sexual health in practice (Carlie) Flashcards
difference between STI and STD
STI is the pathogen that causes infection through sexual contact
STD refers to the disease state that has developed from an infetion
How are STIs transmitte?
unprotected sexual intercourse or intimate contact
organism passes from person to person in blood, semen, vaginal/bodily fluids
How can STIs be transmitted non-sexually?
mother to child during pregnancy/childbirth
blood transfusions
shared needles
bacterial STIs
gonorrhoea
chlamydia
syphilis
viral STIs
HIV/AIDS
genital herpes
HPV - genital warts, cervical cancer
hepatitis B
parasites that can cause STIs
trichomoniasis
lice
scabies
fungal causes of STIs
thrush (can get it not as an STI also)
long term health problems from STIs
pelvic inflam diseases ectopic pregnancy chronic abdominal pain adverse pregnancy outcomes CV/neurological damage cancers arthritis
What STI has the strongest resistance to antibiotics?
gonorrhoea
3 levels of sexual health services
level 1 - asymptomatic
level 2 - symptomatic
level 3 - complex/specialist
What are level 3 SHS?
GUM - genitourinary medicine services
integrated GUM and sexual and reproductive health (SRH) services
What are level 1 and 2 SHS?
GPs
some pharmacies
SRH services (sexual reproductive health services)
online sexual health services
What services do community pharmaies offer?
- sexual health advice/signoosting
- EHC
- contraception PGD/OTC
- chlamydia screening 15-24yrs
- condom distribution
- STI kit collection
- pregnancy testing
- pre-conception care
- ED treatment
- HPV vaccination
at risk grooups for STIs
- adolecents 15-24
- from country/visited with high HIV/STI rates
- men who have sex with men
- multiple/concurrent partners
- early onset of sexual activity (less educated)
- people with sexual partners from these groups
- alcohol/substance abuse
- IV drug use
safe sex advice
- education on STIs
- partner reduction
- condoms
- repeat testing
- vaccination (HIV, hepatitis)
- HIV pe-exposure prophylaxis
condom advice
- most effective against HIV/STIs
- 95% if perfect use
- encourage use
CDS - condom distribution services
C-card most common CDS
targets young people
discussion around condoms/safe sex/contraception/STIs
Fraser guidance with safegurading
Fraser guidance always assessed in under 16
under 13 and safeguarding
- not legally able to consent to sexual activity
- documanet circumstances
- discuss with child protection and record conversation
safeguarding in 13-16 years
consider potential harm to child
consider informing child protection lead
safeguarding in 16-17 years
- over 16 has the right to independence
- child is U18
- offer safeguarding if needed
safeguarding in over 18s
assumed to be competent unless there’s a reason they are not
- don’t need to consider safeguarding unless there are any issues with capacity
signs to be aware of for safeguarding
- learning disability
- older boyfriend
- alcohol/drug use
- multiple presentations EHC/STD/pregnancy tests
- features of abuse
- not consensual
- migrant child (trafficing)
What needs to be taken for the history taking of STI screening?
- reason for attendance
- history of proplem (if symptomatic)
- full sexual history
- PMH, previous STIs
- vaccination Hx
- drug Hx
- allergies
- females - menstrual, contraceptive Hx
What does sexual Hx allow for?
- STI risk
- symptoms
- contraception use/pregnancy risk
- HIV/hepatitis risk
- safeguarding concerns
- recreational drugs/alcohol
- symptom review
sexual Hx - asymptomatic
- confirm lack of symptoms
- competency/safeguarding
- date of last sexual contact (LSC) and no. partners in last 3 mths
- gender of partners, sites of exposure, condom use, suspected infection
- previous STIs
- women - LMP, contraception
- vaccine Hx
- alcohol/drug Hx
sexual Hx - symptomatic (additional questions)
- symptoms
- pregnancy Hx
- PMH/surgical Hx
- med Hx, drug allergies
What is the bacterial cause of chlamydia?
chlamydia trachomatis
How is chlamydia transmitted?
- primarily penetrative sex
- contact with infected genital secretions
- infected secretions onto mucous membranes
- splash from genital fluids
- mother to baby at delivery
Where can chlamydia infect?
endocervix urethra rectum conjunctiva (mother to baby) nasopharynx
symptoms of chlamydia
men - inflammation of the urethra
women - inflammation of the cervix/urethra
What can happen in untreated chlamydia?
- pelvic inflam disease (women)
- epididymo-orchitis
- conjunctivitis
- LGV (men)
- SARA (sexually acquired reactive arthritis)
- adverse outcomes in pregnancy (premature, low weight, infections)
- anxiety/psychological distress
risk factors for chlamydia
- under 25yrs
- new sexual partner
- more than 1 sexual partner in last year
- lack of consistent condom use
symptoms of chlamydia in females
- vaginal discharge
- dysuria
- lower abdominal pain
- fever
- intermenstrual/postcoital bleeding
- deep dyspareunia (pain during SI)
- pelvic pain/tenderness
- cervical tenderness
- inflamed/friable cervix
symptoms of chlamydia in men
- urethritis with dysuria and urethral discharge
- epididymo-orchitis presenting as unilateral testicular pain and swelling
- fever
- reactive arthritis (pain in joints)
What people are screened for chlamydia?
