STIs and Genital Infections Flashcards

Question

What is trichomonas vaginalis

Answer 1

Single celled protozoal parasite Human host only transmitted by sexual contact

Answer 2

High vaginal swab for microscopy | PCR test available but not used in tayside

Answer 3

Oral metronidazole for 5-7 days

Answer 4

Homogenous and may contain bubbles Grey/white in colour Fishy odour - offensive

Answer 5

Adding 10% potassium hydroxide to the discharge on the slide elicits an amine-like, fishy odour, yielding a positive “whiff” test A wet mount of the sample from the vagina will show clue cells. The absence of bacilli and their replacement with clumps of coccobacilli also leads to the diagnosis

Answer 6

increased rate of upper tract infection (endometritis, salpingitis) Premature rupture of the membranes and preterm delivery Increased risk for the acquisition of HIV

Answer 7

Metronidazole oral for 7 days | Relapse rate is 30%

Answer 8

Can do PCR test of swab from lesions Dark Field Microscopy - not done in tayside Doesn't gram stain and cant be grown in culture Or serological blood tests can be done as a screening test

Answer 9

Primary lesion/infection - up to 3 months Secondary stage - up to 2 years Latent stage Late stage

Answer 10

Presents with painless lesion (chancre) at inoculation site Will have non-tender local lymphadenopathy Organism multiplies at site and gets into bloodstream Chancre heals

Answer 11

Large number of bacteria circulating in the blood Multiple manifestations at different sites Snail-track” mouth ulcers, generalised rash, generalised lymphadenopathy, flu-like symptoms, pharyngitis, patchy alopecia etc. Neurological and ophthalmic involvement not uncommon

Answer 12

No symptoms, but low-level multiplication of spirochaete in intima of small blood vessels Some patients will self-cure or be treated inadvertently

Answer 13

Cardiovascular or neurovascular complications many years later

Answer 14

Primary : dark ground microscopy, PCR, IgM Secondary: serology ( specific and nonspecific) Tertiary : serology (non-specific antibodies first then specific test TPPA done if positive)

Answer 15

It is very sensitive to penicillin Injectable long-acting preparations of penicillin used for treatment - IM 1 injection in early disease and 3 if late

Answer 16

Herpes simplex virus type 1 (which also causes “cold sores”) and type 2 More commonly type 2

Answer 17

Transmitted by close contact with someone shedding the virus | Spread by either genital/genital or oropharyngeal/genital contact

Answer 18

Virus replicates in dermis and epidermis Gets into nerve endings of sensory and autonomic nerves Nerve endings get inflamed and you get small vesicles - easily deroofed Virus migrates to the root ganglion and hides from immune system - becomes latent Can reactivate from here causing recurrent genital herpes

Answer 19

Swab in virus transport medium of deroofed blister for PCR test – highly sensitive and specific test No good test for inactive infection

Answer 20

Aciclovir may be helpful if taken early enough Pain relief - topical lidocaine or analgesia Saline bathing Avoid sexual contact until episode is over

Answer 21

Acquired by close genital skin contact

Answer 22

Lice bite skin and feed on blood, which causes itching in pubic area

Answer 23

malathion lotion

Answer 24

IM ceftriaxone (1g) first line Cefixime 400 mg oral and azithromycin 2g oral Test of cure needed for all patients

Answer 25

Only if they show symptoms

Answer 26

``` Small blisters on the genitals - vesicles which then become pustular Extremely painful Vulval inflammation Difficulty passing urine Local lymphadenopathy Fever and myalgia ```

Answer 27

Cryotherapy Topical: Podophyllotoxin cream Imiquimod (Aldara)- immune modifier Electrocautery Curettage Excision

Answer 28

YES | 70-80% of women, 50% of men are asymptomatic

Answer 29

Vaginal, oral or anal sex Or genital contact with an infected partner Pregnant women can pass on the infection to infants during birth

Answer 30

PID This increases the risk of chronic pain, ectopic pregnancy and tubal factor infertility Adhesions can form Epididymo-orchitis and proctitis in men Reactive arthritis, conjunctivitis and urethritis are a common triad - Reiter's syndrome Babies can also get pneumonitis and eye infection due to chlamydia Fitz-Hugh-Curtis Syndrome (Perihepatitis)

Answer 31

``` Post coital or intermenstrual bleeding secondary dysmenorrhoea Lower abdominal/pelvic pain Deep dyspareunia Mucopurulent cervicitis - discharge Dysuria Rectal pain and/or discharge ``` Can be asymptomatic!

