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STIs Flashcards

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1
Q

What is the most commonly reported bacterial STI in sexual health clinics?

A

Chlamydia = 70-80% of women and 50% men are asymptomatic

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2
Q

What causes chlamydia?

A

Gram negative obligate intracellular bacterium = very small and stain poorly

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3
Q

What are the modes of transmission for chlamydia?

A

Vaginal, oral, anal

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4
Q

What age group has the highest incidence of chlamydia?

A

Age 20-24

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5
Q

How common is PID as a result of chlamydial infection?

A

9% of women with chlamydia will go on to develop PID = 10x increase in ectopic pregnancy and 15-20% risk of tubal factor infertility with PID

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6
Q

What is the prognosis of chlamydia?

A

Some can clear infection naturally = good TH1 and gamma interferon
Abnormal host immune response confers damage

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7
Q

What is the primary target of chlamydia?

A

Mucosal epithelial cells = replicates within vacuole

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8
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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9
Q

What is the presentation of chlamydia in males?

A

Urethral discharge, dysuria, urethritis, proctitis, epididymo-orchitis

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10
Q

What are some complications of chlamydia?

A

PID = chlamydia causes 50% of cases
Tubal damage, chronic pelvic pain, adult conjunctivitis
Reiter’s syndrome = more common in men
Transmission to neonate, Fitz-Hugh-Curtis syndrome

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11
Q

Who should be tested for chlamydia?

A

Stop testing in women >age 25 with vaginal discharge

Test women who have had chlamydia in past year

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12
Q

How common is reinfection with chlamydia?

A

1 in 5 women with diagnosed and treated with chlamydia are likely to become re-infected within 10 months after initial treatment

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13
Q

What is LGV?

A

Serovars of chlamydia trachomitis (L1-L3) = common in male/male sex

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14
Q

What are some features of LGV?

A

High risk of concurrent STIs = 67% have HIV

Symptoms = rectal pain, discharge, bleeding

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15
Q

How is chlamydia diagnosed?

A

Test 14 days following exposure

Nucleic acid amplification test = vulvovaginal swab for females and first void urine in males

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16
Q

What swabs should be added when testing for chlamydia if male/male receptive anal sex?

A

Add rectal swab

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17
Q

How is chlamydia treated?

A

Doxycycline 100mg twice daily for 1 week

Azithromycin 1g starting followed by 500mg daily for 2 days

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18
Q

What is mycoplasma genitalium?

A

Emerging sexually transmitted pathogen = associated with non-gonococcal urethritis and PID

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19
Q

What are some features of mycoplasma genitalium?

A

Prevalence of 1-2% of population
Asymptomatic carriage
Tested for using nucleic acid amplification
High levels of macrolide estimated at 40%

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20
Q

What causes gonorrohea?

A

Gram negative intracellular diplococcus

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21
Q

What are the primary sites of gonorrhoea infection?

A

Mucous membranes of urethra, endocervix, rectum and pharynx

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22
Q

What is the incubation period for urethral gonorrhoea in men?

A

Short incubation = 2-5 days

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23
Q

What is the risk of spreading gonorrhoea to a partner?

A

20% risk from infected woman to uninfected male

50-90% risk from infected man to uninfected female

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24
Q

What is the presentation of gonorrhoea in men?

A

Asymptomatic in <= 10% = pharyngeal and rectal infections usually asymptomatic
Urethral discharge in >80%
Dysuria

