Sexual health Flashcards
Chlamydia trachomatis
Most common STI, up to 10% of people under 25 are infected. Often asymptomatic.
Presentation:
- Men - urethritis, mucopurulent discharge (milky), dysuria
- Women - increased vaginal discharge, dysuria, postcoital/intermenstrual bleeding, lower abdo pain
- Proctitis
Investigation:
- If any symptoms or even if asymptomatic but have been in contact with anyone - full STI screen
- NAATs for chlamydia - for women, self-taken vulvo-vaginal swabs; for men - first pass urine sample. (Triple site - oral and anal too if relevant)
Management:
- Doxycycline 100mg twice daily for 7 days
- 1g azithromycin - second line and pregnancy
- Don’t have sex for 7 days/until treatment finished
Gonorrhoea
Can be asymptomatic. Coinfection with CT is common.
Presentation:
- Men - urethritis, mucopurulent discharge (green), dysuria
- Women - increased vaginal discharge, dysuria, postcoital/ontermenstrual bleeding, lower abdo pain.
- Proctitis
Investigation:
- If any symptoms or even if asymptomatic but have been in contact with anyone - full STI screen
- NAATs from self-taken vulvovaginal swabs / first pass urine - men
- Urethral swab for men, endocervical, rectal, pharyngeal swab for GC culture (need to do culture for sensitivities due to increasing gonorrhoea antimicrobial resistance)
- Microscopy - intracellular, gram neg diplococci
Management:
- Single dose ceftriaxone 1g IM (can give empirically if confirmed contact)
- If sensitivity known and sensitive to ciprofloxacin 500mg give this
- For pen allergy, combination includes azithromycin
- No sex for 7 days
- Contact tracing
- Follow up 14 days after treatment - test of cure (NAAT)
Mycoplasma genitalium (M. gen.)
Often CT confection - don’t often go looking for it unless have CT because it’s common and high anti-microbial resistance
Presentation:
- Causes non-gonococcal urethritis in men - mucopurulent urethral discharge, dysuria
Investigations:
- Full STI screen - NAATs
Management:
- Doxycyline 7 days
PID
Happens when infections from cervix/vagina go further up - causes endometritis, salpingitis, pelvic peritonitis. Usually due to CT, GC or M gen. One episode can cause infertility in 10% of women
Presentation:
- Lower abdo pain, increased discharge, irregular bleeding, deep dyspareunia, dysuria
- Adnexal tenderness on bimanual examination
Investigations:
- Clinical signs/symptoms are key to diagnosis
- Microscopy of discharge for BV
- NAATs from swab for CT and GC
- Do a pregnancy test as ectopic is an important differential
- Consider urine dip for UTI
Management:
- Early treatment key - treat empirically with broad spec - 1g IM ceftriaxone, doxycycline for 7 days, metronidazole for 14 days
- No sex until treatment finished
- Contact tracing
Bacterial vaginosis
Most common cause of changes in vaginal discharge. Happens when normal lactobacilli get replaced by gardnerella vaginalis, anaerobes
Presentation:
- Increased vaginal discharge
- Fishy odour
Investigations:
- Microscopy (gram stain) vaginal discharge
- Vaginal pH (will be raised)
Management:
- Oral metronidazole for 7 days
Candida
Not an STI. Very common (75% of women will have symptomatic candida at some point)
Presentation:
- Women - vulva itching, thick vaginal discharge, burning, dysuria
- Men - penile irritation, rash immediately following sex, spotty red itching rash
Investigation:
- Clinical
- (Microscopy )
Management:
- Fluconazole 150mg single dose (if recurrent can have this weekly)
- Clotrimazole pessaries, topical creams
Risk factors:
- Immunosupression
- Diabetes
Trichomoniasis
Most common STI worldwide but not that common in Europe. Often asymptomatic
Presentation:
- Women - purulent discharge (yellow or grey) , malodour, puritis, dysuria. ‘Strawberry cervix’ OE
- Men - mostly no symptoms, if symptoms - urethral discharge, irritation, dysuria
Diagnosis:
- NAATs, first pass urine - men
Management:
- Metronidazole for 7 days
- No sex for 7 days
- Contact tracing
Anogenital warts
Caused by HPV
Skin-to-skin contact with someone who has clinical/subclinical infection - common, people often don’t have signs.. No risk of malignant transformation
Presentation:
- Painless, growing lumps
Investigation:
- Clinical
- No test for HPV
- Differential to consider - molluscum, if very atypical in older patients - ?malignancy
Management:
- STI screen as co-infection common
- Topical podophyllotoxin (not for pregnancy)
- Keratinized warts (on hair skin) respond better to cryotherapy
- Advise condoms to protect
- Vaccination
Herpes simplex
More common in women - larger area of susceptible mucous membrane. Can pass on even if asymptomatic - and only 20% of people who do have it serologically have ever had symptoms.
Presentation:
- Primary genital infection - first exposure - if symptomatic - multiple painful, ulcers, generalised malaise, proctitis if rectal infection
- Recurrent - reactivation of infection (latent in dorsal root ganglia) - prodrome of itching, tingling, pain
- Worse if immunosuppressed
Investigation:
- Swab ulcer - DNA detection
- Full STI screen - confection
Management:
- Aciclovir - reduces severity - also fine to give in pregnancy
- Avoid sex during symptomatic episodes
Syphilis
Treponema palidum
More common in MSM in UK
Presentation:
- Primary - a few weeks after exposure - 1 painless ulcer which goes after 2-6 weeks
- Secondary - occurs in 25% with untreated syphilis. 6 - 10 weeks later - general malaise, widespread skin rash - maculopapular over whole body, lymphadenopathy. Can disappear and reoccur without treatment
- Latent - no symptoms, untreated but syphillis serology - early=<2 years after infection
- Tertiary - 1/3 of people with untreated latent syphillis will get this anything from 2 years to 30 years later - lesions, cardiovascular problems, neuosyphillis
Investigation:
- Immunoassays to detect IgG and IGM. If positive - treponemal tests - this remains positive for life tho. Non -treponemal tests - RPR tests - to see if current infection but can lead to false positives if have other infections/autoimmun disease.
Management:
- Benzathine penicillin
- Doxy if pen allergy
- STI scrren
- No sex for 14 days
- Contact tracing
Lymphogranuloma venereum
Tropical. More common in MSM in UK. Caused by chlamydia trachomatis - but a more invasive type
Presentation:
- Painless papule/ulcer
- Proctitis, mucopurulent discharge, bleeding, tenesmus
Investigation:
- Swab from ulcer for chlamydia NAAT, then type for LGV
- Associated with Hep C so test for that too
Management:
- Full STI screen
- Doxycline for 21 days
- No sex until end of treatment
- Contact tracing
Window period for chlamydia/gonorhoea tests
2 weeks
Window period for HIV test
45 days
When does levonelle need to be taken
within 72 hrs
When does Ella one need to be taken
within 5 days
