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4th Year GOSH > Bacterial STIs > Flashcards

Bacterial STIs Flashcards

1
Q

Things to ask in all male sexual histories?

A 
Pain in testes/scrotum
Swellings
Itching or sore skin
Skin changes
Discharge
Dysuria
Pain in joints/eyes/elsewhere
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2
Q

Things to ask in all female sexual histories?

A 
Discharge
Dysuria/frequency
Vaginal itching/soreness
Genital skin changes
Abdo pain
Pain during/after sex
Systemic symptoms
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3
Q

Tests to do in all female sexual history tings?

A

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

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4
Q

Tests to do in all male sexual history tings?

A

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)

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5
Q

How does chlamydia present in women?

A

Vaginal discharge
Dysuria
PCB/IMB
Pelvic pain

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6
Q

Treatment of chlamydia?

A

Azithro 1g stat - safe in prego
Doxycycline 100mg BD 7/7 - not in prego
Partner notification
No sex until completed course

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7
Q

Yellow/frothy discharge?

A

TV

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8
Q

Homogenous white discharge?

A

BV

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9
Q

Cottage cheese discharge?

A

Candida

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10
Q

Yellowish discharge from os?

A

Gonnorrhoea

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11
Q

Treatment for BV/TV?

A

400mg metronidazole BD 7/7

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12
Q

Treatment for candida?

A

Clotrimazole

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13
Q

Causes of dysuria in a female?

A

UTI, chlamydia, gonorrhoea, genital herpes. genital candidiasis, trichomonas vaginalis, vulval dematoses

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14
Q

Causes of PCB in young woman?

A

Infection - chlamydia, gonorrhoea
Cervical abnormality - polyp, CIN, malignancy, ectropion
PID

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15
Q

Causes of urethral discharge in a man?

A

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

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16
Q

Treatment for gonorrhoea?

A

Ceftriaxone 500mg IM stat

Azithromycin 1g PO

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17
Q

Causes of rash on penis?

A

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

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18
Q

General management of rash on penis?

A

Salt water bathing
Avoid soaps while inflammation persists
Use aqueous cream/E45 wash as soap substitute

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19
Q

Management of penis candida?

A

Topical antifungals - canestan BD until symptoms resolved

20
Q

Management of eczema/psoriasis?

A

Moderately potent topical steroid e.g. betnovate cream

21
Q

Management of lichen planus?

A

usually self limiting

22
Q

Management of lichen sclerosis?

A

Potent topical steroid. Requires long term follow up as small risk of malignant transformation

23
Q

Management of scabies/pubic lice?

A

Topical permethrin and treat all household contacts

24
Q

Causes of sexually acquired proctitis/rectal symptoms?

A 
Lymphogranuloma venerum
Gonorrhoea
Non-LGV chlamydia
Herpes
Shigella
Hepatitis A
Non-sexually acquired (IBD, haemorrhoids, polyps, malignancy)
25
Q

Causes, diagnosisand management of LGV?

A

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

26
Q

Causes of painful swollen testicle?

A

Infections, trauma, torsion, tumours (I and 3 Ts)

27
Q

What is acute epididymo-orchitis?

A

Syndrome of pain, swelling and inflammation of epididymis/testes (must exclude torsion)

28
Q

Causes of acute epididymo-orchitis?

A

Local extension from urethra (chlamydia, gon, enteric organisms from insertive anal)

From bladder (urinary pathogens)

Consider mumps orchitis and TB in high risk groups

29
Q

Management of acute epididymo-orchitis?

A

Abstain until you and partner treated

Ceftriaxone then 10-14 days of doxycycline

If STI cause unlikely –> ofloxacin/ciprofloxacin

30
Q

Local complications of STIs?

A 
FEMALE
PID, endometritis, salpingitis
Tubal infertility, ectopic pregnancy
Peri-hepatitis (Fitz-Hugh Curtis)
Bartholin's abscess

MALE
Epididymo-orchitis, prostatitis
Proctitis

31
Q

Skin/mucus membrane manifestations of STIs?

A

Acute bacterial conjunctivitis
Disseminated gonococcal infection
Reactive arthritis

32
Q

What is reactive arthritis?

A

Sterile inflammation of synovial membranes, tendons, fascia, triggered by infection at distant site.

Urethritis, arthritis, conjunctivitis

Associated with HLA-B27

33
Q

Chlamydia pregnancy complications?

A

IUGR, PROM, pre-term delivery, low birth weight

34
Q

Gonorrhoea pregnancy complciations?

A

LBW, preterm birth

35
Q

BV/TV pregnancy complications?

A

Implicated with adverse pregnancy outcomes

36
Q

What is opthalmia neonatorum?

A

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

37
Q

What is neonatal pneumonitis?

A

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

38
Q

What organism is TV?

A

Flagellated protozoan

39
Q

What organisms cause BV?

A

Gram -ve enterobacteria

40
Q

Symptoms of TV?

A

Vaginal discharge - thick or thin, frothy or yellow, unpleasant smell.

Soreness/itching in and around the vagina
Dysuria
Lower abdominal pain

41
Q

Signs of TV?

A

Strawberry cervix

Raised pH of vaginal discharge

42
Q

Diagnosis of TV?

A

HVS

Wet slide preparation to visualise protozoa under microscope

43
Q

Causes of BV?

A

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

44
Q

Symptoms of BV?

A

White/grey discharge
Fishy smell
May be asymptomatic

45
Q

Diagnosis of BV?

A

HVS and dry slide for microscopy

Reduction in normal lactobacilli
Gram variable bacilli adhering to shed epithelial cells

4th Year GOSH (23 decks)

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