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STIs/STDs Flashcards

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1
Q

Define Genital Warts

A

benign epithelial or mucosal outgrowths caused by the DNA human papilloma virus (HPV)

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2
Q

Most common HPV causing genital warts

A
  • HPV6
  • HPV11
    responsible for roughly 90% of cases.

HPV 16/18 - 70% progress to cervical cancer

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3
Q

Genital Warts Risk Factors

A
  • Early age at first sexual intercourse
  • Multiple partners
  • Immunosuppression
  • Smoking
  • Diabetes associated with persistence of warts
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4
Q

Genital Warts Sx

A
  • Usually asymptomatic
  • Bleeding from local trauma (friction underwear)
  • Pain due to irritation from rubbing
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5
Q

Genital Warts clinical features

A
  • Soft cauliflower-like growths
  • usually < 10 mm in diameter
  • whitish, flesh-coloured, hyperpigmented, or erythematous
  • can be flat, plaque-like, or pigmented
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6
Q

Genital warts prevalence

A
  • 20-24 year-olds
  • 10% sexually active people
  • 92% are heterosexual men/women
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7
Q

Genital warts transmission

A
  1. Direct skin-skin
    - sexual contact
    - Oro-genital
  2. contact with contaminated surfaces or objects.
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8
Q

Genital warts complications

A
  • Disfiguring, and cause anxiety or distress
  • Persistent hypo- or hyper-pigmentation due to ablative therapy.
  • Hypertrophic scarring.
  • Bleeding, infection, or scarring due to surgical removal.
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9
Q

Genital warts Mx

A
  1. Wait & watch: 30% of people resolves in 6/12
  2. podophyllotoxin / Imiquido
    HPV vaccine is a preventative measure
  3. Cryotherapy
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10
Q

Oral HSV type

A

HSV 1

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11
Q

What is the most common symptom of genital ulcers?

A

Pain or discomfort in the affected area.

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12
Q

True or False: Genital ulcers can be caused by both infectious and non-infectious factors.

A

True.

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13
Q

Fill in the blank: Genital ulcers may be accompanied by ________ of the lymph nodes.

A

swelling.

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14
Q

Which of the following is NOT a typical feature of genital ulcers? A) Lesions, B) Itching, C) Fever, D) Bleeding

A

D) Bleeding.

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15
Q

What types of lesions are commonly seen in genital ulcers?

A

Shallow, painful sores or deep, necrotic ulcers.

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16
Q

What is one of the most common viral causes of genital ulcers?

A

Herpes Simplex Virus (HSV)

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17
Q

Syphilis causative bacterium

A

Treponema pallidum

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18
Q

Fill in the blank: __________ is a common cause of genital ulcers associated with sexually transmitted infections.

A

Chancroid

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19
Q

Genital herpes Sx

A
  • Ulcers or blistering lesions affecting the genital area
  • Neuropathic type pain (tingling, burning or shooting)
  • Flu-like symptoms (e.g. fatigue and headaches)
  • Dysuria (painful urination)
  • Inguinal lymphadenopathy
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20
Q

Name one non-infectious cause of genital ulcers.

A

Behçet’s disease

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21
Q

STIs Risk factors

A
  • use of non-barrier contraceptives
  • Relationship dynamics (domestic violence)
  • Limited access to healthcare
  • new sexual partners
  • multiple sexual partners
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22
Q

STIs complications

A
  • PID
  • Recurrent UTIs
  • Infertility
  • Epididymitis
  • Spontaneous miscarriages
  • Ectopic pregnancy
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23
Q

