Sexually Transmitted Diseases Flashcards
Who gets STIs?
- … having sex… BUT the risk groups are:
- Young age (
- Frequent partner change, high no. lifetime partners, C… (simultaneous partners)
- … orientation
- E… for some STIs
- Residence in …/d…
- Use of non … …
- History of …
-
ANYONE having sex… BUT the risk groups are:
- Young age (<20 years) - lower age at 1st intercourse, ‘coitarche’
- Frequent partner change, high no. lifetime partners, concurrency (simultaneous partners)
- Sexual orientation
- Ethnicity for some STIs
- Residence in inner city/ deprivation
- Use of non barrier contraception
- History of previous STI
Coitarche means …
The first sexual intercourse
Does age at first intercourse (coitarche) affect rate of STI?
Yes - lower age = more likely
Is early age intercourse associated with poor subsequent sexual health?
Yes
Young people and STIs
- Behaviourally more vulnerable to STI acquisition
- Why? (5)
- Behaviourally more vulnerable to STI acquisition
- higher numbers of sexual partners / partners change
- greater numbers of concurrent partners
- yet to develop skills and confidence to use condoms, negotiate safe sex
- more risk-taking behaviour/ experimentation
- poor awareness contraception
What does this image show?
A normal cervix
- Cervical ectropion – transformation zone – changing from columnar epithelium to squamous epithelium
- Chlamydia and gonorrhoea infect columnar epithelium
Chlamydia and gonorrhoea infect where? (Cervix)
Chlamydia and gonorrhoea infect columnar epithelium
Percentage of all STIs occuring in young adults (16-24)
- 16-24 year olds only make up …% of population
- BUT - STI proportion in this age is much … (e.g. chlamydia …-…% is among this age)
- 16-24 year olds only make up 12% of population
- BUT - STI proportion in this age is much higher (e.g. chlamydia 55-75% is among this age)
Rates of chlamydia diagnoses by gender and age - England,2019
- Males tend to go for younger females so disproportion with gender
Rates of chlamydia diagnoses by gender and age - England,2019
The earlier intercourse occurs, the higher the proportion:
- Express … they had not …
- Report being … or … willing than their partner
- …% men and …% women express … they had not …
- Express regret they had not waited longer
- Report being more or less willing than their partner
- 20% men and 42% women express regret they had not waited longer
Early intercourse - associated with vulnerabilities:
- leaving home / not living with parents before … years
- leaving … early
- family … & …
- lack of … relationships
- those whose main source of information on sex was not .. or ..
- leaving home / not living with parents before 16 years
- leaving school early
- family disruption & disadvantage
- lack of nurturing relationships
- those whose main source of information on sex was not school or parents
Where do young people get information? (regarding sex)
- Parents? School? Books? Internet??
- …% daily searches access porn sites
- Most common Google search term: “…”
- Unintended exposure reported by …% of 15-17yo while searching or checking e-mails
- Intended viewing - …% teenagers view porn regularly; 1:… every day
- Parents? School? Books? Internet??
- 25% daily searches access porn sites
- Most common Google search term: “sex”
- Unintended exposure reported by 70% of 15-17yo while searching or checking e-mails
- Intended viewing - 58% teenagers view porn regularly; 1:10 every day
…% teenagers view porn regularly; 1:… every day
58% teenagers view porn regularly; 1:10 every day
Negative aspects? - associated with porn
- Unrealistic … & …
- …-image / performance …
- Lack of … / boundaries – hardcore material becomes … / normalised
- Ethical issues: … of women, … blurred
- Lack of … use: reduced risk perception, need to practice safe sex
- Unrealistic nature & expectations
- Self-image / performance anxiety
- Lack of censorship / boundaries – hardcore material becomes addictive / normalised
- Ethical issues: exploitation of women, consent blurred
- Lack of condom use: reduced risk perception, need to practice safe sex
Main messages to get across to young people - Sex
- Don’t rush into it – avoid peer pressure
- Use condoms with all new partners
- Get a STI screen when you have a new partner
- Sort out contraception
- Avoid overlapping sexual relationships
- GBM* should also get vaccinated for hepatitis A/B and HPV & consider HIV PrEP (Gay and Bisexual Men)
Gay, bisexual and other men who have sex with men (MSM) are … likely to be diagnosed with bacterial STIs than other men
- Gay, bisexual and other men who have sex with men (MSM) are more likely to be diagnosed with bacterial STIs than other men
- Over the last decade, there has been a steady increase in the number of new STI diagnoses among MSM. Gonorrhoea has increased from 4,938 diagnoses in 2010 to 33,853 in 2019.
