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finals y3s1 > STI > Flashcards

STI Flashcards

1
Q

which STI legally required to be reported upon diagnosis

A

gonorrhoea, non-gonococcal urethritis, syphilis, chlamydia, genital herpes, HIV/AIDS, viral hepatitis

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2
Q

gonorrhoea general

A

1) causative organism

  • neisseria gonorrhoea (intracellular gram neg diplococci)

2) mode of transmission

  • sex, mother-to-child during childbirth
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3
Q

diagnosis of gonorrhea

A

1) gram stain of genital discharge
2) culture
3) NAAT

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4
Q

infectious site for gonorrhoea

A

urethritis, cervicitis, proctitis, pharyngitis, conjunctivitis, disseminated

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5
Q

clinical presentation of gonorrhoea

A
  • can be asymptomatic
  • symptoms
    1) male: purulent urethral discharge
    2) female: mucopurulent vaginal discharge
    3) both: dysuria, urinary frequency
  • complications
    1) male: epididymitis, prostatitis, urethral stricture
    2) female: pelvic inflammatory disease, ectopic pregnancy, infertility
    3) both: disseminated disease, skin lesion, tenosynovitis, monoarticular arthritis
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6
Q

management of uncomplicated gonorrhoea

A
  • X fluoroquinolone (resistance)
  • gonococcal infection treatment + anti-chlamydia therapy (doxycycline) for concurrent treatment unless X chlamydia
  • 1st line: ceftriaxone
  • alternative: gentamycin + azithromycin
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7
Q

chlamydia general

A
  • causative agent: chlamydia trachomitis
  • infect various site (similar to gonorrhoea)
  • transmission: sex, mother-to-child
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8
Q

diagnosis of chlamydia

A

NAAT

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9
Q

clinical presentation of chlamydia

A

milder symptoms than gonorrhoea, similar complications to gonorrhoea

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10
Q

treatment for chlamydia

A
  • 1st line: doxycycline
  • alternative: azithromycin (use 1st cuz adherence), levofloxacin
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11
Q

management of sex partners for gonorrhea & chlamydia

A
  • evaluate & treat sexual partner in last 60 days
  • if last sexual exposure > 60 days then treat most recent partner
  • if receiving treatment then abstain from sex 7 days after treatment (prevent transmission)
  • abstain from sexual intercourse until all sexual partners treated (prevent reinfection)
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12
Q

syphilis general

A
  • causative organism: treponema pallidum
  • transmission: sex, mother-to-child (transplacental)
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13
Q

serological tests for syphilis

A

1) treponemal

  • use treponemal antigen to detect treponemal activity
  • confirmatory test cuz more sensitive & specific
  • reactive for life X for monitoring response but if infected before

2) non-treponemal

  • cardiolipin to detect treponemal antibodies
  • types: VDRL slide test/RPR card test
  • +ve test: any stage of syphilis
  • quantitative test (measure response)
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14
Q

treat primary/secondary/early latent syphilis

A

1) IM benzathine pen G 2.4 million units
2) pen allergy: PO doxycycline 100mg BD 14 days

  • take w food
  • take w water + upright position at least 30 mins
  • X milk, divalent cation (2 hrs)
  • SE: GI, photosensitivity
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15
Q

treat late latent (> 1 yr)/unknown duration/tertiary syphilis

A

1) IM benzathine pen G 2.4 million units once a wk for 3 doses
2) pen allergy: PO doxycycline 100mg BD 28 days

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16
Q

treat neurosyphilis

A

1) IV crystalline pen G (3-4 million units q4h | 18-24 MU/d as continuous infusion 10-14 days) or IV procaine pen G (2.4 MU daily) + PO probenecid (500mg qid) 10-14 days
2) pen allergy: IV/IM ceftriaxone 2g daily 10-14 days

  • concern cross-sensitivity: skin test to confirm pen allergy, desensitise if required
17
Q

what is the function of PO probenecid in neurosyphilis treatment?

