Sexual Health Demonstrations Flashcards
What is an STI?
An infection which is predominantly sexually transmitted
What is an STD?
Disease that occurs as a result of an STI
Why is someone with an STI at greater risk of contracting another?
Infections have common risk factors
Why are STIs common?
Many are asymptomatic and go undetected and therefore untreated. Therefore the spread easily
What can delay in diagnosis lead to?
Delay in diagnosis can lead to an increased chance of transmission and complications. Asymptomatic chlamydia infection can become four cases of chlamydia and asymptomatic HIV infection can become AIDS. •
What is partner notification?
The activity of identifying and informing sexual contacts of someone with an STI
What is the causative organism in gonorrhoea?
Neisseria gonorrhoea
What are the symptoms of gonorrhoea in males?
- 10% of males have no symptoms though might have clinical signs if examined.
- Thick, profuse yellow discharge, dysuria.
- Rectal and pharyngeal infection often asymptomatic.
What are the symptoms of gonorrhoea in women?
- > 50% asymptomatic
- Vaginal discharge
- Dysuria
- Post-coital bleeding
What are the possible complications of gonorrhoea?
- Epididymitis
- Pelvic inflammatory disease, Bartholin’s abscess
- Acute monoarthritis usually elbow or shoulder
- Disseminated gonococcal infection including skin lesions (pustular with halo)
What is the incubation period of gonorrhoea?
- Average 5 to 6 days
- Range 2 days to 2 weeks
What is the epidemiology of gonorrhoea?
- Much less common than chlamydia.
- Most cases are in men, often in men who have sex with men (MSM).
How is gonorrhoea diagnosed?
- Nucleic Acid Amplification Test (NAAT) on urine or swab from an exposed site – vagina, rectum, throat.
- Gram stained smear from urethra/cervix/rectum in symptomatic people.
- Culture of swab-obtained specimen from an exposed site using highly selective lysed blood agar in a 5% CO2 environment. Should be done for all confirmed cases to assess antibiotic sensitivity.
How is gonorrhoea treated?
Blind treatment
-Ceftriaxone 500mg IM once plus Azithromycin 1g.
Treat according to antibiotic sensitivity
How should gonorrhoea be followed up?
- Test of cure at 2 weeks
- Test of reinfection at 3 months
What is the causative organism of chlamydia?
- Chlamydia trachomatis serovars D to K
- [The rare Serovar L2b, which causes Lymphogranuloma venereum, usually gives symptoms of severe proctitis. ]
How doe chlamydia present in females?
- > 80% asymptomatic
- Vaginal discharge
- Dyuria
- Intermenstrual/post-coital bleeding
- Conjunctivitis
How does chlamydia present in males?
- > 70% asymptomatic
- Slight watery discharge
- Dysuria
- Conjunctivitis
What are the complications of chlamydia?
-Epididymitis
- PID and ectopic pregnancy, pelvic pain and infertility
- Probably only 1% of women will develop fertility problems
-Reactive arthritis/reiter’s syndrome (urethritis,cervicitis, conjunctivitis and arthritis)
What is the epidemiology of chlamydia?
- Common
- Most cases in people under 25 especially sexually active teenage women
How is chalmydia diagnosed?
- First void urine in men
- Swab or cervix, urethra and rectum as appropriate
- Specimens tested using NAAT
How is chlamydia treated?
-Azithromycin 1g PO once-Doxycycline 100mg bd 1 week if rectal infection
What is the follow up for chlamydia?
- Test for reinfection at 3-12 months
- Earlier test of cure not needed unless symptoms persist
What is the causative organism of trichomoniasis?
Trichomonas vaginalis
What are the symptoms of trichomoniasis in men?
Usually asymptomatic
What are the symptoms of trichomoniasis in women?
- 10-30% asymptomatic
- Profuse thin vaginal discharge: greenish, frothy and foul smelling
- Vulvitis
What is the epidemiology oftrichomoniasis?
- Uncommon
- More common in middle aged than some other STIs
What are the possible complications of trichomoniasis?
Miscarriage and preterm labour
How is trichomoniasis diagnosed?
- PCR on a vaginal swab.
- NB not on urine yet so no test for men.
- Point of Care: microscopy of wet preparation of vaginal discharge.
What is the treatment for trochomoniasis?
Metronidazole 400mg po bd for 5 days or 2g single dose
What is the causative organism of herpes?
Herpes simplex virus types 1 and 2
What are the symptoms of herpes?
- 80% asymptomatic
- Rest recurrent symptoms (monthly/annually)
- Burning/itching then blistering then tender ulceration.
- Tender inguinal lymphadenopathy.
- Flu-like symptoms.
- Dysuria, Neuralgic pain in back, pelvis and legs,
What are the possible complications of herpes?
- Autonomic neuropathy (urinary retention)
- Neonatal infection
- Secondary infection
What is the incubation period for herpes?
- About 5 days to months
- Some people never report symptoms
How is herpes diagnosed?
- Clinical impression
- Swab from lesion target using PCR
What is the treatment for primary outbreak herpes?
- Aciclovir: various regimens e.g. 400mg for 5 days
- Lidocaine ointment
What is the treatment for infrequent recurrences?
- Lidocaine ointment
- Aciclovir 1.2g once daily until symptoms have gone (1-3 days)
What is the treatment for frequent recurrences?
Aciclovir 400bd long-term as suppression
What is the causative organism of anogenital warts?
Human papillovirus types 6+11 (occasionally type 1)
What are the symptoms of anogenital warts?
- Lumps with a surface texture of a small cauliflower
- Occasionally itching or bleeding especially if perianal or intraurethral
What is the epidemiology of anogenital warts?
- > 90% of UK population have a genital HPV infection at some point in their life.
- Only about 20% of those infected with a wart-causing strain of human papilloma virus get warts.
- A drop in cases is anticipated in response to quadrivalent HPV vaccine.
What are the possible complications of anogenital warts?
- None in adults
- Neonatal laryngeal papillomatosis
How are anogenital warts diagnosed?
- Appearance
- Biopsy if unusual to exclude intrepuithelial neoplasia (rarely needed)
How are anogenital warts treated?
- Podophyllotoxin (brands warticon and condyline), imiquimod (brand Aldara). (Both home treatments.)
- Others – cryotherapy
- Bulky warts – diathermy, scissor removal.
What is the causative organism of syphilis?
Treponema pallidum
What are the symptoms of syphilis with reference to stage?
- Can be asymptomatic or mild
- Primary: local ulcer (chancre)
- Secondary: rash, mucosal ulceration, neuro symptoms, patchy alopecia, other
- Early latent: no symptoms but <2 years since caught
- Late latent: no symptoms but >2 years since caught
- Tertiary: neurological, cardiovascular or gummatous, skins lesions
What is the epidemiology of symphilis?
> 90% of cases in Scotland are in men who’ve had sex with men
What are the possible complications of syphilis?
Neurosyphilis
-Cranial nerve palsies (commonest)
Cardiac or aortal involvement
Congenital syphilis
What is the incubation period of syphilis?
9 to 90 days until appearance of chancre but can also be asymptomatic
How is syphilis diagnosed?
- Clinical signs
- Serology for TP IgGEIA, TPPA and RPR
- PCR on sample from an ulcer
How is early (<2 years with no neurological involvement) syphilis treated?
-Benzathine penicillin 2.4 MU im once
Or
-Doxycycline 100mg bd po 2 weeks
How is late (>2 years and no neurological involvement) syphilis treated?
- Benzathine penicillin 2.4MU im weekly for 3 doses
- Doxycycline 100mg bd po 28 days
