STIs

Question 1

What are the most common STIs?

Answer 1

• chlamydia
• genital warts
• gonorrhoea
• genital herpes
• syphilis
• HIV

Question 2

What is the cause of chlamydia?

Answer 2

• chlamydia trachomatis (asymptomatic infection)
• serovars D-K
• serovars L1-3

Question 3

What does serovar mean?

Answer 3

• distinct variation within bacteria/viral species/immune cells of different individuals

Question 4

What does serovars D-K cause in males?

Answer 4

Urethritis, epididymitis, prostatitis

Question 5

What does serovars D-K cause in females?

Answer 5

Cervicits
PID
Fitz-Hugh-Curits

Question 6

What does serovars D-K cause in neonates?

Answer 6

Conjunctivitis

Pneumonia

Question 7

What does serovars L1-L3 cause?

Answer 7

• lymphogranuloma venereum (chronic infection of lymphatic system)
  = buboes (swollen inflamed lymph node)
  = proctitis (inflammation of rectum/anus)

Question 8

What are the complications of chlamydia trachomatis?

Answer 8

• reactive arthritis

- infertility

Question 9

How is chlamydia trachomatis treated?

Answer 9

• azithromycin

- doxycycline

Question 10

What causes genital warts?

Answer 10

• HPV (human papilloma virus)
• multiple sites
• some associated with carcinoma (16,18,31,33)
• mostly asymptomatic

Question 11

How is HPV managed?

Answer 11

• vaccine

- genital warts = topical podophyllotoxin, imiquimod, cryotherapy

Question 12

What causes gonorrhoea?

Answer 12

• Neisseria gonorrhoea

Question 13

What does Neisseria gonorrhoea cause in males?

Answer 13

• urethritis
• prostatitis
• sore throat
• epididymitis

Question 14

What does Neisseria gonorrhoea cause in females?

Answer 14

• cervicitis
• PID
• Peri-hepatitis
• Septic abortion

Question 15

What does Neisseria gonorrhoea cause in neonates?

Answer 15

conjunctivitis

Question 16

What are the complications of Neisseria gonorrhoea?

Answer 16

• septic arthritis (bacteria through joints)
• blindness
• infertility
• septicaemia (bacteria poisons blood) = meningitis/endocarditis

Question 17

How is Neisseria gonorrhoea managed?

Answer 17

• ceftriaxone (antibiotic)

Question 18

What are the types of HSV?

Answer 18

HSV -1 = oral
HSV -2 = genital

(blisters scabbing over)

Question 19

What are the important features of HSV?

Answer 19

• latency: lives in trigeminal/sacral ganglia

- reactivation: symptomatic or asymptomatic

Question 20

How is HSV treated?

Answer 20

• not cured
• aciclovir
• valaciclovir
• famciclovir

Question 21

What causes syphilis?

Answer 21

• treponema pallidum

Question 22

What are the types of syphilis?

Answer 22

• primary
• secondary
• latent
• tertiary
• congenital

Question 23

How is syphilis treated?

Answer 23

• penicillin

- doxycycline

Question 24

How does primary syphilis present?

Answer 24

• chancre (genital ulcer disease)

- lymphadenopathy

Question 25

What is chancre?

Answer 25

- single painless ulcer - anywhere at site of infection - heals within few weeks

Question 26

What are the symptoms of secondary syphilis?

Answer 26

- rash - fever - lymphadenopathy - condyloma lata

Question 27

How is the epidemiology of HIV changing?

Answer 27

- reducing incidence (risk of spread) | - increasing prevalence (number of people with disease)

Question 28

What types of HIV testing is done?

Answer 28

- routine testing - opportunistic testing of high risk individuals - diagnostic testing when clinical indicators of the condition

Question 29

What are the common features of a primary HIV infection?

Answer 29

- headache - lymphadenopathy - pharyngitis - oral/genital ulceration - nausea - rash - myalgias - fever/fatigue - weight loss/night sweats (acute retroviral syndrome) (wide differential diagnosis)

Question 30

What is the mechanism of HIV?

Answer 30

- infections CD4+ T cells (T helper cells), macrophages and dendritic cells - acute primary infection = massive CD4+ cell loss - chronic HIV infection = ongoing CD4+ cell loss, immunosuppression, immune cell loss

Question 31

What are the direct effects of HIV?

Answer 31

- wasting - diarrhoea - neurological problems

Question 32

What are HIV opportunistic infections?

Answer 32

- viral/fungal/bacterial/mycobacterial/parasitic infections

Question 33

What malignancies can occur from HIV?

Answer 33

Lymphoma | Cervix carcinoma

Question 34

What is the significance of a CD4 count?

Answer 34

- HIV associated disease risk increases as CD4 cells fall

Question 35

What is retroviral therapy?

Answer 35

HAART - highly active antiretroviral therapy

Question 36

How are the classes of antiretroviral drugs?

Answer 36

- nucleotide reverse transcriptase inhibitors - NNRTI - PIs (protease inhibitors) - fusion inhibitors - integrase inhibitors - co-receptor antagonists

Question 37

How do antiretroviral drugs work?

Answer 37

- during viral replication cycle - prevent production of new HIV particles - combine at least 3 from 2 classes - lifelong treatment - adherence vital for success

Question 38

What are the side effects of HAART?

Answer 38

``` ST: - nausea/vomiting - headache - sleep disturbance LT: - lipodystrophy - renal dysfunction - peripheral neuropathy - lactic acidosis ```

Question 39

When may prophylactic measures be used?

Answer 39

- high risk sexual exposure <72 hours - needles - PrEP (pre-exposure prophylaxis) - PEP (post exposure prophylaxis) - PEPSE (PEP after sexual intercourse)`

Question 40

How is HIV managed in pregnancy?

Answer 40

- early screening - antiretroviral therapy for mother (if low CD4 immediately then continued, if high 2nd trimester then discontinued) - elective C section (vaginal delivery possible if undetectable HIV load) - antiretroviral therapy for infant - no breastfeeding