Answer 32

``` Urethral discharge - clear and milky Dysuria Urethritis Epididymo-orchitis Proctitis ``` Can be asymptomatic!

Answer 33

Lymphogranuloma venereum | Serovars of Chlamydia - more invasive and gives more disease

Answer 34

Men who have sex with men

Answer 35

Rectal pain, tenesmus discharge and bleeding - proctitis Can look like Crohn’s High risk of concurrent STIs (67% HIV)

Answer 36

Test 14 days following exposure if asymptomatic - due to incubation period NAAT- females (vulvovaginal swab), males (first void urine or urethral swab) MSM (add rectal swab if has receptive anal intercourse and pharyngeal)

Answer 37

Emerging STI Often asymptomatic Diagnose with the NAAT test Tested if people fail treatment for PID and NGU

Answer 38

Incubation time is 2-5 days | Still advised to wait 14 days as its in the same test as chlamydia (which has longer incubation)

Answer 39

``` Can be asymptomatic Urethral discharge -green/yellow mucopurulent Dysuria Testicular pain Pharyngeal/rectal infections ```

Answer 40

``` Asymptomatic (up to 50%) Increased/altered vaginal discharge Dysuria Intermenstrual/post-coital bleeding Cervicitis Pelvic pain Pharyngeal and rectal infection are usually asymptomatic. ```

Answer 41

Bartholintiis or tysonsitis - infected genital glands Bartholin's abscesses PID - can lead to ectopics and infertility Hydrosalpinx Urethral strictures Epididymo-orchitis Proctocolitis resulting in strictures, abscesses and fistulae Infection can become disseminated and lead to septic arthritis etc.

Answer 42

Primary – never been exposed to herpes before | Non-primary – have been exposed to the virus before (have antibodies) but this is the first symptomatic presentation

Answer 43

HSV type 2

Answer 44

Suppression needed if they have 6 or more attacks per year | Aciclovir 400mg bd is given for 12 months – should stop recurrence for that year

Answer 45

Risk of giving it to the baby and it can spread to their brain Less worrying if they’ve had herpes before as they will have antibodies that will be passed on to babies

Answer 46

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

Answer 47

6, 11, 16, 18 Adding 31, 33, 45, 52, 58

Answer 48

VERY 80% of populations are exposed at some point Very few go on to develop warts - around 1%

Answer 49

About 20% will spontaneously clear Most need treatment 20% will not respond to treatment

Answer 50

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

Answer 51

Pregnant women - screened at 8-12 weeks | Blood donations

Answer 52

Drugs are used to prolong and enhance sex | Higher risk of having multiple partners and trauma which increases infection risk

Answer 53

Allows us to prevent AIDS | Treatment can lead to normal life expectancy

Answer 54

Opportunistic Infections - pneumonias, fungal infections | AIDS-related cancers - Kaposi

Answer 55

In primates in West-Africa | Spread to humans in the 1930's/40's

Answer 56

HIV infects cells with CD4+ surface glycoprotein It targets the receptors This includes T helper lymphocytes, dendritic cells, macrophages and microglial cells Lymphocytes are the main ones affected

Answer 57

Retrovirus - type of RNA virus | Meaning when it makes DNA it uses reverse transcriptase to turn single stranded RNA to DNA

Answer 58

Reduces circulating CD4 cells by sequestration of cells in lymphoid tissues Reduced proliferation of CD4+ cells Reduction CD8+ (cytotoxic) T cell activation– makes you more susceptible to opportunistic infection Reduction in antibody class switching - less effective antibodies produced In a constant state of immune activation

Answer 59

Viral infections Fungal infections Mycobacterial infections Infection-induced cancers

Answer 60

200 cells/mm3 Normal is 500-1600 cells/mm3

Answer 61

Very rapidly in early and very late infection New generation every 6-12 hours Reverse transcriptase works very fast to produce new virus – doesn’t go through the same rigorous checking as normal DNA

Answer 62

Enters the body across a mucosa - usually via sexual intercose Infection of mucosal CD4 cell - often dendritic cells which are found here Infected cells are transported to regional lymph nodes Here the virus spreads rapidly and infects other cells at the lymph nodes such as T helper cells and macrophages Infection established within 3 days of entry Dissemination of virus

Answer 63

72 hours | After this time the infection is too well established to prevent

Answer 64

Up to 80% present with symptoms around 2-4 weeks after infection Combination of fever, rash (maculopapular), myalgia, pharyngitis, headache/aseptic meningitis Flu like or glandular fever like illness – more than a cold

Answer 65

Yes very high at this stage of illness | This is because there is a big spike in the amount of virus in the blood at this point

Answer 66

An infection caused by a pathogen that does not normally produce disease in a healthy individual. It uses the “opportunity” afforded by a weakened immune system to cause disease

Answer 67

