GOSH > STIs (DNF) > Flashcards

STIs (DNF) Flashcards

(56 cards)

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1
Q

What pathogen causes Gonorrhoea?

A

Neisseria Gonorrhoea
Gram negative diplococci

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2
Q

What is the key epidemiology of Gonorrhoea?

A

30-40yrs
2x more common in males

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3
Q

How does Gonorrhoea tend to present in men?

A

Acute urethritis with purulent discharge and dysuria.

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4
Q

How does gonorrhoea tend to present in women?

A

Cervicitis
Increaed vaginal discharge, intermenstrual bleeding or postcoital bleeding
Can progress to PID
50% asymptomatic

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5
Q

How does anorectal Gonorrhoea infections present?

A

Anal discharge
Pruritus ani
Tenesmu
Rectal bleeding

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6
Q

How do oropharyngeal gonorrhoea infections present?

A

Oro-genital contact history
Asymptomatic
Sore throat/tonsillits like symptoms

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7
Q

What forms of gonorrhoea infections are rarer?
How do they show?

A

Opthalmic -> direct contact -> conjuncitivities
DGI -> bloodstream spread -> tenosynovitis, dermatitis, polyarthralgia
Neonatal -> conjuncitivitis -> corneal scarring and blindness

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8
Q

How long is the incubation period for gonorrhoea?

A

2-5days

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9
Q

How can people have repeated Gonorrhoea infections?

A

No immunisation
Antigen variation of type 4 pilli and Opa proteins -> not recongised by immune system

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10
Q

What is the key treatment for Gonorrhoea?

A

Must be based on cultures for susceptibility before treating.

Uncomplicated anogenital or pharyngeal = IM singe 1g ceftriaxone
If not tolerable = Ciprofloxacin (fluoroquinolone) single dose

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11
Q

How is gonorrhoea diagnosed?

A

NAAT test
Vulovaginal swab in females
First pass urine in males

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12
Q

What additional guidance is needed when being treated for Gonorrhoea?

A

No sex for 7 days after treatment finished
Return in 1 week for test of cure.

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13
Q

How should the sexual contact of patients with Gonorrhoea be managed?

A

Symptomatic men -> all within 2 weeks or most recent
Asymptomatic men or any women -> last 3 months
If within 14days of exposure consider empirical or test at day 14, if over 14days only treat test positive.

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14
Q

What is the most common STI in the UK?

A

Chlamydia

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15
Q

What pathogen causes chlamydia?

A

Chlamydia trochomatis
Intracellular bacteria
Gram negative ovoid

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16
Q

What is the incubation period of chlamydia?

A

7-21days
Although most remain asymptomatic

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17
Q

What is the key epidemiology of chlamydia?

A

20-30yrs
Twice as common in females

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18
Q

What is the key life cycle of chlmaydia?

A

Two stages: elementary body (infectious not metabolic) and reticulate body (non-infectious but metabolically active)

  1. EB attach and invade host cell by endocytosis
  2. EB in vacuole/inclusion
  3. EB differentiates into RB by binary fission
  4. RB replicates, reprogrammes host cell to cuport growth and suppres immune response
    5.Differentiate back to EBs for release.
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19
Q

What are the key clinical features of chlamydia?

A

Asymptomatic
Women - cervicitis (discharge and bleeding), dysuria
Men - urethral discharge and dysuria

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20
Q

How is chlmaydia diagnosed?

A

Testing two weeks after exposure
NAAT test
Females - vulvovaginal swab
Males - first void urine sample

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21
Q

What are some potential complications of chlamydia?

A

Epididymitis
PID
Endometriosis
Increased incidence of ectopic pregnancies
Infertility
Reactive arthritis
Perihepatitis (Fitz-Hugh-Curtis syndrome)

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22
Q

What is the screening process for Chlamydia?

A

All men and women aged 15-24yrs who are sexually active
Opportunistic testing

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23
Q

What is the first line treatment for chlamydia?

Study These Flashcards
A

Doxycycline 7/7
2nd line = azithromycin
If pregnant = erythromycin or amoxicillin

24
Q

Who should be contacted in partner tracing for chlamydia?

Study These Flashcards
A

Men with urethral symptoms -> up to four weeks before symptoms
Women and asymptomatic men -> all partners in last six months or most recent partner
Treat then test approach

