6: STIs Flashcards
What is the most common STI in the UK?
Chlamydia
How does Chlamydia appear on a Gram stain?
Gram negative
But it’s very difficult to stain
What is a rare consequence of chlamydia infection?
Pelvic inflammatory disease (PID)
What type of bleeding occurs in chlamydia infection?
Post-coital and intermenstrual bleeding
How does chlamydia present in females?
Post-coital / intermenstrual bleeding
Mucopurulent discharge
Abdominal pain
Dyspareunia
How does chlamydia present in males?
Urethral discharge
Dysuria
Apart from PID, what are other complications of chlamydia infection?
Tubal damage –> infertility
Neonatal transmission (look out for conjunctivitis)
Reiter’s syndrome
What rheumatological condition can people get following chlamydia infection?
Reactive arthritis
i.e Reiter’s disease
Chlamydia is more common in (men / women).
women
Which variant of chlamydia is more severe than average and presents primarily in MSM?
Lymphogranuloma venereum (LGV)
LGV is primarily found in MSM.
What are the symptoms?
Rectal pain / discharge / bleeding
often misdiagnosed as GI problem
Chlamydia is likely to ___ with other STIs.
coexist
When is chlamydia tested for?
14 days following exposure
What are the NAAT tests used to detect chlamydia, 14 days after exposure, in
a) men
b) women?
a) First pass urine sample +/- rectal swab
b) Vulvovaginal swab
How is chlamydia treated?
Doxycycline 100mg BD 1/52
Which antibiotic is used second-line for chlamydia infection?
Azithromycin
How does Neisseria gonorrhoeae appear on a Gram stain?
Gram negative intracellular diplococci
What is the incubation time of gonorrhoea?
2 - 5 days
Gonorrhoea is more common in (men / women).
men
as opposed to chlamydia
How does gonorrhoea present in men?
Purulent urethral discharge
Dysuria
WHERE must you swab in men with suspected gonorrhoea infection?
Urethra
Rectum
Pharynx…
all the sites
What percentage of women have gonorrhoea and are asymptomatic?
How do they present otherwise?
50%
Vaginal discharge, pelvic pain
How is gonorrhoea screened for?
NAAT testing
First pass urine in men, VV swab in women
Concurrently tests for chlamydia
How is gonorrhoea investigated in patients who are symptomatic?
Culture
How is gonorrhoea treated?
Ceftriaxone 500mg IM
How is gonorrhoea treated if an IM injection of ceftriaxone is rejected by the patient?
Cefixime 400mg PO
What must be done two weeks after antibiotic treatment in all patients with gonorrhoea?
Test of cure
What is the presentation of a primary infection of genital herpes?
Extreme pain
Blistering and ulceration of genitalia
Dysuria
Discharge (urethral / vaginal)
Enlarged inguinal lymph nodes
Viral prodrome (fever and myalgia)
Which subtype of HSV causes recurrent genital herpes?
HSV-2
How often does genital herpes recur when the causal agent is
a) HSV-1
b) HSV-2?
a) Every 1-2 years
b) Every 2-3 months
Genital herpes tends to recur (more / less) often over time.
less often
disease burns itself out
How is genital herpes investigated?
Swab of deroofed lesions for viral PCR
What drugs are used in the treatment of genital herpes?
To treat: Aciclovir 400mg TDS 5/7 PO
For pain: topical lidocaine
Which subtype of HSV sheds more often and causes more recurrent genital herpes?
HSV-2
What drugs can be given for highly recurrent HSV-2 to prevent recurrence and transmission?
Aciclovir 400mg BD for a year
Check this
Why is genital herpes in the 3rd trimester of pregnancy concerning?
Chance of neonatal herpes
What is the most common viral STI in the UK?
HPV
80% of people will have it
HPV has a ton of subtypes.
Which cause
a) low risk disease (e.g genital warts)
b) high risk disease (e.g cancer)?
a) 6 & 11
b) 16 & 18
Which presentations of HPV are caused by
a) HPV 6 & 11
b) HPV 16 & 18?
a) Anogenital warts
b) Cancers
Which drugs are used to kill off genital warts topically?
Podophyllin first-line
Imiquimod second-line
Apart from podophyllin and imiquimod, what treatment options exist for genital warts?
Cryotherapy
Electrocautery
Who is vaccinated against HPV?
11 - 13 year old girls
MSM
(School-age boys are going to be included soon)
Which bug causes syphilis?
Treponema pallidum
What does treponema pallidum look like on microscopy?
Spirochaete
Which stages of syphilis are
a) infectious
b) non-infectious?
a) Primary, secondary and early latent
b) Late latent and tertiary
How long does syphilis incubate for before a chancre appears?
21 days on average
What is a chancre?
Painless ulcer of primary syphilis
What is the presentation of secondary syphilis?
Rashes
Snail-track ulcers
Lymphadenopathy
Alopecia
What is condylomata lata?
V infectious skin lesion of secondary syphilis
Why is syphilis referred to as the great imitator?
Mimics many other diseases (skin, pharynx, rectum, mucous membranes…)
What are two investigations used for syphilis?
Viral swab –> PCR
Serology
Which drug is used to treat syphilis?
Benzathine penicillin IM
What is Reiter’s syndrome?
Triad of arthritis, conjunctivitis and urethritis
Commonly seen after GU and GI infections e.g chlamydia and gonorrhoea