- MSM account for most syphilis and gonorrhoea diagnoses in men.
- Numbers of HIV diagnoses have been decreasing since 2015 largely due to the scale up of a combination of HIV prevention methods
Rates of gonorrhoea diagnoses by Gender and Age - England 2019
Rates of STI diagnoses by ethnic group amongst males: England, 2019
Rates of STI diagnoses by ethnic group amongst females: England, 2019
- The rate of gonorrhoea in BME people is …x that of the general population
- For trichomoniasis, the rate in BME people is …x that of the general population
- The rate of gonorrhoea in BME people is 4x that of the general population
- For trichomoniasis, the rate in BME people is 9x that of the general population
Sexual networks & core groups
- Definition of a “core group”
- ..-… of the population – high …
- Definition of a “core group”
- sub-group of the population – high turnover
- not a static entity
- highly sexually active individuals
- high prevalence of infection
- reservoirs of infection
- high frequency of transmission
- Effective control at the population level based on targeting core groups
Effective control at the population level based on targeting … … (Sexually Transmitted Infections/Diseases)
Effective control at the population level based on targeting core groups (Sexually Transmitted Infections/Diseases)
Rates of STI diagnoses by index of multiple deprivation quintile: England, 2019
- Rates of STI diagnoses were highest among those living in the .. … areas of England.
Rates of STI diagnoses were highest among those living in the most deprived areas of England.
GMC guidance - Genital Examination
- Offer a …
- Explain to patient why examination is … & what it will …
- Give patient …
- Obtain patient’s … before the examination
- … if patient asks you to
- Keep discussion … - avoid unnecessary comments
- Offer a chaperone
- Explain to patient why examination is necessary & what it will involve
- Give patient privacy to undress & dress
- Obtain patient’s permission before the examination
- Discontinue if patient asks you to
- Keep discussion relevant - avoid unnecessary comments
Female genital examination
- Inspect … area, … & … area
- Look between … …
- Inspect & … … region
- Leg … - allow better …
- … examination (use water as lubricant-gels can interfere with tests)
- … examination (if indicated)
- Inspect pubic area, vulva & perianal area
- Look between skin folds
- Inspect & palpate inguinal region
- Leg rests - allow better visualisation
- Speculum examination (use water as lubricant-gels can interfere with tests)
- Bimanual examination (if indicated)
Female genital examination – can you name A-M?
- A - mons pubis
- B - clitoral hood and anterior fourchette
- C - clitoris
- D - vestibule
- E - anus
- F - labia majora
- G - labia minora
- H - urethra
- I - hymen / hymenal remnants
- J - introitus
- K - bartholins glands
- L – posterior fourchette
- M – perineum
Male genital examination – can you name the anatomy
- S – shaft
- F – foreskin
- COS – coronal sulcus
- G – glans
- M – meatus
- Fr – frenulum
- GC – glans corona - corona of glans (we don’t use this term much – GC in sexual health usually means gonococcus or gonorrhoea!)
Male genital examination
- Inspect … area, … region
- Inspect … & … area
- … scrotal contents – note presence of testes, any lumps/ tenderness
- Inspect penis - record whether … - if not inspect under …
- Particular attention to coronal …, F… & M..
- Note presence of urethral …
- Inspect pubic area, inguinal region
- Inspect scrotum & perianal area
- Palpate scrotal contents – note presence of testes, any lumps/ tenderness
- Inspect penis - record whether circumcised - if not inspect under foreskin
- Particular attention to coronal sulcus, frenulum & meatus
- Note presence of urethral discharge
What are Pearly penile papules?
- Pearly penile papules are small dome-shaped to thread-like skin-coloured bumps that are typically located on the sulcus or corona of the glans penis.
