Sexually-transmitted Infections Flashcards
What is the most common bacterial STI? What kind of organism is it?
Chlamydia
Gram negative bacterium
How is chlamydia transmitted?
Vaginal
Anal
Oral
In what age group is the highest incidence of chlamydia?
20-24 year olds
How does chlamydia typically present in a female?
Asymptomatic (70-80%) Post-coital or intermenstrual bleeding Lower abdo pain Dyspareunia Mucopurulent cervicitis
How does chlamydia typically present in a male?
Asymptomatic (50%) Urethral discharge Dysuria Urethritis Epididymo-orchitis Proctitis (LGV)
What is the treatment for chlamydia?
Doxycycline 100mg BD x 1 week
Azithromycin 1g stat followed by 500mg daily for 2 days
What kind of organism is N. gonnorrhoea? How does it appear on gram stain?
Gram negative intracellular diplococcus
Polymorphs, kidney bean shaped diplococci
How does gonnorrhoea typically present in males?
Urethral discharge >80%
Dysuria
Asymptomatic <10%
Pharyngeal/rectal infections mostly asymptomatic
How does gonorrhoea typically present in a female?
Dysuria Pelvic pain (<5%) Increased/ altered vaginal discharge Asymptomatic in up to 50% Pharyngeal/rectal infections mostly asymptomatic
List diagnostic tests for gonorrhoea
NAATs (screening test)
Microscopy if symptomatic
Culture if microscopy positive
What is the treatment for gonorrhoea?
Ceftriaxone 500mg IM
Test of cure in all patients (2 weeks)
If ceftriaxone is contraindicated, what is the 2nd line treatment for gonorrhoea?
Cefixime 400mg oral
How long does genital herpes usually last?
14-21 days following incubation of 3-6 days
How does a primary infection of genital herpes typically present?
Blistering/ulceration Pain Extreme dysuria Discharge Lymphadenopathy Fever and myalgia (prodrome)
Is it more common to get recurrent genital herpes via HSV1 or HSV2?
HSV2
How is genital herpes treated?
Oral aciclovir 400mg TDS
Topical lidocaine 5% if painful
Saline bathing
Analgesia
Viral shedding for HSV1 is higher than HSV2. True/False?
False
HSV2 viral shedding higher than HSV1
What is the most common viral STI in the UK?
HPV (causing genital warts)
What is the incubation period of HPV?
3 weeks to 9 months
Which strain of HPV is the most common cause of anogenital warts? How do they appear?
Low risk - 6 and 11
Cauliflower appearance
How are genital warts caused by HPV treated?
Podophyllotoxin (Warticon) - 1st line Imiquimod (Aldara) - 2nd line (1st if perianal warts or immunocompromised) Cryotherapy - 1st line in pregnancy Electrocautery HPV vaccination
Which organism causes syphillis?
Treponema pallidum (spirochaete)
What are the main modes of transmission of syphilis?
Sexual contact
Trans-placental
Blood transfusion
Non-sexual contact - healthcare workers
What are the 5 stages of syphilis?
EARLY INFECTIOUS Primary Secondary Early latent LATE NON-INFECTIOUS Late latent Tertiary
What are the features of primary syphilis?
Chancre (painless lesions)
Lesions at site of innocculation (genital or extragenital)
Non-tender lymphadenopathy
What are the features of secondary syphilis?
Maculopapular rash Palms and soles affected Lesions of mucous membranes Generalised lymphadenopathy Alopecia Condylomata lata
What are the 2 groups of tests that are down to diagnose syphilis?
Microscopy + PCR to detect organism
Serological testing to detect antibody
What are the non-specific serological tests for syphilis?
VDRL
RPR
What are the specific serological tests for syphilis? Which is used for screening?
TPPA
ELISA (used for screening)
FT antibody absorption
INNO-LIA
How is early and late syphilis treated respectively?
LONG ACTING PENICILLIN
2.4MU benzathine penicillin once or three times a day
What is partner notification? List the main methods
VOLUNTARY process of informing people who have been in contact with an STI
Patient referral
Provider referral
Provisional referral
Partner notification is not needed for…
Warts, herpes (no benefit in asymptomatic finding)
Vaginal thrush, bacterial vaginosis (not STIs)
List vaccinations that can be given to prevent STIs
Hepatitis B
Hepatitis A
HPV
What is PreP therapy?
Medicine taken before exposure to reduce risk of infection, particularly HIV
What is PEPSE?
Medicine taken after exposure to reduce risk of infection, particularly HIV and Hepatitis B
List complications of chlamydia
PID
Tubal damage (infertility, ectopic pregnancy)
Chronic pelvic pain
Transmission to neonate
Adult conjunctivitis
Reiter’s syndrome
Fitz-Hugh-Curtis syndrome (perihepatitis)
What is the triad of symptoms present in Reiter’s syndrome?
Conjunctivitis
Urethritis
Arthritis
What is LGV? What are the clinical signs?
Serovars of chlamydia trachomatis (L1-3), common in MSM
Rectal pain, discharge, bleeding, concurrent STIs
What is the diagnostic tests for chlamydia?
Test 14 days following exposure
NAAT - females (vulvovaginal swab), males (first void urine)
Rectal swab in MSM who have had receptive UPAI
List lower genital tract complications of gonorrhoea
Bartholinitis (inflam of Barth glands next to vagina) Tysonitis (inflam of Tyson glands) Periurethral abscess Rectal abscess Epididymitis Urethral stricture
List upper genital tract complications of gonorrhoea
Endometritis PID Hydrosalpinx Infertility Ectopic pregnancy Prostatitis
How is genital herpes diagnosed?
Swab base of ulcer for HSV PCR
Which group of people are there special circumstances for the management of genital herpes?
Pregnant women
What are the two main classifications of syphillus?
Congenital
Acquired
What is the most highly infectious lesion in syphillus, and it exudes serum?
Condylomata lata
Syphillus is followed up until…
RPR is negative or serofast
What is the interval period for testing for chlamydia or gonorrhoea?
14 days
