Sexually Transmitted Diseases Flashcards
Who should consider taking a sexual history/performing sexual health screen from? [9]
Anyone presenting with symptoms of:
- Vaginitis
- Urethritis
- Epididymo-orchitis
- Pelvic inflammatory disease
- Proctitis
- Ulcer/lumps on genitals
- Possible syphilis (esp. rash (look at hands/feet))
- Possible HIV seroconversion
- Asymptomatic patients (in certain settings)
What are the typical presenting symptoms of vaginitis? [3]
- change in discharge
- dysuria
- change in menstrual bleeding
What are the typical presenting symptoms of urethritis? [3]
- penile discharge
- dysuria
- meatal discomfort
What are the typical presenting symptoms of epididymo-orchitis? [2]
painful, swollen testicle
What are the typical presenting symptoms of pelvic inflammatory disease? [4]
- pelvic pain
- fever
- change in discharge
- dyspareunia
What are the typical presenting symptoms of proctitis? [3]
- rectal discharge
- rectal pain
- rectal bleeding
What is the standard “sexual health screen”? [3]
- Chlamydia and gonorrhoea (NAAT test)
- Syphilis and HIV (blood test - big EDTA bottle)
- Note: screen may be altered based on symptoms, risk, gender non-congruence etc.
Who is at higher risk of gonorrhoea (in terms of epidemiology)? [3]
- Men who have sex with men (MSM)
- Afro-Caribbean
- Urban areas with deprivation
What is the microbiological cause of gonorrhoea, what body parts does it infect and how does it spread within the body? [3]
- Bacterial → gram negative diplococcus N. gonnorhoeae
- Infects mucous membranes of urethra, endocervix, rectum, pharynx and conjunctiva
- Inoculation through secretions from one mucous membrane to another
What are the typical signs & symptoms of gonorrhoea under the following headings…? [11]
- male urethra [2]
- women endocervix/urethra [4]
- pharynx [1]
- rectum [1]
- anus [3]
- Male urethra >90% symptomatic
- Urethral discharge
- Dysuria
- 2-5 days after exposure
- Women (endocervix/urethra)
- 50% asymptomatic
- Change in discharge
- Abdominal/pelvic pain
- Dysuria
- Altered bleeding is rare
- Pharynx
- Usually asymptomatic
- Rectum
- Usually asymptomatic
- Anal discharge, pain or discomfort
What investigations are used to diagnose gonorrhoea? [3]
- NAAT testing (main investigation used)
- Male → urine
- Female → self-taken vaginal swab
- High sensitivity & specificity
- Other investigations that can be done (but not usually)
- Urethral sample microscopy
- Gram negative diplococci seen
- Culture plate
- To test drug resistance
- Urethral sample microscopy
How do you treat gonorrhoea? [2]
- Ceftriaxone lg 1M stat
- (or ciprofloxacin if sensitive)
What are the potential complications of gonorrhoea? [5]
- Epididymo-orchitis
- Prostatitis
- Pelvic Inflammatory disease
- Disseminated gonococcal infection
- Rare in UK
- Usually affects skin and joints
- Resistance
- 48.6% resistant to at least 1 antibiotic
What is chlamydia? [1]
most common bacterial STI in UK
What are the risk factors for chlamydia? [3]
- <25yo
- New sexual partner or >1 partner in 12/12
- Inconsistent condom use
What are the typical signs & symptoms of chlamydia under the following headings? [14]
- male urethra [4]
- women [6]
- pharynx [1]
- rectum [3]
- Male urethra
- Majority asymptomatic
- Discharge
- Dysuria
- Meatal discomfort (urethral dysfunction)
- Women
- Most asymptomatic
- Intermenstrual bleeding
- Postcoital (PC) bleeding (bleeding after sex)
- Cervicitis or contact bleeding
- Change in discharge
- Pelvic pain
- Pharynx
- Usually asymptomatic
- Rectum
- Usually asymptomatic
- Can present with proctitis
- Lymphogranuloma venereum (LGV) subtype often presents as proctitis
- Can have lymphadenopathy/ulcer disease
What investigations are used to diagnose chlamydia? [1]
- NAAT testing
- Same sample as gonorrhoea (urine in males/self-taken vaginal swab in women)
- Too small for microscopy
What is the treatment of chlamydia? [1]
doxycycline
What are the potential complications of chlamydia? [2]
- Pelvic Inflammatory Disease (in women)
- Epididymo-orchitis (in men)
What are the symptoms of Mycoplasma Genitalium?
Some people get symptoms of urethritis/PID
What is the bacterial cause of syphillis? [1]
Gram negative spirochete called Treponema pallidum
How long does it take for primary syphillis to present? [1]
9-90 days
What is the typical clinical presentation of primary syphillis? [1]
Chancre
What is a chancre? [1]
a painless ulcer (usually singular), that develops on the genitals
How long does it take for secondary syphillis to present? [1]
3 months - 2 years
What are the common clinical symptoms of secondary syphillis? [5]
- Usually generalised rash affecting palms and soles
- Muco-cutaneous lesions,
- Condylomata Iata
- Lymphadenopathy
- Fever
What are the 3 typical clinical presentations of tertiary syphilis? [3]
- neurosyphilis
- cardiovascular syphilis
- gummatous syphilis
What are the 3 features of cardiovascular syphilis? [3]
- aortic valve disease
- aortic aneurysm
- aortitis
What is gummatous syphilis and what organs does it usually affect? [5]
- characterized by granulomatous lesions, called gummas, which are characterized by a centre of necrotic tissue with a rubbery texture.
- gummas principally form in the liver, bones, and testes but may affect any organ
What is the treatment for syphilis? [1]
Benzathine penicillin
What is the viral cause of ano-genital warts? [1]
Human papillomavirus (HPV) 6 and 11
What are the treatment options for ano-genital warts? [3]
- Cryotherapy
- Topical treatments: podophyllotoxin/imiquimod
- Surgical excision (rarely required)
What test is used to diagnose herpes simplex virus (HSV)? [1]
viral PCR swab
What are the potential complications of HSV? [5]
- CNS infection
- balanitis
- proctitis
- urinary retention
- If 1st episode in pregnancy: risk of neonatal infection
What is balanitis? [1]
inflammation of the glans penis and often the foreskin
What is the treatment for HSV? [1]
Aciclovir
What are the symptoms of trichomonas vaginalis in males & females? [9]
- Up to half of male and female cases asymptomatic
- Females
- Vaginal discharge
- Classic: frothy, yellow
- Significant vulval itch
- Dysuria
- Offensive odour
- “Strawberry cervix” in 2%
- Urethritis
- Vaginal discharge
- Males
- Usually asymptomatic
- Urethritis
What is the treatment of trichomonas vaginalis? [1]
metronidazole
What are the typical symptoms of scabies? [2]
- Itch, especially at night
- Caused by mite excrement which triggers hypersensitivity reaction
- Burrows
- Classically in web spaces, wrist, elbows, nipples
What are the treatment options for scabies and what should you do with your clothes afterwards? [3]
- Permethrin 5% OR Malathion 0.5%
- Wash off after 24 hours
- Wash contaminated clothes at 50°C
How is phthirus pubis transmitted and where is it commonly found? [2]
- Transmitted by close bodily contact
- Live on course body hair (as opposed to head lice)
What are the treatment of phthirus pubis?
- Malathion 0.5% OR
- Permethrin 1% cream
