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STIS Flashcards

1
Q

What are the different types of microorganisms?

A
  • viruses
  • protozoa
  • bacteria
  • algae
  • fungi
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2
Q

What are the most common STIs in the UK?

A
  • Chlamydia
  • Gonorrhoea
  • Trichomoniasis
  • Genital warts
  • Genital herpes
  • Pubic lice
  • Scabies
  • Syphilis
  • Human papillomavirus (HPV)
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3
Q

What are the most common bacterial STIs?

A
  • Gonorrhoea
  • Chlamydia
  • Syphilis
  • Chancroid
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4
Q

What is gonorrhea?

A
  • Caused by Neisseria gonorrhoeae (gram neg)
  • Gram neg cocci (diplococci)
    Virulent factors :
  • pilus for cell attachment
  • LPS endotoxin
  • Capsule rendering phagocytosis resistant
  • IgA protease destroy IgA1 (mucosal immunity)
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5
Q

What is the clinical presentation of Gonorrhoea and diagnosis:?

A
  • Symptoms develop 2-7 days after infection
  • Around 50% female asymptomatoc
  • Purulent urethral / vaginal discharge
  • Dysuria
  • Rectal/ oral infection
  • Neonatal gonococcal eye infection
  • Pelvic inflammatory disease
  • Untreated may result in infertility

DIAGNOSIS

  • MC+s
  • Microscopy on discharge reveals intracellular ( phagoctyosed) and extracellular Gram neg diplococci.
  • Culture swabs from infected area or discharge ( kept warm in charcoal-enriched transport medium and sent to lab without delay) and urine. Chocolate agar-
  • Nucleic Acid amplification test (NAAT)
  • Culture still vital - need antibiotics sensitivity for treatment due to multi-resistant strains
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6
Q

What is chlamydia?

A
  • Caused by chalmydia trachomatis serotypes D to K
  • Very small obligate intracellular bacteria
  • Gram neg if stained ( normally very weak)
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7
Q

What is the clinical presentation and diagnosis of chlamydia?

A
  • Clinical presentation
  • Approx male 50%, female 70% asymptomatic
  • If sympotomatic :
  • Female :
  • vaginal discharge , intermenstrual bleeding, deep dyspareunia, lower abdominal pain or discomfort
  • Male : Urethral discharfe, dysuria
  • Occular infections in neonates infected during birth may cause blindness. Infected neonates also prone to C trachomatis pneumonia

DIAGNOSIS:
- MC+ S not suitable
- Microscopy unreliable
- Requires specialised techniques (cell culture usinf McCoy cell lines)
- Nucleic Acid Amplification test (NAAT)
- Enzyme linked immunosorbent Assay (ELISA)
- off the shelf test kits available

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8
Q

What is syphilis?

A
  • Caused by treponema pallidum (spirochete)
  • Gram neg
  • Motile corkscrew pattern
  • Sensitive to heat, drying (50-60 degrees)
  • Cannot be cultured in vitro
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9
Q

What are the four stages of clinical presentation of syphilis?

A
  1. Primary : onset = 20-90 days post infection. Presentation : small , red oral lesions on genitalm chancre (painless lesions)
  2. Secondary lesions - 2-10 weeks after primary stage . Presentation = Brown rash on palms and soles, fever, lymphadenopathy, muscle and joint pain, hair loss in patchy pattern, rash on mucosa (mouth, throat and cervix)
  3. Latent - after secondary stage. Asymptomatic
  4. Tertiary - can manifest many years after latency. Disfiguration, neuropathy, CVS abnormality, gumma (rubbery after latency)
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10
Q

What is the diagnosis of syphilis?

A
  • MC + S not suitable
  • Microscopy - dark grounf or immunofluorescent
  • Cannot be cultures
  • Most commonly used serological tests :
  • RPR (rapid plasma reagin)
  • VDRL ( Venereal Disease Reference Laboratory)
  • TPHA (Treponema Pallidum HaemAgglutination)
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11
Q

What is chancroid?

A
  • caused by haemophilius ducreyi
  • Gram neg cococbacilli
  • Primarily in Africa and Asia but also becoming a sexual health issue in UK
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12
Q

What is the clinical presentation and diagnosis of Chancroid?

A
  • Painful non-indurated genital ulcers
  • Ulcers may look like herpes
  • Lymmohadenopathy
  • Diagnosis:
  • MC + S
  • Gram stain on aspirate from ulcer
  • Culture may take 2-9 days
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13
Q

What are the most common viral STIs?