STI causative bacteria

A

Chlamydia
Gonorrhoea
BV
Syphilis
Trichomonas vaginalis

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24
Q

When to suspect chlamydia

A
  • Pelvic pain
  • Purulent Green/yellow vaginal discharge
  • Spotting
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25
chlamydia Sx
- Mild irritation or itching burning urination - slight vaginal discharge - Dyspareunia (deep penetration) - Post-coital bleed Men: - Urethral discharge - Testicular pain / sweeling
26
STIs Screening/Dx
- First catch urine (men) - STI NAAT swab
27
Screening for asymptomatic ind. for chlamydia
- Sexually active < 25 annually - Bimanual examination (intolerated)
28
Chlamydia Mx
- Refer to Sexual health/GUM clinic (contact tracing) - Doxy (contraindicated in preg) - Azithromycin for preg
29
Gonorrhoea bacteria type
Gram-negative
30
Gonorrhoea Sx
Men - Odourless, penile discharge yellow/green - Dysuria - Testicular pain / swelling Women: - Burning urination - Asymptomatic - Vaginal discharge yellow/green
31
Gonorrhoea Mx
- single dose Cipro 500mg PO (sensitivities **ARE** known) - single dose of IM ceftriaxone 1g (sensitivities are **NOT** known)
32
Syphilis Risk factors
- Engaging in unprotected sex – especially with high risk partners. - Multiple sexual partners. - Men who have sex with men (MSM). - HIV infection.
33
Primary syphilis Sx ## Footnote 9 - 90 days post infection
- Chancre (painless ulcer, non-itchy)
34
When do secondary syphilis develop
3 months post infection
35
Tertiary syphilis
Neurosyphilis Gummatous syphilis Cardiovascular syphilis
36
Syphilis
- Dark ground microscopy of chancre fluid- detects spirochaete in primary syphilis - PCR testing of swab from active lesion Serology: Treponemal tests – assess for exposure to treponemes (NB not necessarily syphilis) Treponemal ELISA **(IgG/IgM)** – remains positive for life TPPA or TPHA – remain positive for life Non-treponemal tests: RPR/VDRL: rises in early disease; falling titres indicate successful treatment or progression to late disease. False positives can occur in inflammatory conditions or during pregnancy. Lumbar puncture: CSF antibody tests in neurosyphilis
37
Syphilis Mx
First line treatment for syphilis: Early syphilis: Benzathine penicillin 2.4 MU IM single dose. Late syphilis: Benzathine penicillin 2.4 MU IM 3 doses at weekly intervals. Neurosyphilis (at any stage, including ophthalmic syphilis): Procaine penicillin 1.8 MU–2.4 MU IM OD plus probenecid 500 mg PO QDS for 14 Days or Benzylpenicillin 10.8–14.4 g daily, given as 1.8–2.4 g IV every 4 h for 14 days: ## Footnote GUM clinic + 3/12 monitoring
38
Trichomonas vaginalis microscopic features
anaerobic flagellated protozoan
39
Trichomonas transmission
- Sexually - Vertical transmission
40
Trichomonas Sx
**Female**: **Fishy smell** abnormal vaginal discharge – thick/thin/**frothy and yellow-green** Itchiness or soreness of the vulva Dyspareunia Dysuria **Male**: Symptoms: Urethral discharge Dysuria Urinary frequency Pain or itching around the foreskin
41
Trichomona clinical features
Female: Abnormal vaginal discharge – thick/thin/frothy and yellow-green Vulvitis Vaginitis **Strawberry cervix – punctate and papilliform appearance** Male: Urethral discharge Balanoposthitis – inflammation of the glans penis (rare)
42
Trichomonas Mx
**Refer to GUM** - Metronidazole 400-500mg twice daily for 5-7 days - Metronidazole 2g orally in a single dose **(contraindicated in pregnancy)** Alternatives to the recommended regimes: Tinidazole 2g orally in a single dose
43
Indication for HSV prophylaxis Tx
Outbreak > 6 times a year
44
Genital herpes Mx
**Refer to GUM** 1st: Aciclovir 400mg TDS 5/7 (within 5days of Sx) OR valaciclovir 500mg BD 5/7
45
Genital HSV herpes simplex virus type
HSV 2
46
Genital herpes Mx for immunocompromised
- **Aciclovir** 400 mg five times a day for 7–10 days - Or **Valaciclovir** 500–1000 mg twice a day for 10 days
47
Secondary syphilis Sx
- Skin rash – hands and soles of the feet (not usually itchy or painful) - Fever - Malaise - Arthralgia - Weight loss - Headaches - Condylomata lata- elevated plaques like warts at moist areas of skin e.g. inner thighs, anogenital region, axillae Painless lymphadenopathy
48
Define Bacterial vaginosis (BV)
