STIs Flashcards by frankiespeck@hotmail.co.uk Speck

What main drug classes has Neisseria Gonorrhoeae become resistant too?

Quinolones e.g. Ciprofloxacin
Beta-lactams due to penicillin-binding proteins
Macrolides e.g. Azithromycin

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What are the main mechanisms of antibiotic resistance in Neisseria Gonorrhoeae?

Drug breakdown e.g. Penicillin resistance

Drug efflux causing multiple antibiotic resistance

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What mediates the rapid spread of antibiotic resistance between strains of Neisseria Gonorrhoeae?

Plasmid and chromosome mediated

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What are the principles of antimicrobial therapy for STIs?

Check national/local guidelines but:

Right drug for patient by checking allergies/contraindications/interactions and organism using guidelines (BASHH) on empirical treatment until susceptibility known
Right dose for patient due to weight/liver/renal function and for bacteria i.e. MIC
Right time i.e. immediately
Right duration: single dose can be effective and increases concordance and minimises side effecrs

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How can you diagnose STIs microbiologically?

M, C + S
Detect with protein Ag or nucleic acid i.e. DNA/RNA (NAAT)
Detect response to pathogen via Ab (serology)

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What are the bacterial characteristics of gonorrhoea?

Gram -ve IC diplococci

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What are the advantages and disadvantages of microscopy, culture and sensitivity testing?

Adv:

Rapid (result in clinic)
Gives antimicrobial susceptibility (2-3d after)
Useful for individual patient treatment and epidemiological surveillance

Disadv:

Less sensitive than NAAT
Requires skilled microscopist

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What are the advantages and disadvantages of non-culture methods?

Adv:

24-48hr result
High sensitivity and specificity
Combine with Chlamydia test

Disadv:

No antimicrobial susceptibility
Requires non-inhibitory specimen as body fluids such as urine may inhibit PCR so not suitable for normal swabs

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What are the bacterial features of Chlamydia?

Obligate IC bacterium growing inside columnar epithelial cells

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How do you diagnose Chlamydia?

It will not grow in cell free culture i.e. on an agar plate so needs a Nuclear Acid Amplification Test (NAAT) which can be >99% sensitive and specific

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How do you diagnosis syphilis?

Culture not possible as Treponema Pallidum unculturable SO:

Microscopy with dark ground
Nucleic acid detection via PCR
Ab detection via serology

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What are the advantages and disadvantages of syphilis microscopy diagnosis?

Adv:
- Specific

Disadv:

Low sensitivity
Only available primary syphilis
Skilled technician needed
Relies on good quality specimen

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Why is nucleic acid detection of syphilis good?

High specificity in primary lesions and available in some sexual health clinics

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Why is serology good for diagnosing syphilis?

Reacts to Ags so activity level demonstrated and it allows diagnosis of active syphilis

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How is most syphilis diagnosed and why?

By Ab detection as serum IgM indicates recent infection whilst IgG stays +ve for months/years/life

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What is PREP?

HIV prevention tablet - take 1 pill a day

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How can STIs transmit through sexual contact?

Oral/vaginal/anal/sex toys/douching

2. Skin/skin contact (e.g. HSV, molluscum, HPV)

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What type of gonorrhoea is rising in incidence?

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Extra-genital

What cells at the back of throat house Chlamydia and Gonorrhoea?

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Columnar epithelium

How can STIs transmit through non-sexual contact?

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In utero (e.g. syphilis, BBV)
Peripartum (e.g. Gonorrhoea, Chlamydia and BBV)
Other BBV exposure via occupation, recreational drug use, blood/body fluid/tissue transfusion/transplant

What are the principles of STI control?

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Remove reservoirs/sources
Treat other infections/sources of inflammation
Interrupt transmission
Increase host resistance

What primary prevention exists for STIs?

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Safe sexual behaviours inc. barrier contraceptive methods
Immunisation for HPV (warts), HBV and HAV
PrEP

What secondary prevention exists for STIs?

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Detect via screening
Better access to SH services
Target info (e.g. 16-25s, MSM)
If 1 STI, look for others!
Prompt effective treatment
Partner notification (contact tracing)

Where are we currently at with HIV/AIDs life expectancy?

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It is better than that of a smoker

What are typical clinical presentations of STIs?

``` ASYMPTOMATIC Urethritis Discharge Ulcerative genital lesions PID Epididymo-orchitis Infestations Warts ```

What can happen to the female reproductive tract due to STIs?

``` Vaginitis Vulvitis Cervicitis Endometritis Oophoritis Salpingitis ```

What can happen to the male reproductive tract due to STIs?

``` Urethritis Balanitis Prostatitis Proctitis Epididymitis ```

What differentials exist for urethritis?

Chlamydia Trachomatis Neisseria Gonorrhoeae Non-specific urethritis (NSU) e.g. Mycoplasma Genitalium or no organism found

What differentials exist for vaginal discharge?

STI: Gonorrhoea, Chlamydia or Trichomonas Non-STI: Candidiasis (thrush) or bacterial vaginosis

What STI differentials exist for genital ulceration?

Herpes Simplex Virus (1 or 2) Syphillis

What non-STI differentials exist for genital ulceration?

``` Aphthous Behcet's Drug induced e.g. Foscarnet Pemphigus Lichen sclerosus Lichen planus Crohn's disease Systemic sclerosis Steven Johnsons syndrome Allergy Trauma ```

What are the symptoms of primary syphilis?

Single or multiple primary chancres that are painless or painful but firm/round - sore lasts 3-6 weeks with or w/o treatment

What are the symptoms of secondary syphilis?

Rashes classically on palms/soles, multiple sores on mucous membranes, fever lymphadenopathy, fatigue, neurosyphilis and hepatitis/glomerulonephritis/myelitis etc. anything with 'itis'!

What are the symptoms of latent syphilis?

Occurs asymptomatically is secondary syphilis is untreated and lasts 10-30 years potentially progressing to tertiary

What are the symptoms of tertiary syphilis?

Although now rare classified by tabes dorsalis, general paralysis of insane (GPI) and dementia

What can cause pelvic inflammatory disease (PID)?

STI Non-STI Coil

What are the symptoms of pelvic inflammatory disease (PID)?

``` Pain Discharge PV bleeding Low abdo tenderness inc. RUQ Cervical excitation Endocervical pus Chronic pelvic pain Tubal infertility (or abscess) Ectopic pregnancy ```

What can causes epididymo-orchitis?

UTI e.g. E.Coli STI e.g. Gonorrhoea/Chlamydia Viral e.g. mumps Rarely TB or Brucella

What are the complications of epididymo-orchitis?

Scrotal abscess | Infertility

What other STI presentations exist?

Infestation by scabies or pubic lice Lumps and bumps e.g. genital warts or Molluscum Contagiosum

What extra-genital/systemic manifestations of STI exist?

Red sclera Rashes Swellings and skin markings (Gonorrhoea) SARA

What STIs can manifest genitally and also systemically?

``` Gonorrheal bacteraemia/arthritis PID Perihepatitis 2ndary/3ry syphilis SARA Herpes meningitis Encephalitis ```

What STIs present systemically but NOT genitally?

HIV | Hepatitis A, B and C

STIs Flashcards

(43 cards)