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STIs Flashcards

1
Q

what is the most common bacterial STI

A

chlamydia

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2
Q

how many people with chlaymdia dont have symptoms

A

70-80% of women asymptomatic

50% of men asymptomatic

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3
Q

what type of bacteria is chlamydia

A

gram negative olbigate intracellular bacterium

cell wall lack peptigoglycan so cant be seen on gram stain

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4
Q

how is chlamydia transmitted

A

vaginal, oral or anal sex

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5
Q

which age group has the highest incidence of chlamydia

A

20-24 years

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6
Q

how many women with chlamydia develop PID

A

9%

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7
Q

what does PID increase the risk of

A

ectopic pregnancies x 10

tubal factor infertility 15-20%

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8
Q

what are the patterns of pathogenesis of chlamydia

A

Mucosal epithelial cells are primary target, replicates within vacuole in cytoplasm of host cell

Some can naturally clear their infection (good TH1 and gamma interferon response), some have abnormal host immune response which confers damage

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9
Q

what is the presentation of chlamydia in females

A

Post coital or intermenstrual bleeding
Lower abdominal pain
Dyspareunia
Mucopurulent cervicitis

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10
Q

what should dyspareunia and mucopurulent cervicitis in chlamydia make you worried about

A

upper pelvic infection/ inflammation

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11
Q

what do a lot of women think irregular bleeding is due to

A

poor pill taking

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12
Q

what is the presentation of chlamydia in males

A 
Urethral discharge
Dysuria
Urethritis
Epididymo-orchitis
Proctitis (LGV) (inflammation of anus and lining of rectum)
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13
Q

what are the possible complications of

A

PID - ectopic pregnancy, tubular infertility
conjunctivitis
chronic pelvic pain
transmission to neonate: 17% conjunctivitis, 20% pneumonia
reiters syndrome
fitz hugh curtis syndrome (piano string adhesions between liver and diaphragm)

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14
Q

should you test women with vaginal discharge for chlamydia

A

no- not a good predictor of chlamydia more likely to be candida or BV

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15
Q

is reinfection with chlamydia common

A

yes

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16
Q

what is LGV

A

lymphogranuloma vereneum

serovar of chlamydia trachomatic

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17
Q

how is lGV spread

A

via unprotected anal sex

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18
Q

what are the symptoms of a LGV infection

A

rectal pain, discharge and bleeding

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19
Q

what is there a high risk of in LGV

A

concurrent STIs, 67% have HIV

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20
Q

how is chlamydia diagnosed

A

test 14 days following exposure
NAAT- females self taken vulvovaginal swab, males self taken first void urine
(combined test for chlamydia and gonorrhoea)

MSM - add rectal swab if has receptive anal intercourse (risk missing 1/4 of all infections if dont do this)

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21
Q

what is the treatment for chlamydia

A

1st line- Doxycycline 100mg BD x 1 week

2nd line- Azithromycin 1G stat followed by 500 mg daily for 2 days

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22
Q

what is mycoplasma genitalium associated with

A

non gonococcal urethritis and PID

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23
Q

what are the signs of someone carrying mycoplasma genitalium

A

asymptomatic carriage

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24
Q

what test for mycoplasma genitalium

A

NAAT test but in viral medium

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25
Q

what type of bacteria is gonorrhoea

A

gram -ve intracellular diplococcus

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26
Q

what are the primary sites of dipolococcus infection

A

mucous membranes of urethra, endocervix, rectum and pharynx

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27
Q

what is the incubation period of urethral gonorrhoea infection

A

2-5 days

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28
Q

which gender transmission is highets risk in gonorrhoea

A

from male to female

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29
Q

what is the presentation of gonorrhoea in males

A

asymptomatic = 10%
urethral discharge >80%
dysuria
pharyngeal/ rectal infections are mostly asymptomatic - do swab

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30
Q

what is the presentation of gonorrhoea in females

A

up to 50% asymptomatic
increased/ altered vaginal discharge (40%)
dysuria
pelvic pain (<5%)
pharyngeal and rectal infection usually asymptomatic

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31
Q

what are the possible complications of gonorrhoea

A

lower genital tract:

  • bartholinitis
  • tysonitis
  • periurethrial abscess
  • rectal abscess
  • epididymitis
  • urethral stricture

upper genital tract

  • endometritis
  • PID
  • hydrosalpinx
  • infertility
  • ectopic pregnancy
  • prostatitis
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32
Q

how is a diagnosis of gonorrhoea made

A

NAATS screening test

mciroscopy if symptomatic (urethral more sensitive than endocervical)

culture (in micro + or contact of GC)
(urethral more sensitive than endocervical) to get antibiotic sensitivities

33
Q

what does gonorrhoea look like on microscopy

A

kidney shaped pairs in cells

34
Q

what is the treatment for gonorrhoea

A

1st line- ceftriaxone 1g IM
2nd line- ceftixime 400 mg oral and azithromycin 2g oral

test of cure in all patients- swab sites that were infected

35
Q

what are the difference between primary and non primary first infection genital herpes infection

A

Primary- never been exposed before, have no antibodies, big symptomatic episode

Non primary first episodes- have been exposed, have antibodies but this is first episode of symptoms

36
Q

what is the incubation period for primary infection of genital herpes

A

3-6 days

37
Q

what is the duration of a primary genital herpes infection

A

14-21 days

will be longer than any recurrent episodes

38
Q

what are the symptoms of a primary herpes infection

A

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

39
Q

which type of herpes is recurrent episodes more common in

A

HSV-2

Type 1 is better type to have, 1 attack every 12/18 months
Type 2 usually have 4-6 attacks per year

