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MRCP Infectious Diseases > STIs > Flashcards

STIs Flashcards

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1
Q

Overgrowth of what organism is commonly found in Bacterial Vaginosis (BV)

A

anaerobic organisms e.g. Gardnerella vaginalis

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2
Q

Is vaginal pH low of high in BV?

A

Raised

Colonisation with anaerobic organisms = fall in lactic acid producing aerobic lactobacilli

=> higher vaginal pH.

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3
Q

Features of BV

A

vaginal discharge: ‘fishy’, offensive
asymptomatic in 50%
only occurs in sexually active women, but is not sexually transmitted

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4
Q

Criteria for BV (need 3/4 for diagnosis)

A
  • thin, white discharge
  • clue cells on microscopy
  • vaginal pH > 4.5
  • positive whiff test (addition of potassium hydroxide results in fishy odour)
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5
Q

Management of BV

A
  1. Asymptomatic
    - Tx not req’d
  2. Symptomatic:
    - oral metronidazole 5-7 days
    - Alternatives: topical metronidazole/ clindamycin
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6
Q

Risk of BV in pregnancy

A

increased risk of:
- preterm labour
- low birth weight
- chorioamnionitis
- late miscarriage

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7
Q

Organism which causes chlamydia

A

Chlamydia trachomatis

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8
Q

Incubation period of chlamydia

A

7-21 days

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9
Q

Clinical features of chlamydia

A

asymptomatic

women: cervicitis (discharge, bleeding), dysuria

men: urethral discharge, dysuria

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10
Q

Complications of chlamydia

A

epididymitis
pelvic inflammatory disease
endometritis
increased incidence of ectopic pregnancies
infertility
reactive arthritis
perihepatitis (Fitz-Hugh-Curtis syndrome)

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11
Q

Ix for chlamydia

A

Nuclear acid amplification tests (NAATs)

Females - vulvovaginal swab
Males - first void urine

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12
Q

Ideally when should testing for chlamydia be carried out

A

2 weeks after a possible exposure

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13
Q

Management of chlamydia

A

1st Line:
- doxycycline (7 day course)

2nd Line:
- Azithromycin 1g OD for one day then 500mg OD for 2 days
- Partner/contact tracing

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14
Q

Who should be contacted in chlamydia contact tracing?

A

men with urethral symptoms:
- all partners from 4 wks prior to symptom onset

for women and asymptomatic men:
- all partners from the last 6 months

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15
Q

What virus group s responsible for genital herpes?

A

HSV

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16
Q

Symptoms of genital herpes

A
  • painful ulcers
  • dysuria
  • pruritis
  • systemic symptoms e.g. headache/fever
  • tender inguinal lymphadenopathy
  • urinary retention
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17
Q

Primary infection with genital herpes is often more severe than recurrent episodes. TRUE/FALSE?

A

TRUE

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18
Q

Diagnostic investigations to look for genital herpes

A

nucleic acid amplification tests (NAAT)

HSV serology

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19
Q

Management of genital herpes

A
  • analgesia
  • topical anaesthetic e.g. lidocaine
  • oral aciclovir
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20
Q

If a lady who is >28 weeks pregnant develops a Primary genital herpes infection, what type of delivery is preferable at term?

A

elective caesarean section

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21
Q

women with recurrent herpes during pregnancy should be reassured that risk of transmission to their baby is low. TRUE/FALSE?

A

TRUE

treat with suppressive therapy even during pregnancy

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22
Q

What are condylomata accuminata more commonly known as?

A

Genital warts

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23
Q

What virus is responsible for genital warts?

A

human papillomavirus HPV
- types 6 & 11

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24
Q

A patient presents with new lesions appearing on their genitals. They appear as small (2 - 5 mm) fleshy protuberances which are slightly pigmented
may bleed or itch. What are these?

