Preclerkship > STIs > Flashcards

STIs Flashcards

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1
Q

Most commonly diagnosed bacterial STI

A

Chlamydia

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2
Q

Chlamydia/gonorrhoea primarily affect individuals of what age?

A

Women 15-24

Men 20-29

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3
Q

Syphilis most affects

A

MSM
Sex workers/clients
Peope in endemic regions

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4
Q

70% of adults will have at least one genital __ infection in their life

A

HPV

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5
Q

Relationship between spermicidal lubricated condoms and STIs?

A

Nonoxynol-9 distrupts mucosal lining –> increased infection/transmission of STIs. NEVER use rectally

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6
Q

List reportable STIs in Canada (6)

A 
Chlamydia & Gonorrhea
Chancroid
Syphilis
Hepatitis B
HIV

Some jurisdictions

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7
Q

Why shouldn’t cervical specimens be taken from prepubertal girls?

A

STIs involve VAGINA not cervix

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8
Q

Endocervical samples used for which 2 common STIs?

Exocervical samples used for which 2 common STIs?

A

Endo: Chlamydia, gonorrhoea
Exo: HSV, HPV

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9
Q

Full names for chlamydia & gonorrhea

A

Chlamydia trachomatis, Neisseria gonorrhoeae

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10
Q

What less-invasive exams are available for Chlamydia & gonorrhea

A

First-catch urine (ideally haven’t peed 2 hours before)

Vaginal specimen can be SELF-administered

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11
Q

List 6 types of tests that can be done for C & G

A 
Endocervical sample
Vaginal sample / urethral sample (women/men)
First-catch urine
Rectal 
Pharyngeal
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12
Q

Chlamydia & gonorrhea are associated with what 6 “syndromes”?

A 
Asymptomatic
Urethritis
Cervicitis
Epididymitis
PID
Intestinal/enteric syndromes
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13
Q

4 symptoms of PID

A

Lower abdominal pain
Deep dyspareunia
Abnormal bleeding
Fever

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14
Q

3 bimanual exam findings of PID

A

Cervical motion tenderness
Adenexal tenderness
Adenexal masses

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15
Q

HPV can cause precancerous/cancerous lesions in what areas?

A

Mouth/oropharynx/larynx
Cervix/vagina/vulva
Penis
Anus

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16
Q

Tranmission modes of HPV

A

Receptive/penetrative vaginal/anal/oral sex

Also non-penetrative sexual activity

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17
Q

Nonsexual behaviour that increases risk of HPV?

A

Smoking

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18
Q

What 2 types of HPV are linked to 70% of cervical cancers?

A 
Type 16 (50%)
Type 18 (20%)
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19
Q

Which HPV types are “low-risk”, associated w/ 90% of anogenital warts?

A

Types 6 & 11

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20
Q

What 3 HPV vaccines are approved in Canada?

A

Cervarix: protect against Type 16/18
Gardasil: Types 16/18 & 6/11
Gardasil 9: same as above but additonal 5 cancer-causing types (31, 33, 45, 52, 58)

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21
Q

Do you need to perform C/S if active HPV warts during delivery?

A

No, unless significant bleeding risk or obstructing birth canal

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22
Q

Goal of HPV treatment

A

Topic, for symptom relief (does NOT prevent transmission/recurrence), pt may forgo treatment

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23
Q

How can internal HPV warts be treated?

A

Trichloroacetic acid
Cryotherapy
Electrosurgery
Surgical excision

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24
Q

Clinian-performed HPV treatments

A

Podophyllin (not as good as patient-applied phodophyllotoxin)
TCA
Cryotherapy
Surgical excision or electrosurgery