- normal - sometimes more prominent in some than others - no removal
Genital appearances - Enlarged sebaceous glands and Epidermoid cysts are often mistaken for … by patient
Genital appearances - Enlarged sebaceous glands and Epidermoid cysts are often mistaken for infection by patient - they are considered cosmetic (NHS)
Malignant melanoma can be found on the …
genitals
Psoriasis can also be found on the …
genital area
Tinea cruris – a dermatophyte (…) infection - can be found on the …
pruritic papules on genitals - check the … - what might it be?
check hands - might be scabies
Bacterial/protozoal vs. viral STIs
Bacterial / protozoal * STI’s include … (4)
Chlamydia, gonorrhoea, syphilis, TV* (trichomonas vaginalis)
Chlamydia, gonorrhoea, syphilis, TV* are all what kind of STI? (viral or bacterial/protozoal?)
Bacterial/protozoal STI
Viral STI’s include … (4)
Herpes, warts, HIV, hepatitis
Herpes, warts, HIV, hepatitis are all what kind of STI? (Viral or Bacterial/Protozoal?)
Viral STI’s
Features of Viral STI’s, such as Herpes, Warts, HIV and hepatitis
- many … of infection
- … presentation
- diagnostic tests may be …
- … treatment only
- often …-…
- … reservoirs
- many unaware of infection
- delayed presentation
- diagnostic tests may be unreliable
- symptomatic treatment only
- often life-long
- expanding reservoirs
Features of Bacterial/Protozoal STI’s, such as Chlamydia, gonorrhoea, syphilis, TV (Trichromonas vaginalis):
- more often … symptoms
- … presentation
- … diagnosis
- … treatment available
- c…
- reservoirs can be …
- more often florid symptoms
- early presentation
- rapid diagnosis
- effective treatment available
- curative
- reservoirs can be controlled
Which out of bacterial/protozoal or viral STI’s can be treated?
Bacterial/protozoal - viral is symptomatic treatment only
People with … STI’s may be unaware of infection
Viral (Herpes, warts, HIV, hepatitis)
Gonorrhoea: microscopic
- typical gram-… intracellular diplo…
- microscopic examination of a smear of … exudate (men) of … secretions (women)
- typical gram-negative intracellular diplococci
- microscopic examination of a smear of urethral exudate (men) of endocervical secretions (women)
Primary syphilis
- how long after contact?
- red mark -> raised spot -> … at the site of contact
- Enlarged … … in the groin/neck
- Heals within …-… weeks
- weeks after contact (9-90 days)
- red mark -> raised spot -> ulcer at the site of contact
- Enlarged lymph nodes in the groin/neck
- Heals within 1-3 weeks (with or without treatment)
Secondary syphilis
- ..-.. weeks after primary stage - lasts for ..-.. weeks
- Systemic dissemination - millions spirochaetes
- …-like illness, headache, lymphadenopathy
- … ulcers - “snail track” painless
- Condylomata lata - white/grey lumps in moist areas
- A…
- … resolution with effective treatment
- Particularly suspect if rash involves … & …
- 2-6 weeks after 10 stage - lasts for 2-4 weeks
- Systemic dissemination - millions spirochaetes
- Flu-like illness, headache, lymphadenopathy
- Mouth ulcers - “snail track” painless
- Condylomata lata - white/grey lumps in moist areas
- Arthritis
- Rapid resolution with effective treatment
- Particularly suspect if rash involves palms & soles
Secondary syphilis occurs how many weeks after primary stage?
2-6 weeks
Secondary syphilis lasts for how long?
2-4 weeks
If infection (Rash) involves palms and soles, what STIs are suspected? (what is the differential diagnoses?)
HIV and Secondary Syphilis (main) also non STI - pityriasis rosea (no herald patch)
Secondary syphilis involves the … and …
palms and soles
Trichomonas vaginalis
- … cell protozoan parasite
- Infects … & …
- d.., d…
- Causes … discharge, “… cervix”
- Diagnosed by seeing … organisms on microscopy
- Responds well to …
- Single cell protozoan parasite
- Infects vagina & urethra
- Dysuria, discharge
- Causes frothy discharge, “strawberry cervix”
- Diagnosed by seeing motile organisms on microscopy
- Responds well to metronidazole
Trichomonas vaginalis responds well to …
Responds well to metronidazole
Trichomonas vaginalis causes what kind of discharge?
