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Common STI presentations Flashcards

1
Q

What are some causes of dysuria in young women?

A 
UTI
Chlamydia trachomatis
Gonorrhoea
Genital herpes 
Genital candidiasis 
Trichomonas vaginalis
Vulval dermatoses
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2
Q

What diagnosis would a Hx of vaginal discharge, PCB or IMB and pelvic pain make you consider?

A

Chlamydia
Gonorrhoea
PID

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3
Q

What diagnosis would a Hx of frequent, nocturne, haematuria and loin pain make you consider?

A

UTI

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4
Q

What diagnoses would a presentation of vulval ulcers, itching or soreness and external dysuria make you consider?

A

Herpes

Candida

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5
Q

If someone presents with vaginal skin problems, and skin problems elsewhere, what diagnosis might you consider?

A

Lichoplanus

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6
Q

What examinations and investigations would you do for a woman who presents with:
14 day Hx of dysuria
Trimethoprim not helped
Canesten not helped

A

Examinations:
vulva - looking for excoriation, fissuring, erythema, oedema, ulceration

Investigations:
MSU
Swabs
- any ulcers (herpes/T. pallidum)
- VV swab (chlamydia and gonorrhoea NAAT)
- High vaginal swabs (candida, BV and TV)
- Endocervical swab (gonorrhoea culture)

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7
Q

How should you treat chlamydia?

A

Azithromycin 1g stat (safe in pregnancy)
OR
doxycycline 100mg bd 1/52

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8
Q

Can 1g of azithromycin be given in pregnancy?

A

Yes - safe in pregnancy

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9
Q

Can doxycycline be given in pregnancy?

A

No

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10
Q

What is important to tell someone who has just been diagnosed with chlamydia?

A

Discuss partner notification

Don’t have sex until both partners have completed their ABX

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11
Q

Do patients who have been given azithromycin for chlamydia have to wait 7-10 days before having sex again?

A

Yes

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12
Q

What are some potential causes of vaginal discharge in a young woman?

A

Normal (?genitally aware)

Vaginal infections - BV, TV and candida

Cervical infections - chlamydia trachoma’s
N. gonorrhoea

Physiological - cervical ectopy
pregnancy

Other: retained tampon, foreign body

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13
Q

How would you diagnose a female genital infection?

A

Look at vaginal discharge

Vaginal pH swab (BV)

High vaginal swab: BV, candida, trichomonas

VV swab: chlamydia and gonorrhoea NAAT

Endocervical swab: gonorrhoea culture

Syphilis serology
HIV antibody/antigen testing

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14
Q

What pH should the vagina have? Acidic or alkaline?

A

Acidic

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15
Q

What pH do TV and BV cause on a swab? Acidic or alkaline?

A

alkaline

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16
Q

What are some causes of post coital bleeding?

A

Infection: chlamydia
gonorrhoea

Cervical abnormality: polyp
premalignant
malignancy
ectopy

Pill not strong enough

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17
Q

What are some signs of cervicitis?

A

mucopurulent discharge

contact bleeding

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18
Q

What are some causes of dysuria and urethral discharge in men?

A

STI: chlamydia
gonorrhoea
NGU

UTI

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19
Q

If a young male presents with UTI, what should you do?

A

Consider further investigation of renal tract or referral to urology

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20
Q

In a male presenting with dysuria and penile discharge, how would you distinguish between STI and UTI?

A

other urinary Sx - UTI

testicular pain 
spots/blisters
sexual Hx
PMH
drug Hx
allergies
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21
Q

How would you investigate a male with dysuria and penile discharge?

A

urine: - MSU for microscopy and culture
- first void urine (chlamydia and gonorrhoea)

Swabs: - urethral swab (culture for gonorrhoea)
- Rectal and pharyngeal (chlamydia and gonorrhoea in all MSM. NAAT and culture if going to give ABX on this visit)

Bloods: - syphilis serology
- HIV antibody test

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22
Q

how would you treat a man with chlamydia?

A

azithromycin 1g single dose
OR
doxycycline 100mg bd 7 days

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23
Q

how would you treat a man with gonorrhoea?

A

ceftriaxone 500mg IM single dose
azithromycin 1g PO

site of infection may alter ABX choice eg. pharyngeal gonorrhoea or rectal chlamydia - speak to GUM

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24
Q

What are the two key things to mention to patients with an STI?

A

Avoid unprotected sex until both they and their partner have been treated

Partner notification - text etc.

