Pathogens: Sexually-transmitted infection

Question 1

sexual health clinic

Answer 1

commissioned buy local authority
some provided by NHS
free confidential service
no postcode restriction
STI free treatment

Question 2

STI contacts

Answer 2

when someone is diagnosed with STI contact sexual partners at risk
with patients consent
options include patient themself contacting
or provider referral

Question 3

provider referral

Answer 3

name of index patient isn’t given
need consent from index to name the STI
national network
maintains confidentiality
recommend treatment, don’t have to tell them what for

Question 4

how do patients access sexual health clinics

Answer 4

self referral
recommendations
hand held letter/ “my GP told me to come”
formal referral form GP/ other doctors

with extremely complex problems needing a senior member a formal referral is beneficial but not essential

Question 5

who do sexual health generally see

Answer 5

13+
screening, treatment and prevention of all STI’s
recurrent vaginal discharge
recurrent genital itching
genital lumps, bumps, rashes
emergency and on going contraception
pelvis testicular or genital pain
sexual dysfunction, some services
chronic HIV care, some services

Question 6

sunderland sexual health

Answer 6

manage people living with HIV
chronic pelvic and genital pain, sex related pain
genital problems in transgender people including after gender reassignment
medical psychosexual cre

Question 7

sexual health stats

Answer 7

1 in 2 attend sexual health with identified mental health problems
1 in 3 partners unfaithful in long term relationships
1 in 5 partners in unfaithful marriage
1 in 6 difficulty in sex
1 in 10 genital herpes, men having sex with men
1 in 1000 living with HIV in north east

Question 8

risk of STI’s

Answer 8

everyone
higher prevalence in under 25s and men who have sex with men
important to have regular testing if not in long term relationship, suggest every 3 months
all STI’s can be asymptomatic

Question 9

what should you never assume

Answer 9

someone isn’t at risk of STI’s

Question 10

sexual behaviour

Answer 10

people having sex at younger age

Question 11

sexual history taking

Answer 11

reason for attendance: symptoms and duration
casual and regular sexual contacts, gender
past 3 months or as relevant
sexual practices: oral/anal/vaginal, condom
past history of STI
recent medications and allergies
medical/gynaecolgocial history

Question 12

major presenting complaints

Answer 12

urethral discharge/dysuria (urethritis)
vaginal discharge genital ulcers/sores
lumps and bumps

Question 13

GMC guidance for intimate examination

Answer 13

offer chaperone
obtain consent
keep discussion relevant
explain why examination is necessary and what it involves
give patient privacy to undress and dress

Question 14

genital examination

Answer 14

often only if required
not needed if no symptoms
undress below waist
examine mons pubis to natal cleft including inguinal region, palpate for lymphadenopathy
remember extra genital signs of STI’s, other conditions may present with genital signs

Question 15

females genital exam

Answer 15

lithotomy position allowing good visualisation
speculum exam
bimanual exam only if clinically indicated

Question 16

how to screen

Answer 16

explain what it is!!!!

Question 17

typical check ups

Answer 17

first pass urine if not born with vagina
vaginal swab if born with one
rectal/ throat swabs for MSM
heterosexual men and women don’t routinely have throat or rectal swabs
check up with no concerns or symptoms, no need to examine
self taken swabs better than healthcare taken
blood test for HIV and syphilis encouraged

Question 18

main 4 STI’s

Answer 18

syphilis, gonorrhoea, chlamydia and trichomoniasis

Question 19

declining STI’s

Answer 19

genital warts
pubic lice
new HIV diagnoses

Question 20

decline in pubic lice

Answer 20

shaved pubic hair
now rare to see pubic lice in sexual health clinics

Question 21

genital warts decline

Answer 21

150 types of HPV
6 and 11 cause warts
Gardasil vaccine protects 6,11,16,18
16 and 18 are associated with cancers in cervix, oral cavity, rectum,penis, vulva,vagina
rates of genital warts declined

Question 22

Gardasil vaccine

Answer 22

girls and now boys vaccinated age 12
MSM can be vaccinated for free at sexual health clinics if under 45

Question 23

why have HIV rates declined

Answer 23

use of pre-exposure prophylaxis PrEP, daily tablet stopping you catching HIV
change in guideline and funding so all patients with HIV can now have treatment regardless of their immune function (CD4 count), people taking effective treatment aren’t infectious

Question 24

which STI’s are going up

Answer 24

Gonorrhoea, Syphilis, Herpes, Trichomonas, Chlamydia

Question 25

gonorrhoea

Answer 25

bacterial infection super bug and global threat increasing resistance treatment only in sexual health partner notification is essential test of cure is essential can get everywhere causes: discharge, pain urinating, pelvic and testiculat infection, conjunctivitis rarely: sepsis and arthritis

Question 26

gonorrhoea gram stain

Answer 26

gram negative intracellular diplococci

Question 27

what is the most common bacterial STI in the uk

Answer 27

chlamydia trachomatis

Question 28

chlamydia trachomatis

Answer 28

very transmissible symptoms: discharge, pain urinating, irregular bleeding, pain with sex, testicular swelling, conjunctivitis many asymptomatic NAAT test to diagnose

Question 29

chlamydia treatment

Answer 29

single dose antibiotic doesn't treat rectal infection caused resistance in another STI, no longer recommended

Question 30

syphilis

Answer 30

bacterial infection caused by spirochete called treponema pallidum highest incidence now since WW2 congenital syphilis is back in UK mainly blood tests to diagnose curable with high dose penicillin untreated can cause serious health problems

Question 31

stages of syphillis

Answer 31

early, caught under 2 years ago late, caught more than 2 years ago

Question 32

early syphillis

Answer 32

latent, no symptoms or signs but positive test primary: ulcer "chancre" secondary: whole body infection, multiple organs can be affected

Question 33

late syphillis

Answer 33

latent: no symptoms or sings but positive test cardiovascular neurological gummatous

Question 34

images primary syphilis

Answer 34

Question 35

images secondary syphilis

Answer 35

Question 36

untreated syphilis in pregnancy

Answer 36

Question 37

congenital syphilis early

Answer 37

Question 38

congenital syphilis late

Answer 38

Question 39

mycoplasma genitalium

Answer 39

new STI smallest bacteria ever found NAAT tests available to look for DNA unsure on numbers diagnosis is still not in all clinics

Question 40

when would you test for mycoplasma genitalium

Answer 40

suspected pelvic infection in women male urethritis contacts of mycoplasma already resistant worldwide

Question 41

trichomoniasis

Answer 41

protozoa many people in uk haven't heard of it causes discharge and urethral/vaginal soreness associated with miscarriages

Question 42

most common worldwide STI

Answer 42

trichomoniasis

Question 43

genital herpes

Answer 43

1 in 10 herpes simplex virus primary infection= flu like and lasts 5-7 days painful lymph nodes tingling pain in genital area, bum or legs genital blisters or ulcers can get recurrent sores can't cure but treatment to prevent it coming back life long infection

Question 44

complications of STI's

Answer 44