``` Toxoplasmosis Pneumocystis pneumonia TB CMV Herpes zoster or simplex HPV ```

Answer 68

Caused by Toxoplasma gondii. Lots of people exposed as cats have it but doesn't usually make us ill Leads to multiple cerebral abscess Presents with headache, fever, focal neurology, seizures, reduced consciousness and raised ICP

Answer 69

Insidious onset SOB and dry cough Exercise desaturation = Exercise for 5 mins and sats will often plummet CXR can be normal – often looks more like heart failure than consolidation

Answer 70

Bronchial-alveolar lavage and immunofluorescence | +/- PCR

Answer 71

High dose co-trimoxazole (+/- steroid) Lower dose can be used for prophylaxis for all patients with CD4 <200

Answer 72

Also a very common virus Can reactivate if you become immunosuppressed Causes retinitis, colitis, oesophagitis Presents with reduced visual acuity, floaters, abdo pain, diarrhoea, PR bleeding

Answer 73

They are at a much higher risk of HPV causing dysplasia

Answer 74

Yes HIV itself is a neurotoxic agent Leads to reduced short term memory and motor dysfunction Also makes you more susceptible to neurological infections

Answer 75

``` Neurological condition caused by JC virus Seen in immunosuppression - CD4 <100 Rapidly progressing Focal neurology Confusion Personality change ```

Answer 76

HIV associated cachexia | May be caused by metabolic dysfunction, anorexia, malabsorption and hypogonadism

Answer 77

An AIDs related vascular tumour Caused by human herpes virus 8 Can occur at any CD4 but more common as you decline Tumours can be cutaneous, mucosal or visceral – pulmonary, GI

Answer 78

HAART Local therapies Systemic chemotherapy

Answer 79

Kaposi's sarcoma Non-Hodgkin's lymphoma Cervical cancer

Answer 80

EBV - higher incidence with immunosuppression

Answer 81

``` Mucosal candidiasis Seborrhoeic dermatitis Diarrhoea Fatigue Worsening psoriasis Lymphadenopathy Parotitis Epidemiologically linked conditions (STIs, Hep B and C) ```