An overgrowth of bacteria in the vagina, specifically **anaerobic bacteria** It is caused by a loss of the **lactobacilli** “friendly bacteria” in the vagina
49
BV common causative bacteria
Gardnerella vaginalis
50
BV risk factors
- Multiple sexual partners (although it is not sexually transmitted) - Excessive vaginal cleaning (douching, use of cleaning products and vaginal washes) - Recent antibiotics - Smoking - Copper coil
51
BV Sx
- **Fishy-smelling, thin, grey/white** homogeneous discharge - **NOT** associated with itching or soreness
52
BV Mx
- Avoid smoking, vaginal douching and the use of antiseptics, bubble baths, or shampoos in the bath - PO metronidazole 400 mg twice a day for 5 to 7 days - Topical metronidazole 0.75% for 5/7
53
Location of High vaginal swab
Post. fornix
54
Define Pelvic inflammatory disease (PID)
An infection of the upper genital tract in females, which affects the **uterus, fallopian tubes and ovaries.**
55
PID common causative agents
- Chlamydia - Gonorrhoea
56
PID Sx
- Lower abdo pain - Deep dyspareunia - Menstrual abnormalities (e.g menorrhagia, dysmenorrhoea or intermenstrual bleeding) - Post-coital bleeding - Dysuria (painful urination) - Fishy smell, thick yellow/green discharge - **Fever**
57
PID clinical findings
- Adnexal tenderness - Cervical motion tenderness - Uterine tenderness - On speculum: Abnormal cervical or vaginal mucopurulent discharge (yellow/green)
58
PID Ix
- Pregnancy testing (to exclude ectopic) - CT / NG / Mycoplasma genitalium NAAT swabs - Bloods: FBC, CRP, EST, STI screening (HIV, syphilis, hepatitis) - TVUS
59
PID Mx
**Refer GUM** Single IM Ceftriaxone 1 g, followed by oral **doxycycline 100 mg** twice daily plus oral **metronidazole 400 mg** twice daily for 14 days
60
PID Complications
- **Ectopic pregnancy**– due to narrowing and scarring of the fallopian tubes - **Infertility** – affects 1 in 10 women with PID. - **Tubo-ovarian abscess** - **Chronic pelvic pain** - **Fitz-Hugh Curtis syndrome** – **perihepatitis**that typically causes right upper quadrant pain
61
BV Dx
1. **Clue cells** on microscopy 2. A vaginal **pH >4.5**, thin, homogenous discharge 3. A **'fishy'** amine odour when potassium hydroxide is added to vaginal secretions (positive whiff test)
62
63
Gonorrhoea bacterium shape name
Gram negative diplococci
64
Chlamydia bacterium shape name
Gram negative coccoid (rod shaped)
65
Rare complication of gonorrhoea
Disseminated gonococcal infection
66
Jarisch-Herxheimer reaction
This is an acute febrile illness which is self-resolving within 24 hours after receiving syphilis Tx
67
Gonorrhoea Tx for penicillin Ax
IM gentamicin and oral azithromycin
68
Candida Risk factors
- Increased oestrogen (higher in **pregnancy**, **lower pre-puberty**, **post-menopause**, **COCP**) - Poorly controlled DM - Immunosuppression (e.g. using corticosteroids) - Broad-spectrum antibiotics
69
non-gonococcal urethritis causative agent
Mycoplasma genitalium **(MG)**
70
non-gonococcal urethritis Sx
- urethral discharge - Dysuria - Haematuria - genital itching
71
**Mycoplasma genitalium** complications
Urethritis Epididymitis Cervicitis Endometritis Pelvic inflammatory disease Reactive arthritis Preterm delivery in pregnancy Tubal infertility
72
Mycoplasma genitalium Ix
**NAAT** - First urine sample in the morning for men - Vaginal swabs (can be self-taken) for women
73
Mycoplasma genitalium Mx
- Doxycycline 100mg twice daily for 7 days then; - Azithromycin 1g stat then 500mg once a day for 2 days (unless it is known to be resistant to macrolides)
74
Chlamydia / Gonorrhoea complications
Pelvic inflammatory disease Chronic pelvic pain Infertility Epididymo-orchitis (men) Prostatitis (men) Conjunctivitis Urethral strictures Disseminated gonococcal infection Skin lesions Fitz-Hugh-Curtis syndrome Septic arthritis Endocarditis
75
Disseminated Gonococcal Infection Sx
- Various non-specific skin lesions - Polyarthralgia (joint aches and pains) - Migratory polyarthritis (arthritis that moves between joints) - Tenosynovitis - Systemic symptoms such as fever and fatigue
76
What kind of swab is used for gonorrhoea MC&S?
Charcoal swab
77

Sexual Health (5 decks)

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