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)
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
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)
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)
Viral STI’s are …
HIV, hepatitis, HPV, herpes
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
Complications of STIs
