Sexually transmitted infections

Question 1

Prevention

Answer 1

• comprehensive sex education
• safer sex counselling
• STI interventions targeted at key populations
• STI prevention education targeted at adolescents

Question 2

Common STI symptoms

Answer 2

• unusual discharge from vagina, penis or anus
• pain when urinating
• lumps or skin growths around the genitals or anus
• rash
  unusual vaginal bleeding
• itchy genitals or anus
• blisters and sores around the genitals or anus

Question 3

Chlamydia

Answer 3

• caused by chlamydia trachomatis
• small obligate intracellular bacteria

Undergoes a dimorphic life cycle existing in two forms :
- ROBUST EXTRACELLULAR INFECTIVE ELEMENTARY BODY ( EB )
- FRAGILE INTRACELLULAR REPLICATING RETIULAR BODY ( RB )

Transmission is through unprotected sex

Diagnosis
- from swab samples
- from urine samples
- If infection is suspected treatment can commence in absence of positive diagnosis

Symptoms :
- often asymptomatic
- pain during urination
- unusual discharge
- in women, pain in stomach, bleeding after sex and between periods
- in men, pain and swelling in the testicles

Complications :
- in women = cervicitis and pelvis inflammatory disease and pregnancy complication
- in men = inflammation of testicles and epididymis

Question 4

Gonorrhoea

Answer 4

• caused by Neisseria gonorrhoea
• gram negative diplococcus obligate aerobe
• transmission only by intimate person to person contact

DIAGNOSIS :
- urethral, cervical, rectal and pharyngeal swabs
- plated immediately into warm selected media
- microscopy to see if its gram negative
- home kits available from pharmacy

SYMPTOMS IN WOMEN :
- unusual discharge which may be thin or watery and green or yellow in colour
- pain or burning feeling when passing urine
- pain or tenderness in lower abdominal area
- bleeding between periods, heavier periods or bleeding after sex

SYMPTOMS IN MEN :
- discharge which may be white, green or yellow
- pain or burning feeling when passing urine
- inflammation of the foreskin
- pain or tenderness in the testicles

COMPLICATIONS IN WOMEN :
- pelvic inflammatory disease leading to long term pelvic pain , ectopic pregnancy and infertility
- during pregnancy can cause miscarriage and premature labour and the baby can be born with conjunctivitis

COMPLICATIONS IN MEN :
- painful infection in testicles and prostate gland which can lead to infertility

Question 5

Syphilis

Answer 5

• caused by treponema pallidum
• spirochete which stains poorly
• transmission via sex with infected person
• fragile and does not live in culture and dies quickly with drying/heat

DIAGNOSIS :
- physical examination to look for growths or rashes
- blood test to be used for serology
- swab test of fluid from sores of microscopy
- all pregnant women are offered a blood test for syphilis

Pathogenies and symptoms :
- characterised by an ulcer called a chancre
- fever and myalgia
- lymphadenopathy, patchy alopecia, symmetrical rash on palms and soles
- painless shallow infectious ulcers of mucous membranes and genitalia
- can also include cardiovascular, CNS, bone, joint or skin involvement

If a women becomes infected during pregnancy it can cause serious complications :
- miscarriage
- stillbirth
- congenital syphilis

Question 6

Trichomoniasis

Answer 6

• caused by trichomonas vaginalis
• urogenital flagellate parasite
• very common in the vagina of sexually active women and transmission is via unprotected sex
• trophozoite form which reproduces by binary fission and can be transmitted

DIAGNOSIS :
- physical examination
- swabs analysed by microscopy

Symptoms in women :
- abnormal vaginal discharge
- discharge with unpleasant fishy smell
- soreness, inflammation and itching around the vagina
- pain or discomfort when passing urine or during sex

Symptoms in men :
- pain during ejaculation or urination
- needing to urinate more frequently
- thin white discharge from penis
- soreness, swelling and redness around the head of the penis or foreskin

Complications are rare