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Flashcards in STIs 2 Deck (40):
1

commonest bacteria STI

chlamydia

2

mocopurulent discharge from the penis and painful urination is what

gonorrhoea

3

chancre develops at what stage of syphilis

primary

4

which infection leads to PID in women

chlamydia

5

which STI is known as the great imitator because its symptoms resemble other infections

syphilis

6

when is the HPV vaccine recommended for females

11-13

7

viral shedding is higher with which type of genital herpes simplex virus

HSV 2

8

chlamycida - GS
transmission
age

GN bacterium
vaginal, oral, anal
20-24s

9

pathogenesis of chlamydia

unclear
chlamydia can cause PID in 50%
PID increases risk of ectopic preg by 10% and carries a risk of tubal factor infertility of 15-20%

10

presentation of chlamydia in a female

post coital or inter menstrual bleeding
lower abd pain
dyspareunia
mucopurulent cervicitis

11

male presentation of chlamydia

urethral discharge
dysuria
urethritis
epididymis-orchitis

12

cx of chlamydia

PID
tubal damage
chronic pelvic pain
tranmission to neonate (17% conjunctivitis, 20% pneumonia)
adult conjunctivitis - occaisionally
sexually acquired reactive arthritis /reiters - commoner in men
Fitz - high - curtis syndrome (perihepatitis)

13

dx and rx of chlamydia

test 14 days following exposure
NAAT - females (vulvovaginal swab), males - first void urine
MSM - add real swab if receptive anal sex

azithromycin 1g stat
doxycycline 100mg BD x 1 week if rectal chlamydia

14

gonorrhoea GS
sites of infection

GN intracellular diplococcus
mucous membranes of urethra, endocervix, rectum and pharynx

15

incubation/transmission of G

incubation period of urethral infection in men is shorter (2-5days)
20% of risk from infected women to male partner
50-90% risk from infected man to female partner

16

presentation in males - G

asymp in less than 10%
urethal discharge - purulent and green/yellow
dysuria
pharyngeal/rectal infections which are mostly asymp

17

females presentation - G

asymp in almost 50%
increased/altered vaginal discharge in 40%
dysuria
pelvic pain in <5%
pharyngeal and rectal infection are usually asymp

18

cx of G

3% in females and <1% in males

lower genital trat - bartholinitis, tysonitis, periurethral anscess, rectal abscess, epididymitis, urethral stricture

upper genital tract - endometritis, PID, hydrosalpinx, infertility, ectopic pregnancy, prostatitis

19

cx of G

3% in females and <1% in males

lower genital trat - bartholinitis, tysonitis, periurethral anscess, rectal abscess, epididymitis, urethral stricture

upper genital tract - endometritis, PID, hydrosalpinx, infertility, ectopic pregnancy, prostatitis

20

dx of G

microscopy - urethral 90-95% sensitivity, endocervical 37-50% sensitivity

culture >95% sensitivity (male urethra), 80-92% sensative (female endocx)

NAATs>96% sensitiivty (both in symp and asymp)

21

rx of G

ceftriaxone 500mg IM 1st line
cefixime 400mg PO - if IM injection contra indicated or refused

azithromycin 1g given regardless of chlamydia result

test of cure in all px

22

genital herpes pattern

primary infection
non primary first episode
recurrent infection

23

GH primary infection incub
duration
symptoms

3-6 days
14-21 days

blistering and ulceration of the external genitalia
pain
external dysuria
vaginal or urethral discharge
local lymphadenopathy
fever and myalgia

24

recurrent episodes GH
more common with what
mis dx as what
symptoms

more common with HSV2

thrush

unilateral small blisters and ulcers, minimal systemic symptoms

resolves within 5-7 days

25

management of GH

swab base of ulcer for HSV PCR
oral acyclovir
consider topical lidocaine if painful
saline bathing
analgesia

26

viral shedding common with which type
when
who
reduced by what

following HSV 2 is commoner than for HSV 1

more frequent in the first year of infection

more individuals with frequent recurrences

reduced by suppressive therapy

27

HPV is the commonest what
life time risk of acquiring it

viral STI in the UK
80%

28

HPV genotypes
total
certain
low risk
high risk

>170
40 infect anogenital epithelium
6, 11, 42, 43, 44
16, 18, 31, 33, 35, 45, 51, 52, 66

29

HPV transmission

incub

80% of the population are exposed
10% harbour detectable infection
1% develop anogentail warts

likely to have acquired form asymp partner

incub 3 weeks to 9 months

30

HPV immunology

spontaneous clearance of warts 20-34%
clearance with treatment 60%
persistence despite treatment 20%

31

anogenital warts caused by which type of HPV

>90% by 6/11

32

HPV treatment

podophyllotoxin (wart icon) - cytotoxic, not licensed for extra genital warts

iminquimod - immune modifier, for all anogenital warts

cryotherapy - cytolytic can require repeat treatments

electrocautery

33

HPV vaccination

MSM and HIV+ included

34

syphillis transmission

classification

sexual contact, transplacental/during birth, blood transfusions, non sexual contact

congenital, acquired

35

acquired syphilis types of infections

early have primary, secondary and early latent

late non infectious have late latent and tertiary

36

primary syphilis incub period
lesion
sites
other signs

9-90 days (mean of 21days)
lesions - primary chancre - painless, appear at site of inoculation
sites are genital 90% of the time

non tender local lymphadenopathy

37

secondary syphilis
incub period
signs

6 weeks - 6 months

skin - macular, follicular/pustular rash on palms and soles
lesions of mucous membranes
generalised lymphadenopathy
patchy alopecia
condylomata lata (most infectious lesion in syphilis)

38

dx of syphilis

demonstration of trepnonema palladium from lesions of infected LNs - dark field microscopy, PSCR

serological testing - detects AB to pathogenic treponemes

39

serological testing in syphilis

non-treponema - VDRL, RPR (rapid plasma reagin)

treponema - TPPA, ELISA/EIA (screening test), INNO-LIA, FTA abs

40

rx and follow up in syphilis

early - 2.4 MU benzathine penicillin x1

late 2.4 MU benzathine pencilline x3

until RPA is negative to serofast
tires should decrease fourfold by 3-6 months in early
serological relate/reinfection if titres increase by fourfold