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
