Infections - STIs Flashcards
How can STis occur?
skin on skin contact or exchange of bodily fluids during insertive vaginal or anal sex
Epidemiology - Chlamydia + gonorrhoea
most common worldwide
rate at its highest 15-19 and 20-24
gonorrhoea is the second most common bacteria sexually TI
Epidemiology - Syphilis + Herpes simplex
Syphilis - ^ in recent years
Herpes; 6% of all diagnosed STIs
Uncomplicated Genital Chlamydia
causes inflammation of urethra in men and cervis/ urethra in women
asymptomatic in - 70% women
50% - men
Trachomatis - cause
What is the assessment for chlamydia?
samples for nucleic acid amplifications tests (NAATs)
Chlamydia test WOMAN
a vulvo-vaginal or endocervical swab
first urine sample can be collected
Chlamydia test MEN
A FCU specimen of choice
urethral swab is an alt.
Symptoms of chlamydia in women
heavier periods
abdomen/ pelvic pain
vaginal discharge
irregular periods
bleeding between periods
pain during urination
pain and bleeding during and after sex
Symptoms of chlamydia MEN
pain during urination
pain in testicles
swelling in testicles
swelling of testicles
burning or itching of urethra
white/ watery or cloudy discharge from penis
Tests for chlamydia are recommended if a sexually active person has the following symptoms and signs
In women: post-coital or intermenstrual bleeding, increased or purulent vaginal discharge, mucopurulent cervical discharge, deep dyspareunia, dysuria, pelvic pain and tenderness, an inflamed or friable cervix.
In men: dysuria, urethral discharge, urethral discomfort, epididymo-orchitis or reactive arthritis
Complications of chlamydia LEAD TO»_space;>
Pelvic inflammatory disease (PID)
Epididymo-orchitis
Lymphogranuloma venereum (LGV)
Sexually acquired reactive arthritis (SARA)
Perihepatitis
Adverse outcome in pregnancy
Conjunctivitis
Anxiety and psychological distress
How should I manage a person with suspected or confirmed chlamydia?
confirmed > refer to genito-urinary medicine (GUM) clinic > manage in GUM clinic ( if poss) / manage in primary care (not poss) > offer written info, advice to treat partner, treat, investigations, arrange follow up, refer if poss
Management of chlamydia: non-pregnant adults and children over age of 13 years:
1st line: doxycycline 100mg bd for 7 days
if contraindicated or not tolerated = azithromycin 1g orally as a single dose fro 1 day > 500mg orally OD for 2 days
Managment for pregnant women
Azithromycin, 1g orally for 1 day > 500mg orally OD for 2 days
Erythromycin 500mg qds daily for 7 days or erythromycin 500mg bd for 14 days
or
amoxicillin 500mng tds for 7 days
Gonorrhoea - cause?
Gram- negative neisseria gonorrhoeae
What does gonorrhoea affect?
mucous membranes of urethra, endocervix, rectum, pharynx and conjunctiva
How is gonorrhoea transmitted?
direct inculation of secretions from one mucous membrane to another
infection of eye most commonoly results from autoinoculation
Gonococcol infection among infants > exposure to infected cervical exudates at birth
Symptoms of gonorrhoea WOMEN
vaginal discharge
burning/painful urination
bleeding between periods
Symptoms of gonorrhoea MEN
penile discharge
burning urination
testicular swelling
Assessment of gonorrhoea:
nucleic acid amplification tests (NAATs) or by culture
What specimens get tested fro culture = gonorrhoea?
urethral, endocervical, neovaginal, anorectal and phatyngeal swabs
How should I manage a person with suspected gonorrhoea?
confirm > refer to GUM > (if poss) manage in GUM clinic / (not poss) manage in primary care > prescribe AB, screening for other STIs and HIV, patient-led partner notification, info, follow up
Antibiotic choices for the treatment of gonorrhoea:
uncomplicated
antimicrobial susceptibility KNOWN:
cipofloxacin 500mg orally as single do
antimicrobial susceptibility UNKNOWN: Caftriaxone 1g intramuscular (IM) injection as a single dose
Antibiotic choices for the treatment of gonorrhoea: people with allergy/ needle phobia or comntraindications:
Gentamicin 240mg Im as single dose plus azithromycin 2g orally
OR
cefixime 400mg orally as single dose plus azithromycin 2g orally
Antibiotic choices for the treatment of gonorrhoea: people with penicillin allergy
cefriaxone and cefixime suitabkle treatment options unless history of hypersensitivity e.g. to a beta-lactam antibacterial agent
Antibiotic choices for the treatment of gonorrhoea: pregnant or breastfeeding
ceftriaxone 1g Im injection as a single dose
azithromycin 2g as single oral dose
DO NOT prescribe CRIPOFLOXACIN
Prognosis
- gonorrhoea
most solve spontaneously
Complications of untreated gonorrhoea
men ; epididymo-orchitis, prostatitis, infertility, urethral structure, infection of mullerian or cowper glands
women ; PID, pregnancy complications
Syphilis - caused by:
spirochete bacterium Treponema pallidum
Untreated syphilis: persist for years > what stages?
early syphilis; 3 stages
primary, secondary and early latent syphilis
Late syphilis; 2 stages
Late latent syphilis and tertiary syphilis
Complications syphilis:
Neurosyphilis
Cardiovascular syphilis
Gummatous syphilis
Adverse outcomes in pregnancy.
Facilitation of HIV transmission.
symptoms of syphilis:
chancres (sores)
hair loss
swollen lymph nodes
sore throat
rash
Assessment
of syphilis
suspect if:
Genital lesion(s) - Chancre
Associated regional lymphadenopathy
A non-pruritic maculopapular rash
Moist wart-like lesions (condylomata lata)
Patchy lesions on the oral mucosa (‘snail tract’ lesions).
Generalized lymphadenopathy.
Unexplained neurological or ophthalmological symptoms.
How should I manage a person with suspected syphilis?
confirm > refer to GUM > (poss) manage in GUM clinic / (not poss) primary care > explain conditions + risk factors, discuss prevention, discuss GUM and screening for other STIs
syphillis treatment with Benzathine benzylpenicillin: LATE stage (latent seropositive)
2.4 million units once weekly for 3 weeks
syphilis Treatment with Benzathine benzylpenicillin
adult - PRIMARY / SECONDARY STAGE
2.4 million units as single dose
how to prevent syphilis?
use condom
complete treatment if you and your partner have it
do not share sex toys
do not share needles if you inject drugs
MCQ: When untreated, whichONEof the following sexually transmitted infections (STIs) can cause neurological damage, blindness and cardiovascular disease?
Chlamydia
MCQ: Destie is a 32 year-old pregnant woman. She underwent screening for STIs but she has no symptoms of infection. However, her first pass urine is positive for Chlamydia trachomatis on NAAT. Which of these treatment options would you recommend?
Azithromycin, 1 g orally for 1 day, then 500 mg orally once daily for 2 days
