Bacterial STIs Flashcards
Things to ask in all male sexual histories?
Pain in testes/scrotum Swellings Itching or sore skin Skin changes Discharge Dysuria Pain in joints/eyes/elsewhere
Things to ask in all female sexual histories?
Discharge Dysuria/frequency Vaginal itching/soreness Genital skin changes Abdo pain Pain during/after sex Systemic symptoms
Tests to do in all female sexual history tings?
Swab any vulval ulcer/break in skin - herpes/T.pallidum PCR
VVS - chlam, gon NAAT
HVS - candida, BV, TV
Endocervical swab - gon culture
HIV/Syphilis serology
MSU
?smear - SMEAR IS FIRST
Tests to do in all male sexual history tings?
Swab any breaks in skin/ulcers - herpes/T.pallidum PCR
Urethral swab - gram stain/culture for gon
First void urine - chlam/gon NAAT
Syphilis/HIV serology
MSU - dipsitck if appropriate
MSM - (Rectal/pharyngeal swabs - NAAT and culture for chlam and gon)
How does chlamydia present in women?
Vaginal discharge
Dysuria
PCB/IMB
Pelvic pain
Treatment of chlamydia?
Azithro 1g stat - safe in prego
Doxycycline 100mg BD 7/7 - not in prego
Partner notification
No sex until completed course
Yellow/frothy discharge?
TV
Homogenous white discharge?
BV
Cottage cheese discharge?
Candida
Yellowish discharge from os?
Gonnorrhoea
Treatment for BV/TV?
400mg metronidazole BD 7/7
Treatment for candida?
Clotrimazole
Causes of dysuria in a female?
UTI, chlamydia, gonorrhoea, genital herpes. genital candidiasis, trichomonas vaginalis, vulval dematoses
Causes of PCB in young woman?
Infection - chlamydia, gonorrhoea
Cervical abnormality - polyp, CIN, malignancy, ectropion
PID
Causes of urethral discharge in a man?
Chlamydia - 50% asymptomatic, clear discharge
Gonorrhoea - lots and lots of yellow/green discharge
Non-gonococcal urethritis - gram stained urethral smear (>5 PMNL per high power field)
UTI - MSU if symptoms suggestive
Treatment for gonorrhoea?
Ceftriaxone 500mg IM stat
Azithromycin 1g PO
Causes of rash on penis?
Infection - candidad, staph/strep, anaerobes, trichamonas, gardanella, syphiilis
Derm - circinate balanitis, lichen sclerosis, zoons balanitis, erythroplasia of queryat, lichen planus, psoriasis, eczema, pemphigus
Miscellaneous - trauma, irritant, poor hygiene, contact allergy, fixed drug eruption, Steven-Johnson syndrome
General management of rash on penis?
Salt water bathing
Avoid soaps while inflammation persists
Use aqueous cream/E45 wash as soap substitute
Management of penis candida?
Topical antifungals - canestan BD until symptoms resolved
Management of eczema/psoriasis?
Moderately potent topical steroid e.g. betnovate cream
Management of lichen planus?
usually self limiting
Management of lichen sclerosis?
Potent topical steroid. Requires long term follow up as small risk of malignant transformation
Management of scabies/pubic lice?
Topical permethrin and treat all household contacts
Causes of sexually acquired proctitis/rectal symptoms?
Lymphogranuloma venerum Gonorrhoea Non-LGV chlamydia Herpes Shigella Hepatitis A Non-sexually acquired (IBD, haemorrhoids, polyps, malignancy)
Causes, diagnosisand management of LGV?
Causes - 3 types of chlamydia trachomatis. Dense sexual networks in big cities, associated with big sex parties, chem sex, Hep C outbreaks.
Diagnosis - only in central lab if NAAT chlamydia +ve.
Management - abstain, partner notification, safer sex advice, need for WP blood testing. Doxycycline 3 week course.
Follow up - risk of permanent damage (fibrosis, strictures, fistulae) may need surgery
Causes of painful swollen testicle?
Infections, trauma, torsion, tumours (I and 3 Ts)
What is acute epididymo-orchitis?
Syndrome of pain, swelling and inflammation of epididymis/testes (must exclude torsion)
Causes of acute epididymo-orchitis?
Local extension from urethra (chlamydia, gon, enteric organisms from insertive anal)
From bladder (urinary pathogens)
Consider mumps orchitis and TB in high risk groups
Management of acute epididymo-orchitis?
Abstain until you and partner treated
Ceftriaxone then 10-14 days of doxycycline
If STI cause unlikely –> ofloxacin/ciprofloxacin
Local complications of STIs?
FEMALE PID, endometritis, salpingitis Tubal infertility, ectopic pregnancy Peri-hepatitis (Fitz-Hugh Curtis) Bartholin's abscess
MALE
Epididymo-orchitis, prostatitis
Proctitis
Skin/mucus membrane manifestations of STIs?
Acute bacterial conjunctivitis
Disseminated gonococcal infection
Reactive arthritis
What is reactive arthritis?
Sterile inflammation of synovial membranes, tendons, fascia, triggered by infection at distant site.
Urethritis, arthritis, conjunctivitis
Associated with HLA-B27
Chlamydia pregnancy complications?
IUGR, PROM, pre-term delivery, low birth weight
Gonorrhoea pregnancy complciations?
LBW, preterm birth
BV/TV pregnancy complications?
Implicated with adverse pregnancy outcomes
What is opthalmia neonatorum?
Presents after 1-2 weeks of life
Conjunctivits, chemosis (oedema of conjunctiva), purulent exudate
NAAT forchlam and gon from everted eyelide
Gram stain and culture for GC
STI screen in parents
What is neonatal pneumonitis?
Due to chlamydia - occurs 1-3 months of age
Staccato cough, tachypnoea
CXR - hyperinflation, bilateral diffuse infiltrates
Nasopharyngeal swabs/tracheal aspirates for chlamydia NAATs
Erythromycin
Screen and treat parents
What organism is TV?
Flagellated protozoan
What organisms cause BV?
Gram -ve enterobacteria
Symptoms of TV?
Vaginal discharge - thick or thin, frothy or yellow, unpleasant smell.
Soreness/itching in and around the vagina
Dysuria
Lower abdominal pain
Signs of TV?
Strawberry cervix
Raised pH of vaginal discharge
Diagnosis of TV?
HVS
Wet slide preparation to visualise protozoa under microscope
Causes of BV?
Imbalance of vaginal flora with overgrowth of gram -ve organisms
Vaginal douching/perfumed soaps
Unprotected sex (presence of semen in vagina)
Hormonal changes in female cycle
Symptoms of BV?
White/grey discharge
Fishy smell
May be asymptomatic
Diagnosis of BV?
HVS and dry slide for microscopy
Reduction in normal lactobacilli
Gram variable bacilli adhering to shed epithelial cells
