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Sexually Transmitted Infections Flashcards

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1
Q

What are the standard STIs tested for?

A

Chlamydia
Gonorrhoea
HIV
Syphillis

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2
Q

How do you test for chlamydia and gonorrhoea?

A

NAAT

Increased sensitivity over culture

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3
Q

Where are NAAT samples taken?

A

Vulvovaginal swab or endocervical swab
Throat swab
Rectal swab
Urine - first void sample in males

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4
Q

What is a problem with NAAT?

A

It can detect dead organisms - wait 5 weeks to do cure test

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5
Q

How do you test for HIV/Syphilis?

A

Blood test

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6
Q

When a patient presents with discharge what tests can be done?

A

Cervical microscopy (gram stain)
Vaginal microscopy and pH (>4.5 in pathology)
Urethral microscopy (gram stain)
Amies swab

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7
Q

When should a amies swab be done?

A

High vaginal swab in HSV, unknown cause of discharge, pregnant, postpartum, post gynae, PID

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8
Q

What is the commonest STI in the UK?

A

Chlamydia

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9
Q

Where does chlamydia infect?

A

Columnar epithelium at mucosal site - urethra, rectum, throat, eyes, endocervix

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10
Q

How is chlamydia transmitted?

A

Vaginal, oral or anal sex

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11
Q

What percentage of patients with chlamydia are asymptomatic?

A

70-80% of women

50% of men

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12
Q

What are the symptoms of chlamydia?

A 
Milky Discharge (men)
Irregular bleeding (women) 
Abdominal pain (both)
Dysuria (men)
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13
Q

What are the signs of chlamydia?

A

Urethritis
Cervicitis
Epididymo-orchitis
Proctitis (LGV)

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14
Q

Name the three serological groups of chlamydia

A

Serovars A-C - trachoma
Serovars D-K - genital infection
Servers L1-L3 - lymphogranuloma venereum

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15
Q

Describe lymphogranuloma venereum

A

Mainly in MSM, rectal pain, discharge and bleeding

67% also have HIV

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16
Q

Describe the bacteria chlamydia trachomatis

A

Obligate intracellular bacteria with biphasic life cycle, does not stain with gram stain - no peptidoglycan in cell wall. Cannot reproduce outside of host.

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17
Q

What is the treatment of chlamydia?

A

1st - doxycycline 100mg BD 7 days

2nd - azithromycin 1g stat followed by 500mg daily for 2 days

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18
Q

What is the treatment in PID?

A

Inpatient - ceftrixone, metronidazole, doxycycline

Outpatient - ofloxacin & metronidazole

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19
Q

State the complications of chlamydia

A

PID, tubal damage, conjunctivitis, pneumonia, reactive arthritis (righters), Fitz Huge Curtis

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20
Q

Describe Fitz Huge Curtis

A

Perihepatitis - piano string adhesions from liver

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21
Q

What is the testing advice for chlamydia?

A

14 days following exposure, >25 years old with discharge rarely chlamydia - high re-infection rate

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22
Q

Describe the action of bacteria neisseria gonorrhoea

A

Gram negative intracellular diplococcus - attaches to host epithelial cells and endocytose into the cell to replicate

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23
Q

Why does GC appear intracellularly on gram film?

A

Easily phagocytose by polymorphs

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24
Q

How does gonorrhoea present?

A

Mucopurulent urethral discharge, dysuria, endocervical - discharge, irregular bleeding, external dysuria, pharyngeal/rectal is usually asymptomatic

