathy
silvery-grey mucous membranes -oral, pharyngeal, genital
Condylomata lata - elevated papules like warts at moist areas of skin e.g. axilla, anogenital

many other manifests can infect kidneys liver and brain

71

if syphilis is left untreated what proportion will self heal?

1/3

72

what are tertiary features of syphilis?

Gummatous syphilis
Neurosyphilis
cardiovascular syphilis

73

what is gummatous syphilis ?

form of tertiary syphilis
granulomas form in bone, skin, mucous membranes of the upper respiratory tract, mouth and viscera or connective tissue.

74

which stages of syphilis is a patient not infective?

latent and tertiary
i.e. gummatous syphilis is not infectious

75

describe features of neurosyphilis.

Tabes dorsalis: degeneration of neural tracts predominately dorsal columns.

Dementia - cognitive impairment, mood alterations, psychosis

meningovascular complications - cranial nerve palsies, stroke, cerebral gummas

Argyll Robertson pupil: pupil constricted and unreactive to light but reacts to accommodation

76

what are the symptoms of Tabes dorsalis?

Ataxia
numb legs
reduced reflexes
shooting pains
loss of pain and temperature sensation

77

what are the cardiovascular complications of syphilis?

aortic regurgitation due to aortic valvulitis
aortic root dilation
angina due to stenosis of coronary ostia
dilation and calcification of ascending aorta

78

what investigations can be done to identify syphilis?

dark ground microscopy of chancre fluid - detects spirochaete in primary syphilis = looks like stars in a night sky and constantly moving

PCR testing of swabs from active lesions

serology
lumbar puncture - CSF ab tests in neurosyphilis

79

what different serological tests are available for syphilis?

Treponemal ELISA (IgG/M) - positive for life

TPPA (enzyme immune assay) or TPHA - positive for life

Rapid plasma regain (RPR) test / VDRL - rises in early disease, falling titres indicate progression to late disease (RPR test is similar to CRP but for syphilis)

since Ab are present for life even after cure, the best way to test cure is via RPR test and only way to test reinfection is RPR being raised.

80

How can syphilis be managed?

Penicillin is the treatment of choice
need long course because of slow replication of treponema pallidum

early syphilis: benzathine penicillin IM single dose
late syphilis: benzathine penicillin IM 3 doses at weekly intervals
neurosyphilis = procaine penicillin + probenecid 14 days OR benzylpenicillin every 4 hours daily for 14 days

other: avoid sexual contact, screen for other STIs, contact tracing. follow up serology to check response.

81

what could be done in syphilis patients with penicillin allergy?

desensitisation to penicillin should be considered

82

what is the Jarisch Herxheimer reaction?

inflammatory response secondary to death of treponemas
flu like illness within 24 hours of treatment

treat this with supportive measures unless cardio or neurosyphilis then give oral steroids prior to Abx to reduce acute localised inflammation

83

can syphilis affect pregnancy?

T. pallidum has the potential to cross the placenta or infect the baby during delivery

pregnant women need to be treated early otherwise can lead to miscarriage , still birth, preterm labour or congenital syphilis.

84

what are the features of congenital syphilis?

saddle nose, rash, fever, failure to gain weight

85

what type of organism causes gential warts?

HPV - DNA virus
HPV 11 and 6 cause the majority of angogenital warts

86

describe the pathogenesis of HPV

replicates in keratinocytes and causes mucosal outgrowths
spread by skin to skin contact during vaginal and anal intercourse
can be passed vertically to baby during delivery but rare

87

what are the risk factors for genital warts?

early age at first intercourse
multiple sexual partners
immunosuppressed
smoking
diabetes

88

how does HPV present?

mostly asymptomatic
warts can develop weeks, months to years after initial infection
painless outgrowths

89

state 2 differentials for genital warts:

Molluscum contagiosum - viral

Vestibular papillomatosis - projections of vestibular epithelium or labia minora (non viral)

90

how can vestibular papillomatosis be differentiated from HPV?

