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PBL Week 16 > Sexually transmitted pathogens > Flashcards

Sexually transmitted pathogens Flashcards

(44 cards)

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1
Q

Risk factors for developing STD?

A

Unprotected sex

multipel partners

history of infection

alcohol or drug abuse

Sex workers

Men who have sex w. men

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2
Q

What are some reasons for increasing prevalence of STIs

A
  • The absence of vaccines for almost all STIs, except HPV
  • Increasing density & mobility of human populations
  • Difficulty of engineering changes in human sexual behaviour
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3
Q

What should you remember if one STI is present?

A

The chances there will be another one due to co-infection is high - so always test for others!

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4
Q

What are the most common STIs in the UK?

A
  • Genital chlamydia
  • Gonorrhoea
  • Genital warts (HPV)
  • Herpes (HSV)
  • HIV/AIDS
  • Syphilis
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5
Q

What’s the importance of early detection of STIs?

A
  • Reduces the spread of infection
  • May avoid or delay serious complications and consequences
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6
Q

What is the causative organism for chlamydia?

A

Chylamydia trachomatis

  • D-K serotypes = non-specific urethritis
  • L serotypes = lymphogranuloma venereum
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7
Q

What’s the transmission of chlamydia?

A
  • Horizontal - sexual contact
  • Vertical - perinatal transmission from infected mother to baby during vaginal delivery is possible. Can lead to neonatal conjunctivitis & pneumonia.
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8
Q

How does chlamydia present?

A

Asymptomatic in over 80% of cases

Males:
- Mucopurulent urethral discharge
- dysuria
- scrotal pain
- proctitis

Females:
- Mucopurulent vaginal discharge
- cervicitis
- cervical bleeding upon contact
- proctitis
- post-coital bleeding
- intermenstrual bleeding

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9
Q

How can you test for chlamydia?

A

Nucleic Acid Amplification Test (NAAT)
- Males: First pass urine
- Women: Vulvovaginal swab
- If applicable, oropharyngeal & rectal sites also swabbed

Can take up to 14 days from exposure for infection w/ to show up on NAAT test, therefore screening should be repeated after this window

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10
Q

How is chlamydia managed?

A

Doxycycline or azithromycin

Full STI screen including blood tests

All forms of sexual intercourse need to be avoided until all parties are tested & treated

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11
Q

What complications can be had from chlamydia?

A

Women: Pelvic inflammatory disease (PID) - increases risk of infertility &ectopic pregnancy

Men: Epididymitis & prostatitis

Reactive arthritis

Lymphogranuloma venererum (LGV) - caused by a more invasive serotype of chalymdia trachomatis & treated w/ 3 weeks of Doxycycline

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12
Q

What is the causative organism for gonorrhoea?

A

Neisseria gonorrhoeae/gonococcus

Gram negative coccus bacteria

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13
Q

How is gonorrhoea transmitted?

A

Same as chlamydia

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14
Q

What’s a microbial strategy of gonorrhoea?

A

Virulence factors give pathogens their transmission potential e.g. pilus in Gonorrhoeae give it a big advantage in infecting genitals

Host defence: Integrity of mucosal surface
Microbial strategy: Specific attachment mechanism

Also:

Host defence: Phagocytes
Microbial strategy: Resists phagocytosis using its capsule

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15
Q

How does gonorrhoea present?

A

Males: Urethral discharge (can be thick yellow/green discharge from penis and vagina)

Women: Often asymptomatic but may have vaginal discharge

Both:
- Rectal infection
- Oropharyngeal infection
- pain on urination

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16
Q

How can you test for gonorrhoea?

A

Cultures taken prior to antibiotics to assess antibiotic susceptibility

Nucleic Acid Amplification Test (NAAT)- same as chlamydia

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17
Q

How is gonorrhoea managed?

A

High rates of antimicrobial resistance reported therefore treatment should be guided by guidelines.
- e.g. rising resistance to penicillin
- Dual therapy of more than 1 drug is more effective due to this resistance.

Cephalosporin e.g. ceftriaxone & azthromycin

Test of cure following two weeks after treatment using NAAT is recommended

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18
Q

What complications can be had from gonorrhoea?

Study These Flashcards
A

Can disseminate to cause skin & synovial infections

Pelvic inflammatory disease (PID) - increases risk of infertility & ectopic pregnancy

Fitz-Hugh-Curtis syndrome- secondary to PID there’s inflammation of the hepatic capsule leading to perihepatic adhesions

Chronic pelvic pain in females

Infertility in males secondary to epididymitis

19
Q

What is the causative organism for herpes?

Study These Flashcards
A

Herpes simplex virus (HSV) 1 & 2

  • HSV-1 is the usual cause of labial (oral) & anogenital herpes infections
  • HSV-1: Oral & genital herpes
  • HSV-2: Genital herpes
20
Q

What’s the transmission of herpes?

Study These Flashcards
A
  • Mucosal surfaces or broken skin

Infection can be:
- Primary or secondary
- Episodes symptomatic or asymptomatic
- Clinical manifestations initial or recurrent infection

Infection w/ HSV is lifelong as the virus lies dormant w/in local sensory ganglia
- Intermittent reactivation can be symptomatic w/ lesions to the skin
- or asymptomatic w/ unnoticed active viral shedding.

21
Q

How does herpes present?