- asymptomatic who are high risk
- symptomatic patients
How to screen for chlamydia
nucleic acid amplification tests (NAATs)
- highly specific/sensitive
- women - vulvovaginal swab (1st line) OR first void urine sample/endocarvical swab
- men - first void urine sample (1st line)
What is MGen?
mycoplasmic genitalium
emerging sexually transmitted pathogen
can have co-infection with chlamydia
has increasing macrolide resistance because of SDA
What used to be used for chlamydia treatment but now there’s increased resistance?
1g single dose of azithromycin (SDA)
What is first line treatment for chlaymdia?
doxycycline 100mg BD for 7 days
When is doxycycline contraindicated?
pregnancy
breast feeding
children under 12 years (can’t give tetracyclines, risk of deposition in bones and discolouration of teeth)
side effects of doxycycline
GI (n&v, GI discomfort, diarrhoea)
photosensitivity (avoid direct sunlight, esp in summer)
alternatives if doxycycline is contraindicated
- azithromycin 1g orally as a single dose
followed by 500mg orally OD for 2 days - erythromycin 500mg BD for 10-14 days
- ofloxacin 200mg BD for 7 days
What treatment is used for chlamydia in pregnancy?
- azithromycin 1g stat
followed by 500mg for 2 days - erythromycin 500mg BD for 14 days
- amoxicillan 500mg TDS for 7 days
What drugs for chlamydia are c/i in pregnancy?
doxycycline
ofloxacin
follow up/guidance for chlamydia
- avoid sexual intercourse/oral until treatment completed (or 7 days after treatment for azithromycin)
- screen for other STIs
- refer to GUM clinic for partner notification
Why can chlamydia teatment fail?
re-infection
What partners should symptomatic males notify?
all partners within 2 weeks
Who should asymptomatic patients notify?
partners in last 3 months
What is the bacterial cause of gonorrhoea?
Neisseria gonorrhoeae
How is gonorrhoea transmitted?
sexual contact where infected secretiong are passed from one mucous membrane to another
during childbirth
What body parts does gonorrhoea infect?
mucous membranes of the
- urethra
- endocervix
- rectum
- pharynx
- conjunctiva
What is disseminated gonorrhoea?
complication of gonorrhoea is it’s not mamaged properly
bacteria invades the blood stream and spreads to different areas
skin lesions, arthralgia, tenosynovitis, arthritis
What are the complications of gonorrhoea?
men - epididymitis, prostatitis, infertility
women - PID, pregnancy problems
babies - blindness
symptoms of gonorrhoea in females (urogenital)
50% asymptomatic
- increased/altered vaginal discharge
- lower abdominal pain
- dysuria
- intermenstrual bleeding/menorrhagia
- dyspareunia (pain on SI)
symptoms of rectal/pharyngeal gonorrhoea in females
asymptomatic
symptoms of genital gonorrhoea in men
usually symptomatic
- urethral discharge
- dysuria
symptoms of rectal/pharyngeal gonorrhoea in men
asymptomatic
What is used to screen for gonorrhoea?
NAAT (nucleic acid amplification test)
women - vulvovaginal swab
men - first pass urine sample
What is required is patient’s NAAT positive for gonorrhoea?
culture required
to test for susceptibility and ID resistant strains
What is a difference between screening for chlamydia and gonorrhoea?
need to do a culture for gonorrhoea to test for susceptibility/ID resistant strains
What is super gonorrhoea?
resistant to the most common antibiotics
What used to be used for gonorrhoea treatment?
dual therapy of ceftriaxone and azithromycin
What treatmens is used for gonorrhoea when antimicrobial susceptibility is not known?
ceftriaxone 1g IM injection as a single dose
Can ceftriaxone be given in pregnancy/BF?
yes it’s safe
What treatment is used for gonorrhoea when antimicrobial susceptibility IS KNOWN?
ciprofloxacin 500mg orally as a single dose
pregnancy/BF
- azithromycin 2g orally as a single dose
How to treat disseminated gonorrhoea
ceftriaxone 1g IM/IV every 24hrs
cefotaxime 1g IV every 8hrs
after 24/48hrs switch to oral form
What treatment is given after 24/48hrs when disseminated gonorrhoea symptoms improve?
cefixime 400mg BD
or
ciprofloxacin 500mg BD
-> guided by sensitivity
guidance for gonorrhoea
- avoid SI/oral until person/partner finished treatment (or 7 days after azithromycin)
- follow up 1 week after treatment
follow up after gonorrhoea
- confirm adherance to treatment and symptm resolution
- ask about adverse reactions
- confirm partner notification
- ask about recent sexual activity (re-infection?)
- reinforce safe sexual practices
What test of cure is used for gonorrhoea?
asymptomatic - NAAT at least 2 weeks after finishing treatment
symptoms - test with culture, at least 3 days after finishing treatment
-> additional NAAT after 1 week if culture negative