40
Q

what are recurrent episodes of HSV like

A

usually unilateral, small blisters and ulcers

minimal systemic symptoms, resolves within 5-7 days
often overlooked/misdiagnosed as “thrush“ (mild, localised anogenital tingling, burning or soreness)

41
Q

what should you think when there is brojen skin/ ulceration of genitals

A

herpes

42
Q

test for herpes

A

Swab base of ulcer for HSV PCR

43
Q

treatment for herpes

A

oral antiviral Treatment (Aciclovir 400mg TDS x 5/7)
Consider topical Lidocaine 5% ointment if very painful
Saline bathing
Analgesia

44
Q

which type of herpes virus has more viral shedding

A

HSV 2

-more recurrent and severe

45
Q

when is viral shedding in herpes more frequent

A

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

46
Q

when do you give suppressive therapy for herpes

A

more than 6 episodes per year

47
Q

what is the suppressive treatment for herpes

A

Acyclovir 400mg BD taken for 4 months. When stop will have a breakthrough episode then should tract recurrences. Can be on acyclovir for years, reduces transmission

48
Q

what needs to be done in herpes in pregnancy

A

if first episode in 3rd trimester then do serology to see if primary or secondary
50% risk of transmission if primary HSV. 50% type 1 50% type 2
70% can have localised CNS or disseminated disease
Disseminated hsv more common in preterm infants and exclusively in women following primary infection. Transplacental antibodies do not prevent HSV spreading to brain of neonate

Better if not primary as mum will have antibodies which can transfer to baby

49
Q

what is the most common viral STI in the uk

A

HPV

50
Q

what is the lifetime risk of acquiring HPV

A

80%
most people’s immune system deals with it:
10% probably harbour detectable infection

1% develop anogenital warts

51
Q

what are the low risk types of HPV

A

6,11,42,43,44

52
Q

what are the high risk forms of HPV

A

16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68

53
Q

what types of HPV are currently covered by the vaccine

A

6, 11, 16, 18

54
Q

what does HPV 6 and 11 cause

A

anogenital warts

55
Q

what does HPV 1 and 2 cause

A

palmoplantar warts

56
Q

what does HPV types 16 and 18 cause

A

cellular dysplasia- cervical, anal, penile, vulva and oropharyngeal cancer

57
Q

who do most people get HPV from

A

asymptomatic partner

58
Q

what is the incubation period of HPV

A

3 weeks to 9 months

59
Q

what is common in HPV transmission

A

transmission of more than 1 type of HPV

60
Q

what are the different progression of HPV infection

A

Spontaneous clearance of warts 20-34%

Clearance with treatment 60%

Persistence despite treatment 20%

treatment needed in vast majority

61
Q

what do anogenital warts look like

A

Cauliflower lesions, keratinized lesions
Can be planar or pedunculated
Can be perianal, can present anywhere in anogenital region, don’t have to have had anal sex

62
Q

what is the treatment for HPV

A

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

Imiquimod (Aldara)
immune modifier
1st line for Anogenital warts

Cryotherapy

Electrocautery

63
Q

what organisms causes syphilis

A

treponema pallidum (shirochete)

64
Q

how is syphilis transmitted

A

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

classified as congenital or aquired

65
Q

what are the stages of early infectious syphilis

A

primary
secondary
early latent

66
Q

what are the stages of late non infectious syphilis

A

late latent

tertiary

67
Q

when does syphilis become late non infectious

A

after two years infected

68
Q

what is the incubation period of primary syphilis

A

9-90 (mean 21 days)

69
Q

where do chancres occur

A

at site of inoculation

Sites are Genital=90% Extra-Genital=10%

70
Q

what are the symptoms of primary syphilis

A

painless chancre

no tender local lymphadenopathy

71
Q

what is the incubation period of secondary syphilis

A

6 weeks to 6 months

72
Q

what are the signs of secondary syphilis

A

Skin (macular, follicular or pustular rash on palms + soles)
Lesions of mucous membranes
Generalized Lymphadenopathy
Patchy Alopecia
Condylomata Lata (most highly infectious lesion in syphilis, exudes a serum teeming with treponemes)

known as the great imitator

73
Q

how do you diagnose syphilis

A 
Demonstration of Treponema Pallidum 
(from lesions or infected lymph nodes)
Techniques  
Dark Field Microscopy
PCR (polymerase chain reaction)

Serological Testing
Detects antibody to pathogenic treponemes

74
Q

what are the serological tests for syphilis

A

ELISA/EIA (Enzyme Immunoassay- IgM and IgG) SCREENING TEST

if +ve:
VDRL test/ RPR (activity- non specific)
TPPA test (specific)

75
Q

what is the treatment for early syphilis

A

2.4 MU Benzathine penicillin x 1

76
Q

what is the treatment for late syphilis

A

2.4 MU Benzathine penicillin x 3

77
Q

how do you follow up syphilis treatment

A

serologically
Until RPR is negative or serofast
Titres should decrease fourfold by 3-6 months in early syphilis.
There is serological relapse/reinfection if titres increase by fourfold.

78
Q

Profuse mucopurulent discharge form penis and painful urination are more commonly symptoms of what

A

gonorrhoea

79
Q

what age do girls and boys get HPV vaccine

A

11-13

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