Viral exanthams + STIs Flashcards
1st: Measles
NOTIFIABLE DISEASE
Cause: measles virus
Prodrome: [2-4 days] cough, coryza + conjunctivitis
Symptoms: fever (resolves once rash appears), rash (head>torso>limbs) + Koplik spots (red spots w/ white/blue centre
Treatment: supportive + avoid pregnant/immunocompromised
Complications: otitis media, pneumonia, sev. diarrhoea, dehydration, convulsions, encephalitis + SSPE
2nd: Scarlet fever
NOTIFIABLE DISEASE
10 (penicillin) Ss: Scarlet, S. pyogenes, sore throat, sandpaper rash, strawberry tongue, skin peeling, supportive (as well as abx), sinusitis, sepsis + systemic spread (strep nephritis, rheumatic fever + endocarditis)
Cause: S. pyogenes
Prodrome: [12-48hrs] sore throat, headache, fever, N+V
Symptoms: [SS] sandpaper rash (chest>peripheral), strawberry tongue (white then sheds layer), lymphadenopathy, fatigue + skin peeling as rash fades
Treatment: phenoxymethylpenicillin OR amoxicillin OR erythromycin + supportive
Complications:ear infections, throat abscess, pneumonia, sinusists, cellulitis, arthritis, sepsis, meningitis, rheumatic fever, post-strep nephritis, liver abscess + endocarditis
3rd: Rubella
NOTIFIABLE DISEASE
Cause: rubella virus
Prodrome:lymphadenopathy up to 2 weeks before rash
Symptoms: bright, red maculopapular rash (face + neck>generalised), Forcheimer spots on soft palate, arthritis, headache, malaise, N+V + low grade fever
Treatment: supportive +/- IVIg if pregnant
Complications: [rarely in healthy people] arthritis, low plats, encephalitis, optic neuritis + GBS
5th: Erythema infectiosum
Cause: parvovirus B19
Prodrome: [2-5 days] low grade fever, nasal discharge, headache, myalgia, N+V
Symptoms: maculopapular rash (perioral/periorbital sparing>trunk/back/limbs after a few days>fades after 1-2 weeks) +/- arthritis of knees/ankles
Treatment: supportive + regular fluids [contact trace up to 3 weeks prior]
Complications: can cause transient aplastic anaemia, pure red cell aplasia or neuro complications in immunocompromised/SCC/thalassaemia
6th: Roseola infantum
Cause: HHV-6 or HHV-7
Prodrome: [3-5 days] high fever (~40)
Symptoms: pink-red maculopapular rash (trunk, neck, proximal extremities +/- face), diarrhoea, abdo pain + middle ear infection
Treatment: supportive
Complications: seizures, peri-orbital oedema + febrile convulsions
Trichomonas vaginalis
Females: asymptomatic (up to 50%), offensive odour discharge (thin/scanty OR thick profuse), vulval itching, ulceration, dysuria + lower abdo pain
Males: asymptomatic (up to 50%), urethral discharge, dysuria, urinary frequency + prostatitis
Treatment: Metronidazole
Neisseria gonorrhoea
Females: urethral (dysuria w/o frequency) OR endocervical (symptoms in 50%: mucopurulent d/c)
Males: mucopurulent discharge +/- testicular pain (10% asymptomatic)
Other: rectal (can be without anal sex: anal discharge +/- pain OR asymptomatic) + pharyngeal (asymptomatic or sore throat)
Treatment: empirical/pregnant/disseminated (ceftriaxone) Or ciprofloxacin (if sensitivities known)
Chlamydia trachomatis
Females: mostly asymptomatic OR discharge (mucopurulent discharge +/- contact bleeding), PCB, IMB, dysuria, lower abdo pain + deep dyspareunia
Males: mild (discharge/dysuria) so commonly unnoticed
Treatment: (1st) doxycycline, (2nd) azithromycin STAT or (3rd) erythromycin/ofloxacin
Mycoplasma genitalium
Females: most asymptomatic OR dysuria, PCB, painful IMB, cervicitis + lower abdo pain (can’t diagnose clinically)
Males: most asymptomatic OR urethral discharge, dysuria, penile irritation + urethritis
Treatment: uncomplciated (doxycycline then 2 doses of azithromycin) or complicated (moxifloxacin)
Herpes Simplex Virus 1 or 2
Symptoms: ulcers (multiple, painful vesicular blisters that ulcerate then crust over), painful lymphadenopathy (b/l on primary and unilateral on secondary, fever myalgia + can have proctitis/oral infection as well
Treatment: conservative (saline baths, analgesia + topical anaesthetic) + aciclovir (doesn’t alter disease course, only reduces symptoms and risk of side effects)
Anogential warts
Symptoms: asymptomatic OR 1+ lumps leading to irritation, bleeding or secondary infection
Treatment: non-keratinised (podophyllotixin + trichloroacetic acid) OR keratinised (cryotherapy, excision, TCA or cautery) OR imiquimod for both
Primary syphilis
Symptoms: single painless/painful chancre +/- purulent (resolves over 3-8 weeks)
Treatment: benzathine penicillin single shot
Secondary syphilis
Symptoms: [4-10 weeks after primary] widespread, itchy mucocutaneous rash (involving palms/soles), condylomata lata (perineum/anus - highly infectious), hepatitis, splenomegaly, glomerulonephritis + CNS symptoms (meningitis, optic neuropathy, CN palsies + uveitis)
Treatment: benzathine penicillin (3 weeks)
Tertiary syphilis
Symptoms: [20-40 years later in 1/3 of untreated patients] gummas (pansystemic, destructive granulomas - mostly skin/bone), CVS (aortitis, AR, HF + aneurysms) + neurosyphilis (headache, emotional lability, gradual decline in cognition, personality change, psychosis, dementia, seizures, hemiparesis, parasthesia, lightning pains, Charcot joints, sensory ataxia + tabes dorsalis
Treatment:
Bacterial vaginosis
Female: asymptomatic (50%), thin/white fishy smelling discharge without soreness/itching
Treatment: metronidazole STAT/BD 5-7 days/intravaginal OR clindamycin IR tinidazole
