(ID)- STIs Flashcards
What is chancroid?
Infection of genital skin caused by Haemophilus ducreyi
How does chancroid present?
Painful and potentially necrotic genital lesion which can bleed on contact
Associated with painful lymphadenopathy (bubo) which can rupture and discharge pus
4-10 days after exposure to bacterium
How is chancroid diagnosed?
Culture (often difficult and time-consuming)
PCR (can be performed on genital ulcer specimens)
Where are people affected by chancroid?
Tropical and subtropical regions
Poor living conditions
Sexual behaviour
What are some differential diagnoses for chancroid?
Herpes Simplex Virus
- Multiple, small, vesicular lesions that become ulcers
- Systemic symptoms
Syphilis
- Painless ulcer (chancre)
- Generalised non-tender lymphadenopathy
Lympogranuloma Venerum
- Small painless ulcer or papule
- Followed by painful inguinal lymphadenopathy (bubo)
How is chancroid managed?
Ceftriaxone
Azithromycin
Ciprofloxacin
Analgeisa
Incision and drainage of buboes
What causes chlamydia?
Chlamyida trachomatis
Who is affected by chlamydia?
Most common bacterial STI
Young adults between 15-24
How does chlamydia present?
Urethral discharge
Dysuria in men
Intermenstrual bleeding
Vaginal discharge
Anal infections may manifest as dicharge or anorectal discomfort
Many cases, especially infection remains asymptomatic
What can happen to neonates that are exposed to chlamydia during birth?
Pneumonia
Conjuctivitis
How is chlamydia diagnosed?
NAATs on vaginal swabs for women
Urine or urethral swabs on men
How is chlamydia treated?
7 day course of oral doxycycline
What are some differential diagnoses for chlamydia?
Gonorrhoea
- Asymptomatic
- Urethral discharge
- Dysuria
- Intermenstrual or postcoital bleeding
- Lower abdominal pain
Trichomoniasis
- Pruritis
- Dysuria
- Discharge in men and women
Genital herpes
- Painful vesicular lesions
- Dysuria
- Flu-like symptoms
What are some complications of chlamydia?
If left untreated
- PID
- Epididymitis
- Reactive arthritis
- Conjunctivitis and pneumonia in neonates
- Increased risk of acquiring or transmitting HIV
What causes genital herpes?
HSV-1 and HSV-2
Clinically indistinguishable
How do patients present with genital herpes?
May be asymptomatic or
- Multiple painful genital ulcers
- Dysuria
- Discharge vaginal or urethral
- Crusting and healing of lesions
- Systemic symptoms
How is genital herpes diagnosed?
Swab from the base of the ulcer using NAATs
What are the differentials of herpes?
Syphillis
Chancroid
Lymphogranula venereum
What investigations are used for herpes?
Clinical history
Swab from ulcer base and NAATs
How is herpes treated?
5 days after symptom onset
Aciclovir
Valaciclovir
Aciclovir
Famciclovir
Topical lidocaine for symptom relief
How is herpes managed during pregnancy?
Referral to GUM clinic
Informing women that neonatals risk is low even with lesions present
Supportive treatment with saline bathing and paracetamol is sufficient
What is vulvovaginal candidiasis?
Fungal infection caused by Candida Albicans
How does vulvovaginal candidiasis present in women?
Itching
White curdy discharge
Burning sensation
Sour milk odour
Dyspareunia
How does genital candidiasis present in men?
Soreness, pruritis, redness
Dry, red-glazed plaques and papules
What are the risk factors for vulvovaginal candidiasis?
Pregnancy
Antibiotic use
Immunosuppression
How is vulvovaginal candidasis investigated?
Only for unclear cases
Microscopy and culture
How is vulvovaginal candidiasis managed?
Oral
Fluconazol
Itraconazole
Intravaginal
Clotrimazole pessary
Vulval
Topical clotrimazol cream
What causes genital warts?
HPV 6 and HPV 11
How do genital warts present?
Painless
Keratinised or non-keratinised in areas that undergo trauma during sex
How are genital warts diagnosed?
Clinical diagnosis
Biopsy may be performed in some cases
How are genital warts managed?
Podophyllotoxin - antiviral that destroys wart tissue
Cryotherapy
Trichloroacetic acid
High likelihood of recurrence after treatment
What is molluscum contagiosum?
Viral skin infection caused by Molloscum Contagiosum virus
How does molluscum contagiosum present?
Small pearly papules
Central umbilication
Can occur anywhere, commonly on genitals
How is molluscum contagiosum diagnosed?
Visual inspection
Full STI screen advised
How is molluscum contagiosum managed?
Resolves spontaneously in 18 months
Cryotherapy
What causes gonorrhoea?
Neisseria gonorrhoeae
What are the symptoms of gonorrhoea?
Genital discharge
Dysuria
Tender inguinal nodes in men
Abnormal bleeding in women
Extragenital complications
Pharyngitis
Rectal pain and discharged
Disseminated infection
How is gonorrhoea disagnosed?
NAAT with culture
Presence of monomorphic gram-negative diplococci with polymorphonuclear leukocytes
How is gonorrhoea treated?
Ceftriaxone
What can gonorrhoea lead to if untreated?
Infertility due to PID
Infertility due to epididymitis
Increased susceptibility to HIV
What causes syphilis?
Treponema pallidum
How is syphilis transmitted?
Direct contact with syphilis sores of rash during sex
Vertical transmission
What are the signs of primary syphilis?
Single painless lesion (Chancre), round with indurated bases heals in 3-8 weeks
What are the signs of secondary syphilis?
Symmetrical maculopapular rash, involving palms, soles and face
4-10weeks after primary infection
Some patients may get hepatitis, glomerulonephritis and neurological complications
What are the signs of tertiary syphilis?
20-40 years after primary infection in untreated patients
Gummatous disease
CV complications
Neurological complications
What are the signs of congenital syphilis?
Rash on palms/soles of feet
Mucuous patches/lesions in mouth/nose/genitals
Hepatosplenomegaly
Saber shins
Seizures
Developmental delay
How is syphilis investigated?
Serological testing
Dark-field microscopy
CSF examination (tertiary syphilis for CNS involvement)
How is syphilis managed?
Primary, secondary and early latent
IM penicilin G (benzylpenicillin)
Tertiary and late latent
IM penicillin G for 2-3 weeks
Neurosyphilis
IV penicillin G for 10-14 days
Doxycyclin if allergic
What is trichomoniasis?
STI caused by flagellated protozoan Trichomonas vaginalis
What are the signs and symptoms of trichomoniasis?
Profuse, frothy yellow vaginal discharge
Vulval irritation
Dyspareunia in women
Urethritis in men
Strawberry cerix
What investigations are used to confirm trichomoniasis?
Microscopy and culture of causative organism
What is the management of trichomoniasis?
Oral mentronidazole 5-7 weeks
Abstrain from sexual activity for at least 1 week or until patient and partners have completed treatment
Screening
Contact tracing
