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)
symptoms of syphilis (gram-ve)
- small sores around your genitals or bottom
- rash (usually on your hands or feet)
- white patches in your mouth
diagnosis of syphilis
- routine serology in GUM clinic
- dark ground microscopy
- PCR
treatment of syphilis
- IM benzylpenicillin single dose
*effective for primary/secondary
*safe in pregnancy
*2 week course for tertiary syphilis (systemic) - doxycycline, azithromycin, ceftriaxone, erythromycin, amoxicillin if allergic to penicillin etc
what happens if a pregnant women gets secondary syphilis
- infects foetus
- miscarriage
- stillbirth
- congenital syphilis
symptoms of trichomoniasis (protozoa parasite) in women
- up to 50% asymptomatic
- symptoms can be 5-28 days after infection or more
- itching
- soreness
- inflam of vagina
- dysuria
- thin smelly vaginal discharge (different to gonorrhoea)
symptoms of trichomoniasis in men
- up to 50% asymptomatic
- symptoms can be 5-28 days after infection or more
- itching inside penis
- burning sensation when urinating or ejaculating
- discharge
treatment of trichomoniasis
- oral metronidazole (400mg twice daily for 5-7 days or 2g dose)
*ok in pregnancy but trichomoniasis increases risk of pre-term delivery and LBW baby
*avoid high doses in breastfeeding
*avoid alcohol as disulfiram reaction makes people very sick
treatment for public lice (parasitic insect)
- topical insecticide: malathion 0.5% lotion, permethrin 1% cream applied to hair
- OTC
- wash clothing and bedding >50 degrees Celsius to kill lice
prevention of HPV
- vaccination and screening
- NHS cervical screening programme as HPV related to cervical cancer
- liquid-based cytology: smear taken, applied to slide, microscope
- colposcopy
- biopsy
- histology
- excision or ablation of HPV-infected abnormal cells
- severe infection: hysterectomy
HPV vaccine
- Gardasil vaccine to girls and boys between 12-13 (protective against types 6, 11, 16, 18)
- Cervarix vaccine (protective against 16 and 18)
- don’t use in pregnancy
- effective against HPV types 16 and 18 (high risk cervical cancer) and 6 and 11 (low risk but associated with anogenital warts - most common)
- 2nd injection 6-12 months after 1st
- protective for 8 years
what usually causes anogenital warts
- HPV types 6 and 11
- can take up to a year to develop after infection
symptoms of anogenital warts
- usually painless
- itching or bleeding from urethra
- small, flesh-coloured or grey swellings in genital area
- warts will clear in 18 months
treatment for anogenital warts
- treatment only for visible warts
- soft non-keratinised warts:
0.15-0.5% podophyllotoxin cream (not in pregnancy)
imiquimod 5% cream (POM) for keratinised and non-keratinised warts (not in pregnancy) - physically ablative therapies are more effective (cryotherapy, electrocautery, surgery, laser treatment)
- 40% reoccurrence after successful treatment
what causes genital herpes (viral)
HSV-2
treatment for genital herpes
antiviral: Aciclovir 200mg 5x daily for 5 days
not OTC
how to treat primary genital herpes in pregnancy so not passed to baby
- oral or IV aciclovir
- Caesarean section for women with genital lesions within 6 weeks birth
- antivirals not recommended for recurrent genital herpes during pregnancy
who should have a vaccine for hepatitis B (viral)
high risk travel
healthcare worker
babies as part of 6-in-1 vaccine at 12 months, need revaccination later in life
treatment for hepatitis B
- no treatment as usually short term (few months)
- can become chronic: leads to liver damage (cirrhosis)
- antivirals (entecavir or tenofovir)
how does a community pharmacy contribute to STI help
- advice
- PGD or independent prescribing for chlamydia
- vaccination for HPV and maybe hepB
how does a GUM clinic contribute to STI help
- diagnose and treat all STIs
- advice
- free condoms, pregnancy testing
- drop in sessions/appointments
- walk-in
how does infectious disease ward contribute to STI help
- severe/resistant cases (HIV, gonorrhoea, syphilis)
