Bacterial STIs Flashcards
How long is the half life of azithromycin?
68 hours
What % of NGU is cause by M genitalium?
25%
What is the commonest cause of non STI PID?
Anaerobes-most commonly E coli
Often severe and in older women
Why should all PID regimens be effective against GC and CT?
Negative vulvovaginal tests don’t rule out upper reproductive tract infection
What is association between PID and anaerobes/BV?
Endometritis causes bleeding- which can provoke BS
Is metronidazole important in management of PID?
Abx regimes without metronidazole perform as well suggesting that anaerobes are less important in mild PID
Is test of cure required for Mycoplasma genitalium?
Yes - 5 weeks post treatment to ensure microbiological cure
Who do BASHH Recommend that we test for Mycoplasma genitalium?
Recommend: NGU PID Consider: Cervicitis Epidydimitis Proctitis
What is recommended to manage GC if penicillin allergy?
3rd generation cephalosporins (cefixime and ceftriaxone show negligible cross allergy)
Gentamycin 240 mg IM + azithromycin 2g
Spectinomycin 2g IM +azithromycin 2g
Azithromycin 2g alone (high resistance)
What is recommended treatment of recurrent/persistent NGU?
If treated with doxycycline regimen first line:
Recommended
Azithromycin 1g stat then 500 mg once daily for the next 2 days,
PLUS metronidazole 400mg twice daily for five days
Azithromycin should be started within 2 weeks of finishing doxycycline. This is not necessary if the person has tested Mgen-negative.
NB patients should be advised to abstain from sexual intercourse until 14 days after the start of treatment and until symptoms have resolved.
If treated with azithromycin regimen first line:
Recommended
Moxifloxacin 400mg once daily for 10 days, PLUS metronidazole 400mg twice daily for five days
Alternative
Doxycycline 100mg twice daily for 7 days, plus metronidazole 400mg twice daily for five days
What is the treatment for 1st episode NGU?
Doxycycline 100mg twice daily for 7 days
Alternatives
Azithromycin 1g stat then 500mg once daily for the next 2 days
or
Ofloxacin 200mg twice daily, or 400mg once daily, for 7 days
How long should patients abstain from sex if being treated for NGU?
14 days after the start of treatment, and until symptoms have resolved.
Why should patients abstain from sex for 14 days after start of treatment for NGU?
This is likely to reduce the risk of selecting/inducing macrolide resistance if exposed to Mgen or Neisseria gonorrhoeae which would make these infections more difficult to treat.
What is the commonest cause of NGU?
chlamydia 11-50% M gen- 6-50% Ureaplasma 11-26% TV 1-20% Adenovirus 2-4% HSV 2-3%
What are the STI causes of neonatal conjunctivitis?
CT
GC
Group B beta haemolytic strep
What is the management of neonatal ophthalmia neonatorum cause by CT
50 mg/kg erythromycin orally
4 doses in 24 h
14 day course
What is the risk of neonatal ophthalmia neonatorum if mother has untreated CT and what are complications?
30-50% risk of vertical transmission
67% bilateral conjunctivitis
Corneal scarring is RARE
What is the risk of neonatal ophthalmia neonatorum if mother has untreated GC and what are complications?
30-40% risk of vertical transmission
Can lead to ulceration, corneal scarring, blindness
What is the management of neonatal ophthalmia neonatorum cause by GC
25-50mg /kg of Ceftriaxone IM/IV
Is GC and CT neonatal ophthalmia neonatorum a notifiable disease?
No - not since 2010
What is the commonest cause of neonatal ophthalmia neonatorum in the UK?
Chlamydia
what i’ll is the recommended antibiotic regime for SARA?
standard course of antibiotics for whichever STI is identified?
morphology of chlamydia?
Gram negative ovoid
Morphology of M genitalium?
Flask shaped with narrow terminal rod
Morphology of haemophilia ducreyi?
Shoals of fish
Small gram negative coccobacillus in chains
(Microscopy low sensitivity- PCR most sensitive 95%)
Morphology of klebsiella granulomatosis?
donovanosis Donavon bodies deep purple Wrights/giemsa stain Closed safety pin appearance Shiny halo around bacteria Bipolar inclusions in bacteria Cant do PCR/culture- not available
Morphology of GC?
Gram negative diplococci
Incubation of LGV?
3-30 days
What constitutional symptoms are associated with LGV?
Fever, arthritis, aseptic meningitis, hepatitis, pneumonia
Erythema multiforme
Erythema nodosum
What is tertiary LGV?
Anorectal syndrome
Direct infection from AI
Proctitis
Anal discharge with bleeding, rectal pain, tenesmus, fever
Chronic–> fistula, abscesses, strictures, scarring
(saxophone penis)
Management of LGV?
Doxycycline 100mg po bd 21 days
or
Erythromycin 500mg ads 21 days
PN for LGV?
30 days from symptom onset
Or 3/12 of asymptomatic (like CT)
Epidemiological treatment
Should be examined and tested for chlamydial infection and receive presumptive treatment with 21 days of doxycycline 100 mg twice daily or alternative regimen for the same duration
Does LGV require follow up
Patients should be followed up until symptoms resolve.
Routine TOC not necessary if recommended regimen has been completed.
If TOC is required it should be performed 2 weeks after completion of therapy.
Is routine LGV typing of symptomatic and asymptomatic Chlamydia infection at any site recommended?
Only in HIV-positive MSM