A
  • Herpes
  • Genital wart
  • HIV
  • Hepatitis
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14
Q

What is herpes?

A
  • Caused by herpes simplex virus
  • Conventionally type I oral and Type II genital. More recently mixed patterns
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15
Q

What is the herpes virus family?

A
  • Herpesviridae
  • Different viral pathogens expressed in different diseases e.g.:
  • chickenpoc, shingles
  • cold sore
  • genital herpes
  • ## Cytomegalic inclusion disease
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16
Q

What is hepres latency?

A

Incominf HSV-1 virion
a.) Establishment : retrogade transport of incominf capsids denuded of tegument proteins. Diffusion barrier. Cell body compartment.
b.) Nuclear accumulation of VP16 & HCF-1 supporting IE gene expression leading to productive reactivation
- Shedding of new HSV-1 virions

17
Q

What is genital wart?

A
  • Caused by HPV
  • HPV over 120 typesm with less than 50% homology in genome
  • HPV 6 and 11 cause 90% genital warts
  • HPV 16 AND 18- high risk types causing 70% cervical cancer
  • NHS vaccines available for 12- 18 yr old females
  • Clinical presentation:
  • itchy or burning sensation developing into raised lu,ps with characteristic cauliflower appearance
  • Treatment: surgical or liquid nitrogen removal, topical applications such as richloroacteic acid, imiquimod, cinecatechins
  • HPV transformation of cervical epithelial cells results in pre-cancerous squamous intra-epithelial lesions - neoplasia grading 1-3 according to severity
  • Progression of cancer formation genetic and cellular changes results in invasive cancer masses
18
Q

What are the mechanisms of HPV-induced carcinogenesis?

A
  • HPV induces inflammatory responses
  • Inflammatory immune cells release reactive oxygen and nitric species (ROS/RNS)
  • ROS and RNS induces DNA strand breaks, allows integration of viral genome into infected host cell genome
  • HPV genome contains tumour promoting sequences
  • Prolonged inflammation - risk for cancer development
  • Host cell exposed to infflammatory signals which undergo cellular changes pre-disposing to cancer development
19
Q

What is HIV?

A
  • Double-stranded RNA
  • Enveloped
  • Attachment molecules (Receptors)
  • HIV pathogenesis:
  • HIV attachment molecule gp120 (gp = glycoproteinm 120 MW)
  • GP120 binds to helper lymphocyte CD4 cell surface molevule
  • Viral envelope fuses with host cell membrane
  • Viral particle internalised by host cells
20
Q

What is Kaposi sarcoma (AIDS)?

A
  • Caused by Herpesvirus family member
  • Human herpes virus 8
  • Opportunistic infection (only when host immunity collapses)
21
Q

What are hepatitis infections?

A
  • Primarily Hep B as STI
  • Hep B infection route - body fluid and maternal transfer
  • Hep C co-infection with HIV also been reported
  • Hep C infection route - blood
  • Transmitted during sex due to presence of bleeding lesions
  • Other factors involved for Hep B and C infection as STI- drug use
22
Q

What are the most common protozoan STIs?

A
  • Trichomoniasis- caused by trichomonas vaginalis
  • Both male and fenale approx 50% asymptomatoc
    Common symptom
  • vaginal or urethral discharge, dysuria, vaginitis
    Diagnosis:
    Microscopy and culture both successful
    NAAT
23
Q

What is pubic lice?

A
  • Caused by the crab louse Phthirus pubis
  • Clinical presentation:
  • Incubation between 5 days to weeks
  • Itch caused by hypersenitivuty reaction. Bites may become visible
  • Eggs on hair may be visible

Diagnosis :
- Microscopy reveals adult lice and eggs
-Treatment
- Malathion applied to dry hair and wash out permethrin cream (same as head lice)

24
Q
A
25
Q

What is scabies?

A
  • Caused by sarcoptes scabiei
  • Can survive for up to 7 days
  • Symptoms may begin 3-6 weeks , nocturnal pruritus, Microscopy, NAAT or antibody assays
  • Treatment as per head lice
  • Peremethrin or malathion cream
26
Q

What is candidiasis?

A
  • Thrush
  • 80-90% caused by Candida albicans, Other candida species also involved
  • Vaginal discharge being main clinical presentation
  • Microscopy reveal yeast particles sometimes with hyphae
  • Vaginal swab culture also reveal fungal growth (pure or heavy growth. If scanty or light growth, non-significant)
  • Although candidasis can be transmitted sexually, most cases of candidiasis are general health issues rather than STIs

Reproduction (22 decks)

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