sexually transmitted infections Flashcards
gonorrhoea cause
neisseria gonorrhoeae
male symptoms of gonorrhea
10% of males have no symptoms though might have clinical signs if examined.
Thick, profuse yellow discharge, dysuria. Rectal and pharyngeal infection often
asymptomatic.
female symptoms of gonorrhea
> 50% have no symptoms.
vaginal discharge, dysuria or intermenstrual/post-coital bleeding
possible complications of gonorrhoea
Male: Epididymitis
Female: Pelvic inflammatory disease. Bartholin’s abscess. [Gonococcal ophthalmia neonatorum.]
Both: Acute monoarthritis usually elbow or shoulder. Disseminated
Gonococcal Infection: skin lesions - pustular with halo
incubation period of gonorrhea
average 5 to 6 days. Range 2 days to 2 weeks
how is gonorrhea diagnosed
nucleic Acid Amplification Test (NAAT) on urine or swab from an exposed site – vagina, rectum,
throat. Could be self-obtained or clinician-obtained.
Gram stained smear from urethra/cervix/rectum in symptomatic people.
Culture of swab-obtained specimen from an exposed site using highly selective lysed blood agar in a
5% CO2 environment. Should be done for all confirmed cases to assess antibiotic sensitivity
treatment plan and follow up for gonorrhea
blind treatment with ceftriaxone 1g im.
Can also treat according to antibiotic sensitivities.
Follow-up: Test of cure at 2 weeks and test of reinfection at 3 months
Chlamydia cause
chlamydia trachomatis serovars D to K
[The rare Serovar L2b, which causes Lymphogranuloma venereum, usually gives symptoms of severe
proctitis. ]
symptoms of chlamydia
Men: >70% asymptomatic
Slight watery discharge, dysuria,
Women: >80% asymptomatic
vaginal discharge, dysuria, intermenstrual/post-coital bleeding.
Both: Conjunctivitis
complications of Chlamydia
Men Epididymitis.
Women: PID and hence ectopic pregnancy, pelvic pain and infertility. Probably only ~1% of women
who get chlamydia will develop a problem with their fertility
Both: Reactive arthritis/ Reiter’s syndrome – urethritis/cervicitis + conjunctivitis + arthritis
how is Chlamydia diagnosed
first void urine in men. Self-taken or clinician-taken swab from cervix, urethra, rectum as appropriate.
All specimens tested using a NAAT
treatment and follow up for Chlamydia
Doxycycline 100mg bd 1 week
Azithromycin 1g po once if pregnant
Follow-up: Test for reinfection at 3-12 months. Earlier test of cure not needed unless symptoms persist.
herpes cause
herpes Simplex Virus types 1 and 2
herpes symptoms
80% have no symptoms. The rest have recurring symptoms – monthly, annually.
Burning/itching then blistering then tender ulceration.
Tender inguinal lymphadenopathy. Flu-like symptoms.
Dysuria, Neuralgic pain in back, pelvis and legs,
complications of herpes
autonomic neuropathy (urinary retention), neonatal infection, secondary infection.
incubation period herpes
about 5 days to months. Some people never report symptoms
diagnosis and treament for herpes
Clinical impression.
Swab from lesion tested using PCR.
Treatment: Primary outbreak: Aciclovir: various regimens – eg 400mg tds for 5 days
Lidocaine ointment
Infrequent recurrences: Lidocaine ointment. Aciclovir 1.2g once daily until symptoms gone (1-3
days)
Frequent recurrences: Aciclovir 400bd long-term as suppression.
trichomoniasis cause
trichomonas vaginalis
symptoms trichomoniasis
men: usually asymptomatic
Women: 10-30% asymptomatic
Profuse thin vaginal discharge - greenish, frothy and foul smelling. Vulvitis.
complications trichomoniasis
miscarriage and preterm labour
diagnosis trichomoniasis
PCR on a vaginal swab. NB not validated on urine yet so no test for men.
Point of Care - Microscopy of wet preparation of vaginal discharge.
treatment trichomoniasis
metronidazole 400mg po bd for 5 days or 2g single dose.
anogenital warts cause
Human Papilloma Virus types 6 and 11 (and occasionally type 1). (NB different strains from those that
cause cervical cancer.
symptoms anogenital warts
lumps with a surface texture of a small cauliflower. Occasionally itching or bleeding especially if
perianal or intraurethral.