Answer 82

Anaemia Thrombocytopenia Neutropaenia Lymphopaenia

Answer 83

Anoreceptive sex Trauma Genital ulceration Concurrent STI

Answer 84

``` Sex - 95% of new infections Injection drug use - sharing needles Infected blood products - rare now Iatrogenic Mother to child ```

Answer 85

In utero/trans-placental Delivery Breast-feeding Without treatment the ¼ will be infected and 1/3 will die before age of 1

Answer 86

Africa - particularly sub-Saharan

Answer 87

Men who have sex with men Female partners of bisexual men Black African men and women People who inject drugs - shaare needles Partners of people living with HIV Adults, children and those with sexual partners from endemic areas Children born to HIV+ or untested mothers from endemic areas

Answer 88

Universal testing in high prevalence areas Screening of high risk groups Testing in the presence of “clinical indicators” Opt-out testing at GUM clinics,, TOP services, antenatal services, assisted conception services

Answer 89

Only test if in patient’s best interest Consent from relative not required If safe, wait until patient regains capacity Obtain support from HIV team if required

Answer 90

Viral RNA Antigens - fastest Antibodies - take up to 3 months to appear

Answer 91

14-45 days Combined antibody and antigen test Carried out on blood sample

Answer 92

Fingerprick blood specimen or saliva Results within 20-30 minutes Can be 3rd generation tests which are antibody only, whereas 4th are antigen/antibody

Answer 93

``` Simple to use No lab required No venepuncture required No anxious wait Reduce follow-up Good sensitivity ```

Answer 94

``` Expensive ~£10 Quality control Poor positive predictive value in low prevalence settings Not suitable for high volume Can’t be relied on in early infection ```

Answer 95

Enzymes: Reverse transcriptase Integrase Protease Can also block entry and maturation of the virus

Answer 96

A combination of 3 drugs from at least 2 drug classes to which the virus is susceptible

Answer 97

Tenofovir Emtricitabine Efavirenz Nevirapine

Answer 98

``` GI side effects Skin rashes, hypersensitivity Steven Johnsons Mood changes Psychosis Renal toxicity Osteomalacia Increased MI risk Anaemia ```

Answer 99

No its voluntary Can take a long time to contact people Can be done by the clinician with patient consent

Answer 100

``` Condom use HIV treatment STI screening and treatment Disclosure Post-exposure prophylaxis Pre-exposure prophylaxis ```

Answer 101

``` HAART during pregnancy Vaginal delivery if undetected viral load Caesarean section if detected viral load 4/52 PEP for neonate Exclusive formula feeding ```

Answer 102

Treatment as prevention | PrEP for partner

Answer 103

Treatment as prevention Artificial or self insemination PrEP for partner

Answer 104

``` Age over 16 HIV negative Can commit to 3/12’ly follow-up Willing to stop if eligibility criteria no longer apply Resident of Scotland ``` Given to high risk groups or people with HIV+ partners

Answer 105

``` Condom programmes Behavioural change programmes Treatment and support of those living with HIV Increase uptake of testing Prevent children being born with HIV ```

Answer 106

``` Diagnosis and management of STIs Partner notification Infection prevention Genital dermatology Contraception Community gynaecology Menopause Psychosexual counselling ```

Answer 107

Warts Herpes Vaginal thrush BV

Answer 108

Male urethral - 2 weeks | Any other - 3 months

Answer 109

4 weeks before a previous negative test or before most likely time of infection

Answer 110

Male with symptoms- 4 weeks prior to symptom onset | Any other patients - 6 months

Answer 111

Primary - 90 days Secondary - 2 years Other infection - 3 months prior to negative test

Answer 112

``` MSM High prevalence countries (travellers) Sexual assault Contacts Healthcare workers ```

Answer 113

Tenofovir disoproxil / emtricitabine

Answer 114

Medicine taken before exposure to HIV to reduce risk of infection Can be taken on daily or event-based basis Given to high risk patients

Answer 115

Hep B - vaccine can be given up to 7 days later | HIV - anti-retrovirals given within 72hrs for 28 days

Answer 116

``` Consider forensic examination Immediate safety Injuries Emergency contraception HBV vaccination HIV PEP STI/pregnancy care Counselling ```

Answer 117

``` Being female Disability Pregnancy Addictions HIV ```

Answer 118

At least 2 weeks

Answer 119

If they have symptoms - urethritis, pain etc. If they have been contact traced If they have any other STI Asymptomatic screening in high risk groups

Answer 120

If they have symptoms - urethritis, pain etc. If they have been contact traced If they have any other STI Asymptomatic screening in high risk groups

Answer 121

Test only accurate 3 months after sexual contact

Answer 122

Confirmed after 45 days | Can get a good indication after 4 weeks with a 4th generation test - commonly used

Answer 123

- First pass urine sample for chlamydia and gonorrhoea (tested by NAAT testing) Rectal swab for chlamydia and gonorrhoea (NAAT) Pharyngeal swab for chlamydia and gonorrhoea (NAAT) Blood sample for HIV and syphilis Also test for Hep B - bloods

Answer 124

Blood test You would test for core antibody first line which would be positive in both past and current infection. If it was positive then surface antigens are tested as these would be positive in a current infection only.

