Lecture 17: Pharmaceutical Care Of STI Flashcards
What is sexual health?
- A state of physical, emotional, mental, and social wellbeing in relation to sexuality
- It requires positive approach to sexuality and relationships
What are some consequences associated with poor sexual health?
- Cervical and other genital cancers
Hepatitis - Pelvic inflammatory disease
& Recurrent genital herpes/warts - Unplanned pregnancies and abortions
- HIV transmission
- Psychological consequences (normal function of cells, tissues)
Why are STIs a pubic health concern
- High prevalence
- Leads to pregnancy complications, neonatal infections, cardiovascular & neurological damage (huge impact on health & wellbeing)
- Rising anti microbial resistance
How do STIs increase the risk of HIV?
- STIs cause sores and lesions, making HIV transmission easier
- Weakened immune system increases HIV viral payload (amount in persons blood)
- HIV actively binds to macrophages at sites of infection
Which groups are high risk for STIs?
- young heterosexuals (aged 15-24)
- black minority
- gay, bisexual + men who have sex with men
- deprived areas
What is chlamydia and its symptoms?
- Caused by chlamydia trachomtis bacteria
- Often asymptomatic but causes bleeding after sex, discharge, pelvic pain, painful urination and reactive arthritis (painful joints due to infection)
- Attaches to mucosal surface to induce strong inflammatory response
What are the complications of chlamydia?
- Pelvic inflammatory disease in females
- epididymitis in males (inflammation in testicle)
How is chlamydia diagnosed?
- NAAT (nucleic acid amplification test using:
- First catch urine sample or swab sample of vagina or urethra
How is chlamydia treated?
- First line Doxycycline 100mg BD for 7 days
- 2nd line Azithromycin and Erithromycin (A is 2nd line due to resistance developed )
What is gonorrhoea and their symptoms?
- Caused by neisseria gonorrhoeae bacteria which attaches to mucosal surface and resists phagocytosis
- Less asymptomatic than chlamydia
- Cause pain in urination, discharge and bleeding after sex
What are the complications of gonorrhea?
- Pelvic inflammatory disease in women
- Epiditymis in males
- Passed from mother to child in childbirth
How is gonorrhoea diagnosed?
- NAAT testing
- First catch urine sample or vaginal/ urethral swab
What is the treatment for gonorrhea?
- Ceftriaxone 1g IM injection (suitable in preg) (Can give if sensitivity is unknown)
- Ciprofloxacin 500mg oral (must be sensitive (on lab report on culture must be sensitive not resistant)
What are the causes of syphilis and modes of transmission?
- caused by bacterium T pallidum and transmitted through sexual contact or blood transfusions, direct contact with/ infectious lesions
What is the pathogenesis of syphilis?
- After entering the body through mucous membranes or broken skin it spreads via blood or lymphatic vessels
- Can invade multiple organs (different stages)
What are the different stages of syphilis?
- Initial contact: 2-10wk, painless, firm ulcer at the entry area
- Primary syphilis: 1-3mnth, enlarged lymph nodes
- Secondary syphilis: 6wk-6mnth, skin growths, rash, flu-like symptoms
- Latent: 3-30yrs remains dormant
- Tertiary: if untreated cardiovascular syphilis, neurosyphilis (stroke, meningitis, dementia, numbness)
What is the testing for syphilis?
- Blood sample for syphilis serology measuring antibody to surface protein of T-palladium
- or virology swab taken from active lesion to exclude herpes simplex virus
What is the treatment like for syphilis?
- Usully penicillins or doxycline/ceftriaxone if penicillin allergic
What is the aetiology of genital warts?
- Caused by HPV types 6 and 11 and lead to benign growths
- sexual contact, direct skin contact, infected saliva, semen, vaginal fluid
What are the symptoms like for genital warts?
- Headache, fever, malaise, dysuria or tender lymph nodes on groin
- Painful ulcers in genital area
- Discharge
What are the tests to be done for genital warts?
- Visual diagnosis, Swab a lesion for viral culture or polymerase chain reaction?
What are the types of treatment for genital herpes?
- 1st line: Aciclovir for 5-10 days
- 2nd line Valaciclovir orally 500mg BD 5-10days
or famciclovir 250mg orally TDS for 5-10days - paracetamol can be used to reduce fever, topical lidocaine to numb the area
What are some self care measures for STIs?
- Avoid tight clothing use cotton underwear
- Take adequate pain relief
- Avoid sharing towels
- Increase fluid to produce dilute urine
- Avoid intercourse w/ symptoms
- Keep skin dry
- No fragrance (soap/shower gels)
What are some symptoms/conditions that are confused w/ STIs (differential diagnosis)?
- Vulval itching/soreness: Candida (thrush), Bacterial vaginosis, vaginal atrophy in post menopause
- Abnormal vaginal discharge: watery/ greyish white w/ fishy odour = bacterial vaginosis, Cottage cheese-like white discharge = thrush
- Painful urination: Cystitis
What is Candida and what does it affect?
- Fungal infection by candida albicans species (most common)
- Can affect mucous membranes (skins, nails)
- Oral canidiasis: itchy patches on skin, scales over w/ white or yellow discharge on tongue
What are some risk factors for Candida?
- Antibiotics
- Diabetes (poorly controlled)
- Immunosuppressive therapies (steroids)
- Pregnanct/ Contraceptive use
- Broken skin
What are the symptoms of Thrush for women?
- Originates from spread from GI tract and/or sexual transmission
- Thick, cottage like cheese vaginal discharge
- Painless
- Itchy
- Dysuria
- Thrush is infection caused by candida overgrowth
What are the symptoms of Thrush for men?
- Irritation, burning, redness around head of penis
- White discharge (cottage cheese like)
- Unpleasant smell
- Difficulty pulling back the foreskin
How do you diagnose thrush?
- History taking and clinical presentation
- Swab and culture
What are the pharmacological treatment strategies for thrush?
- Local imidazole cream or pessary (clotrimazole 500mg pessary)
- Or oral azole (fluconazole 150mg) : Contraindicated in pregnancy
- Resolves symptoms in 7-14 days, partners only treated if asymtomatic
What are some further advice/ services you could refer patient to?
- Open access to Sexual Health Services (SHS) in person or online
- UK national HPV immunisation programme
- National chlamydia screening programme - free screening available at GP surgeries