A

Genital warts

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25
Management of genital warts
1st Line: - topical podophyllum (if multiple) - cryotherapy (if single lesion) 2nd Line: - imiquimod
26
Genital warts are often resistant to treatment. TRUE/FALSE?
TRUE - recurrence is common
27
Organism causing gonorrhoea
Neisseria gonorrhoeae (Gram-negative diplococcus)
28
Apart from genitourinary infection, where else can gonorrhoea affect?
rectum and pharynx
29
What is the incubation period of gonorrhoea?
2-5 days
30
Clinical features of gonorrhoea
Males: - urethral discharge - dysuria Females: - cervicitis => vaginal discharge
31
Rectal and pharyngeal gonorrhoea infection is usually asymptomatic. TRUE/FALSE?
TRUE
32
Why is reinfection with gonorrhoea common?
- no vaccine - antigen variation
33
Local complications of gonorrhoea
- urethral strictures - epididymitis - salpingitis => may lead to infertility
34
Management of gonorrhoea
1st line: - IM ceftriaxone 1g If sensitivities to cipro- => oral ciprofloxacin 500mg
35
3 features of disseminated gonococcal infection
- tenosynovitis - migratory polyarthritis - dermatitis (lmaculopapular or vesicular)
36
Complications of gonococcal arthritis
septic arthritis endocarditis perihepatitis (Fitz-Hugh-Curtis syndrome)
37
Incubation period for pubic lice
5 days
38
Typical symptoms/signs of pubic lice
- Itching worse at night - 'black/rust-coloured powder' in underwear - Excoriation marks - blue macules
39
Investigation of pubic lice
- Microscopic evaluation of hair to identify presence of lice/ eggs - full sexual health screen
40
Management of pubic lice
- wash clothing and bed linen - malathion 0.5% OR permethrin 1% - re-applied after 3-7 days (lice and eggs at different stages of their life cycle) - nit-combs
41
Who should be contact traced after a case of pubic lice?
- any sexual partners within the past 3 months
42
Painful genital ulcers associated with unilateral, painful inguinal lymph node enlargement. The ulcers typically have a sharply defined, ragged, undermined border.
Chancroid (Haemophilus ducreyi) - tropical disease
43
Stage 1: small painless pustule which later forms an ulcer Stage 2: painful inguinal lymphadenopathy Stage 3: proctocolitis
Lymphogranuloma venereum (LGV) - caused by Chlamydia trachomatis.
44
Treatment of lymphgranuloma venereum
doxycycline (same tx as for chlamydia)
45
What organism causes syphilis
Treponema pallidum (spirochaete)
46
Incubation period in syphilis
9-90 days
47
Features of PRIMARY syphilis
- chancre - local, non-tender lymphadenopathy
48
Why may the typical syphilis chancre not be visible in females
lesion may be on the cervix
49
Typical features of SECONDARY syphilis (6-10 weeks post infection)
systemic symptoms: - fevers - lymphadenopathy - rash on trunk, palms, soles - buccal 'snail track' ulcers - condylomata lata (painless, warty lesions on the genitalia )
50
Typical features of TERTIARY syphilis
- gummas (granulomatous lesions of the skin and bones) - ascending aortic aneurysms - paralysis - spinal cord degeneration - Argyll-Robertson pupil
51
Features of congenital syphilis
- blunted upper incisor teeth (Hutchinson's teeth), 'mulberry' molars - rhagades (linear scars at the angle of the mouth) - keratitis - saber shins - saddle nose - deafness
52
Investigation for syphilis
non-treponemal test + treponemal test
53
Describe how non-treponemal tests work
- reactivity of serum from infected patients to a cardiolipin-cholesterol-lecithin antigen examples include: - rapid plasma reagin (RPR) - Venereal Disease Research Laboratory (VDRL)
54
Give examples of treponemal tests for syphilis
TP-EIA (T. pallidum enzyme immunoassay) TPHA (T. pallidum HaemAgglutination test) - these are qualitative => results are either 'reactive' or 'non-reactive'
55
Causes of false positive non-treponemal tests
pregnancy SLE, anti-phospholipid syndrome TB leprosy malaria HIV
56
Positive non-treponemal test + positive treponemal test
active syphilis infection
57
Positive non-treponemal test + negative treponemal test
false-positive result e.g. due to pregnancy or SLE
58
Negative non-treponemal test + positive treponemal test
successfully treated syphilis
59
Management of syphilis
IM benzylpenicillin (or doxycycline)
60
How do we monitor response to syphilis treatment?
Monitor non-treponemal titres
61
Fever, rash, tachycardia after the first dose of antibiotic in syphilis
Jarisch-Herxheimer reaction
62
What type of organism is trichomonas vaginalis
highly motile, flagellated protozoan parasite
63
Features of trichomonas infection
- offensive yellow/green discharge - vulvovaginitis - strawberry cervix - vaginal pH > 4.5 - men usually asymptomatic but may cause urethritis
64
Investigation findings in trichomonas infection
microscopy of a wet mount shows motile trophozoites
65
Treatment of trichomonas
oral metronidazole for 5-7 days
66

MRCP Infectious Diseases (73 decks)

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