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25
What is the presentation of gonorrhoea in women?
Asymptomatic in up to 50% = pharyngeal and rectal infections usually asymptomatic Increased or altered vaginal discharge in 40% Dysuria and pelvic pain (<5%)
26
How common are complications from gonorrhoea?
Occur in 3% of females and <1% of males
27
What are some lower genital tract complications of gonorrohea?
Bartholinitis, tysonitis, periurethral abscess, rectal abscess, epididymitis, urethral stricture
28
What are some upper genital tract complications of gonorrhoea?
Endometritis, PID, hydrosalpinx, infertility, ectopic pregnancy, prostatitis
29
What tests can be done for diagnosing gonorrhoea?
Nucleic acid amplification test = >96% sensitivity | Microscopy and culture
30
When is microscopy done for gonorrhoea?
Symptomatic testing = urethral has 90-95% sensitivity, endocervical has 37-50% sensitivity
31
When is culture done for gonorrhoea?
If microscopy positive or if contact of case = urethral has >95% sensitivity, endocervical has 80-92% sensitivity
32
What is the treatment of gonorrhoea?
First line = IM ceftriaxone 500mg | Second line = oral cefixime 400mg (only if IM contraindicated or refused)
33
When do you do test of cure for gonorrhoea?
After two weeks of treatment
34
What kind of infections may cause genital herpes?
Primary infection, non-primary first episode, recurrent infection
35
How long does genital herpes last for?
Incubation period of 3-6 days | Duration of 14-21 days
36
What are the symptoms of genital herpes?
Blistering and ulceration of external genitalia, pain, external dysuria, vaginal/urethral discharge, local lymphadenopathy, fever, myalgia
37
What are some features of recurrent episodes of genital herpes?
``` More common with HSV-2 Often misdiagnosed as thrush Usually unilateral small blisters and ulcers Minimal systemic symptoms Resolves within 5-7 days ```
38
What do you swab for diagnosing genital herpes?
Swab base of ulcer for HSV PCR
39
What is the treatment for genital herpes?
Oral aciclovir 400mg 3x for five days a week Consider topical lidocaine 5% ointment if very sore Saline bathing and analgesia
40
What are some features of viral shedding in genital herpes?
Higher in HSV2 and reduced by suppressive therapy More frequent in 1st year of infection More common in people with frequent recurrences
41
When would you consider giving suppressive therapy for genital herpes?
If patient has 6 or more attacks per year
42
How does genital herpes affect pregnancy?
50% risk of transmission if primary HSV 70% of babies have localised CNS or disseminated disease Disseminated HSV more common in preterm infants
43
What is the most common viral STI in the UK?
HPV = lifetime risk of up to 80%
44
How many genotypes are there of HPV that could cause an STI?
>40 genotypes that infect anogenital epithelium Low risk = types 6, 11, 42, 43 and 44 High risk = types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and 68
45
What are some types of infection that different HPV genotypes can cause?
Anogenital = types 6 and 11 Palmoplantar warts = types 1 and 2 Cellular dysplasia = type 16 Cervical, anal, penile, vulval and oropharyngeal = type 18
46
What is the incubation period for HPV?
3 weeks up to 9 months
47
What is the prognosis of HPV?
20-34% will clear spontaneously 60% clear with treatment 20% are treatment-resistant
48
What causes over 90% of anogenital warts?
HPV types 6 and 11
49
What are the treatments for HPV?
Imiquimod = can be used for all anogenital warts but not licensed for pregnancy Podophyllotoxin = not for extra-anogenital use, not licensed for pregnancy Cryotherapy and electrocautery
50
Who is vaccinated against HPV?
Girls aged 11-13, adolescent boys, gay men
51
What causes syphilis?
Treponema pallidum bacteria
52
How is syphilis transmitted?
Through sexual contact, during birth, through placenta, via blood transfusion = classed as congenital or acquired
53
What types of syphilis are infectious?
``` Infectious = primary, secondary, early latent Non-infectious = late latent, tertiary ```
54
What is the incubation period of primary syphilis?
Incubation from 9-90 days = mean is 21 days
55
What are the symptoms of primary syphilis?
Non-tender local lymphadenopathy | Lesion known as primary chancre = painless and at site of inoculation (90% are genital)
56
What is the incubation period of secondary syphilis?
incubation of 6 weeks -6 months
57
How may the skin be involved in secondary syphilis?
Macular, follicular or pustular palmoplantar rash
58
What are the symptoms of secondary syphilis?
Rash, lesions of mucous membranes, generalised lymphadenopathy, patchy alopecia, condylomata lata
59
What is condylomata lata?
Most highly infectious lesion of syphilis = exudes serum filled with treponemes
60
How is syphilis diagnosed?
Samples from lesions or infected lymph nodes used for dark field microscopy or PCR Serological testing for antibodies
61
What are some serological tests done for syphilis?
``` Non-treponemal = VDRL, RPR Treponemal = TPPA, INNO-LIA, FTA abs ```
62
What is the screening test done for syphilis?
ELISA enzyme immunoassay
63
What is the treatment for syphilis?
Early syphilis = 2.4 MU benzathine penicillin x1 | Late syphilis = 2.4 MU benzathine penicillin x3
64
How long do you follow up syphilis patients for?
Until RPR is negative or serofast = titres should decrease by fourfold by 3-6 months in early syphilis
65
When does syphilis relapse occur?
If titres increase by fourfold
66
What STIs are tested for in an STI screen?
Gonorrhoea, chlamydia, syphilis and HIV
67
What samples are taken for gonorrhoea and chlamydia?
Vulvovaginal swab = women First pass urine sample = men Rectal and throat swab = male/male sex, gonorrhoea on microscopy and gonorrhoea contacts
68
What symptomatic sampling can be done for vaginal/urethral discharge?
``` Cervical and urethral microscopy = gram stain Vaginal microscopy (gram stain, wet prep) and narrow range pH Amies swab = HVS culture and sensitivity ```
69
When would you take an Amies swab?
``` Recurrent or persistent discharge Vaginitis of unknown cause Pregnant or post partum Post gynaecological surgery or instrumentation Signs and symptoms of PID ```
70
How is PID treated?
Ceftriaxone 1g IM, doxycycline 100mg twice daily for two weeks and metronidazole 400mg twice daily for two weeks
71
What are the serovars of chlamydia?
``` A-B = endemic trachoma (ocular infections) D-K = urethritis, PID, epididymo-orchitis, neonatal pneumonia and conjunctivitis L1-3 = lymphogranuloma venereum ```
72
How does gonorrhoea presentation vary depending on the site that is infected?
``` Urethral = discharge in >90%, dysuria Pharyngeal/rectal = mostly asymptomatic Endocervical = discharge in 50%, irregular bleeding, external dysuria ```

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