Answer 125

HPV | Hep B and Hep A

Answer 126

Mainly in young men and women aged under 25. Higher incidence in females than males in Scotland.

Answer 127

No Unless the patient is pregnant, there is a risk of reinfection or the treatment compliance is in question. A test of cure is routine for rectal infections.

Answer 128

If they have recurrent/persistent non-chlamydial, non-gonococcal urethritis Male contacts of affected women are also treated.

Answer 129

Type 6 and 11

Answer 130

Non-painful, non-pruritic genital lumps

Answer 131

Yes RPR (rapid plasma reagin) –essential for monitoring response to therapy, often never becomes negative Test for RPR for 12 months to ensure a four-fold reduction

Answer 132

Caused by coiled spirochete bacterium Treponema pallidum

Answer 133

``` Blistering ulcer(s) at external genitalia Pain External dysuria Vaginal or urethral discharge Local lymphadenopathy Fever and myalgia ```

Answer 134

``` Mild anogenital tingling, burning or itching Usually unilateral small vesicles or ulcers which heal with scabbing on keratinised skin. Minimal systemic symptoms Recurrences last up to 7 days ```

Answer 135

C. albicans

Answer 136

Symptoms of UTI, Lower abdominal pain/back/perineal/penile pain Obstructive voiding symptoms Fever and rigors Digital rectal examination will reveal a tender, boggy prostate gland

Answer 137

Usually caused by E. coli, other coliforms and Enterococcus sp. ``` May also (very uncommonly) be caused by gonorrhoea or chlamydia Therefore, men under the age of 35 presenting with prostatitis should be screened for STIs. ```

Answer 138

``` Recent a urogenital procedure Recent prostate biopsy Intermittent bladder catheterisation Recent urinary tract infection (rare) ```

Answer 139

MSSU for culture and sensitivity (+/- first pass urine for chlamydia/gonorrhoea tests)

Answer 140

Chronic bacterial prostatitis (<5% of cases) or Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS)

Answer 141

ofloxacin 400mg bd for 28 days

Answer 142

Should also been screened for rectal gonorrhea

Answer 143

NO However, it is almost exclusively seen among sexually active women and more frequent where other risks for STIs exist. It is more common in women whose sexual partners are women.

Answer 144

It is usually found to be >4.5 This due to the overgrowth of anaerobic organisms leading to a consequent fall in lactic acid producing aerobic lactobacilli resulting in a raised vaginal pH

Answer 145

A coincident | infection, possibly trichomoniasis or bacterial cervicitis

Answer 146

Gardnerella vaginalis, a species of anaerobic bacteria

Answer 147

Current or past history of history of injecting drugs Sex with a partner from or in a country with a high HIV or Hep B prevalence MSM or women who have had sex with HSM If they have ever exchanged money in return for sex Medical treatment / tattooing where sterility cannot be guaranteed

Answer 148

HIV - Gonorrhoea - Chlamydia - Trichomoniasis - Syphilis - Lymphogranuloma venereum - Pelvic inflammatory disease - Hepatitis A, B and C - Epididymo-orchitis - Mycoplasma genitalium - Non-gonococcal urethritis

Answer 149

HIV-1 | HIV-2 is rarer

Answer 150

YES Some people have mutations in the CCR5 co-receptors which are used by HIV to enter the cell This means they are immune to infection by a CCR5-using virus. If the mutation is homozygous, they are immune, if its heterozygous the disease will slowly progress.

Answer 151

