Sexually transmitted diseases Flashcards
What are the clinical presentations of STIs?
vaginal discharge, urethritis, ulcerative genital lesions, pelvic inflammatory disease, epididymo-orchitis, infestations, warts
What are the major systemic viral diseases transmitted via sexual contact?
hepatitis B, C, HIV
Describe the epidemiology of Gonorrhoea.
People feared it could become untreatable due to antibiotic resistance
It became resistant -> Super-gonorrhoea
Describe the epidemiology of Neisseria Gonorrhoea.
People feared it could become untreatable due to antibiotic resistance
It became resistant -> Super-gonorrhoea
2 cases of resistant gonorrhoea diagnosed in the U.K.
Very hard to treat with 4th/5th line of treatments
Which STI is Azithromycin used to treat?
Chlamydia
Describe the prevalence of Mycoplasma Genitalium (MG).
Already resistant to 2 agents
Resistance higher in those countries using azithromycin
How can you diagnose Gonorrhoea? (2 methods - compare both)
1) Microscopy - gram-negative diplococci
Quick test, less sensitive than NAAT
Required skilled microscopist
Gives antimicrobial susceptibility result
Useful for individual treatment
2) NAAT - Nucleic acid amplification test
24-48 for result
High sensitivity and specificity
No antimicrobial susceptibility
Required non-inhibitory specimen (no body fluids)
How can you diagnose Chlamydia?
NAAT diagnosis
Can’t do microscopy as its an obligate intracellular bacterium - will not grow in cell free culture (e.g. on agar plate)
How can you diagnose syphilis? Can you culture it?
1) Michroscopy: dark ground
specific, low sensitivity, only for primary syphilis
Skilled technician, good quality specimen
Culture - not possible as Treponema Pallidum is unculturable
2) Nucleic acid detection: PCR
High specificity in primaru lesions
3) Serology (antibody detection)
active syphilis
What are some key things to know about antibody detection of syphilis?
Serum: IgM indicates recent infection
IgG stays positive for years/life
+ve doesn’t mean active infection
How can you prevent HIV?
1) Use condoms
2) PrEP (HIV prevention with just 1 pill a day)
How can STI’s be transmitted? (sexual contact and non-sexual contact)
Sexual contact: Oral/vaginal/sextoys/douching
Skin/skin contact (HSV, HPV, molluscum)
Non-sexual contact: In utero - syphilis, BBV
Peripartum: gonorrhoea, chlamydia, BBV
blood.body fluid transfusion, recreational drug use
What are the main principles of STI control?
Remove reservoirs & sources
Treat other infections/sources of inflammation
Interrupt transmission
Increase host resistance
What is the difference between primary and secondary prevention of STIs?
Primary prevention
Safe sexual behaviours
Including but not limited to, barrier contraceptive methods
Immunisation: currently only available for HPV (warts), HBV. HAV
PrEP
Secondary prevention
Detect: screening, better access to SH services, targeted information (16-25s, MSM). If 1 STI, look for others!
Prompt effective treatment
Partner notification (contact tracing)
What are the side effects of HIV meds?
Crix belly
Diarrohea
Facial wasting
What are the clinical presentations of Urethritis?
Noticed discharge from penis, staining in pants
Pain on passing urine
No regular sexual partner
6 partners in last 2 weeks, 2 male, 4 female, no condoms, oral sex
What are the clinical presentations of Vaginal discharge?
5 days vulval itching and soreness
Creamy discharge
1 sexual partner
What are the clinical presentations of Genital ulceration?
2 days painful sores on vulva/ thighs, blisters which burst Very painful dysuria Headache Myalgia New sexual partner 6d prior Used condoms
What are the clinical presentations of Pelvic inflammatory disease?
4 week history increasing lower abdo pain Severe dyspareunia (pain during sex) Mild dysuria 1d high fever Stable partner, on depot contraceptive Pregnancy test negative
What are the clinical presentations of Epididymo-orchitis?
3 days of painful scrotum
Fever 39C
Ultrasound: no torsion
New partner 5d previously, no condoms
