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Flashcards in STIs Deck (77):
1

What is the most common bacterial STI?

Chlamydia

2

Profuse mucopurulent discharge from the penis and painful urination are most commonly symptoms of what STI?

Gonorrhoea

3

During which stage of syphilis does a chancre develop?

Primary

4

Which STI can lead to pelvic inflammatory disease in women?

Chlamydia

5

Which STI is known as the great imitator?

Syphilis

6

At what age is the HPV vaccine recommended for females?

11-13yo

7

Which type of genital HSV has a higher level of viral shedding?

Type 2

8

What type of organism is chlamydia?

Gram -ve bacteria

9

How is chlamydia transmitted?

Vaginal
Oral
Anal

10

What age group has the highest incidence of chlamydia?

20-24yo (M+F)

11

By how much does an episode of PID increase the risk of ectopic pregnancy by?

10x

12

What risk of tubal factor infertility does an episode of PID carry?

15-20%

13

How does chlamydia present in females?

Post coital or intermenstrual bleeding
Lower abdo pain
Dyspareunia
Mucopurulent cervicitis

14

How does chlamydia present in males?

Urethral discharge
Dysuria
Urethritis
Epididymo-orchitis

15

What are some complications of chlamydia?

PID (50% of cases)
Tubal damage
Chronic pelvic pain
Transmission to neonate
Adult conjunctivitis
Sexually acquired reactive arthritis/Reiter's syndrome
Fitz-Hugh-Curtis Syndrome (perihepatitis)

16

How is chlamydia diagnosed?

Test 14 days following exposure
NAAT- females (vulvovaginal swab), males (first void urine)
MSM (rectal swab if receptive anal intercourse)

17

How is chlamydia treated?

Azithromycin 1g stat
Doxycycline 100mg BD x 1wk

18

What type of organism is gonorrhoea?

Gram -ve intracellular diplococcus

19

Where are the primary sites of infection of gonorrhoea?

Mucous membranes of:
urethra
endocervix
rectum
pharynx

20

What is the incubation period of urethral gonorrhoea infection in men?

Short: 2-5 days

21

What is the transmission risk of gonorrhoea from an infected woman to male partner?

20%

22

What is the transmission risk of gonorrhoea from an infected man to female partner?

50-90%

23

How does gonorrhoea present in males?

Asymptomatic in =<10%
Urethral discharge >80%
Dysuria
Pharyngeal/rectal infections mostly asymptomatic

24

How does gonorrhoea present in females?

Asymptomatic (up to 50%)
Increased/altered vaginal discharge (40%)
Dysuria
Pelvic pain (<5%)
Pharyngeal/rectal infections mostly asymptomatic

25

What are the lower genital tract complications of gonorrhoea?

Bartholinitis
Tysonitis
Periurethral abscess
Rectal abscess
Epididymitis
Urethral stricture

26

What are the upper genital tract complications of gonorrhoea?

Endometritis
PID
Hydrosalpinx
Infertility
Ectopic pregnancy
Prostatitis

27

How is gonorrhoea diagnosed through microscopy?

Urethral 90-95% sensitivity
Endocervical 37-50% sensitivity

28

How is gonorrhoea diagnosed through culture?

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

29

How is gonorrhoea diagnosed through NAATs?

>96% sensitivity (both symptomatic + asymptomatic)

30

What is the first line treatment of gonorrhoea?

Ceftriaxone 500mg IM

31

What is the second line treatment of gonorrhoea?

Ceftriaxone 400mg oral (only if IM contraindicated or refused)

32

What is the co-treatment of gonorrhoea?

Azithromycin 1g (regardless of chlamydia result) given at same time as gonorrhoea treatment
Test of cure in all patients

33

What is the incubation and duration of the primary infection of genital herpes?

Incubation 3-6 days
Duration 14-21 days

34

What are the symptoms and signs of the primary infection of genital herpes?

Blistering and ulceration of the external genitalia
Pain
External dysuria
Vaginal or urethral discharge
Local lymphadenopathy
Fever and myalgia (prodrome)

35

Which HSV, 1 or 2, has more recurrent episodes?

2

36

What are the recurrent episodes of HSV often misdiagnosed as?

Thrush

37

Describe recurrent episodes of HSV

Usually unilateral, small blisters and ulcers
Minimal systemic symptoms, resolves within 5-7 days

38

How should HSV recurrent episodes be managed?