``` It kicks in and lowers levels of the virus in the blood by 12 weeks (still detectable). At this point the patient enters the chronic and clinically asymptomatic phase (lasting between 2-10 years) ```

Answer 152

The body's immune system lowers the viral load after around 12 weeks The patient becomes clinically asymptomatic Virus would still be detectable on testing This phase can last between 2-10 years During this chronic phase T cells may have a level of >500 cells/mm3 however this is still enough to fight infection

Answer 153

Respiratory tuberculosis Pneumocystis Pneumonia Aspergillosis Bacterial pneumonia

Answer 154

``` Persistent cryptosporidiosis Oral and oseophageal candidiasis Oral hairy leukoplakia Chronic diarrhoea of unknown cause Weight loss of unknown cause Salmonella, shigella or campylobacter Hepatitis B infection Hepatitis C infection ```

Answer 155

``` Cerebral toxoplasmosis Progressive multifocal leukoencephalopathy HiV-associated neurocognitive impairment - reduced short-term memory with/without motor dysfunction Aseptic meningitis /encephalitis Primary cerebral lymphoma Cerebral abscess Cryptococcal meningitis Space occupying lesion of unknown cause Guillain–Barré syndrome Transverse myelitis Distal sensory polyneuropathy Mononeuritis multiplex Vacuolar myelopathy Neurosyphilis ```

Answer 156

Kaposi’s sarcoma Severe or recalcitrant seborrhoeic dermatitis Severe or recalcitrant psoriasis Multi-dermatomal or recurrent herpes zoster HPV- huge warts with increasing tendency for dysplasia

Answer 157

Non-Hodgkin’s lymphoma Kaposi sarcoma Anal cancer or anal intraepithelial dysplasia Lung cancer Seminoma Head and neck cancer Hodgkin’s lymphom Multi-centric Castleman’s disease (HHV8-mediated) Cervical cancer Vulval intraepithelial neoplasia Cervical intraepithelial neoplasia grade 2 or above

Answer 158

Cytomegalovirus retinitis - leads to reduced acuity, floaters, abdo pain, diarrhoea and PR bleeding Infective retinal diseases including herpesviruses and toxoplasma Any unexplained retinopathy

Answer 159

Lymphadenopathy of unknown cause Chronic parotitis Lymphoepithelial parotid cysts

Answer 160

Patients taking HIV PEP should have a 4th generation HIV test (along with syphilis, HBV and HCV serology) and have appropriate biochemistry tests, renal and liver function tests done. They should be advised to have: • A single follow-up HIV test 8-12 weeks after exposure, using a 4th generation test • To practise safer sex (condom use)

Answer 161

To give contraceptive advice and treatment to a young person under the age of 16 without their parent’s knowledge Only if they have the maturity and intelligence to give fully informed consent, cannot be persuaded to tell a parent, likely to have sex anyway, if it is in their best interest

Answer 162

16 Some under 16s will have consensual sex (both must be competent and under 16) but must check for safeguarding A child who has not yet reached the age of 13 is incapable of consenting to any form of sexual activity

Answer 163

If a person (“A”) performs any sexual activity— •without another person (“B”) consenting, and •without any reasonable belief that B consents

Answer 164

Penetration - vagina, anus or mouth Intentionally or recklessly touching sexually Engaging in any other form of sexual activity in which the perpetrator intentionally or recklessly, has physical contact (whether bodily contact or contact by means of an implement and whether or not through clothing) Intentionally or recklessly ejaculates semen onto someone Intentionally or recklessly emits urine or saliva onto someone sexually.

Answer 165

``` 7 days (168 hours) to capture DNA and bodily fluids ```

Answer 166

Avoid: • Bathing, showering, washing • Douching • Washing clothes worn at the time of the assault • Urinating until after a forensic examination if choosing to have forensic capture Preserve: • Underwear and clothes worn at the time of the incident • Sanitary pads/tampons worn at the time • Condoms • Retain tissue used to wipe after urinating

STIs and Genital Infections Flashcards

(194 cards)