sexual health Flashcards
neisseria gonorrhoeae
gram neg diplococcus bacteria
spread via mucous secretions from infected area
infects mucous membranes with a columnar epithelium - endocervix, urethra, rectum, conjuntiva, pharynx
high levels of antibiotic resistance to gonorrhoea
neisseria gonorrhoeae presentation
more symptomatic than chlamydia
- odourless purulent discharge, possibly green/yellow
- dysuria
- pelvic pain(F), testicular pain (M)
urethritis, PID, pharyngitis, proctitis
neisseria gonorrhoeae investigation
screen by PCR, NAAT
requires chocolate agar to grow
neisseria gonorrhoea management
1st = ceftriaxone IM or ciprofloxacin
2nd = cefixme plus azithromycin - only if IM contraindicated or refused (needle phobic)
test of cure in all patiennts after 2-3weeks
partner notification
chlamydia trachomatis
gram neg
intracellular bacterium - enters + replicates before rupturing the cell + spreading to others
commonest ST in uk, significant cause of infertility
up to 50% resolve untreated after 12months
incubation period of chlamydia trachomatis
7-21days
lots are asymtpmatic - 70% W, 50%M
incubation period of gonotthoea
2-5days
(chlamydia 7-21days)
chlamydia presentation
increased vaginal discharge - milky
irregular bleeding
abdo pain
dyuria
dyspareunia
urethritis, epididymo-orchitis, proctitis
chlamydia trachomatis
NAAT - nucleic acid amplification test
management of chlamydia
doxycycline for 7 days
or azithromycin 1g stat followed by 500mg for 2days
contact tracing
chlamydia complication
PID
salpingitis, endometritis
tubal infertility
ectopic pregnancy
reactive arthritis
mycoplasma genitalium + Mx
not sustainable ass lacking cell walls
assoc with non-gonococcal urethritis + PID
Ix = NAAT
doxycycline then azithromycin
-> azithromycin used alone in pregnancy/breast feeding
test of cure
investigation of mycoplasma genitalium
NAAT
men = first urine sample in morning
women = vaginal swabs
what does treponema pallidum cause
syphillis
spirochaete - moves by rapid rotation, sprial shaped
found in 1-11% of pregnant women during screening
similar in MSM
how is syphilis spread? incubation period?
sexually transmitted
via blood transfusion
during pregnancy
incubations = 9-90days
syphilis investigations
Samples from sites of infection to confirm presence of T. pallidum
o Dark field microscopy
o Polymerase chain reaction (PCR)
syphilis management
IM benzathine benzylpenicillin
- alternative = doxycycline
- Contact tracing
tertiary, neurosphylisi, pregnancy -> specialist management
transmission of syphilis
sexually - oral, vaginal, anal
vertically -mother to baby
IV drug use
blood transfusions/transplants
stages of syphilis
primary = painless ulcer (chancre) at orignial site of infection, local lymphadenopathy
secondary = systemic symptoms (see other)
latent = symptoms disappear for >=2yrs
tertiary = many organs affected, gummas, neurosyphilis
secondary stage of syphilis
systemic symptoms
o maculopapular copper palmar/plantar/trunk rash
o snail trail mouth ulcers
o patchy alopecia
o flu like illness
o condylomata lata – painless, warty lesions on genitalia
o generalised lymphadenopathy
can resolve after 3-12wks when enter latent stage
tertiary stage of syphilis
many years after initial infection, affect many organs
- gummas – granulomatous lesions of the skin + bones
- ascending aortic aneuryms
- neurosyphilis
o argyll-robertson pupil
———> (bilateral small pupils that reduce in size for near object but NOT when exposed to light)
———> Often irregularly shaped
differentials for vaginal discharge
Candida –> cottage cheese discharge, vulvitis, itch
Trichomonas vaginalis –> offensive, yellow/green, frothy discharge, vulvovaginitis, strawberry cervix
Bacterial vaginosis –> offensive, thin, white/grey, “fishy” discharge
risk factors for candida
antibiotics
poorly controlled diabetes
high oestrgen levels - high in pregnancy
immunocompromised
candida presentation
thick, white cottage cheese discharge - NOT SMELLY
vulvitis - superfical dysparenunia, dysuria
itch