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25
what is balanitis?
inflammation of the glans penis, it is a collection of disparate conditions with a similar clinical picture and varying aetiologies.
26
What are infective causes of balanitis, genital itch, rash and vulvitis?
Candidiasis Trichomoniasis (females) Scabies Pthyris pubis
27
What are non-infective causes of balanitis, genital itch, rash and vulvitis?
``` Non-infective Dermatitis Irritant vulvitis (females) Irritant balanitis (males) Lichen sclerosis Lichen planus Lichen simplex ```
28
What investigations would you do for someone who presented with balanitis?
Subpreputial swab for candida and bacterial culture urinalysis (candida) Viral swab (HSV) Syphilis serology STI screen Biopsy if uncertain and condition persists
29
What conservative management would you suggest for someone with balanitis?
Salt water bathing Avoid soaps while inflammation persists Use aqueous cream/E45
30
What management would you suggest for someone with balanitis caused by chlamydia?
topical antifungals eg. canesten cream BD until symptoms resolve
31
What management would you suggest for someone with balanitis caused by eczema/psoriasis?
moderately potent topical steroid (betnovate)
32
What management would you suggest for someone with balanitis caused by lichen plants?
usually self-limiting
33
What management would you suggest for someone with balanitis caused by lichen sclerosis?
potent topical steroid requires long-term follow up as small risk of malignant transformation
34
What management would you suggest for someone with balanitis caused by scabies/pubic lice?
topical permethrin treat all household/sexual contacts
35
How does candida balanitis present? how would you treat it?
red papules Superficie erosions or white plaques Topical therapy eg. clotrimazole cream OR oral fluconazole
36
What things do you need to exclude/consider in someone who presents with candida balanitis?
Diabetes ?immunosupression Lichen planes and penile intraepithelial neoplasia - mimic candida balanitis
37
How does circinate balanitis? What is it almost indistinguishable from?
Painless mucocutaneous lesions Psoriasis
38
What is circinate balanitis associated with?
SARA Sexually acquired reactive arthritis
39
How might scabies present?
widespread pyritic dermatitis genital nodules burrows in finger spaces
40
How would you diagnose scabies?
Clinical Skin scrapings
41
How would you treat scabies?
Permethrin 5% cream Treat household and close contacts
42
What is pthyris pubis?
pubic lice
43
How might pthyris pubis present? how is it diagnosed?
genital itch blue spots perifolliculitis clinically
44
How would you treat pthyris pubis?
Permethrin 1% OR malathion 0.5% Treat sexual partners
45
What can cause genital dermatitis?
Irritant Atopy Allergic Seborrhoeic
46
How would you treat dermatological eczema?
avoid precipitants General skin care advice +/- topical steroids
47
What causes lichen simplex?
Chronic rubbing or scratching
48
How does lichen simplex present?
Poorly demarcated plaques of thickened skin Usually effects scrtoum in men and labia major in women
49
How would you treat lichen simplex?
Avoid irritants Emollients/moisteriser Mild topical steroid
50
what are symptoms and signs of lichen sclerosis?
itch soreness atrophic skin erosions telangiectasia loss of architecture
51
How would you diagnose lichen sclerosis?
Clinical or biopsy
52
What is the treatment for lichen sclerosis?
General skin care advice Potent topical steroids
53
What is a complication (rare) of lichen sclerosis?
Squamous cell carcinoma
54
What causes lichen planus?
Unknown
55
How might lichen plants present?
Different morphological appearances: Violaceous, flat-topped papule, white lacy papules, plaques and erosions
56
What is the main symptom of lichen planus?
itching
57
What is the treatment for lichen planus?
Generally self-limiting
58
What diagnosis would you suspect in someone who presented with a 2 day Hx of a sore spotty penis, sore left groin and generally feeling unwell?
Herpes
59
What do herpes ulcers look like on penises?
shallow ulcers under foreskin
60
How long does a primary infection of HSV take to present? What happens after this time?
2 days -2 weeks Becomes a latent virus in local sensory ganglia outbreaks occur when the virus is reactivated
61
When does viral shedding generally occur in HSV?
First year of infection Those with frequent outbreaks
62
What are the different types of HSV? What organisms cause these?
HSV1 - usual cause of oral (now most common cause of genital disease) Caused by 6, 11 HSV2 - more likely to cause anogenital symptoms Caused by 16, 18
63
Which type of HSV is more associated with recurrent outbreaks?
HSV2 (about 4 per year) HSV1 (about 1 per year) Recurrent outbreaks limited to infected dermatome Recurrence rate decreases over time
64
If someone presents with genital warts/ulcers and have a history of unprotected sex, what tests might you do?
Swabs (NAAT): Chlamydia Gonorrhoea HIV serology Syphilis serology Swab from ulcers for HSV 1& 2 and syphilis (PCR)
65
How would you treat someone with herpes simplex virus?
Salt water bathing Topical anaesthetic/oral analgesia Acicolvir 300mg 3 x a day for 5 days
66
How is Herpes spread?
Direct contact with mucous membrane or skin
67
When is herpes simplex most infectious?
During recurrence BUT asymptomatic viral shedding occurs
68
How would you counsel someone who's got HSV?
acknowledge distress Info about disease, recurrence rate etc. Condoms reduce transmission Avoid sex during recurrences Disclosure is advised and should be documented
69
How might syphilis present?
single non-tender ulcer on penis non-tender lymph nodes in groin
