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Exam - M - Reproduction System (Megan and Rachel) > STIs > Flashcards

STIs Flashcards

1
Q

what pathogen causes gonorrhoea

A

Neisseria gonorrhoeae

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2
Q

what type of tissues can gonorrhoeae affect

A

mucous membranes with columnar epithelium

Commonly - cervix, urethra, anus, throat.

Common in children - lining of eyes.

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3
Q

what are risk factors for gonorrhoeae

A

young
sexually active
multiple partners
MSM

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4
Q

what is the incubation period for gonorrhoea

A

usually 5-6 days

can range from 2-14 days

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5
Q

how does gonorrhoea present in women

A 
most have no symptoms 
vaginal discharge (odourless, can be green or yellow) 
dysuria 
intermenstrual/post coital bleeding
pelvic pain
pharyngeal/rectal infection
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6
Q

how does gonorrhoea present in men

A

thick yellow discharge
rectal infection - usually asymptomatic, can cause discomfort and discharge
pharyngeal infection - usually asymptomatic, can cause sore throat
testicular pain/swelling
more likely to be symptomatic

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7
Q

what are complications of gonorrhoea

A 
acute monoarthritis usually in elbow or shoulder 
disseminated gonococcal infection 
women - pelvic inflammatory disease
men - epididymitis
infertility
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8
Q

what investigations could you do for gonorrhoea

A

nucleic acid amplification testing - optimum
swabs - rectal and pharyngeal for MSM
urine sample for men
endocervical/urethral swab for microscopy, culture, abx sensitivities
gram stained smear in symptomatic people

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9
Q

how do you treat gonorrhoea

A

ceftriaxone 1g IM if sensitivities not known
oral ciprofloxacin if sensitivities known
follow up NAAT testing
- test of cure at 1 weeks
- test of reinfection at 3 months
give advice
test for other STIs

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10
Q

what pathogen causes chlamydia

A

chlamydia trachomatis serovars D to K

most common STI in UK

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11
Q

how does chlamydia present in women

A 
over 80% are asymptomatic 
increased vaginal discharge 
dysuria 
intermenstrual/post-coital bleeding 
conjunctivitis 
pelvic pain 
painful sex - dyspareunia
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12
Q

how does chlamydia present in men

A

urethral discharge/discomfort
dysuria
epididmyo-orchitis
reactive arthritis

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13
Q

what are complications of chlamydia

A

men - epididymitis
women - ectopic pregnancy, pelvic pain, infertility
both - reactive arthritis, reiter’s syndrome

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14
Q

what investigations could you do for chlamydia

A

NAATs from swabs from cervix, urethra, rectum

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15
Q

how do you manage chlamydia

A

doxycycline 100mg 2x a day for 7 days
or oral azithromycin 1g if pregnant
test for reinfection at 3-12 months
dont do an earlier test of cure unless symptoms persist
need to trace sexual partners
avoid intercourse until treatment is complete

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16
Q

what is genital herpes caused by

A

herpes simplex virus 1 and 2

HSV-2 associated with genital herpes and is a co-factor in HIV transmissionHSV-1 with cold sores

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17
Q

how does genital herpes present

A

ulcers or blistering lesions in genital area
neuropathic pain in back, pelvis, legs
flu like symptoms
dysuria
80% asymptomatic
symptoms recur but are less severe in recurrent episodes

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18
Q

what are complications of genital herpes

A

autonomic neuropathy (urinary retention)
neonatal infection
secondary infection

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19
Q

what is the incubation time for herpes

A

5 days - months

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20
Q

what investigations could you do for genital herpes

A

swab the lesion, send to PCR

ask about contacts

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21
Q

how do you manage genital herpes

A

aciclovir
lidocaine ointment

for infrequent recurrences aciclovir 1.2g once daily until symptoms go

for frequent reoccurences give aciclovir 400mg 2x daily until symptoms stop

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22
Q

what is trichomoniasis caused by

A

trichomonas vaginalis (parasite)

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23
Q

what are symptoms of trichomoniasis

A 
men are usually asymptomatic 
10-30% of women are asymptomatic 
profuse vaginal discharge - greenish frothy and foul smelling - fishy
vulvitis
itch
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24
Q

what are complications of trichomoniasis

A

miscarrige
preterm labour
increased risk of HIV, cervical cancer, pelvic inflammatory disease, bacterial vaginosis