Vestibular papilomatosis does not turn white under acetic acid. HPV does

91

how is HPV investigated?

genitalia examination - can magnify small lesions

speculum/colposcopy +/- acetic acid to identify cervical lesions

92

how is HPV infection managed?

lesions are most likely to spontaneously resolve overtime.

topical treatments
- Imiquimod
- Podophyllotoxin

Ablation:
- excision under local anaesthetic
- cryptotherapy - freezing with liquid nitrogen
- laser surgery
- electrosurgery

93

state 2 types of topical treatment for warts, how they differ in dose and what type of warts they are suited for..

- Imiquimod = apply 3x weekly and then wash off after 6 to 10 hours (up to 16 weeks) - good for large warts
- Podophyllotoxin = applied 2 times a day for 3 days and then 4 days rest (4 to 5 cycles) - good for small clusters

94

Does HPV/warts cause problems in pregnancy?

NOT associated with miscarriage, preterm etc
however due to immunosuppression the warts can multiple/grow larger

in very rare case, child can develop respiratory papillomatosis - genital warts in throat.

95

how does treatment of warts in pregnancy differ from non-pregnancy?

topical treatments cannot be used
so ablation used instead

96

what is the pathophysiology behind herpes infection?

HSV1 and 2 are responsible for infection of mucosal areas around mouth and genitals.
HSV enters body through small cracks in the skin and mucous membranes
it then travels to the nearest nerve to reach the ganglion where it remains.
the virus can stay dormant and then reactivate at a later date.

there are 4 stages of infection:
- vesicle and feeling unwell
- blisters
- crusted lesion
- healing

97

what is the incubation for HSV?

incubation of about 3 to 14 days

98

what is autoinoculation?

HSV can be transferred to different regions of the body of the same individual

99

what are the risk factors for HSV infection?

multiple sexual partners
oral sex with someone with coldsores

100

Describe the clinical features of the primary HSV infection on genitals...

small red blisters around genitals that are very painful and can form open sores. In women found on vulva, clitoris, buttocks and anus. in men found on penis, anus, buttocks and thigh.

dysuria - acid irritates sores - not quite same symptoms as a UTI so ask this in history to distinguish
vaginal / penile discharge
flu-like symptoms - fever, malaise, muscles (systemic symptoms are only in primary attacks)
itchy genitalia
after around 20 days, lesions crust and heal

101

Describe the clinical features of secondary infection i.e. recurrent infection?

shorter and less severe attacks compared to primary
this is because Ab production is quicker due to recognition
still get burning and itchy and red painful blisters

102

what are cold sores?

HSV infection around the mouth
painful lesions around the mouth and nose that lasts between 7-10days
mainly caused by HSV1 but overlap

103

what investigations are recommended in someone presenting with genital herpes?

history - no. of partners, partners with cold sores
examination - vulva are swollen and can see sores
swabs from open sores - PCR to test for viral genomes
rule out UTI and thrush

104

can Ab testing be used to diagnose for HSV?

50% of people have HSV so Ab are not useful
only useful in pregnancy to see if mother has Ab to give to baby

105

how is HSV managed for primary infection?

- aciclovir - reduces no. and size of lesions
- educate about preventing transmission to others
- Full STI screen
- avoid sexual contact during outbreak
- analgesia
- advice - wee in salt water to prevent urine touching sores. OR use lidocaine cream before weeing. advice to prevent autoinoculation

106

how does management of recurrent HSV infections differ?

usually just with analgesia and icepacks

if outbreaks are regular then episodic aciclovir treatment can be used - use aciclovir ASAP to reduce time and severity of outbreak

if outbreaks become very frequent (>6/yr) then suppressive treatment is recommended - daily doses of aciclovir

107

what are the complications of genital herpes?

vulval adhesions can occur - use Vaseline to prevent this
urinary retention - too much pain from weeing
meningism
reoccurance
psychological - reassure them that it doesn't mean partner is sleeping around, could be from a coldsore

108

how is herpes infection managed in pregnant women?

depends if it Is a primary or recurrent attack.

recurrent attacks are no problem because Ab has already been passed to baby through placenta (can double check by Ab testing mother). So no treatment is required, however for anxious mothers to supress likelihood of recurrent attack during time of childbirth, prophylactic aciclovir in T3 can be given. However C section is not recommended because no risk to baby

if mother contracts herpes during last trimester of pregnancy, there is no time to transfer Ab to baby and thus C section is recommended to prevent transmission in childbirth

109

what are the forms of neonatal herpes?

skin, eyes and mouth (SEM herpes)

Disseminated herpes - effects internal organs

CNS herpes - can lead to encephalitis

110

how is neonatal herpes managed?

antiviral therapy is usually enough for SEM herpes but mortality is much higher for disseminated and CNS herpes

111

what organism causes Trichomoniasis ?