A

reduce secretion of penicillin = increase penicillin concentration in systemic

18
Q

monitoring for syphilis treatmtent response - JH reaction

A
  • acute febrile reaction + headache, myalgia
  • within first 24 hrs
  • not preventable, can give antipyretics to help
19
Q

monitoring for syphilis treatment response - pri/secondary/latent

A
  • quantitative VDRL or RPR 3, 6, 12, 18, 24 months
  • treatment success if decrease of VDRL/RPR titre by at least fourfold
    ** lower antibody = lesser antibody titre (good) = body X producing antibody to fight antigen = little antigen
20
Q

monitoring for syphilis treatment response - neurosyphilis

A

CSF examination every 6 month until CSF normal

21
Q

syphilis management of sex partners

A
  • all at risk sexual partners evaluated & tested
  • X sex w new partners until all lesions healed
22
Q

genital herpes causative agents

A

herpes simplex virus (HSV-1, HSV2)

  • HSV-2 cause recurrence
23
Q

cycle of HSV infection

A

1) primary mucocutaneous infection
2) infection of nerve ganglia
3) establishment of latency
4) reactivation
5) recurrent outbreak/flares

24
Q

route of transmission for HSV infection

A

1) body fluids
2) intimate skin-to-skin contact

25
Q

infection progress for HSV

A

1) Vesicles develop over 7 - 10 days
2) heal in 2-4 wks
3) intermittent viral shedding from epithelial cells

26
Q

clinical presentation of genital herpes

A

1) multiple painful vesicles (break to form ulcerative lesions)
2) local itching, pain, tender inguinal lymphadenopathy
3) flu-like symptoms

  • fever, headache, malaise
    first few days after appearance of lesions

4) prodromal symptoms

  • mild burning, itching, tingling
  • prior to appearance of recurrent lesion
27
Q

type-specific (HSV 1/2) serologic test

A
  • Ab to HSV develop during first few wks after infection, persist indefinitely
  • X useful for first ep of infection cuz take 6-8 wks for serological detection
  • HSV-2 Ab = anogenital infection
28
Q

genital herpes supportive care

A

1) warm saline bath relieve discomfort
2) symptom management: analgesia, anti-itch
3) good genital hygiene to prevent superinfection
4) counselling

29
Q

MOA of antivirals for genital herpes

A

inhibit viral DNA polymerase -> inhibit DNA synthesis & replication

30
Q

types of antivirals for genital herpes

A

1) acyclovir

  • PO 400mg TDS 7-10 days
  • severe/complicaations that require hospitalisation: IV 10mg/kg q8h x 2-7 days + PO 10 days
  • hydration to prevent crystallisation in renal tubule

2) valacyclovir

  • PO 1g BD for 7-10 days
31
Q

pharmacological management of recurrent genital herpes

A

antiviral as chronic/suppressive therapy

32
Q

advantages of chronic suppressive therapy for genital herpes

A
  • reduce frequency by 70-80%
  • X symptomatic outbreak = improve QoL
  • long term safety & efficacy
  • decrease risk of transmission + consistent condom use & abstinence
33
Q

disadvantages of chronic suppressive for recurrent genital herpes

A

$$$$$$, compliance

34
Q

chronic suppressive therapy regimen for genital herpes

A
  • acyclovir 400mg PO BD
  • valacyclovir 500mg PO OD
  • valacyclovir 1g PO OD
  • when indefinite suppression indicated:
    ** complicated disease course (disseminated disease: encephalitis, meningitis, keratitis)
    ** immunocompromised host
35
Q

advantages of episodic treatment for genital herpes

A

1) Shorten duration & severity of symptoms
2) cheaper
3) more likely to be compliant

36
Q

disadvantages of episodic treatment for genital herpes

A

1) require indication of therapy within 1 day of lesion onset or during prodromal that precedes some outbreaks
2) X reduce risk of transmission

37
Q

possible meds for episodic treatment for recurrent genital herpes

A
  • acyclovir 800mg oral BD 5 days
  • acyclovir 800mg TID for 2 days
  • valacyclovir 500mg oral BD 3 days
  • valacyclovir 1g oral OD 5 days

finals y3s1 (10 decks)

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