STIs and GUM other infections

Question 1

Chlamydia is caused by and what kind of organism is it?

Answer 1

Chlamydia trachomatis

Obligate intracellular bacteria

Question 2

Symptoms of chlamydia?

Answer 2

Mostly asymptomatic

or white, cloudy watery discharge, pain/bleeding in sex/urination

Question 3

Which serological groups cause genital infections in chlamydia?

Answer 3

Serovars D-K

Question 4

Investigation of chlamydia?

Answer 4

14 DAYS AFTER

Men- first pass urine
Women- HVS or vulvovaginal swab

For NAAT or PCR

Question 5

Treatment of chlamydia?

Answer 5

Doxycycline 100mg bd PO x 7 days

Question 6

What causes gonorrhoea?

Answer 6

Neisseria gonorrhoeae (gram -ve diplococcus)

Question 7

Symptoms of gonorrhoea?

Answer 7

2-5 DAYS AFTER

Asymptomatic
or purulent discharge, burning/pain on urination

Question 8

Investigation of gonorrhoea?

Answer 8

Men- first pass urine
Women- HVS or vulvovaginal swab
or rectal swab

For NAAT or PCR

Question 9

Treatment of gonorrhoea?

Answer 9

IM ceftriaxone 500mg + TEST OF CURE at 2 weeks

Question 10

What causes syphilis and incubation period?

Answer 10

Treponema pallidum (spirochaete)

Incubation= 9-90 days

Question 11

Primary syphilis infection?

Answer 11

Painless chancre

Question 12

Secondary syphilis infection?

Answer 12

“snail track” mouth ulcers, palm/sole rash, flu-like, lymphadenopathy

Question 13

What comes after the secondary infection in syphilis?

Answer 13

Latent phase- no symptoms

Question 14

What happens in the late stage of syphilis?

Answer 14

CV and neurovascular complications

Question 15

Diagnosis of syphilis?

Answer 15

Swab for PCR
Serology
- TPPA, TPHA, IgM + IgG ELISA

Question 16

Treatment of syphilis?

Answer 16

Injectable long-acting penicillin (Benzathine)

Question 17

What are genital herpes caused by and incubation period?

Answer 17

HSV 1 +2

Incubation= 3-6 days

Question 18

Symptoms of genital herpes?

Answer 18

Shallow ulcers and excruciating pain, local lymphadenopathy, fever, myalgia

Question 19

Diagnosis of genital herpes?

Answer 19

Swab of deroofed blister for PCR

Question 20

Why can genital herpes reoccur?

Answer 20

Stay dormant in root ganglia

Subsequent episodes shorter + less painful

Question 21

Treatment of genital herpes?

Answer 21

Aciclovir 400mg tds x 7 days

Question 22

What is genital warts caused by and incubation period?

Answer 22

HPV 6 + 11

Incubation= 3 weeks-9 months (ave. 3 months)

Question 23

Treatment of genital warts?

Answer 23

Cryotherapy
Podophyllotoxin cream
Electrocautery

Question 24

Symptoms of public lice?

Answer 24

Itching and visible eggs

Question 25

Treatment of pubic lice?

Answer 25

Malathion lotion

Question 26

Symptoms of trichomonas vaginalis (parasite)?

Answer 26

Vaginal discharge, irritation

Question 27

Investigation of trichomonas vaginalis?

Answer 27

HSV for microscopy

Question 28

Treatment of trichomonas vaginalis?

Answer 28

Metronidazole PO

Question 29

What kind of virus is HIV and what does it target?

Answer 29

HIV- retrovirus (reverse transcriptase for replication) Targets CD4+ receptors Causes DYSFUNCTIONAL AND UNREGULATED immune system

Question 30

HIV causes susceptibility to...

Answer 30

Viral infections Fungal infections Mycobacterial infections Infection-induced cancers

Question 31

What is a normal CD4 T helper cell count?

Answer 31

500-1600 cells/mm3

Question 32

How is the HIV virus transmitted?

Answer 32

Through mucosa- rectal, buccal, cervical

Question 33

Average life expectancy of HIV without treatment?

Answer 33

9-11 years

Question 34

What is the predominant bacteria in the vaginal and what do they produce?

Answer 34

Lactobacillus ssp. Lactic acid and hydrogen peroxide

Question 35

What is the average pH of the vagina?

Answer 35

4-4.5

Question 36

Other organisms present in vagina?

Answer 36

Strep viridans Group B strep Candida spp.

Question 37

What is vaginal thrush caused by?

Answer 37

Candida albicans (only a problem if symptomatic)

Question 38

Symptoms of thrush?

Answer 38

Female- Itchy, white vaginal discharge | Male- spotty penile rash

Question 39

Predisposing factors to candida infection?

Answer 39

Recent antibiotics High oestrogen (pregnancy, contraceptives) Poorly controlled diabetes Immunocompromised

Question 40

Treatment of thrush?

Answer 40

Topical co-trimoxazole

Question 41

Recurrent oropharyngeal candida may be a sign of?

Answer 41

HIV/immunosuppression

Question 42

Bacterial vaginosis is more common in?

Answer 42

Sexually active people

Question 43

What commonly causes BV?

Answer 43

Gardnerella vaginalis +/- anaerobes

Question 44

Symptoms of BV?