Protozoan Trichomonas Vaginalis
anaerobic flagellated protozoan

112

describe the pathogenesis of trichomoniasis ?

transmitted through unprotected vaginal sexual intercourse (not oral/anal)
can infect female urethra, vagina and paraurethral glands and male urethra and under the foreskin
can be transmitted to baby via delivery but RARE
replicates by binary fision, destroying epithelial cells and releasing cytotoxins

113

what is the link between HIV and trichomoniasis?

thought that Trichomoniasis infection increases risk of contracting HIV.

114

what are the risk factors for Trichomoniasis infection?

multiple sexual partners
unprotected sex
history of STIs
older women are more at risk of being infected

115

what are the clinical features of Trichomoniasis?

many infections are asymptomatic
if symptoms do develop it takes around 28 days after infection.

female:
- offensive vaginal odour
- abnormal vaginal discharge - thick/thin/frothy and yellow/green
- itchiness or soreness of the vulva
- dyspareunia
- dysuria

males:
- urethral discharge, dysuria, urinary frequency, pain and itching around foreskin.

116

what is the sign 'A strawberry cerix' and when is it seen?what other signs are associated with this condition?

strawberry cervix - punctate and papilliform appearance of cervix in women with Trichomoniasis infection

other signs of trichomoniasis:
- vulvitis
- vaginitis
- urethral discharge
- balanoposthitis (inflammation of glans)

117

what investigations should be performed to diagnose trichomoniasis?

females - high vaginal swab taken from posterior fornix
males - urethral swab or first void urine sample.

if positive contract tracing and full STI screen

118

how is trichomoniasis infection managed?

can the same medication be used in pregnancy?

Metronidazole 2g in one single dose OR 500mg twice daily for 5-7 days

metronidazole can be used in pregnancy but not high doses

119

are there risks of Trichomoniasis infection in pregnancy?

premature labour
low birth weigh
risk of post partum sepsis

120

list causes of genital sores?

HPV, HSV, candida, herpes zoster, granuloma inguinale, LGV, chanchoid

trauma e.g. rampant rabbit vibrator

skin conditions: lichen planus, drug reactions, Bechets, malignancy, pemphigus and apthosis

121

can an individual refuse HIV testing?

yes. If an adult has capacity they can refuse HIV testing if they feel that they are not at risk or a positive diagnosis will impact relationship, finance or lead to discrimination

122

can a pregnant woman refuse HIV testing?

yes

123

can a pregnant woman refuse HIV treatment?

yes, but should be continually persuaded throughout pregnancy
if she continues to refuse can be made a child protection issue and child can be tested and treated at birth (without mothers consent)

124

If an individual knows they have HIV do they have to tell their partner?

yes - considered as grievous bodily harm if the individual knows they have it, knows how it is transmitted and doesn't tell partner and has sex without a condom

however if a condom is used then this is not considered as an offence. if the condom fails, it can be investigated and taken further so best way is to inform partner before intercourse

125

can a person be charged for transmitting HIV if they were unaware of their own diagnosis?

no

126

when can confidentiality be broken for HIV patients?

status should be kept confidential unless
- partner of that patient needs to be notified (despite having advised patient to inform their partner)
- health care professional e.g. GPs and needle stick injuries
- immigration offices

127

who should be tested for HIV?

GUM clinic
pregnancy
all patients with STIs
all men who have sex with men - annually
all individuals with HIV + partner
those diagnosed with TB, hepatitis , lymphoma
all injecting drug users - annually
blood donors, organ donors, needle stick injuries and dialysis patients

128

what is discussed before a HIV test?

benefits
clear instructions with how results are given
discuss window of 3 months before results will test positive for those newly infected
reassure about confidentiality but partner notification
details on risk of transmission