INF2 - A. TREATMENT OF STIS-COVERED Flashcards
signs and symptoms of chlamydia (gram-ve) in men
- 50% asymptomatic
- urethritis
- unilateral pain and swelling of scrutum
signs and symptoms of chlamydia in women
- 70% asymptomatic
- post-coital or inter menstrual bleeding
- purulent vaginal discharge
- dyspaneuria
- lower abdominal pain
diagnosis of chlamydia in women
- first void urine sample (NAAT test) or vulvo-vaginal/cervical swab
treatment of chlamydia and advice
single dose azithromycin (1g) orally followed by 500mg once daily for 2 days (better tolerated and less side effects and interactions)
or
7 days doxycycline (100mg twice daily)
*no test for cure unless pregnant
*partner notification
*avoid sex (oral aswell) until treatment completed or for 7 days if azithromycin treatment
diagnosis of chlamydia in men
- first void urine sample or urethral swab if symptomatic
what to use if pregnant/breastfeeding
- azithromycin, erythromycin, amoxicillin
- NOT doxycycline or ofloxacin
signs and symptoms of gonorrhoea (gram-ve) in men
- mucupurulent urethral discharge
- epididymal swelling
- dysuria 2-5 days after infection
- rectal infection can cause anal discharge and pain in intercourse
signs and symptoms of gonorrhoea in women
- 50% asymptomatic
- dysuria
- vaginal discharge 10 days after infection
- rectal infection can cause anal discharge and pain in intercourse
diagnosis of gonorrhoea in men
- first pass urine for men
- ID by microscopy, culture, NAAT
- NAAT: allows testing for chlamydia at same time
diagnosis of gonorrhoea in women
- vaginal or endocervical swab
- ID by microscopy, culture, NAAT
- NAAT: allows testing for chlamydia at same time
treatment for gonorrhoea and advice
- 1st line: IM ceftriaxone (cephalosporin antibiotic), single dose (1g) if susceptibility not known prior
Ciprofloxacin 500mg orally as single dose if susceptibility known prior or if allergic to penicillin - 2nd line: gentamicin, azithromycin etc
*avoid sex (oral aswell) until treatment completed or for 7 days if azithromycin treatment
*follow up after 1 week
*confirm partner notification
*return for TOC
what is PID
- inflam of uterus, ovaries, fallopian tubes
- abscess, peritonitis?
- scar formation with adhesions to neighbouring organs
- 15% risk of infertility after 1 attack, 50-80% after 3 due to adhesions
- complication of chlamydia or gonorrhoea in women
- can be caused also by IUD or tampons
- increased risk of cervical cancer
- miscarriage in pregnancy and infertility
symptoms of PID
- often asymptomatic
- lower abdominal pain
- deep abdominal pain on intercourse
- intermenstrual bleeding
- green/yellow vaginal discharge
- fever or vomiting
- could be appendicitis or endometriosis etc
diagnosis of PID
- STI screen
- ultrasound
- laparoscopy (incision)
treatment of PID
- pain relief: paracetamol, ibuprofen, codeine
- combined antibiotics for 14 days
- IM ceftriaxone (1g single dose) + oral doxycycline (100mg twice daily) + oral metronidazole (400mg twice daily)
- oral ofloxacin + oral metronidazole (both 400mg twice daily)
different antibiotics used to cover different microbes (aerobic, anaerobic etc)