Sexually Transmitted Diseases Flashcards
Organism involved in genital herpes
HSV 1 and 2
1 mostly oral (10%)
2 mostly genital (90%)
Description of genital herpes
Herpes simplex virus is a common STD, adult prevalence of HSV-2 is 22%, but most are asymptomatic. Clinically infections can be primary, nonprimary first episode (HSV-2 infection after HSV-1) and recurrent infection. Transmission: between asymptomatic Pt with a break of epithelium and those with ulcers.
Incubation <14 days
Clinical Presentation of genital herpes
Asymptomatic
Classically there is multiple painful blisters/ulcers that may be vesicular. Can be associated with dysuria, urine retention, local lympadenopathy, discharge, anorectal spasm. They have prodrome symptoms. These resolve over 2 weeks but reoccur.
Investigations for genital herpes
PCR swab/scrap (100% SEN) in the first 48 hours hence, most Dx are clinical.
Clinical diagnosis is unreliable
Pregnancy: If there is a lesion present do a C-section (due to encephalopathy risk).
Management for genital herpes
Pain: Topical lignocaine PLUS Aciclovir 400mg for 5days OR Famciclovir 250mg for 5days OR Valaciclovir 500mg for 5days
Recurrent: Aciclovir for 4/12
Organism involved in Chlamydia
Chlamydia trachomatis (intracellular parasite)
Description of Chlamydia
Chlamydia trachomatis is the most common bacterial cause of sexually transmitted infections among men and women. Risk factors include young age, multiple sexual partners, limited use of barrier contraceptives and Hx of prior STDs. The incubation period is 7-14 days.
Clinical Presentation of Chlamydia
Asymptomatic (50%)
Cervicitis, vaginal discharge mucopuruent, intermenstrual bleeding and post-coital bleeding (left d/c from the os) Dysuria-pyuria UTI symptoms PID (30% of those untreated) Perihepatitis (5-15%)
Investigations for Chlamydia
Nucleic acid amplification (NAAT) from first catch urine (males) or vaginal swabs (female) is the gold standard aka PCR.
Management for Chlamydia
Doxycycline 100 mg for 7 days
OR
Azithromycin 1g oral stat (in pregnant)
A second course may be indicated
Organism involved in Syphilis (condyloma lata)
Traponema pallidum (Gram -ve spirochaete)
Description of Syphilis (condyloma lata)
Syphilis is a chronic infection with a bacterium that can be early with the stages of syphilis (10, 20 and early latent) or latent. It is spread by sexual, contact, IVDU, open lesions, transplacental and is commonest in MSM.
Incubation ∼21 days
Clinical Presentation of Syphilis (condyloma lata)
Asymptomatic
Primary (21 days):
Chancre, a painless ulcer at the site of entry
Secondary (2-3 months):
Systemic maculo-papular rash on soles of feet and palms of hand, fever, alopecia and LN
Can go Latent: +ve serology, no signs
Tertiary (>3years):
Neurological disease, gummas of any organ or CVS disease.
Investigations for Syphilis (condyloma lata)
The organism has never been cultured in vitro…
Primary: Chancre biopsy, with dark field microscopy
Secondary: Serology, both nontrepnemal and trepnemal tests.
Screening: VDRL
Diagnosis: TPHA3
Management for Syphilis (condyloma lata)
Penicillin for single dose or 10 days
Singe dose for 1 or latent Long-acting for those of unknown duration
Organism involved in Gonorrhoea
Neisseria gonorrhoea (Gram -ve intracellular diplococci)
Description of Gonorrhoea
Gonorrhoea is a major cause of urethritis in men and cervicitis in women, which can cause PID, infertility, ectopic pregnancy and chronic pelvic pain.Affects endometrium, oropharynx, conjunctitia, rectum.
Incubation 2-7 days
Clinical Presentation of Gonorrhoea
Asymptomatic (60% but 10% of men)
Women: Gonorrhoea in women can involve any part of the genital tract, oropharynx or become disseminated.
Associated with bloodly coloured discharge.
Men: discharge and dysuria.
Investigations for Gonorrhoea
Endocervical swab with culture and sensitivities. Culture of the anus, oropharynx, abscess Urine (first catch)
Management for Gonorrhoea
Ceftriaxone 500 mg stat
PLUS
Azithromycin 1g oral stat
OR
Doxycycline 100 mg for 7 days
Follow up, re-swab in 7/7.
Organism involved in Genital warts (condyloma acuminatum)
HPV
Esp 6 & 11
Description of Genital warts (condyloma acuminatum)
Human papillomavirus in the genital tract is largely asymptomatic and transient, detectable only by changes seen on cytology in the Pap smear, colpsocopy or HPV-DNA testing. The incidence of HPV is 50% UNI students with a lifetime risk of 80%.
Incubation weeks to months.
Clinical Presentation of Genital warts (condyloma acuminatum)
Asymptomatic
Genital warts that are skin colored or pink that range from smooth flattened papiles to papilliform.
Associated with pain, pruritus and bleeding.
Polps can be in anus or around opening of urethra
Investigations for Genital warts (condyloma acuminatum)
Clinical Dx
HPV typing Histology (if unsure)