Answer 44

Thin, watery, fish-smelling discharge | can use whiff test to increase odour

Question 45

What does BV increase the risk of?

Answer 45

Endometriosis, HIV contraction, premature labour

Question 46

Treatment of BV?

Answer 46

Metronidazole PO for 7 days

Question 47

Symptoms of acute bacterial prostatitis?

Answer 47

UTI symptoms, lower abdo /back/perineal/penile pain

Question 48

Diagnosis of prostatitis?

Answer 48

Mid-stream urine sample for culture

Question 49

Treatment of prostatitis?

Answer 49

Ciprofloxacin for 28 days

Question 50

What can prostatitis lead to?

Answer 50

Chronic prostatitis- chronic pelvic pain syndrome

Question 51

Symptoms of primary HIV infection?

Answer 51

2-4 weeks after transmission: Fever, myalgia, maculopapular rash, pharyngitis, headache

Question 52

What is an opportunistic infection?

Answer 52

Caused by pathogen that doesn't normally cause disease in healthy individual

Question 53

At what CD4 count do opportunistic infections occur?

Answer 53

<300 cells/mm3

Question 54

2 opportunistic infections affecting the lungs in HIV?

Answer 54

Pneumocystis pneumonia | TB

Question 55

What is pneumocystis pneumonia caused by and symptoms?

Answer 55

Pneumocystis jiroveci SOB, dry cough, fever

Question 56

Treatment of pneumocystis pneumonia?

Answer 56

High dose co-trimoxazole

Question 57

Complications of chlamydia in women?

Answer 57

PID, tubal damage, chronic pelvic pain

Question 58

Who is the HPV vaccination given to?

Answer 58

Girls 11- 13 years | MSM

Question 59

Worried about genital herpes but asymptomatic?

Answer 59

Leaflet for symptoms and test only if symptoms

Question 60

Gonorrhoea management in primary care?

Answer 60

Refer to sexual health for treatment, test of cure and contact tracing

Question 61

A cause of cerebral abscesses in HIV?

Answer 61

Cerebral toxoplasmosis

Question 62

Which STI shows clue cells?

Answer 62

Gardnerella vaginalis (bacterial vaginosis)

Question 63

What is a cause of cerebral abscess in HIV patients?

Answer 63

Cerebral toxoplasmosis (toxoplasma gondii)

Question 64

Cause of retinitis, colitis and oesophagitis in HIV patients?

Answer 64

CMV infection

Question 65

Common skin infections in HIV patients?

Answer 65

Herpes zoster Herpes simplex HPV

Question 66

What is progressive multifocal leukoencephalopathy (PML)?

Answer 66

In HIV patients- due to John Cunningham virus | focal neurology, personality change, confusion

Question 67

Why can wasting occur in HIV patients?

Answer 67

Chronic immune activation Anorexia Malabsorption/diarrhoea Hypogonadism

Question 68

3 AIDs related cancers and what causes them?

Answer 68

Kaposi's sarcoma (herpes 8 virus) Non-Hodgkin's Lymphoma (EBV) Cervical cancer (HPV)

Question 69

Where does Kaposi's sarcoma occur?

Answer 69

Mostly skin, but can be ANYWHERE

Question 70

Transmission methods of HIV?

Answer 70

Sexual Parenteral (drug use, blood products) Vertical (mother-to-child)- in-utero, delivery or breastfeeding

Question 71

How can we prevent vertical transmission of HIV?

Answer 71

Mother's viral load undetectable at birth

Question 72

How is HIV diagnosed?

Answer 72

Venous sample for SEROLOGY or Fingerprick/saliva test for antibodies (rarer)

Question 73

What tests do the labs carry out to confirm HIV? (4)

Answer 73

1. HIV antibodies (IgM+IgG)- only after 3 months 2. Antigen + antibody test (p24) 3. Viral load (RNA) 4. RITA

Question 74

Approach to HIV management?

Answer 74

``` Stage infection Opportunistic infection prophylaxis + vaccinations STI screening Support Partner notification Prevent onward transmission ```

Question 75

Aim of anti-retroviral therapy?

Answer 75

Reduce viral load to ZERO

Question 76

What is the most common target for anti-retroviral therapy?

Answer 76

Integrase (inhibit function) Can use combination of 3 drugs to treat- called HAART

Question 77

What is the most important factor in preventing resistance against anti-retroviral therapy?

Answer 77

ADHERENCE If given chance to breath, virus will select out resistant strains only Better to STOP completely (by step-down)

Question 78

Side effects of HAART (toxicity)?

Answer 78

Diarrhoea, N+V, rash/Steven's Johnsons, psychosis, proximal tubulopathies, osteomalacia, anaemia, hepatitis

Question 79

Methods to prevent transmission of HIV?

Answer 79

HAART (UNDETECTABLE=UNTRANSMITTABLE) Condoms Regular testing Partner disclosure

Question 80

What does mycoplasma genitalium cause and how is it diagnosed?

Answer 80

Urethritis NAAT from swab or urine

Question 81

Is transmission of gonorrhoea more common from an infected man or woman?

Answer 81

Infected man

Question 82

Which type is HSV more commonly causes recurrence of genital herpes and has more viral shedding?

Answer 82

HSV 2

Question 83

Which STI can cause neonatal conjunctivitis?

Answer 83

Chlamydia