Sexual Health Condition Flashcards
List morbidities of STIs
- Infertility
- maternal mortality
- ectopic pregnancy
- cervical cancer
- co-factor HIV transmission
- persistent genital pain/discomfort • psychological
STI epidemiology
- Clear link between sexual ill health, poverty and social exclusion
- Certain ethnic/minority groups disproportionately effected
- Risk behaviour occurs across all social strata No condom use and >1 sexual partner in past year
What type of organism is chlamydia? Where does it infect?
Chlamydia are obligate intracellular pathogens related to the gram-negative bacteria
They are small - 2-300 nm Genome just over 1.0 mb.
They infect mostly cuboidal epithelial cells, notably those of
the urethra and cervix ( but also the conjuctiva )
Some infections ascend to the endometrium, fallopian tubes and occasionally enter the peritoneal cavity. In the male, the epididymis can be infected.
They cause persistent infections which are slow to resolve. (1 year?)
What are the symptoms of Chlamydia trachomatis in women?
- Women
- Usually asymptomatic • Cervicitis
- PID/Salpingitis
- Infertility
- Proctitis
- Conjunctivitis
- Reactive arthritis • Premature labour
What are the symptoms of Chlamydia trachomatis in men?
- Men
- Usually symptomatic
- non-gonococcal urethritis (30-50%)
- Epididymo-orchitis • Proctitis
- Reactive arthritis
- Conjunctivitis
How is chlamydia diagnosed?
- Culture- slow and highly skilled, essential for medico-legal cases. 2. Direct immunofluorescence -fast and highly skilled!
- Enzyme-linked immunoassay
- DNA amplification assays. PCR, SDA
NB- Contact trace and investigate all partners.
The samples taken for chlamydial diagnosis In the female are:
- In the female- An endocervical canal swab and
a urethral swab.
a ‘first catch’ or early morning urine.
Rectal swabs from both sexes.
The samples taken for chlamydial diagnosis In the males are:
In the male - A deep urethral swab (3-4 cms- Ouch) - a ‘first catch’ or early morning urine.
3. Rectal swabs from both sexes.
Outline Therapy for Chlamydia trachomatis infections.
Chlamydia trachomatis is susceptible to a range of antibiotics and resistance is not a problem.
Uncomplicated infections are usually treated with
Doxycycline 100mg bd 7 days or (if non-compliance is suspected) 1g azithromycin stat. Ofloxacin is an alternative
In pregnancy erythromycin is preferred (500mg qds 2 weeks). Test of cure is not considered necessary but vital in pregnancy Penicillins are only chlamydiostatic ( post-gonococcal urethritis).
Human papilloma virus Treatment
- Genital warts
- 20% resolve spontaneously
- Anti-viral, Ablative, Immuno-modulation • Counselling
- Partner notification
- Condoms
- Does not eradicate HPV infection
- No effective therapy for HPV infection
- Pregnancy – avoid topical treatments. Cryotherapy esp. if obstructing vaginal canal.
- Little risk to newborn
Neisseria Gonorrhoeae - describe the pathogen
- Gram-negative bacterium - diplococcus. 2. Capable of intracellular growth.
- Has fastidious growth requirements
- Antibiotic resistant strains are becoming increasingly common. Multiple resistance is also seen. Resistance is both plasmid and chromosomally mediated.
- Strains vary greatly- genetically resourceful
what are the symptoms of Gonorrhoea in women?
- Women
- Usually asymptomatic • Cervicitis
- PID/Salpingitis
- Infertility
Infection with Neisseria Gonorrhoeae - Diagnosis
Gram-stained smear of urethral swab may reveal diplococci but -
- Culture remains the mainstay due to need to test sensitivity. Chocolate blood agar with growth supplements and vancomycin, carbon dioxide.
- Because there are related Neisseria strains which may give a false diagnosis- stringent identification is essential. Oxidase production, sugar fermentation (only glucose)- agglutination tests.
- Non-culture tests based on antigen or DNA detection are coming on the market but they do not test Ab. sens.
- Direct microscopy in the clinic is often effective.
Describe Gonorrhoeae antibiotic Therapy
Antibiotic therapy now depends upon the particular Ab. sensitivity of local strains.
Penicillinase production is relatively common making these antibiotics less useful.
Fluoroquinolones and cephalosporins are in common use (cefixime 400mg stat). IM ceftriaxone 250 mg given in some cases. The inclusion of an anti-chlamydial antibiotic such as doxycycline is common since the two infections often occur together.
Single doses are preferred to avoid non-compliance. Test of cure vital. Give Rx for Chlamydia as well.
Herpes Simplex virus genital infection- describe the virus
Herpes viruses are large (150nm) enveloped, DNA viruses with a genome of 150 kb. Two types -1&2.
1.They infect, initially, epidermal cells of the skin or mucous membranes with a productive infection leading to tissue damage
2. Move into nerve cells and axonal cytoplasmic
flow transports them to the ganglia. Establish latent infections.
3. Occasionally, recrudescence occurs and the virus tracks back along the nerve to the original site of infection
what are the symptoms of herpes Simplex virus genital infection
1.Primary lesion small vesicles on penis or vulva which burst
to give shallow painful ulcers. Cervicitis is also common.
2. Lesions shed virus for 15-20 days and then resolve.
3. There may be systemic symptoms- malaise, fever, headache. 4. Asymptomatic 70%
Herpes Simplex virus genital infection- Management
Some relief is afforded by the acyclic neucleosides. Acyclovir- Zovirax.
Function by being added to viral DNA - chain terminators They are important in controlling infection in the
immunosuppressed patient. Role in prevention recurrences
What effect does Herpes Simplex virus genital infection have in pregnancy?
- No problems in conceiving
- High neonatal mortality if in 3rd Trimester thus c/section needed • Aciclovir not licensed for pregnacy but can be given at any stage • Link closely with Obs/Gyn & GUM for surveillance
Syphilis - The pathogen
Caused by a spirochaete called Treponema pallidum. Characteristic corkscrew spiral shape and motility. Genetically simple - v. small genome - 1.3Mb.
No culture system- but can be grown in animals Closely related sub-species cause non-STD infections.
Describe the progression of Syphilis
- Early - infectious (2yrs)
- Primary - chancre
- Secondary - rash • 20% relapse
- Latent
- congenital •up to 4 years
- Late
- Latent - 60%
- Tertiary - 40% • Neurosyphilis • Cardiovascular • Gummatous
Diagnosis of Syphilis
- Primary syphilis- Diagnosis by demonstration of spirochaetes in the primary chancre by dark field microscopy
- Serology is the mainstay. Abs appear after 2 weeks and persist.
Two types- Non-treponemal - cardiolipin- glycolipid. host antigens. These may be present in other tissue-destructive disease and IDUs. Have use in screening and test of cure and neurosyphilis. Mainly agglutination tests.
Treponemal- Can cross react with other spirochaetes. Hence adsorption of sera is normal TPHA, FTA, EIA. Recombinant Ags becoming available.
Syphilis - Treatment.
No problem at all with antibiotic resistance T. pallidum remains highly penicillin sensitive.
In UK procaine pen. i.m. is used - less failure than benzathine pen. as used in USA
Tetracyclines are preferred in cases of penicillin allergy.
Neurosyphilis and pregnancy requires prolonged treatment and intravenous administration of benzylpenicillin is preferred.