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25
How is gonorrhoea investigated?
NAATs - urethral/endocervical swab Microscopy if symptomatic Culture is positive microscopy or GC contact - endocervical, rectal, throat swab
26
Why are cultures only done in the clinic?
GP were false negatives as the organism would die on the way to lab
27
How is gonorrhoea treated?
1st Ceftriaxone 1g IM | 2nd Cefixime 400mg + azithromycin 2g
28
What is the incubation period for gonorrhoea?
2-5 days
29
What are the lower genital tract complications of gonorrhoea?
``` Bartholinitis Tysonitis Periurethral abscess Rectal abscess Epidiymitis Urethral stricture ```
30
What are the upper genital tract complications of gonorrhoea?
``` Endometritis PID Hydrosalpinx Infertility Ectopic pregnancy Prostatis ```
31
What is the new emerging STI?
Mycoplasma genitalium
32
How is mycoplasma genitalium managed?
NAAT test - high levels of macrolide resistance
33
What bacteria causes syphilis?
Treponema Pallidum Palldium subtype
34
How is syphilis transmitted?
Sex During birth Trans-placental
35
Describe primary syphilis
Organism multiples at inoculation site to form a chancre (90% genital) and then gets into the blood stream
36
What is the incubation period of primary syphilis?
9-90 days
37
Other than chancre what else can be present in primary syphilis?
Non-tender local lymphadenopathy
38
Describe secondary syphilis
Large number of bacteria circulating in blood with multiple manifestations at different sites
39
What is the incubation period for secondary syphilis?
6 weeks to 6 months
40
Describe the signs and symptoms of secondary syphilis
``` Snail track mouth ulcers Generalised rash (hands and feet) Malaise Anterior uveitis Cranial nerve lesion Condylomata lata ```
41
Describe condylomata lata
Highly infectious lesion exudes a serum teeming with treponemes
42
Describe latent syphilis
No symptoms but low level multiplication of spirochaete in intima of blood vessels
43
What happens in late syphilis?
Cardiovascular and neuromuscular complications
44
How is primary syphilis diagnosed?
Dark field microscopy PCR IgM
45
How is secondary and tertiary syphilis diagnosed?
Serology to detect antibodies - non-treponemal (RPR - disease activity) - treponemal
46
Describe the treatment of syphilis
Early - 2.4MU benzathine penicillin stat | Late - 2.4MU benzathine penicillin weekly x 3 weeks
47
What follow up should be done in syphilis?
Serology - RPR is negative, decrease by four fold by 3-6 months post treatment
48
What causes genital herpes?
HSV1 and HSV2
49
Describe the herpes virus
Enveloped virus containing double-stranded DNA transmitted by close contact with someone shedding the virus
50
Which virus is shed more easily?
HSV2
51
Describe the pathogenesis of herpes
1. Virus duplicates in dermis and epidermis 2. Gets into nerve endings of sensory and autonomic nerves 3. Inflammation causes painful small vesicles which are easily reroofed 4. Virus migrates to sacral root ganglion and hides from immune system 5. Reactivation leads to genital herpes
52
What is the duration and incubation of primary herpes?
Incubation 3-6 days | Duration 14-21 days
53
How can primary herpes present?
Blistering, ulceration, pain, dysuria, discharge, lymphadenopathy, fever, malaise
54
Describe recurrent herpes
Usually HSV2 unilateral small blisters and ulcers, minimal systemic involvement - resolves in 5-7 days
55
How is herpes diagnosed?
Swab in virus transport medium of reroofed blister for PCR
56
How is herpes treated?
Aciclovir 400mg TDS 5 days Topical lidocaine 5% ointment if painful Saline bathing Analgesia
57
What is the special circumstance for herpes treatment?
First episode in 3rd trimester within 6 weeks of delivery dates, ask if first episode - HSV NAAT and type specific serology for antibodies Risk of neonatal herpes
58
State the differential diagnosis of genital lumps
- skin tags - molluscum contagiosum (pox virus) - spots of fordyce (blockage of sebaceous gland) - pearly penile papules (normal)
59
What is the most common viral STI in UK?
HPV
60
What is the most oncogenic type of HPV?
Type 16
61
Which types of HPV cause warts and are low risk?
Type 6 and 11
62
Name the different features of HPV depending on type
- latent infection - anogenital warts - palmar and plantar warts (11 and 6) - cellular dysplasia/intra-epithelial neoplasia (16 and 18)
63
What is the incubation period of HPV?
3 weeks to 9 months
64
Describe anogenital warts
Cauliflower lesions at sites of friction - HPV 6 and 11
65
What are the treatment options for HPV?
Podophyillotoxin - cytotoxic liquid Imiquimod - immune modifier better for peri-anal disease and supports immune and superficial clearance Cryotherapy - requires multiple treatments Electrocautery
66
Who is given the HPV vaccination?
Girls 11-13 MSM S1 boys
67
Describe pubic lice
Close genital skin contact, they bite and feed on blood causing itch Female lay eggs and can survive unto 17 days Males can survive for 22 days
68
How are pubic lice treated?
Malathion lotion
69
What bacteria are naturally present in the vagina?
Lactobacillus Group B Strep Candida Strep viridian's
70
Why is lactobacillus significant?
Produces lactic acid+/- hydrogen peroxide to create an acidic pH
71
What is the characteristic appearance of candida?
Budding yeast and hyphae
72
State the predisposing factors to candida?
Recent antibiotics High oestrogen (pregnancy/contraception) Poorly controlled diabetes Immune-compromised patients
73
How does candida present?
Itchy cottage cheese white discharge
74
How is candida diagnosed?
Examination and high vaginal swab
75
How is candida treated?
Clotrimazole Pessary or cream | Oral fluconazole
76
What does candida look like in males?
Spotty rash of balanitis
77
Name a sexually transmitted parasite
Trichomonas vaginalis
78
How does Trichomonas vaginalis present?
Vaginal discharge and irritation in females
79
What is the diagnosis and treatment of Trichomonas vaginalis ?
Diagnosed with high vaginal swab for microscopy | Treatment with oral metronidazole
80
What is bacterial vaginosis?
Overgrowth of anaerobic bacteria - homogenous discharge may contain bubbles
81
Describe the microscopic appearance of bacterial vaginosis
Bacilli replaced with coccobacilli and few leukocytes
82
How does bacterial vaginosis present?
Asymptomatic, vaginal discharge, fishy odour particularly worse after sex/menstruation
83
What does bacterial vaginosis increase your risk of?
Upper tract infection, premature rupture of membranes and preterm delivery, increased risk of acquiring HIV
84
How is bacterial vaginosis treated?
Metronidazole 7 days
85
What is the relapse rate of bacterial vaginosis?
30%

Reproduction & Sexual Health (36 decks)

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