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STDs and HIV Flashcards

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1
Q

How are infections transmitted during sex (6 methods)?

A 
Direct innoculation, e.g: Herpes Simplex Virus
Trauma, e.g: hepatitic C virus
IV drug use, e.g: HIV and hep C
Fomites (objects), e.g: gonorrhea
Ingestion, e.g: shigella
Sexual/genital secretions
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2
Q

Which STIs can affect the mouth/oropharynx?

A

HPV, HSV, Chlamydia, LGV, Gonorrhea, Syphilis, HIV

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3
Q

Which STIs can affect the liver/biliary tract?

A

Chlamydia
Syphilis
HIV
Hep A, B, C

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4
Q

Which STIs can affect the stomach?

A

Syphilis

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5
Q

Which STIs can affect the small bowel?

A

HIV, Giardia, Shigella

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6
Q

Which STIs can affect the large bowel?

A

Chlamydia, LGV, Gonorrhea, Syphilis, HIV

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7
Q

Which STIs can affect the rectum?

A

HPV, HSV, Chlamydia, LGV, Gonorrhea, Syphilis, HIV

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8
Q

Which STIs can affect the anus?

A

HPV, HSV, LGV, Syphilis, HIV

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9
Q

What would be on an STI differential diagnosis?

A

Inflammatory Bowel Disease

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10
Q

Testing for STIs?

A

Urethral swab for microscopy; can also use NAAT (nucleic acid amplification test)

Stool culture

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11
Q

Cause of rectal gonorrhea and transmission?

A

Neisseria gonorrhea transmitted by direct contact of mucosal surfaces

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12
Q

How is gonorrhea spread for proctitis?

A

Anal sex, transmucosal spread, fomite

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13
Q

Symptoms of gonorrhea and differentiation from IBD?

A

Short incubation period (5-10 days):
Lower abdominal pain, diarrhoea, rectal bleeding, anal discharge, tenesmus

May have assoc. symptoms:
Urethral/vaginal discharge and dysuria (not in IBD)

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14
Q

What does proctoscopy show with gonorrhea?

A

Inflamed mucosae and purulent exudate

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15
Q

Complications of rectal gonorrhea?

A

Abscess formation and increased susceptibility to HIV (in response to inflammation, there are many CD4+ cells)

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16
Q

Cause of rectal chlamydia and tranmission?

A

Chlamydia trachomatis transmitted by direct contact between mucosal surfaces

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17
Q

Why can Chlamydia diagnosis be missed if only urine is tested?

A

50% of Chlamydia in MSM is found solely in the rectum

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18
Q

Symptoms of rectal chlamydia?

A

70% asymptomatic but, when symptomatic, tends to be milder than Gonorrhea (proctoscopy is less severe); inc. anal discomfort/itch, discharge and assoc. symptoms

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19
Q

Testing for rectal chlamydia?

A

NAAT

CT and GC

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20
Q

Signs of primary syphilis?

A

Solitary painless ulcer

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21
Q

Signs of secondary syphilis?

A

Mucosal patches and ulcers
Mouth, anogenital, rectal

Condylomata lata - warty lesions that can form in the anal cleft

Hepatitis

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22
Q

Transmission of herpes simplex virus?

A

Ano-genital or oro-anal

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23
Q

Type of HSV in proctitis?

A

Usually, HSV 2 affecting the peri-anal mucosa, but may extend into rectum

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24
Q

Symptoms of HSV?

A

Pain and ulcers
Painful defecation, with bleeding and mucous

Viraemic symptoms (in primary infection)