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25
What is the only HPV treatment safe during pregnancy
Trichloroacetic acid
26
What is a significant public health issue wrt treating gonnorhoea, and what do we do because of this?
AB resistance Do NOT use penicillin/tetracyclines/quinolones Notify PH after treatment failures
27
Patients treated for gonorrhoea should abstain from sex for __ days after completion of treatment & asymptomatic
3 days
28
Gonnorrhea infections incubate for ___ days and are often ____
2-7 | Often asymptomatic
29
What is disseminated gonococcal infection?
Gonorrhea can spread tematogenously (<1% of cases) --> arthritis, dermatitis; pericarditis/endocarditis/meningitis/perihepatitis rare
30
Major sequelae of gonorrhea in women (6)
PID Infertility, ectopic pregnancy, chronic pelvic pain Reactive arthritis, disseminated gonococcal infection
31
Major sequelae of gonorrhea in men (4)
Epididymo-orchitis Reactive arthritis Disseminated gonococcal infection (infertility rare but can occur)
32
What is reactive arthritis? 2 other names?
AKA Reiter Syndrome, oculo-urethro-synovial syndrome "can't see, can't pee, can't bend my knee" Postinfectious autoimmune process after STIs, postenteric infection (e.g. traveller's diarrhea)
33
General treatment for gonorrhea
``` Combo therapy (AB resistance + co-infection with chlamydia common) Cephalosporin (cefixime, ceftriaxone) + Azithromycin ```
34
What type of AB therapy for gonorrhea preferred?
Directly observed single-dose therapy
35
How would you treat Neonates born to mother w/ untreated gonorrhea OR with symptoms
Cephalosporine (don't co-treat for chlamydia w/out positive test)
36
Trace-back period for reporting chlamydia/Gonorrhea
60 days (or last partner if no partner in last 60 days)
37
Nucleic acid tests need to wait how long after treatment before testing again? Why?
2-3 weeks (false-positives from dead organisms)
38
What is lymphogranuloma vereneum? (LGV)
Disease caused by L1/L2/L3 serotype of C trachomatis | Invades lymph --> chronic swelling --> scarring, systemic symptoms
39
Transmission of Chlamydia
Vaginal, anal ,oral | Vertical transmission
40
Incubation period of Chlamydia
usualky 2-3 wks, up to 6 weeks
41
50% of males and 70% of females with chlamydia are...
Asymptomatic
42
Pregnant women are routinely screened at initial prenatal visit for...
HIV, HBV, syphilis, and (if <25 or risk factors) chlamydia & gonorrhea
43
Chlamydia may cause cervicitis characterized by
Friability of the os
44
Complications of untreated chlamydia
PID, ectopic pregnancy, infertility, CPP Epididymo-orchitis Reactive arthritis
45
Annual screening for C trachomatic recommended in..
<25 yo | gbMSM, transgender populations
46
Testing for asymptomatic chlamydia in males and females?
First-void urine in either | Female: also vaginal swab (can be self-admin) or cervical swab are options
47
Additional tests for chlamydia that can be done in patients with symptoms?
Swabs: urethral, rectal, pharyngeal, conjunctival, lesion (in addition to vaginal/cervical/FVU)
48
Treatment indications for chlamydia
1) Positive test for chlamydia 2) Positive test for gonorrhea 3) Suspected if compatible syndrome or partner has STI
49
After chlamydia treatment, how long do you need to wait before you can have unprotected sex again?
End of multi-dose treatment | 7 days after single-dose treatment
50
When do you need to test for cures for C/G?
Persistent symptoms, non-ideal treatment regime, prepubertal/pregnant, suspected non-adherence
51
Preferred treatment for non-pregnant/non-lactating adults with chlamydia?
Doxycycline (BID for 7 days) = tetracycline | Azithromyzin (single dose, more compliance) = macrolide
52
Paps: | Benign-appearing endometrial cells are only reported in women ___ and require evaluation in ____
45+ yo | Postmenopausal women
53
Types of glandular cell abnormalities on Pap
Atypical glandular cells AGC, favor neoplastic (suggestive but not specific of adenocarcinoma) Endocervical adenocarcinoma in situ Adenocarcinoma
54
What is the current Ontario recommended Pap schedule?
25+ yo, every 3 years (if negative) | Stop at 70yo if negative cytology for previous 10 years
55
Squamous cervical cytologic abnormalities on Paps are called ____. 2 types?
CSIL = cervical squamous intraepithelial lesions | LSIS (low grade) or HSIL (high-grade)
56
LSIS on Pap, especially in young women, is usually ____
a transient HPV infection
57
LSIL cervical cytologic specimens that contain a few cells that are suspicious for but not diagnostic of HSIL are reported as
atypical squamous cells, cannot exclude a high-grade squamous intraepithelial lesion (ASC-H)
58
LSIL (Bethesda system) corresponds to Cervical Intraepithelial Neoplasia (CIN) what?
CIN I
59
HSIL = CIN ?
CIN II/III
60
What is the next stage after HSIL/CIN III?
Invasive squamous cell carcinoma
61
Cytologic abnormalities must be further evaluated using...
Colposcopy, potentially biopsy
62
For ASCUS or LSIS, the next step is
Repeat cytology in 6 months (if same or worse then refer to colposcopy)
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