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Sexually Transmitted Infections Flashcards

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1
Q

What is the most commonly reported bacterial STI in sexual health clinics?

A

Chlamydia

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2
Q

What percentage of women and men with chlamydia are asymptomatic?

A

70-80% of women, 50% of men

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3
Q

Chlamydia is a gram ____ ______ ______ bacterium

A

Chlamydia is a gram negative obligate intracellular bacterium

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4
Q

How is chlamydia transmitted?

A

Vaginal, oral or anal sex

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5
Q

Which age group have the highest incidence of chlamydia?

A

20-24 years

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6
Q

Chlamydia is very small, stain _____ with gram stain have a typical ___ wall of gram ___ bacteria

Cell wall lacks ________

A

Chlamydia is very small, stain poorly with gram stain have a typical LPS wall of gram negative bacteria

Cell wall lacks peptidoglycan

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7
Q

The percentage of women with chlamydia who develop PID is estimated at _%

A

The percentage of women with chlamydia who develop PID is estimated at 9%

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8
Q

An episode of PID increases the risk of ectopic pregnancy ___ fold and carries a risk of tubal factor infertility of __-__%

A

An episode of PID increases the risk of ectopic pregnancy ten fold and carries a risk of tubal factor infertility of 15-20%

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9
Q

What is the primary target of chlamydia?

A

Mucosal epithelial cells, replicates within vacuole in cytoplasm of host cell

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10
Q

How can some people clear chlamydia infection?

A

Good TH1 and gamma interferon response, some have abnormal immune response which confers damage

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11
Q

How does chlamydia present in females?

A
  • post coital or intermenstrual bleeding
  • lower abdominal pain
  • dyspareunia
  • mucopurulent cervicitis
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12
Q

How does chlamydia present in males?

A
  • Urethral discharge
  • Dysuria
  • Urethritis
  • Epididymo-orchitis
  • Proctitis (LGV)
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13
Q

What are the complications of CT?

A
  • PID 50%
  • tubal damage
  • chromic pelvic pain
  • transmission to neonate
    • conjunctivitis
    • pneumonia
  • SARA- sexually acquired reactive arthritis
  • reiters syndrome (commoner in men)
  • hugh-curtis syndrome
    • perihepatitis
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14
Q

Who should be tested for chlamydia?

A

Women who have had chlamydia trachomatis in the past year

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15
Q

1 in 5 women who are diagnosed and treated for chlamydia are estimated to become infected within __ months after initial treatment

A

1 in 5 women who are diagnosed and treated for chlamydia are estimated to become infected within 10 months after initial treatment

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16
Q

What is LGV?

A

Serovars of chlamydia trachomatis (L1-L3)

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17
Q

How does LGV present?

A

in MSM

Rectal pain, discharge and bleeding

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18
Q

Describe the testing for CT?

A

Test 14 days following exposure

NAAT (nucleic acid amplification test)- females (vulvovaginal swab), males (first void urine)

MSM (add rectal swab if has receptive anal intercourse)

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19
Q

What is the treatment for chlamydia trachomatis?

A

Doxycycline 100mg BD x 1 week

Azithromycin 1G stat followed by 500mg daily for two days

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20
Q

What is associated with mycoplasma genitalium?

A

Non gonococcal urethritis (15-25%) and PID

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21
Q

How is mycoplasma genitalium tested for?

A

NAAT test (same sample sites as GC/CT

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22
Q

Why is mycoplasma genitalium so easily spread?

A

It has asymptomatic carriage

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23
Q

Gonorrhoea is a gram _____ _________ _______
The primary sites of infection are; (4)

A

Gonorrhoea is a gram negative intracellular diplococcus
The primary sites of infection are;

  1. Mucous membranes of urethra
  2. endocervix
  3. rectum
  4. pharynx
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24
Q

What is the incubation period of gonorrhoeal urethral infection?

A

Short in men (3-5 days)