70
How might you investigate someone you thought had syphilis?
``` Chlamydia Gonorrhoea HIV Hepatitis Syphilis ```
71
What would you want to discuss with someone who has suspected syphilis?
Sexual health screen Partner notification Discuss HIV risk since last test Repeat 'window period' bloods Hep B vaccination Safer sex advice
72
How is syphilis spread?
Oral contact | Skin to skin contact with chancres/mucosal lesions
73
How do you treat primary syphilis?
First line: benzathine penicillin 2.4MU IM stat
74
How might early primary syphilis present?
Chancre | Regional lymphadenopathy
75
When does secondary syphilis occur? How does it present?
If patient doesn't seek treatment or not fully treated ``` Systemic infection: flat red rash on chest, torso, palms or feet. Snail trail in mouth splenomegaly neurological (eg. hearing) ```
76
After 4-12 weeks of primary/secondary syphilis, what happens? What stage of disease could this be?
Sx disappear Symptoms can be silent for up to 2 years ``` Early latent (up to 2 years) Late latent (after 2 years) ```
77
If someone has no symptoms, but screens positive for syphilis, what is it important to know? Why?
Syphilis can be asymptomatic after initial presentation Need to know when they were last screened -ve for syphilis. Tells you when they acquired syphilis. Decides whether early latent or late latent. Effects treatment.
78
What type of syphilis does someone have if they HAVE had a NEGATIVE syphilis screen within the last 2 years?
Early latent - acquired within the last 2 years
79
What type of syphilis does someone have if they HAVEN'T had a NEGATIVE syphilis screen within the last 2 years?
Assume late latent - unsure whether this was acquired within the last 2 years, could be longer
80
How would you treat early latent syphilis?
1 injection of
81
How would you treat late latent syphilis?
1 injection every 3 weeks
82
What is a cardiovascular manifestation of syphilis?
aortic root involvement
83
What is a gummatous manifestation of syphilis?
nodules
84
What is a neurological manifestation of syphilis?
meningovascular tabes dorsalis general paresis
85
How does genital ulceration impact the risk of HIV transmission?
Increases the risk of transmission
86
What are other (non-syphilitic) causes of genital ulceration?
``` Chancroid Shingles Lichen sclerosis and planus Aphthous ulcer Malignancy Zion's balanitis Eczema or psoriasis Pyoderma gangrenosum Behcets Crohns SJS ```
87
If a patient comes back with recurrent genital ulcers, what is an important differential to keep in mind?
Behcets
88
What is molluscum contagiosum?
Self-limiting infection Caused by molluscs virus (DNA poxvirus)
89
How do you diagnose molluscum contagiosum?
Clinically
90
How long can molluscum contagious take to go away?
6-12 months
91
What is the treatment for molluscum contagiosum?
Watch and wait If no resolution: cryotherapy curette enucleation podophyllotoxin
92
If someone has lumps that are well defined, itchy and darker than flesh, what diagnosis might this lead you to?
Genital warts
93
What type of HPV is considered 'low risk'?
6 11 Most likely to cause warts
94
What HPV is most commonly associated with cancer?
16, 18 Unlikely to cause warts
95
What causes genital warts?
HPV infection
96
How are genital warts transmitted?
through micro abrasions in genital skin during sexual contact 6 and 11 can be transmitted via oral-genital contact Likely to have acquired HPV from 'asymptomatic' partner
97
In which was is HPV unlikely to be transmitted?
digital-genital contact via fomite transmission
98
What is the average incubation period for HPV (6/11)?
median: 3 months Can be as short as 3 weeks Can be as long as 2 years
99
How long do genital warts tend to last?
3 months with appropriate treatment BUT HPV DNA can be found in skin for a median duration of about a year Small minority may have warts for longer than a year
100
When are people with HPV most infectious?
When they have visible warts | transmission can still occur via sub-clinical lesions and latent infection
101
Do condoms prevent the transmission of HPV?
NO - they just reduce it
102
How can we treat genital warts?
Ablative therapies: cryotherapy podophyllotoxin cream/solution electrocautery Immune modulation: imiquimod 5% cream - keratinised/persistent/recurrent warts Reduced recurrence rate Surgical: curettage excision debulking
103
Why wouldn't you treat a pregnant woman with genital warts?
Cream is teratogenic
104
Why is only cryotherapy used for anal warts?
More difficult to treat
105
How should you counsel a man with genital warts who is concerned about giving his girlfriend cervical cancer?
Low risk subtypes (6, 11) EXCEPTIONALLY UNLIKELY TO CAUSE PRE-MALIGNANT CHANGE High risk subtypes (16,18) UNLIKELY TO CAUSE VISIBLE WARTS Girlfriend should attend cervical screening as normal GF is likely to have been vaccinated against 16 and 18 (if younger, 6, 11, 16, 18)
106
Why might someone get anal warts without having had anal sex?
HPV is a multi-centric infection | Not limited to initial site of inoculation
107
What might you tell a woman who has warts during her pregnancy/who is trying to get pregnant?
Warts may appear, recur or persist in pregnancy treatment options are limited Warts usually resolve after delivery
108
Why isn't HPV screened for in sexual health screening?
No clear link between detection of HPV and visible warts Used in cervical screening
109
How is HPV testing used in cervical screening?
Used in samples with borderline or low grade dyskariosis HPV positive: refer to colposcopy HPV negative: refer back to routine screening

GOSH (33 decks)

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