Sexually transmitted infections Flashcards
Who gets STIs?
Young age
Frequent parter change, high no. lifetime partners, concurrency
Sexual orientation
Ethnicity for some STIs
use of non-barrier contraception
Residence in inner city/ deprivation
History of previous STI
Young people
Early age associated with poor subsequent sexual health status
Behaviourally more vulnerable to STI acquisition
- higher number of sexual partners
- greater number of concurrent parters
- yet to develop skills and confidence to use condoms
- more risk taking behaviour
- poor contraception awareness
Physiology
Early intercourse
The earlier intercourse occurs, the higher the proportion express regret and report being more or less willing than their partner
20% men, 42% women express regret that they had not waited longer
Early intercourse: vulnerabilities
Leaving home/ not living with parents before 16 years
Leaving school early
Family disruption and disadvantages
Lack of nurturing relationships
Those whose main source of information on sex was not school/ parents
Negative aspects
Unrealistic nature and expectations
Self image/ performance anxiety
Lack of censorship/ boundaries- hardcore material becomes addictive/ normalised
Ethical issues: exploitation of women
Sexual consent blurred
Lack of condom use: reduced risk perception/ perceived need to practice safe sex
Concurrent partnership
Individuals engaged in >1 sexual partnership at once
Important in STI epidemiology-> opportunity for transmission
NATSAL 14.6% men and 9% women had concurrent partnership within last 5 years
Higher rates concurrence in the younger age range
Rates of STI by ethnicity
Rates highest in black or black british
lowest rates in asian or asian british
Definition of a core group
Sub-group of the population
Not a static entity
Highly sexually active individuals
High prevalence of infection
Reservoirs of infection
High frequency of transmission
GMC guidance for examination
Offer a chaperone
Explain to patient why examination is necessary and what it will involve
Give patient privacy to undress/ dress
Obtain patient’s permission before the examination- discontinue if patient asks you to
Keep discussion relevant- avoid unnecessary comments
Female genital examination
Inspect pubic area, labia majora and minora and perianal area
Inspect and palpate inguinal region
Leg rests- allow better visualisation
Speculum examination (use water as a lubricant, gels can interfere with tests)
Bimanual examination
Male genital examination
Inspect pubic area, inguinal region
Inspect scrotum and perianal area
Palpate scrotal contents- note presence of testes, any lumps/ tenderness
Inspect penis- record whether circumcised- if not inspect under foreskin
Particular attention to coronal sulcus, frenulum and meatus
Note presence of urethral discharge
Bacterial/ protozoal
Chlamydia, gonorrhoea, syphillis, trichomonas
- more often florid symptoms
- early presentation
- rapid diagnosis
- effective treatment available
- curative
- reservoirs can be controlled
Viral
Herpes, warts, HIV, hepatitis
- many unaware of infection
- delayed presentation
- diagnostic tests may be unreliable
- symptomatic treatment only
- often life long
- expanding reservoirs
Primary syphillis
1-3 weeks after contact, red mark -> raised spot -> ulcer at the site of contact
Enlarged lymph noes in the groin/ neck, heals within 1-3 weeks
Secondary syphillis
2-6 weeks after 1’ stage- lasts for 2-4 weeks
Systemic dissemination- millions spirochaetes spread throughout the body
Flu-like illness, headache, lymphadenopathy
Mouth ulcers- snail track- painless
Condylomata lata- white/ grey lumps in moist areas
Arthritis
Rapid resolution with effective treatment
Particularly suspect if rash involves palms and soles
Trichomonas vaginalis
Single cell protozoan parasite
Infects vagina and urethra
Dysuria, discharge
Causes frothy discharge ‘strawberry cervix’
Diagnosed by seeing motile organisms on microscopy
Responds well to metronidazole
Genital warts
Extremely common, HPV
Type 6 and 11 in 90%
Vs type 16 and 18, 31, 33 (cervical cancer)
Herpes simplex symptoms
Painful ulceration, dysuria, vaginal discharge
Systemic symptoms e.g. fever and myalgia (more common in 1’)
Herpes simplex signs
Blistering and ulceration
Inguinal lymphadenopathy
Candida/ thrush
Non-sexually transmitted
Fungal
Itching, discharge, swelling
Papular rash in males
Topical antifungals
Bacterial vaginosis
Non-sexually transmitted
Discharge/ fishy odour
Imbalance of vaginal flora
Overgrowth of anaerobes
Often result of over washing/ bubble baths etc
Responds to metronidazole
Complications of STIs
Chlamydia: PID, epididymitis, infertility, chronic pain, Reiter’s syndrome
HPV/ warts: cervical cancer, AIN, VIN, PIN
Bacterial vaginosis: miscarriage, early labour, low birth weight
Trichomonas vaginalis: miscarriage, early labour, low birth weight
Syphillis: dementia, cardaic abnormalities
Hep B/C: cirrhosis, liver cancer
HIV: long term morbidity and mortality opportunistic infections, tumours, non-AIDS malignancies
