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Common STIs Flashcards

Chlamydia, gonorrhoea, bacterial vaginosis, trichomoniasis, herpes simplex

1
Q

What is the most prevalent STI in the UK?

A

chlamydia

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2
Q

What pathogen causes chlamydia?

A

Chlamydia trachomatis - an obligate cellular pathogen

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3
Q

What proportion of young women in the UK have chlamydia?

A

1 in 10

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4
Q

What is the incubation period of chlamydia?

A

7-21 days

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5
Q

What makes it hard for chlamydia to be diagnosed/ an incubation period established sometimes?

A

a large percentage of cases of chlamydia are asymptomatic

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6
Q

In what proportion of women is chlamydia asymptomatic?

A

70%

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7
Q

In what proportion of men is chlamydia asymptomatic?

A

50%

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8
Q

What are 6 symptoms of chlamydia in females?

A
  1. Vaginal discharge
  2. Dysuria (can cause sterile pyuria)
  3. Vague lower abdominal pain
  4. Fever
  5. Intermenstrual or postcoital bleeding
  6. Deep dyspareunia
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9
Q

What are 5 symptoms of chlamydia in males?

A
  1. Classical urethritis
  2. Dysuria
  3. Urethral discharge
  4. Epididymo-orchitis - unilateral testicular pain ± swelling
  5. Fever
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10
Q

What are 4 features of chlamydia that may present in both sexes?

A
  1. Reactive arthritis (conjunctivitis, arthritis, urethritis)
  2. Upper abdominal pain due to perihepatitis (Fitz-Hugh Curtis syndrome)
  3. Proctitis with mucopurulent discharge (rectal chlamydia after anal intercourse)
  4. Pharyngeal infection
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11
Q

What are 7 potential complications of chlalmydia?

A
  1. Epididymitis
  2. Pelvic inflammatory disease
  3. Endometritis
  4. Increased incidence of ectopic pregnancies
  5. Infertility
  6. Reactive arthritis
  7. Perihepatitis (Fitz-Hugh Curtis syndrome)
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12
Q

What is the investigation of choice for chlamydia?

A
  • NAAT: nucleic acid amplification tests
  • Urine (first void urine sample), vulvovaginal swab or cervical swab may be tested using NAAT
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13
Q

What investigation for chlamydia is first line in women?

A

NAAT technique using vulvovaginal swab

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14
Q

What investigation for chlamydia is first line in men?

A

First void urine sample for NAAT

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15
Q

What are 3 samples that can be used for NAAT to diagnose chlamydia?

A
  1. Vulvovaginal swab
  2. Cervical swab
  3. First void urine sample
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16
Q

When should chlamydia testing be carried out?

A

2 weeks after possible exposure

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17
Q

What screening for chlamydia is available and for what age group?

A

National Chlamydia Screening Programme - open to all men and women aged 15-24 years

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18
Q

What type of screening programme is the National Chlamydia Screening Programme?

A

heavily relies on opportunistic testing

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19
Q

What is a typical sign of chlamydia on a swab?

A

red inclusion bodies red

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20
Q

What is now the first line treatment for chlamydia?

A

doxycycline 7 day course

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21
Q

Why has first line management of chlamydia changed?

A

changed from azithromycin to doxycycline due to concerns about Mycoplasma genitalium - infetion often co-existent in patients with chlamydia, evidence of rising macrolide resistance

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22
Q

What is second-line treatment for chlamydia if doxycycline is contraindicated/ not tolerated?

A

azithromycin 1g od for one day, then 500mg od for 2 days

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23
Q

What is the drug of choice to treat chlamydia in pregnancy and what dosing?

A

azithromycin 1g stat

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24
Q

What are 3 options for treatment of chlamydia in pregnancy?

A

azithromycin, erythromycin or amoxicillin

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25
Q

What must always be done in addition to drug treatment for chlamydia?

A

contact tracing/ partner notification

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26
Q

What are the 2 choices of providers for initial partner notification when a patient is diagnosed with chlamydia?

A
  1. Trained practice nurses with support from GUM
  2. Referral to GUM
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27
Q

Which partners must be notified in the case of a male patient with urethral symptoms diagnosed with chlamydia?

A

all contacts since and in the four weeks prior to the onset of symptoms

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28
Q

What is the partner notification for women and asymptomatic men who are diagnosed with chlamydia?