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25
\_\_% risk of gonorrhoea transmission from infected woman to male partner \_\_-\_\_% risk from infected man to female partner
20% risk of gonorrhoea transmission from infected woman to male partner 50-90% risk from infected man to female partner
26
How does gonorrhoea present in males?
Asymptomatic (\<10%) Urethral discharge \>80% Dysuria Pharyngeal/rectal infections- mostly asymptomatic
27
How does gonorrhoea present in females?
Asymptomatic (up to 50%) Increased/altered vaginal discharge (40%) Dysuria Pelvic pain (\<5%) Pharyngeal and rectal infection are usually asymptomatic
28
Complications of gonorrhoea favour \_\_\_\_\_:\_\_\_\_\_\_ \_% females: \<\_% males
Complications of gonorrhoea favour females:males 3% females: \<1 % males
29
What are the lower genital tract complications of gonorrhoea?
Bartholinitis Tysonitis Periurethral abscess Rectal Abscess Epiididymitis Urethral stricture
30
What are the upper genital tract complications of gonorrhoea?
Endometritis PID Hydrosalpinx Infertility Ectopic pregnancy Prostatitis
31
What is tysonitis
inflammation of Tyson's glands (preputial glands).
32
How is gonorrhoea diagnosed?
NAATs (screening test) \>96% sensitivity
33
How is gonorrhoea tested for if symptomatic
Microscopy Urethral (90-95% sensitivity) Endocervical 37-50% sensitivity
34
What are the advantages of gonorrhoea testing via * microscopy * culture * NAAT
**Microscopy** * Near Pt diagnosis* * Timely treatment* **Culture** *Always allows antibiotic sensitivity and monitoring* **NAAT** * Non invasive* * Less problems with transport, media and storage*
35
What are the disadvantages of gonorrhoea testing via * Microscopy * Culture * NAAT
**Microscopy** * Invasive test* * Low sensitivity* * Requires confirmation* **Culture** * Invasive test* * Requires specific media and incubation* **NAAT** * Risk of false positive* * Positive result should be confirmed by NAAT with different targer*
36
What is the first line treatment for Gonorrhoea?
Ceftriaxone 500mg IM
37
What is the second line treatment for Gonorrhoea?
Cefixime 400mg oral (only if IM injection is contraindicated or refused by patient )
38
What is the most important aspect of gonorrhoea testing in all patients
Test of a cure
39
What are the three variations of genital herpes?
Primary infection Non-primary first episode Recurrent infection
40
Genital herpes (primary infection) Incubation- \_- _ days Duration- \_\_-\_\_ days
Genital herpes (primary infection) Incubation- 3- 6 days Duration- 14-21 days
41
What are the symptoms of genital herpes primary infection?
* Blistering and ulceration of the external genitalia * pain * external dysuria * vaginal or urethral discharge * local lymphadenopathy * fevel and myalgia (prodrome)
42
Recurrent episodes of herpes symptoms are common with which HSV?
HSV 2
43
Describe recurrent episodes of HSV2
Often overlooked/misdiagnosed Usually unilateral, small blisters and ulcers minimal systemic symptoms, resolves within 5-7 days
44
How should herpes be investigated and managed?
* Swab base of ulcer for HSV PCR * Give oral antiviral treatment (aciclovir 400mg TDS x5/7) * Consider topical lidocaine 5% ointment if very painful * saline bathing * analgesia
45
Viral shedding following HSV _ is consistently higher than for HSV \_
Viral shedding following HSV 2 is consistently higher than for HSV 1
46
How can viral shedding be reduced?
By supressive therapy
47
What should be done if herpes is diagnosed within 5 weeks of EDD
Inform O+G
48
What is the mose common viral STI in the UK
HPV
49
How many hpv genotypes are there?
\>200
50
What are the high risk HPV types
16, 18 ## Footnote *31, 33, 25, 52, 58*
51
Which HPV genotype presents with; * anogenital warts * palmar and plantar warts * cellular dysplasia/intraepithelial neoplasia
Which HPV genotype presents with; * anogenital warts= **6/11** * palmar and plantar warts= **1/2** * cellular dysplasia/intraepithelial neoplasia **= 16/18**
52
Who are you most liekly to have acquired HPV from?
Asymptomatic partner
53
What is the incubation period of HPV?
3 weeks to 9 months
54
Where is subclinical HPV common?
On all anogenital sites
55
HPV immunology Spontaenous clearance of warts: \_\_-\_\_% Clearance with treatment: \_\_% Persistence despite treatment: \_\_%
HPV immunology Spontaenous clearance of warts: 20-34% Clearance with treatment: 60% Persistence despite treatment: 20%
56
What is the treatment for HPV
**Podophyllotoxin** (Warticon) * cytotoxic* * Not licensed for extragenital warts- but widely used* **Imiquimod** (aldara) * Immune modifier* * Can be used on all anogenital warts* **Cryotherapy** *cytolytic can require repeat treatments* **Electrocautery**
57
Who gets HPV vaccine?
MSM Women Adolescent boys
58
What causes syphilis?
Treponema pallidum (spirochete)
59
How is syphillis transmitted?
Sexual contact Trans-placental/during birth Blood transfusions Non-sexual contact- healthcare workers
60
What are the classifications of syphilis?
Congenital Acquired
61
What are the phases of early infectious acquired sphilis?
Primary Secondary Early latent
62
What are the phases of late non-infectious acquired sphilis?
Late latent tertiary
63
What is the incubation period of primary syphilis?
From 9-90 days (mean of 21 days)
64
What is the primary syphilis lesion known as?
Chancre (painless)
65
Where to chancres appear?
At the site of inoculation
66
What percentage of chancres are genital?
90%
67
Primary syphilis presents with a chancre and what else?
Non-tender local luymphadenopathy
68
What is the incubation period for secondary syphillis?
6 weeks to 6 months
69
Describe the presentation of secondary syphillis?
* Skin (macular, follicular or pustular rash on palms + soles) * Lesions of mucous membranes * Generalised lymphadenopathy * Patchy alopecia * Condylomata lata
70
What are condylomata lata?
Most highly infectious lesion in syphilis, exudes a serum teeming with treponemes
71
How is syphillis diagnosed?
**Demonstration of treponema pallidum** From lesions or infected lymph nodes Techniques; - *Dark field microscopy* * - PCR (Polymerase Chain Reaction)* **Serological testing** *- detects antibody to pathogenic treponemes*
72
What are the non-treponemal serological tests for syphillis?
VDRL (venereal disease research laboratory) RPR (rapid plasma reagin)
73
What are the treponemal serological tests for syphillis?
TPPA (treponemal pallidum partical agglutination) ELISA/EIA (enzyme immunoassay) **Screening test** INNO-LIA (line immunoassay) FTA abs (fluorescent treponemal antibody absorbed)
74
What is the treatment for early and late syphilis?
**Early** - 2.4 MU Benzathine penicillin x 1 **Late** - 2.4 MU Benthatine penicillin x 3
75
What is the serological follow up for early/late syphillis?
Until RPR is negative or serofast - titres should decrease fourfold by 3-6 months in early syphillis - there is serological reslapse/reinfection if titres increase fourfold

Reproductive & Sexual Health (54 decks)

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