Swab ulcer base for HSV PCR
Oral Aciclovir
Consider topical Lidocaine 5% ointment if v. painful
Saline bathing
Analgesia

39

When is viral shedding more common?

HSV 2
More frequent in first year of infection
More in individuals with frequent recurrences
Reduced by suppressive therapy

40

What is the most common viral STI?

HPV

41

What are some of the associated clinical sequelae with different HPV genotypes?

Latent infection
Anogenital warts
Palmar and plantar warts
Cellular dysplasia/intraepithelial neoplasia

42

What is the incubation period of HPV?

3 weeks to 9 months

43

Where is subclinical disease common in HPV?

All anogenital sites

44

Is transmission of more than one type common in HPV?

Yes

45

What types of HPV cause >90% of anogenital warts?

6 and 11

46

What is the treatment for HPV anogenital warts?

Podophyllotoxin (Warticon)
Imiquimod (Aldara)
Cryotherapy
Electrocautery

47

Describe podophyllotoxin in wart treatment

Cytotoxic
Not licensed for extra genital warts (but widely used)

48

Describe imiquimod in wart treatment?

Immune modifier
Can be used on all anogenital warts

49

Other than 11-13yo girls, who currently gets the HPV vaccine?

MSM
People living with HIV

50

How is syphilis usually transmitted?

Sexual contact
Trans-placental/during birth
Blood transfusions
Non-sexual contact - healthcare workers

51

How is syphilis classified?

Congenital
Acquired

52

What stages of acquired syphilis can lead to an infectious state?

Primary
Secondary
Early Latent

53

What is the incubation period of primary syphilis?

9-90 days (mean 21)

54

Where do the lesions of primary syphilis appear?

Site of inoculation

55

What are the sites of inoculation of primary syphilis?

Genital 90%
Extra Genital 10%

56

What is the incubation period of secondary syphilis?

6wks to 6/12

57

What are some clinical features of secondary syphilis?

Skin (macular, follicular or pustular rash on palms + soles)
Lesions of mucous membranes
Generalised lymphadenopathy
Patchy alopecia
Condylomata Lata (most infectious lesion in syphilis)

58

How is syphilis diagnosed?

Demonstration of Treponema Pallidum (lesions, infected LNs): dark field microscopy, PCR
Serological testing- detects antibody

59

What are some non-treponemal serological tests?

VDRL (Venereal Disease Research Laboratory)
RPR (Rapid Plasma Reagin)

60

What are some treponemal tests?

TPPA (Treponemal Pallidum Particle Agglutination)
ELISA/EIA (Enzyme Immunoassay) SCREENING TEST
INNO-LIA (Line immunoassay)
FTA abs (Fluorescent Treponemal Antibody absorbed)

61

What is the treatment for early syphilis?

2.4 MU Benzathine penicillin x 1

62

What is the treatment for late syphilis?

2.4 MU Benzathine penicillin x 3

63

What is the serological follow up for syphilis?

Until RPR is -ve of serofast:
Titres should decrease fourfold by 3-6 months in early syphilis
There is serological relapse/reinfection if titres increase by fourfold

64

What is the look back period for chlamydia?

Male urethral 4 weeks, any other 6 months

65

What is the look back period for gonorrhoea?

Male urethral 2 weeks, any other 3 months

66

What is the look back period for non-specific urethritis?

4 weeks

67

What is the look back period for trichomonas vaginalis?

4 week

68

What is the look back period for epididymitis?

As CT/GC or if -ve, 6 months

69

What is the look back period for HIV?

3 months before -ve test, or before most likely time of infection

70

What is the look back period for syphilis?

Primary 90 days
Seconary 2 years
Other 3 months before most recent -ve test

71

What is partner notification not required for?

Warts
Herpes
Vaginal thrush
Bacterial vaginosis

72

What constitutes rape?

Penetration of the vagina, anus or mouth by the penis without consent

73

What invalidates sexual consent?

Incapacitated by alcohol or drugs
Incarcerated
Violence or threat of violence

74

Describe female sterilisation

Permanent
Laparoscopic
Fallopian tubes cut/tied/blocked
No reliance on hormones
Similar efficacy to Mirena IUS

75

Are there any non-contraceptive benefits to female sterilisation?

No

76

Describe the use of diaphragms as contraception

Silicon diaphragm
Use with spermicidal gel
Use within 4 hours of insertion, stays in 6 hours after sex
Fitted by medic, user dependent
Does not prevent infections

77

Who can use Caya diaphragms?

Users of the 65-80mm diaphragm
No medical fitting necessary