A

all partners from last 6 months or most recent sexual parter (if none in past 6 months)

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29
Q

What should be offered to contacts of confirmed chlamydia cases?

A

offer treatment prior to results of their investigations being known (treat then test)

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30
Q

What causes gonorrhoea?

A

gram-negative diplococcus Neisseria gonorrhoeae

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31
Q

Where can acute gonorrhoea infection occur?

A

on any mucous membrane surface, typically genito-urinary but also rectum and pharynx

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32
Q

What is the incubation period of gonorrhoea?

A

2-5 days

33
Q

What are 2 key symptoms of gonorrhoea in males?

A
  1. urethral discharge
  2. dysuria
34
Q

What are the symptoms of gonorrhoea in females?

A

cervicitis e.g. leading to vaginal discharge

35
Q

How to rectal and pharyngeal gonorrhoeal infection often present?

A

often asymptomatic

36
Q

Why is immunisation not possible and reinfection common with gonorrhoea?

A

variation of type IV pili (proteins which adhere to surfaces) and Opa proteins (surface proteins which bind to receptors on immune cells)

37
Q

What are 6 possible complications of gonorrhoea?

A
  1. Urethral strictures
  2. Epididymitis
  3. Salpingitis
  4. Infertility
  5. Disseminated gonococcal infection
  6. Gonococcal arthritis (septic arthritis)
38
Q

What is now the treatment of choice for gonorrhoea?

A

Single dose of IM ceftriazone 1g (without azithromycin)

if sensitivities known (and organism sensitive to ciprofloxacin) then single dose of oral ciprofloxacin 500mg should be given

39
Q

If the first line treatment for gonorrhoea (IM ceftriazone 1g) is refused (e.g. needle phobic) what is second line treatment?

A

oral cefixime 400mg (single dose) + oral azithromycin 2g (single dose)

40
Q

What is the most common cause of septic arthritis in young adults?

A

gonococcal infection

41
Q

What is thought to be the pathophysiology of DGI?

A

haematogenous spread from mucosal infection (e.g. asymptomatic genital infection)

42
Q

What may be the classic triad of symptoms initially in disseminated gonococcal infection (DGI)?

A
  1. Tenosynovitis
  2. Migratory polyarthritis
  3. Dermatitis (lesions can be maculopapular or vesicular)
43
Q

What are 3 later complications of DGI?

A
  1. Septic arthritis
  2. Endocarditis
  3. Perihepatitis (Fitz-Hugh-Curtis syndrome)
44
Q

What is trichomonas vaginalis?

A

highly motile, flagellated protozoan parasite - sexually transmitted infection

45
Q

What are 4 features of trichomonas vaginalis in women?

A
  1. Vaginal discharge: offensive, yellow/green, frothy
  2. Vulvovaginitis
  3. Strawberry cervix
  4. pH >4.5
46
Q

What is the presentation of trichomonas vaginalis in men?

A

usually asymptomatic but may cause urethritis

47
Q

What investigation can show the appearance of trichomonas and what will it show?

A

microscopy of a wet mount: motile trophozoites

48
Q

What are 2 treatment options for trichomonas vaginalis?

A
  1. Oral metronidazole for 5-7 days
  2. One-off dose of 2g metronidazole
49
Q

What is the histological appearance of trichomonas vaginalis?

A

largely transparent core with finely granular esoinophilis cytoplasm. surrounded by neutrophils with segmented nuclei

50
Q

What is bacterial vaginosis?

A

overgrowth of predominantly anaerobic organisms such as Gardnerella vaginalis

leads to consequent fall in lactic acid produced aerobic lactobacilli, resulting in a raised vaginal pH

51
Q

Is bacterial vaginosis sexually transmitted?

A

no BUT seen almost exclusively in sexually active women

52
Q

In what proportion of women is bacterial vaginosis asymptomatic?

A

50%

53
Q

If bacterial vaginosis is symptomatic, how does it present?

A

vaginal discharge: fishy, offensive. thin, white, homogenous

54
Q

What is the appearance of bacterial vaginosis on microscopy?

A

clue cells: epithelial cells develop stippled appearance due to being covered with bacteria.

55
Q

What is the name of the criteria used to diagnose bacterial vaginosis?

A

Amsel’s criteria

56
Q

What are Amsel’s criteria to diagnose bacterial vaginosis?