25
What is syphylis?
STI Bacteria -> spirochaetal -> Treponema pallidum
26
What is the key epidemiology of syphylis?
Peak 30-40yrs More common in males
27
What are the risk factors for syphylis?
Unprotected sexual intercourse Multiple sexual partners Co-infection with HIV MSM Pregnancy -> transmit to unborn child risk of congenital syphylis -> hence perinatal screening
28
What is the key pathology of primary syphylis?
Infection with treponema pallidum through microscopic abrasions or mucus membranes Initial ulcer = chancre Infiltarted by polymorphnuclear leukocyte Resolves in 3-6 weeks
29
What is the pathology of second syhphylis?
Haematogenous spread of obacteria causes endarteritis obliterans -> immune complexes, spirochetal parts and complement in arterial walls Resolution by macrophages and cell-mediated immunity
30
How common is progression to late syphilis?
Up to 40% of untreated patients
31
What are the signs of late syphilis?
Neuro -> chronic inflam of meninges, tabes dorsalis (loss of dorsal columns), neuron loss and general paresis Gummatous -> granulomas Cardiovascular -> blood vessels and perivascular tissue -> occlusion aortic vaso vasorum necrosis and weakening of tunica media = aortic aneurysm Narrowing coronary ostia -> aortic regurg
32
What is the clinical definition of early syphilis?
First 2 years after infection Includes the primary, secondary and early latent phase
33
What are the symptoms of primary syphilis?
Painless chancre - site of entry, post 3w, may be hidden in vagina or rectum Local lymphadenopathy
34
What are the symptoms of secondary syphilis?
6w to 6m post infection Symmetrical maculopapular rash -> trunk, face, palms or soles Constitutional -> fever, malaise etc Lymphadenopathy Tonsilitis Hepatitis Oral snail-track ulcers Optic neuritis Many more
35
What is the clinical definition of tertiary or late syphilis?
More than 2yrs of infection
36
Identify the disease causing the rash Often predated by a chancre
Syphilis
37
What is the first line investigations should be done for syphilis?
Treponemal test -> TPPA and EIA test typically blood (positive for life once infected) Non-treponemal tests -> measure cellular damage due to infection, monitor disease progression or treatment response -> RPR or VDRL (show active disease)
38
What additional tests may be done for a patient with suspected syphilis?
Darker field microscopy = image chancre look for treponema pallidum CSF exam = neurosyphilis, lumbar puncture, CSF sample for VDRL, or abnormal cell count or protein HIV testing -> due to shared mode of transmission
39
What are the key differentials for syphilis?
Chancroid -> most common cause of ulcer, recent travel to (sub)tropical area, develops from painless to tender or pustule after several weeks Genital herpes -> typically paindul, multiple sores. Must have herpes virus PCR if suspected
40
What is the gold standard treatment for syphilis? (not pregnant)
Benzathine benzylpenicillin - IM 2-3 doses 1 week apart 14days if early 28 days if late
41
What is the gold standard treatment for syphilis if you are pregnant?
Erythromycin 500mg/6hr PO
42
What follow up is required for syphilis?
3,6,12 months appointments in a GUM clinic
43
What are the key signs of neurosyphilis?
Cranial nerve palsies Dementia, psychosis Loss of proprioception, vibration, incontinence and ataxia
44
What is genital herpes?
STI -> viral infection by type 1/2 HSV Lifelong -> latent in sensory neurons can reactivate Causes vesicles or ulceration of genitals More common in females and immunosuppressed
45
What is the most common pathogen causing genital herpes?
Herpes simplex virus type 2 Type 1 -> more common for orogenital lesions
46
What is the key pathophysiology of genital herpes?
Viral infection through mucosal surface or broken skin - inserts into DNA, cell lysis or exocytosis of new virus. Infect nerve endings in the dermis -> sensory nerves -> latent in neuron nucleus in dorsal root ganglia or death of neuron. Immune system can partially control but not eradicate. Asymptomatic carrier - dormant virus can shed intermittently from the epithelium so spread.
47
What factors can cause latent genital herpes to reappear?
UV light exposure Emotional stress Immunosuppression
48
What are the key clinical features of genital herpes?
First presentation -> grouped painful blisters burst in 3days -> crusted erosions/ulcers Painful -> affect urination and sitting down Prodrome -> tingling and burning Urethral or vaginal discharge Painful bilateral lymphadenopathy Systemic illness Can last up to 20 days
49
How do the recurrent episodes of genital herpes compare to the primary infection?
Prodrome period is shorter Lesions same area but less severe Lesions crust and heal in 10 days. Less frequent and less severe over time
50
How is genital herpes diagnosed?
NAAT test Scraped sample of an ulcer base
51
What is the key management for genital herpes?
Antiviral is within 5 days of onset or new lesions still forming Oral acyclovir, valaciclovir, famciclovir Support with analgesia, saline bathing, ice packs and no sex untile healed
52
When might suppressive antiviral therapy be offered to patients?
If 6 recurrences a year or more Duration of therapy is 6 months to 1yr.
53
How should genital herpes be managed during pregnancy?
First episode before 28 weeks -> therapy at time and 36w until birth If first episode at or after 28 weeks -> continuous antiviral till birth Elective C-section delivery might be considered if first episode within 6w of due date.
54
What is the alternative medical name for genital warts?
Condylomata accuminata
55
What are the key features of genital warts?
Small 2-5mm fleshy protuberances - slightly pigmented May bleed or itch
56
What is the management first line for genital warts?
Multiple non-keratinised - topical podophyllum Solitary or keratinised - cryotherapy
GOSH
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