Sexually Transmitted Disease Flashcards
A sexual history should be obtained from any patient presenting with symptoms of…?
Vaginitis Urethritis Epididymo-orchitis Pelvic inflammatory disease Proctitis Ulcer/lumps on genitlas Possible syphillis Possible HIV seroconversion
What infections are screening for in a standard sexual health screen?
Chlamydia
Gonnorrhoea
Syphillus
HIV
How is a NAAT sample for chlamydia testing obtained from a woman?
Self swab of vagina
How is a NAAT sample for chlamydia testing obtained from a man?
Urine sample
How is a NAAT sample for chlamydia testing obtained from a MSM?
Urine sample
Self swab of throat and rectum
In what populations is gonorrhoea more common?
MSM
Afro-carribbean
Urban areas with deprivation
What type of bacteria is n.gonnorrhoeae?
Gram negative diplococcus
How is gonorrhoea spread?
Through mucous membranes
Through secretions
What are the signs and symptoms of gonorrhoea in men?
Urethral discharge and dysuria 2-5 days after exposure in men
What are the signs and symptoms of gonorrhoea in women?
Change in discharge, abdominal/pelvic pain, dysuria and altered bleeding in women
How is gonorrhoea treated?
1mg ceftriazone IM
Why should the test for gonorrhoea be repeated, 2 weeks after treatment?
To ensure cure as gonorrhoea is highly resistant
Who should be treated for gonorrhoea?
Positive test result
Clinical suspicion of gonorrhoea
Recent or ongoing sexual contact with gonorrhoea
What are the possible complications of gonorrhoea?
Epidiymo-orchitis Prostatitis Pelvic inflammatory disease Disseminated gonococcal infection Resistance
What is the most common bacterial STi in the UK?
Chlamydia
What are the risk factors for chlamydia infection?
<25 years old
New sexual partner
>1 sexual partner in a month
Inconsistent condom use
Some people will self-clear a chlamydia infection. T/F?
True
Chlamydia is usually asymptomatic in females but symptomatic in males. T/F?
False - it is usually asymptomatic in both men and women
What are the possible symptoms of chlamydia in men?
Discharge, dysuria and meatal discomfort
What are the possible symptoms of chlamydia in women?
Intermenstrual or post-coital bleeding
Chalmydia can present with proctitis. What are the symptoms of this?
Rectal pain PR discharge Rectal bleeding Tenesmus Constipation
How is chlamydia treated?
Doxycycline 100mg BD for a week
What are the symptoms of pelvic inflammatory disease?
Pelvic pain
Fever
Dys[areunia
What are the complications. of chlamydia?
Tubal infertility Pelvic inflammatory disease Ectopic pregnancy Fizz-high-curtis syndrome Epididymo orchitis
When ids mycoplasma genitalium infection treated?
When patient or their partner has symptoms
How is mycoplasma genitalium infection diagnosed?
NAAT - urine sample for men, self vaginal swab for women
What symptoms/conditions can result from mycoplasma genitalium?
urethritis
pelvic inflammatory disease
What is the causative organism of syphillis?
Treponema pallidum
How is latent syphillis defined?
patient is asymptomatic but tests positive for syphillis
How soon after exposure does primary syphillis present?
9-90 days
Describe the presentation of primary syphillis
Presents 9-90 days after exposure
Single, painless ulcer (chancre) which many patients do not realise they have
Describe the presentation fo secondary syphillis?
3 months to 2 years after exposure
Generalised rash which affects palms and soles
Muco-cutaneous lesions, condylomata lata, lymphadenopathy and fever
Describe the presentation of tertiary syphillis?
Neurosyphilis (variety of neurological symptoms including cognitive symptoms) cardiovascular syphilis (aortic valve disease, aortic aneurysm and aortitis) gummatous syphilis
How is syphylis diagnosed?
Microscopy/viral PCR swab of chancre
Bloods for antibody (stay positive even after completed treatment)
Rapid plasma reagin
What antibiotic is used to treat syphilis?
Benzathin penicillin
What is the causative organism of anogenital warts?
HPV
Which strains of HPV most commonly cause anogenital warts?
6 and 11
When are anogenital warts most likely to spread?
When warts are present
What problems do anogenital warts cause?
Itch and aesthetic problems
Patients with anogenital warts need to notify their partner and previous partners. T/F?
False since there is such a high population prevalence of the virus but condoms should be used to prevent further transmission
How are anogenital warts treated?
Cryotherapy Topical treatments (podophyllotoxin or imiquimod) Surgical excision (rarely required)
What strains of the virus usually cause herpes simplex virus infection?
Types 1 and 2
How is herpes simplex virus diagnosed?
Viral PCR swab
What are the possible complications of herpes simplex virus?
CNS infection
Balanitis
Proctitis
Urinary retention
What is the risk of herpes simplex virus infection in pregnancy?
If this is the first infection then there is a risk of neonatal infection
How is herpes simplex virus treated?
Aciclovir
What group of patient is particularly susceptible to trichomonad vaginalis infection?
Black women
What are the symptoms of trichomonas vaginalis in women?
Vaginal discharge - frothy, yellow Significant vulval itch Dysuria Offensive odour Strawberry cervix
What are the symptoms of trichomonas vaginalis in men?
Asymptomatic usually
Can cause urethritis
How is trichomonas vaginalis treated?
Metronidazole
Describe the pathogenesis of scabies?
Mite excrement triggers a hypersensitivity reaction. Burrows occur especially in the web spaces wrists, elbows and nipples
How is scabies treated?
5% permethrin or
0.5% malathion
Should be washed off after 24 hours
How is phthirus pubis transmitted?
Close bodily contact
Lives on course body hair
How is phthirus pubis treated?
0.5% Malathion
1% permethrin
What are the benefits of regular sexual health. checks for MSMs?
Allows discussion of preventative measures (e.g. partner. choice, condom. use)
Raise awareness of HIV symptoms and indications for post exposure prophylaxis against HIV
Discussion re use of alcohol/drugs in relation to sex
Can address other concerns and signpost to other. services e.g. recreational drug use, ‘coming out’, relationship issues
What can be done to minimise the. development of drug. resistant strains of gonorrhoea?
Rapid accurate diagnosis via microscopy and NAAT
Avoidance of blind. therapy with inappropriate. drugs
Partner notification to limit onward spread of resistant infection
Good regional formulary policies using an antibiotic known to cover >95% infections
Epidemuology monitor or and policy. reaction to.resistance data
