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STI Flashcards

(47 cards)

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1
Q

Gonorrhoea

A
  • Gonorrhoea is most commonly diagnosed in men who have sex with men, young (heterosexual) Aboriginal and Torres Strait Islander people
  • travellers returning from high prevalence areas overseas.
  • Neisseria gonorrhoeae, (Gram-negative)
  • IP 2-7 days
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2
Q

Gonorrhoe - Clinical presentation

A
  • often asymptomatic
  • Penile urethral discharge
  • Dysuria
  • Vaginal discharge
  • Dyspareunia with cervicitis
  • Conjunctivitis: purulent, sight-threatening
  • Anorectal symptoms: discharge, irritation, painful defecation, disturbed bowel function
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3
Q

Gonorrhoe - Complication

A
  • Epididymo-orchitis (uncommon): painful, red swollen testicle/s
  • Prostatitis (very rarely)
  • Pelvic inflammatory disease (PID): dyspareunia, intermenstrual bleeding, post-coital bleeding, discharge
  • Bartholin gland abscess
  • Disseminated disease (rarely):
    macular rash that may include necrotic pustules
    septic arthritis
  • Meningitis or endocarditis (rarely)
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4
Q

Gonorrhoe - Diagnostic

A
  • First pass urine (FPU) - NAAT
  • Penile urethral swab ( just if discharge)
  • Clinician-collected endocervical swab -best
  • Clinician-collected endocervical swab (men)
  • Pharyngeal swab (men)
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5
Q

Gonorrhoe - Treatment uncomplicated

A
  • Ceftriaxone 500 mg IMI, stat. in 2 mL 1% lignocaine+ Azithromycin 1 g PO, stat.

same treatment in pregnancy

  • test 2 weeks after
  • Contact tracing 2month
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6
Q

Gonorrhoe - Treatment Conjunctivitis

A
  • Ceftriaxone 1 g IMI, stat. in 2 mL 1% lignocaine+
    Azithromycin 1 g PO, stat.
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7
Q

Gonorrhoe - other MX

A
  • no sexual contact for 7 days
  • Partner notification and testing ( 2 month back)
  • Notify health department
  • Testing for other STIs
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8
Q

Chlamydia

A
  • most commonly
  • Those < 30 years are at greatest risk.
  • Frequently asymptomatic.
  • Simple to test and treat
  • IP 5days to 12month

Chlamydia trachomatis

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9
Q

Chlamydia - Symptoms

A

85%-90% have no symptoms

  • Dysuria
  • Penile urethral discharge
  • Vaginal discharge
  • Testicular pain
  • Pelvic Pain
  • Intermenstrual bleeding
  • Postcoital bleeding
  • Pain with sex - dyspareunia
  • Anorectal symptoms
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10
Q

Clamydia - complications

A
  • Epididymo-orchitis
  • Pelvic inflammatory disease (PID)
  • Infertility
  • Pregnancy - Ectopic pregnancy, Premature rupture of the membranes, preterm delivery, and low-birthweight infants
  • Reactive arthritis: arthritis, sometimes with concurrent rash and gastrointestinal symptoms
  • Cervicitis
  • Conjunctivitis
  • Perihepatitis
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11
Q

Clamydia - Diagnostic

A
  • First pass urin ( NAAT)
  • Endocervical swab
  • Anorectal swab
  • Pharyngeal swab

NAAT highly sensitive

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12
Q

Chlamydia - Treatment

A

**For uncomlicated genital or pharyngial
** Doxycylin 100 mg for 7 days
* Alternative Azithromycin 1g, immed.

**Anorectal asymptomatic
** Doxycylin 100 mg for 7 days
* Alternative Azithromycin 1g, immedi repeat in 12-24 hrs

**Anorectal symptomatic
** Doxycylin 100 mg for 21 days
* Alternative Azithromycin 1g, stat repeat in 12-24 hrs

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13
Q

Chlamydia - further MX

A
  • No sexual contact for 7 days or until symptoms resolved
  • Contact tracing and testing 6 month
  • notify health department

Pregnancy : Azythromycin 1g immed

Retest in 3 month

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14
Q

Syphillis

A
  • high prevalence : homosexual, Abor/torres
  • in pregnancy - congenital syphylis ( urgent specialist advice

Treponema Palidum

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15
Q

Syphillis- Clinic

A
  • 50% asymptomatic
  • mimic many other conditions , consider testing in all pat with unexplained symptoms
  • 3 stages
    early infectious
    late latent
    tertiary or late symptomatic
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16
Q

Syphylis - early

A
  • primary and secondary and early latent infection
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17
Q

Syphylis - Primary

A
  • genital, anal, oral ulcer (chancre)
  • enlarge LN, rubbery non tender
  • mostly painless
  • Incubation 10-90 days
  • high infectious
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18
Q

Syphylis - secondary

A
  • more than 6 weeks after infection
  • systemic signs and symptoms
  • fever, malaise, headache and Lymphadenopathy
  • rash( 90%) trunk, palms and soles
  • Incubation averrage 6 Weeks
  • highly infectious
  • psoriatic rahes/warty lesion
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19
Q

Syphylis - early latent

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A
  • <2 years
  • positive syphilis serology with no clinical symptoms
  • high infectious
20
Q

Syphylis - late

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A
  • > 2years
  • absence of any symptoms
  • no longer infectious to sexual partners but transmitted during pregnancy
21
Q

syphylis - Tertiary

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A
  • development of complication:
    Skin lessions ( gumma)
    Cardiovascular
    neurological (visual changes, tinnitus, deafness, cranial nerve palsies, meningitis), require intravenous treatment.)
22
Q

Syphylis - congenital

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A
  • severe multi-organ disease with very high mortality and morbidity in both in-utero and neonatal periods
23
Q