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25
Transmission of human papillomavirus (HPV)?
Ano-genital, oro-anal
26
What is Lymphogranuloma venereum?
Primarily an infection of lymphatics and lymph nodes, caused by Chlamydia trachomatis
27
Risk factors for LGV?
Group sex Drug use Syphilis and hep C
28
Primary, secondary and tertiary features of LGV?
Primary (3-30 days): ulcer Secondary (3-6/12): inguinal syndrome, ano-rectal syndrome Tertiary: strictures, fistulae, genital elephantiasis
29
Testing for LGV?
MSM with haemorrhagic proctitis HIV + MSM with +ve rectal chlamydia Failed chlamydia test of cure Contact of LGV
30
In somebody diagnosed for LGV, what else should be tested for?
HIV, hep C, syphilis
31
What is GALT?
Gut-assoc. lymphoid tissue - largest immune compartment in the body
32
Where are the mucosal lymphocytes present in the GI tract and why do they allow HIV to enter the host cell?
Rectum, foreskin and cervico-vagina have a higher proportion of CD4+ T helper cells (express CCR5 - co-receptor for HIV entry into the host cell)
33
What happens to the GALT in HIV?
Depletion of intestinal GALT regardless of site of infection - can lose up to 60% by day 14
34
Clinical result of GALT loss?
Unknown but may inc: HIV enteropathies Opportunistic infection Persistent immune activation (microbial translocation) Accelerated immunosecescence (aging of the immune system)
35
STI risk factors?
36
Which STIs can affect the mouth/oropharynx?
HPV, HSV, Chlamydia, LGV, Gonorrhea, Syphilis, HIV
37
Which STIs can affect the liver/biliary tract?
Chlamydia Syphilis HIV Hep A, B, C
38
Which STIs can affect the stomach?
Syphilis
39
Which STIs can affect the small bowel?
HIV, Giardia, Shigella
40
Which STIs can affect the large bowel?
Chlamydia, LGV, Gonorrhea, Syphilis, HIV
41
Which STIs can affect the rectum?
HPV, HSV, Chlamydia, LGV, Gonorrhea, Syphilis, HIV
42
Which STIs can affect the anus?
HPV, HSV, LGV, Syphilis, HIV
43
What would be on an STI differential diagnosis?
Inflammatory Bowel Disease
44
Testing for STIs?
Urethral swab for microscopy; can also use NAAT (nucleic acid amplification test) Stool culture
45
Cause of rectal gonorrhea and transmission?
Neisseria gonorrhea transmitted by direct contact of mucosal surfaces
46
How is gonorrhea spread for proctitis?
Anal sex, transmucosal spread, fomite
47
Symptoms of gonorrhea and differentiation from IBD?
Short incubation period (5-10 days): Lower abdominal pain, diarrhoea, rectal bleeding, anal discharge, tenesmus May have assoc. symptoms: Urethral/vaginal discharge and dysuria (not in IBD)
48
What does proctoscopy show with gonorrhea?
Inflamed mucosae and purulent exudate
49
Complications of rectal gonorrhea?
Abscess formation and increased susceptibility to HIV (in response to inflammation, there are many CD4+ cells)
50
Cause of rectal chlamydia and tranmission?
Chlamydia trachomatis transmitted by direct contact between mucosal surfaces
51
Why can Chlamydia diagnosis be missed if only urine is tested?
50% of Chlamydia in MSM is found solely in the rectum
52
Symptoms of rectal chlamydia?
70% asymptomatic but, when symptomatic, tends to be milder than Gonorrhea (proctoscopy is less severe); inc. anal discomfort/itch, discharge and assoc. symptoms
53
Testing for rectal chlamydia?
NAAT | CT and GC
54
Signs of primary syphilis?
Solitary painless ulcer
55
Signs of secondary syphilis?
Mucosal patches and ulcers Mouth, anogenital, rectal Condylomata lata - warty lesions that can form in the anal cleft Hepatitis
56
Transmission of herpes simplex virus?
Ano-genital or oro-anal
57
Type of HSV in proctitis?
Usually, HSV 2 affecting the peri-anal mucosa, but may extend into rectum
58
Symptoms of HSV?
Pain and ulcers Painful defecation, with bleeding and mucous Viraemic symptoms (in primary infection)
59
Transmission of human papillomavirus (HPV)?
Ano-genital, oro-anal
60
What is Lymphogranuloma venereum?
Primarily an infection of lymphatics and lymph nodes, caused by Chlamydia trachomatis
61
Risk factors for LGV?
Group sex Drug use Syphilis and hep C
62
Primary, secondary and tertiary features of LGV?
Primary (3-30 days): ulcer Secondary (3-6/12): inguinal syndrome, ano-rectal syndrome Tertiary: strictures, fistulae, genital elephantiasis
63
Testing for LGV?
MSM with haemorrhagic proctitis HIV + MSM with +ve rectal chlamydia Failed chlamydia test of cure Contact of LGV
64
In somebody diagnosed for LGV, what else should be tested for?
HIV, hep C, syphilis
65
What is GALT?
Gut-assoc. lymphoid tissue - largest immune compartment in the body
66
Where are the mucosal lymphocytes present in the GI tract and why do they allow HIV to enter the host cell?
Rectum, foreskin and cervico-vagina have a higher proportion of CD4+ T helper cells (express CCR5 - co-receptor for HIV entry into the host cell)
67
What happens to the GALT in HIV?
Depletion of intestinal GALT regardless of site of infection - can lose up to 60% by day 14
68
Clinical result of GALT loss?
Unknown but may inc: HIV enteropathies Opportunistic infection Persistent immune activation (microbial translocation) Accelerated immunosecescence (aging of the immune system)
69
Public health interventions with STDs and HIV?
Prevent re-infection | Maintain good sexual health for future

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