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25
what investigations could you do for trichomoniasis
PCR of vaginal swab microscopy of vaginal discharge NAAT culture
26
how do you treat trichomoniasis
metronidazole 400mg 2x/day for 5 days or 2g single dose | partner tracing + avoid intercourse until treatment is completed
27
what causes anogenital warts
human papilloma virus types 6 and 11
28
what are symptoms of anogenital warts
lumps | sometimes itching and bleeding
29
what are complications of anogenital warts
neonatal laryngeal papillomatosis
30
how do you treat anogenital warts
``` podophyllotoxin imiquimod cyrotherapy diathermy scissor removal ```
31
what is syphilis caused by
treponema pallidum | bacteria that gets into body through mucous membranes or skin.
32
how does syphilis present (stages)
incubation period of 21 days primary - chancre (painless ulcer) secondary - systemic symptoms, maculopapular rash, condylomata lata, fever, lymphadenopathy, alopecia, oral lesions latent stage - symptoms resolve but patient is still infected (early latent stage is within 2 years of initial infection, late latent stage is after 2 yrs) tertiary - can happen many years after initial infection, gummas develop, can have CVS and neuro complications neurosyphilis - infection involves CNS
33
what are complications of syphilis
neurosyphilis CN palsies cardiac or aortal involvement congenital syphilis
34
what investigations could you do in syphilis
serology for TP IgGEIA, TPPA, RPR | samples from infection site can be sent for dark field microscopy, PCR
35
how do you treat syphilis
under 2years with no neuro invovement - IM benzathine penicillin or doxycycline 100mg bd 2wks if late stage (over 2yrs) with no neuro invovement - IM benzathine penicillin for 3wks, doxycycline 100mg bd 28dys screen for other STIs
36
what is genital candidiasis caused by
candidia albicans (thrush)
37
what are risk factors for genital candidiasis (thrush)
increased oestrogen poorly controlled diabetes immunosuppressants broad-spectrum antibiotics
38
how does genital candidaisis present
itch burning thick white discharge dyspareunia
39
what investigations can you do for genital candidiasis
test vaginal pH - usually <4.5, if its >4.5 consider trichomonas swab for microscopy and culture
40
how can you manage genital candidiasis
antifungal cream or pessary - clotrimazole if severe oral fluconazole condoms will not be as effective for 5 days after so alternative contraception is needed
41
what are risk factors for genital candidiasis
pregnant antibiotic therapy DM immunosuppressed
42
what causes bacterial vaginosis
overgrowth of bacteria in the vagina
43
how does bacterial vaginosis present
thin white fishy smelling discharge like megans xx no itch or pain
44
what investigations could you do for bacterial vaginosis
gram stain to examine vaginal flora
45
how do you manage bacterial vaginosis
oral or PV metronidazole | PV clindamycin
46
What are the signs and symptoms of neurosyphilis?
- Argyll- robertson pupil - headache - dementia - tabes dorsalis (lots of presentations) - paralysis - sensory impairment
47
What is the feature of argyle's Robertsons pupil?
- pupil changes for accommodation but DOESNT change in reaction to light
48
What is HIV?
Human immunodeficiency virus.
49
What is AIDS?
Acquired immunodeficiency syndrome - it occurs when HIV progresses and the person becomes immunodeficient.
50
What is the pathophysiology of HIV?
It enters the body and destroys CD4 T-helper cells. (these are the cells that trigger the body's response to an infection) It can take up to 3 months for antibodies to be made
51
What are the signs and symptoms of HIV?
A flu like illness for the first few weeks (fever and body aches). Asymptomatic after this until immunodeficient
52
How is HIV transmitted?
- Anal or vaginal sex - from mother to baby either during pregnancy, birth or breast feeding (vertical transmission) - mucous membrane, blood or open wound exposed to infected blood or bodily fluids
53
What is the pathophysiology of AIDS?
When the CD4 T-helper cells have dropped so low that opportunistic infections can occur.
54
What are examples of AIDS defining illnesses?
- tuberculosis - candidiasis - lymphomas - cytomegalovirus - kaposis sarcoma - pneumocystitis pneumonia
55
When should repeat testing be done in HIV?
3 months after the initial contact with the virus, as this is when antibodies will have developed by.
56
When is HIV screened for?
When pregnant as routine.
57
What are the normal and AIDS levels of CD4?
Normal = 500-1200 cells/mm3 | End stage HIV/AIDS = <200cells/mm3
58
What is an undetectable Viral load?
When the HIV RNA is under 50-100 copies/ml. It can be in the hundreds of thousands in untreated patients.
59
What is the treatment for HIV?
1. ART - antiretroviral therapy (offered to everyone with HIV regardless of CD4 count or viral load) 2. Two NRTI's -tenofovir and emtricitabine 3. HAART 4. prophylactic co -trimoxazole (if CD4<200)
60
How should HIV patients be treated when they have an infection?
If they have normal CD4 and undetectable viral load, they should be treated like non-HIV patients. Make sure to check drug interactions with their HIV medications.
61
What are women with HIV at increased risk of?
HPV - cervical cancer they receive yearly smears
62
What vaccines should HIV patients avoid?
Live vaccines.
63
What are mothers with HIV advised against?
Breastfeeding | even with undetectable viral load they can pass on HIV to baby
64
What is the prophylaxis therapy for contact with HIV?
Must be within 72hrs of contact ART therapy - Truvada and raltegravir for 28 days

Exam - M - Reproduction System (Megan and Rachel) (45 decks)

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