Syphylis - Diagnostic

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A
  • Blood Serolgy ( antibody)
  • Swab of ulcer (NAAT/PCR)
  • Test in pat with HIV
  • In remote Australia include donovanosis Pcr
24
Q

Syphilis Treatment early stage

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A
  • Benzathine benzylpenicillin 2.4 MU (1.8 g) IMI, Stat, given as 2 injections containing 1.2 MU
25
Syphilis Treatment Late/ unclear stage
* Benzathine benzylpenicillin 2.4 MU (1.8 g) IMI, given as 2 injections containing 1.2 MU (0.9 g) weekly for 3 weeks
26
Syphilis - further Mx
* no sexual contact for 7 days or symptoms resolve * Contact tracing 3 month/6month/12month * Notify health department
27
Discharge
**Bacterial vaginosis**: thin, grey-white, offensive and fishy odour **Candidiasis**: thick, white, non-offensive **Chlamydia and M. genitalium**: minimal discharge or purulent (cervicitis) **Gonorrhoea**: purulent (cervicitis) *** Trichomoniasis:** offensive green and yellow, scanty to profuse and frothy (vaginitis)
28
Donovaosis granuloma inguinale
- Indigenous - sores , destructive infection - NAAT - Azithromycin or Doxycyclin for 4 weeks
29
**Bacterial vaginosis**
* Garnerella * Amsel test : ph>4.5, Clue cells, Amin test pos * thin, grey-white, offensive and fishy odour * mc cause of Vaginitis * oral metronidazol or tinizole * Clindamycin in pregnancy * no need to treat partner
30
Candidiases
* thick, white, non-offensive * pruritus /Brick like vagina/dysuris * Clotrimazole vag tabl and cream * Nystatin for recurent * fluconazol ( not in preg)
31
Trichimoniasis
* offensive green and yellow, scanty to profuse and frothy (vaginitis) * Inv PCR * Strawberry cervix * Metronidazol or tinidazol * treat partner
32
HIV - investigation
* **Elisa**- antibody screning * **Western blot** - to confirm Elisa * **Immune function** - CD4 cell count * **Viral load** - treatment response
33
HIV acute seroconvertion
* within 6 weeks, flue like symptoms * Headache, malaise, photophobia * fever night sweats, anorexia, sore throat, diarrhoe, lymphadenopathy Resemble ebv inifection( monospot test)
34
HIV - Clinic
* Fever * weight loss * respiratory: Pneumocystis Jerovicii Pneumonia/Tb reactivation * GI : diarrhoe * Neuro GBS HIV encephalopathy, Cryptococcal meningitis * Kaposy sarcoma, Herpes * Sti, candidiasis * Ulcer
35
What is its significance in HIV?
* As the antibodies take about 2-8 weeks to present in the blood stream, the window period varies between 3 - 12 weeks in case of HIV.
36
What is the window period?
time between the initial infection and a positive test results.
37
PrEP - Pre-exposure prophylaxis
Perform a risk assessment to determine the risk of HIV INFECTION: * men who have sex with men - MSM * transgender and gender diverse people * heterosexual people * people who inject drugs 3 months is the key word
38
Before prescribing HIV PrEP
Perform baseline testing: * HIV, * Hepatitis B and C virus * Sexually transmitted infections * RFT - LFT * Pregnancy USE: Tenofovir + Emtricitabine (Truvada) orally, daily.
39
Guidelines before starting antiretroviral therapy in Australia:
HIV antibody - antigen * CD4 cell count * Plasma HIV RNA (viral load) * HIV genotypic resistance as soon as possible after diagnosis * Hepatitis B and C virus serology * FBE – RFT – LFT * FBS and serum lipids * Serum cryptococcal antigen if CD4 cell count is less than 100 cells/ microlitre * Tests to exclude opportunistic and co-infections if the patient is symptomatic.
40
HIV antiviral therapy
Dolutegravir + abacavir + lamivudine= Triumeq * Tenofovir alafenamide + emtricitabine + bictegravir = Biktarvy * Tenofovir alafenamide + emtricitabine + elvitegravir + cobicistat = Genvoya
41
HIV Infant management
* 4-week course of oral zidovudine prophylaxis for all HIV-exposed infants * Started ORALLY or IV as soon after birth as possible, within 6 hours of delivery
42
DX of HIV in Infant
During pregnancy, the foetus passively acquires maternal HIV antibodies across the placenta – so Elisa/WB will be (+) * It can take up to 12 to 18 months for an infant to clear these maternal antibodies.
43
HIV post- exposure prophylaxis
LOW RISK: * Zidovudine + Lamivudine 12 hourly for 4 weeks HIGH RISK: (ASAP) * Zidovudine + Lamivudine + Indinavir within 8 hrs for 6 weeks MONITORING at 0,4,6,12,24 and 52 weeks.
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45
Pregnancy and HIV
* Risk of transmission: 15 to 25% * Antiretroviral therapy given to the mother during pregnancy and to the infant post delivery * Caesarean section delivery * Exclusive formula feeding.
46
When do you start Antiretroviral therapy
- Reduces morbidity and mortality regardless of CD4 cell count, so it is recommended for all people with HIV infection. - For patients without opportunistic or co-infections, start antiretroviral therapy as soon as possible. - Once started, treatment should be continued indefinitely without interruption, unless oral therapy cannot be taken, or severe toxicity develops.
47
Jarisch-Herxheimer reaction
* common reaction to treatment in patients with primary and secondary syphilis * 6-12 hours after commencing treatment * fever, headache, malaise, rigors and joint pains, and lasts for several hours * analgesics and rest * Patients should be alerted to the possibility of this reaction and reassured accordingly.
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