Study These Flashcards
A

Most individuals asymptomatic

Blisters which progress to painful ulcers around anogenital area

Dysuria, discharge & inguinal lymphadenopathy

In primary infection, systemic symptoms e.g. pyrexia & myalgia can occur

Symptoms from primary infection tend to be more severe than those of recurrent infection

22
Q

How can you test for herpes?

Study These Flashcards
A

HSV PCR from swabs taken from lesions- when taking sample, burst lesion & swab base of the ulcer.

NAAT testing is also used in some centres.

Testing for HSV does not form part of routine STI screening in the UK

23
Q

How is herpes managed?

Study These Flashcards
A
  • Primary episode: Aciclovir 400mg for 5 days
  • Recurrent episode: Aciclovir 800mg for 2 days
  • Prophylaxis in patients with >5 episodes per year: Aciclovir 400mg x2 daily

refrain from intercourse

Condoms

Full STI screening

24
Q

What complications can be had from herpes?

Study These Flashcards
A

Urinary retention

HSV keratitis- dendritic lesion on the cornea

Aseptic meningitis

Herpes proctitis

25
What’s HIV?
Retrovirus that infects & replicates in human lymphocytes & macrophages, eroding the integrity of the human immune system over a number of years
26
What’s the transmission of HIV?
- Mucosal surfaces, in particular cervicovaginal, penile & rectal - IV or percutaneous (skin) routes
27
How does HIV present?
Primary HIV infection: mild mononucleosis-type illness
28
How can you test for HIV?
HIV antibody or combination antibody/antigen test confirmed using a more specific test (ELISA)
29
How is HIV managed?
Post-exposure prophylaxis (PEP) - reduces probability of HIV transmission by 80% when taken w/in 72 hours following exposure - All patients infected w/ HIV, regardless of CD4 cell count, should start on antiretroviral drugs as soon as possible
30
What complications can be had from HIV?
AIDS- serious vulnerability to infections & illnesses w/ life expectancy of around 3 years
31
What is the casusative organism for genital warts?
Human papillomavirus (HPV) - Low-risk strains of HPV cause genital warts - High-risk strains of HPV can cause cancer
32
What’s the transmission of genital warts?
- Direct skin to skin contact - Rare: perinatally - The incubation period from exposure to infection can be up to 8 months.
33
Who is the HPV vaccine offered to?
- All girls aged 12-13 in the UK - All MSMs (men who have sex w/ men) who attend a sexual health clinic in the UK & are 45 years old
34
How does genital warts present?
Anogenital warts - vary in size, number, colour and texture - but mostly appear as Textured, soft growths around the vaginal opening & penis. - anus, cervix & urethral meatus can also be affected Predominantly genital warts are asymptomatic however itching, bleeding & pain can occur
35
How can you test for genital warts?
speculum exam should be performed to visualise the cervix Diagnosis is clinical however biopsies should be obtained if lesion bleeds is ulcerated or indurated Testing for HPV does not form a part of routine STI screening in the UK
36
How are genital warts managed?
In 1/3 of patients, warts will resolve without intervention - Warts can re-occur after initial resolution-several treatment courses are often required -Smoking is known to increase risk of recurrence Topical: - Podophyllotoxin - Imiquimod Physical ablation: - Cryotherapy - Surgical excision A full STI screen including blood tests should be offered.
37
What complications can be had from genital warts?
- Ano-genital cancer - Scarring following treatment
38
What is the causative organism for syphillis?
Treponema pallidum - a spirochetal bacterium
39
What’s the transmission of syphillis?
- Horizontal - direct sexual contact w/ infected individual who has a lesion on the skin or muscosa - Vertical - trans-placental transmission which increases risk of stillbirth & miscarriage; or congenital abnormalities
40
How does syphillis present?
-Often asymptomatic 3stages - individual is most infectious during primary &secondary stages 1. Primary: Development of: - hardened, painless ulcer on genitals called a chancre 2. Secondary: -widespread non-pruritic maculopapular rash involving the palms & soles develop - alopecia - generalised lymphadenopathy - oral snail-track lesions - constitutions symptoms (pyrexia, fatigue, malaise) 3. Tertiary: Untreated syphilis over many years can develop into neurosyphilis, cardiovascular syphilis & gummatous syphilis
41
How can you test for syphillis?
Non-specific tests (screening): - Cardiolipin serology tests are used as an indicator to measure disease activity, disease staging & treatment efficacy. - Rapid Plasma Reagin (RPR) Test - Venereal Disease Research Laboratory (VDRL) Test Specific tests (diagnosis): - ELISA - detects IgM & IgG - The fluorescent treponemal antibody absorption (FTA-ABS) test. - The microhaemagglutination assay for T. pallidum (MHA-TP) Can take up to 12 weeks from exposure for tests to show positive result. Tests should, therefore, be repeated at 12 weeks post-exposurE
42
How is syphillis managed?
- Penicillin - Repeat serology testing at 3, 6 & 12 months.
43
What complications can be had from syphillis?
Jarisch-Herxheimer reaction - antibiotic treatment of syphilis causes a sepsis-like picture due to release of toxins from treponemal bacterium breakdown, - steroids are administered beforehand to prevent this. If untreated, facilitates HIV transmission
44
How can we prevent STDs?
- Educate on how they’re spread - Eliminate stigma - so people are less embarassed to get tested - Encourage condom use - Encourage regular testing - Target prevention to at risk groups (homosexuals and drug addicts)

PBL Week 16 (5 decks)

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