A

3 of the following 4 should be present:

  1. thin, white, homogenous discharge
  2. clue cells on microscopy: stippled vaginal epithelial cells
  3. vaginal pH > 4.5
  4. positive whiff test (addition of potassium hydroxide results in fishy odour)
57
Q

What is the management of bacterial vaginosis?

A

oral metronidazole for 5-7 days

58
Q

What is the success rate of treatment of BV with oral metronidazole?

A

70-80% initial cure rate; relapse rate >50% within 3 months

59
Q

What are 2 alternatives to first line management for bacterial vaginosis?

A
  1. Topical metronidazole
  2. Topical clindamycin
60
Q

What are 4 risks of bacterial vaginosis in pregnancy?

A
  1. Preterm labour
  2. Low birth weight
  3. Chorioamnionitis
  4. Late miscarriage
61
Q

What is suggested about the management of bacterial vaginosis in pregnancy?

A

suggest oral metronidazole can be used throughout pregnancy

BNF still advises against use of high dose metronidazole regimes

62
Q

What was previously thought to be the type of herpes that caused genital herpes?

A

HSV-2 and HSV-1 causes cold sores - but now known there is considerable overlap

63
Q

What are 5 possible features of genital herpes?

A
  1. Painful genital ulceration
  2. Dysuria
  3. Pruritus
  4. Tender inguinal lymphadenopathy
  5. Urinary retention
64
Q

How does the severity of the primary episode of genital herpes often compare with subsequent episodes?

A

primary often more severe than recurrent; systemic features e.g. headache, fever, malaise more common in primary episodes

65
Q

What are 3 features that may be present with the primary episode of genital herpes but not recurrent episodes?

A
  1. Headache
  2. Fever
  3. Malaise
66
Q

What is the investigation of choice for genital herpes?

A

nucleic acid amplification tests (considered superior to viral culture)

67
Q

In addition to NAAT what other investigation may be performed in suspected genital herpes and why?

A

HSV serology: may be useful in certain situations such as recurrent genital ulceration of unknown cause

68
Q

What are 4 aspects of the management of genital herpes?

A
  1. Saline bathing
  2. Analgesia
  3. Topical anaesthetic agents e.g. lidocaine
  4. Oral aciclovir
69
Q

What treatment may be indicated in some patients with frequent exacerbations of genital herpes?

A

longer-term aciclovir

70
Q

What is advised if a primary attack of herpes occurs during pregnancy?

A

elective C-section at term if occurs at greater than 28 weeks gestation

71
Q

What is the management of women with recurrent genital herpes who are pregnant?

A

treat with suppressive thearpy, advise risk of transmission to baby is low

72
Q

What are 2 STIs that can be detected using NAAT on an endocervical swab?

A

chlamydia

gonorrhoea

73
Q

What are 4 vaginal conditions that can be detected using a high-vaginal charcoal media swab?

A
  1. Bacterial vaginosis
  2. Trichomonas vaginalis
  3. Candida
  4. Group B streptococcus
74
Q

What STI can be detected using an endocervical charcoal media swab?

A

gonorrhoea

75
Q

What are triple swabs vs double swabs?

A
  • triple swabs: endocervical NAAT swab, high-vaginal charcoal media swab, endocervical charcoal media swab
  • double swabs: endocervical NAAT swab, high vaginal charcoal media swab
76
Q

What is the primary treatment for the first episode of genital herpes?

A

oral antivirals - treatment should commence within 5 days of start of episode or while new lesions forming

oral aciclovir 400mg tds for 5-10 days or 200mg 5x a day for 5-10 days

valaciclovir or famciclovir can also be used

77
Q

What is the recommendation about topical antivirals for genital herpes?

A

not recommended as offer minimal benefit

78
Q

What are 3 options for treatment of recurrent genital herpes?

A
  1. Self care alone may work
  2. Episodic antiviral treament if <6 attacks per year e.g. oral aciclovir 800mg tds for 2 days
  3. Suppressive antiviral tx if >6 attacks per year/psych distress/affecting social life e.g. aciclovir 400mg bd - continue for maximum of 1 year then stop to assess recurrence (for minimum of 2 recurrences)
79
Q

If after stopping suppressive antiviral treatment for genital herpes there are high rates of recurrence, what is the management?

A

consider restarting suppressive antiviral treatment

GP (43 decks)

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