Session 9 Flashcards
Factors effecting STI transmission
Burden of STI/problems with having STIs
How can STIs present?
Give examples of bacteria, viruses, parasites, fungi & Protozoa causing STIs
What investigations can you perform for STI in men?
first pass urine (men only) – urethral GC/CT (can be sent in white universal pot)
vulvo-vaginal swab – vaginal/cervical GC/CT (use chlamydia swab pack and break pink swab tip into NAAT medium)
pharyngeal swab – GC/CT of the throat (use plain purple swab and break tip into NAAT medium)
rectal swab – GC/CT of the rectum (send as for pharyngeal swab)
What investigations would you perform in women?
All of these samples can be self-taken. Rectal swabs should be introduced approx. 2cm into the rectum, rotated against the rectal wall, and removed. Vulvo-vaginal swabs should be inserted as far into the vagina as possible, and swept along the vaginal walls and vulva as they are removed to maximise sample volume.
Additional tests for symptomatic patientsmay include the following:
urethral discharge – charcoal swab to microbiology requesting Gonococcal culture
vaginal discharge – charcoal swab from cervical os for Gonococcal culture; additional charcoal swab from posterior fornix for Trichomonas vaginalis and Candida culture
oral/genital ulceration – green viral swab for herpes simplex virus (HSV) 1 and 2 PCR
anal discharge – charcoal swab for Gonococcal culture, HSV swab if significant anorectal discomfort
conjunctivitis – GC/CT NAAT from conjunctiva; charcoal swab for Gonococcal culture if significant purulent discharge.
Chylamydia trachomatis
Niesseria gonorrhoea
Symphilis
HSV presentation
Ulcer base specific type serology
Trichomonas vaginalis
How to treat scabies and pubic lice
- Features of scabies
- Management
- The BNF advises to apply the insecticide to all areas, including the face and scalp, contrary to the manufacturer’s recommendation. Patients should be given the following instructions:
Image below is Norwegian scabies
skin contact
scabies mite lays its eggs in the stratum corneum. The intense pruritus associated with scabies is due to a delayed type IV hypersensitivity reaction to mites/eggs which occurs about 30 days after the initial infection.
1.
- widespread pruritus
- linear burrows on the side of fingers, interdigital webs and flexor aspects of the wrist
- in infants the face and scalp may also be affected
- secondary features due to scratching: excoriation, infection
2.
permethrin 5% is first-line
malathion 0.5% is second-line
pruritus persists for up to 4-6 weeks post eradication
3.
- apply the insecticide cream or liquid to cool, dry skin
- between fingers and toes, under nails, armpit area, creases of the skin such as at the wrist and elbow
- allow to dry and leave on the skin for 8-12 hours for permethrin, or for 24 hours for malathion, before washing off
- reapply if insecticide is removed during the treatment period, e.g. If wash hands, change nappy, etc
- repeat treatment 7 days later
What is this image showing
HPV - anogential warts
6 11 non harmful
16 18 harmful - cervical cancer
Bacterial vaginosis
Vulvovaginal candidiasis
State some less complicated UTIS
Systemic complications of STIs
The result of infection ascending
from the endocervix, causing
endometritis, salpingitis,
parametritis, oophoritis, tubo-
ovarian abscess and/or pelvic
peritonitis”
- What is PID?
- Pathophysiology?
- The result of infection ascending from the endocervix, causing endometritis, salpingitis,
parametritis, oophoritis, tubo- ovarian abscess and/or pelvic peritonitis
ESPOAP
parametritis inflammation of CT of uterus/parametrium
oophoritis - ovary
- Ascending infection from the endocervix and vagina
Infection causes inflammation
Inflammation causes damage:
Thus damaged tubal epithelium
Thus adhesions form
Some recovery of tubal epithelium does occur
- Aetiology
- Risk factors
- Sexually transmitted infections:
- Chlamydia trachomatis D-K
- Neiserria gonorrhoea
Others
- **Gardnerella vaginalis
- Mycoplasma hominis**
- Anaerobes
- Actinomycosis
Often polymicrobial
- As for STIs:
- Young age
- Lack of use of barrier contraception
- Multiple sexual partners
- Low socioeconomic class
IUCD
Clinical features to check for PID
- Investigations
- Clinical findings for PID
Urinary and/or serum pregnancy test
Endocervical and High vaginal swabs
- Presence of NG/CT supports diagnosis
- Absence of NG/CT does not exclude diagnosis
Blood tests
- WBC and CRP
Screening for other STIs including HIV
Diagnostic laparoscopy is gold standard
- Can also perform adhesiolysis and drain abscesses
- Findings at laparoscopy in women with suspected PID
- Management
- IMAGE
fibre-optic instrument is inserted through the abdominal wall to view the organs in the abdomen or permit small-scale surgery
- Low threshold for empirical treatment
- Delayed treatment increases longterm sequelae
Symptomatic management with analgesia and rest
Management of sepsis
Severe disease requires IV antibiotics and admission for observation and possible surgical intervention
- Pyrexia >38, signs of tubo-ovarian abscess, signs of pelvic peritonitis
- No response to oral therapy
- Increased risk of longterm sequelae
Contact tracing essential for partners, and full screen for woman
- GUM best able to do this
Antiobiotics treatment regime for PID
When might laparoscopy be considered?
Surgical management - Laparoscopy/laparotomy may be considered if:
- no response to therapy
- Clinically severe disease
- Presence of a tubo-ovarian abscess
