Sexually Transmitted Infections Flashcards
What can cause genital ulcers?
Herpes and syphilis - STD
Candida
What can cause vaginal discharge?
Chlamydia, M genitalium, gonorrhoea, trichomoniasis and herpes
BV and candida
What can cause urethral discharge?
Chlamydia, m genitalium, gonorrhoea and trichomoniasis
H. influenza and adenovirus
What can cause genital lumps?
Warts, molluscum and scabies
Folliculitis and calcinosis
What can cause genital itching?
Scabies, lice, herpes and trichomoniasis
Candida and eczema
What can cause a genital rash?
Scabies and syphilis
What is gonorrhoea caused by?
Neisseria gonorrhoeae
What symptoms does gonorrhoea cause in men?
10% have no symptoms
Thick, profuse yellow discharge and dysuria
Rectal and pharyngeal infection are often asymptomatic
What are the symptoms of gonorrhoea in women?
More than 50% have no symptoms
Vaginal discharge, dysuria and intermenstrual bleeding
What are the complications of gonorrhoea?
Men - epididymitis
Women - Pelvic inflammatory disease and Bartholin’s abscess
Both - rectal symptoms and conjunctivitis
Acute monoarthritic of elbow or shoulder and disseminated gonococcal infection
What is the incubation period of gonorrhoea?
Average is 5 to 6 days but ranges from 2 days t 2 weeks
How is gonorrhoea diagnosed?
Nucleic acid amplification test (NAAT) on urine or swab
Microscopy of gram stained sample
Culture using highly selective lysed blood agar
What is the treatment for gonorrhoea?
Blind treatment with ceftriaxone 1mg IM
Also can treat according to antibiotic sensitivities
When is the follow up to test for cure in gonorrhoea?
3 weeks
What is chlamydia caused by?
Chlamydia trachomatis serovars D to K
What are the symptoms for men in chlamydia/
More than 70& asymptomatic
Slight watery discharge and dysuria
Rectal symptoms and conjunctivitis
What are the symptoms for women with chlamydia?
More than 80% asymptomatic
Vaginal discharge, dysuria and intermenstrual bleeding
Rectal symptoms and conjunctivitis
What are the complications of chlamydia?
Men - epididymitis
Women - PID and ectopic pregnancy, pelvic pain and infertility
Both - reactive arthritis/ Reiter’s syndrome
How is chlamydia diagnosed?
First void urine in men
Swab from cervix, urethra and rectum as appropriate
What is the treatment for chlamydia?
Doxycycline 1 week
Azithromycin 1g once if pregnant
What is the follow up for chlamydia?
Test for re-infection at 3-12 months
Earlier test not need unless symptoms persist
What are the symptoms for men with mycoplasma genitalium?
More than 90% asymptomatic
Slight watery discharge and dysuria
Conjunctivitis
What are the symptoms of mycoplasma genitalium in women?
More than 50% asymptomatic
Vaginal discharge, dysuria, intermenstrual/ post coital bleeding
Conjunctivitis
What are the complications of mycoplasma genitalium?
Men - none confirmed
Women - PID, preterm birth, miscarriage and infertility
Both - rectal symptoms
How is mycoplasma genitalium diagnosed?
First void in men
Swab from cervix, urethra and rectum as appropriate
NAAT
What is the treatment of mycoplasma genitalium?
Doxycycline 100mg 1 week then Azithromycin 1g on day 8 and 500mg once daily on days 9-10
If resistant to macrolides then moxifloxacin
When is the follow up for mycoplasma genitalium?
5 weeks
What is herpes caused by?
Herpes simplex virus types 1 and 2
What are the symptoms of herpes?
80% are asymptomatic and rest have recurring symptoms (annually, monthly)
Burning/ itching then blistering then tender ulceration
Tender inguinal lymphadenopathy
Flu like symptoms
Dysuria, neuralgic back, pelvis and leg pain
What is the complications of herpes?
Autonomic neuropathy (urinary retention), neonatal infection and secondary infection
What is the incubation period for herpes?
5 days to months
Some people never report symptoms
How is herpes diagnosed?
Clinical impression
Swab lesion tested using PCR
What is the treatment for herpes?
Aciclovir - 400mg for 5 days
Lidocaine ointment or oral
Infrequent recurrences - Aciclovir 800mg 3 x daily
Frequent recurrences - Aciclovir long term
What is trichomoniasis caused by?
Trichomonas vaginalis
What are the symptoms of trichomoniasis?
Men - usually asymptomatic
Women - 10-30% asymptomatic
Profuse thin vaginal discharge - greenish, frothy and foul smelling. Vulvitis
What are the complications of trichomoniasis?
Miscarriage and preterm labour
How is trichomoniasis diagnosed?
PCR on vaginal swab
Microscopy of wet preparation of vaginal discharge
What is the treatment for trochomoniasis?
Metronidazole 400mg for 5 days
What are anogenital warts caused by?
Human papilloma virus types 6 and 11
What are the symptoms of anogenital warts?
Lumps with surface texture of small cauliflower
Occasionally itching or bleeding esp. if perianal or intraurethral
What is a complication of anogenital warts?
None common
Neonatal laryngeal papillomatosis
How is anogenital warts diagnosed?
Appearance
Biopsy is unusual
What is the treatment for anogenital warts?
Podophyllotoxin and imiquimod - both home treatments
cryotherapy
Bulky warts - diathermy and scissor removal
What is syphilis caused by?
Treponema pallidum subspecies pallidum
What are the symptoms/ signs of syphilis?
Primary - local ulcer
Secondary - rash, mucosal ulceration, neuro symptoms and patchy alopecia
Early latent - no symptoms but under 2 years since caught
Late latent - more than 2 years since caught
Tertiary - neuro, cardio and gummatous
What is the incubation period of syphilis?
9 to 90 days until appearance of chancre
What is a complication of syphilis?
Neurosyphilis - cranial nerve palsies are commonest
Congenital syphilis
How is syphilis diagnosed?
Clinical signs
Serology for TP IgGEIA< TPPA and RPR
PCR on sample
What is the treatment for early syphilis?
Under 2 years and no neuro involvement
Benzathine penicillin once MU or doxycycline for 2 weeks
What is the treatment for late syphilis?
More than 2 years and no neuro involvement
Benzathine penicillin IM weekly for 3 doses
Doxycycline 100mg for 28 days