Causes frothy discharge, “strawberry cervix”
Viral STI’s are …
HIV, hepatitis, HPV, herpes
Genital warts
- How common?
- What virus?
- Type … and Type … in 90%
- What types are related to cervical cancer?
- Extremely common
- Human papilloma virus (HPV)
- Type 6 & 11 in 90%
- Vs types 16 & 18, 31, 33 etc. (cervical cancer)
HPV types 16 & 18, 31, 33 etc can cause what type of cancer?
Cervical cancer
What HPV types can cause cervical cancer?
16, 18, 31, 33
What are the most common HPV types? (90% of cases)
6 and 11
Number of anogenital warts (first episode) diagnoses by sexual risk: England, 2015 to 2019
Introduction of vaccine for HPV (Australian data)
Molluscum contagiosum
- What are they?
- Molluscum contagiosum is an infection caused by a poxvirus (molluscum contagiosum virus). The result of the infection is usually a benign, mild skin disease characterized by lesions (growths) that may appear anywhere on the body.
- common in kids - not STI related
Herpes simplex type 1 & 2
- Symptoms
- painful …, …, vaginal …
- … symptoms e.g. fever and myalgia (more common in first occurrence)
- recurrences generally … severe
- Signs
- blistering & … (+/- cervix/rectum)
- painful inguinal lymphadenopathy
- heals after …-… days
- Symptoms
- painful ulceration, dysuria, vaginal discharge
- systemic symptoms e.g. fever and myalgia (more common in first occurrence)
- recurrences generally less severe
- Signs
- blistering & ulceration (+/- cervix/rectum)
- painful inguinal lymphadenopathy
- heals after 5-14 days
What are the symptoms of Herpes Simplex T1 and T2?
Painful ulceration, dysuria, vaginal discharge - possibly systemic symptoms also (fever, myalgia - more common in first occurence)
Herpes Simplex T1 and T2 heals after … - … days
5-14 days
Only 1:… people aware they have herpes (…%)
Only 1:5 people aware they have herpes (20%)
- Oral HSV: usually type …
- Genital HSV: …% type 1, …% type 2
- Oral HSV: usually type 1
- Genital HSV: 50% type 1, 50% type 2
Non-Sexually Transmitted Infections
- What 2 infections are there?
- Candida / thrush
- Bacterial vaginosis
Candida / thrush
- f… infection
- not an …
- symptoms (3)
- … rash in males
- treatment is … …
- fungal
- not an STI
- itching, discharge, swelling
- papular rash in males
- treatment is topical antifungals
Bacterial vaginosis
- symptoms - discharge / “…” odour
- imbalance of vaginal …
- overgrowth of …
- often result of … / …etc.
- responds to …
- discharge / “fishy” odour
- imbalance of vaginal flora
- overgrowth of anaerobes
- often result of over-washing / bubble baths etc.
- responds to metronidazole
Complications of STIs
Complications of Chlamydia / gonorrhoea
- PID, epididymitis, infertility, chronic pain, seronegative arthritis +/- urethritis and conjunctivitis
Complications of HPV / warts
- cervical cancer, anal/vulval/penile intraepithelial neoplasia (AIN/VIN/PIN)
Complications of Bacterial vaginosis and Trichomonas vaginalis
- miscarriage, early labour, low-birth weight (pregnant)
Complications of Syphilis
- dementia, cardiac abnormalities etc etc - tertiary stage progression
Complications of Hepatitis B, hepatitis C
- cirrhosis, liver cancer
Complications of HIV
- opportunistic infections, lymphoma, non-AIDS malignancies
Most STIs increase the risk of … transmission
Most STIs increase the risk of HIV transmission
Summary of STI’s
- Rates of STIs are increasing because of changing behaviour, communication, globalisation
- Certain groups are more vulnerable to STIs due to links with core groups through sexual networks
- Patients may present with ‘normal anatomy’ or non-STI pathology
- Differences between bacterial vs viral infections
- Serious complications therefore correct diagnosis & prompt treatment essential
