Sexually transmitted infections Flashcards
Most commonly reported bacterial STI in sexual health clinics?
Chlamydia (CT)
Gram stain of Chlamydia ?
Gram negative obligate intracellular bacterium
How is Chlamydia transmitted?
Vaginal, oral or anal
An episode of PID increases the risk of?
Ectopic pregnancy ten fold and carries a risk of tubal factor infertility of 15-20%.
Presentation of chlamydia in female?
Post coital or intermenstrual bleeding
Lower abdominal pain
Dyspareunia
Mucopurulent cervicitis
NOTE: 70-80% of women
Presentation of chlamydia in male?
Urethral discharge Dysuria Urethritis Epididymo-orchitis Proctitis (LGV) NOTE: 50% of men are asymptomatic
Complications of chlamydia?
PID (CT accounts for 50% of cases)
Tubal damage (infertility, ectopic pregnancy)
Chronic pelvic pain
Transmission to the neonate (17% conjunctivitis, 20% pneumonia)
Adult conjunctivitis
Sexually acquired reactive arthritis (SARA) /Reiter’s syndrome (commoner in men)
Fitz-Hugh-Curtis Syndrome (Perihepatitis)
Testing advice for chlamydia?
Stop testing for CT in women >25 with vaginal discharge
Do test women who have had CT in past year
What is LGV?
LGV stands for lymphogranuloma venereum. It’s a type of chlamydia bacteria that attacks the lymph nodes, which are an important part of your body’s defence against infections
Symptoms of LGV?
Rectal pain, discharge and bleeding
What group of people is LGV common in ?
MSM
Diagnosis of chlamydia?
Test 14 days following exposure NAAT females (vulvovaginal swab) males (first void urine) MSM (add rectal swab if has receptive anal intercourse)
Chlamydia treatment?
Doxycycline 100mg BD x 1 week
or (if contraindicated)
Azithromycin 1G stat followed by 500 mg daily for 2 days
Associated with Non Gonococcal Urethritis (15-25%) and PID?
Mycoplasma Genitalium
Test for Mycoplasma Genitalium?
NAAT test
Associated with high levels of macrolide?
Mycoplasma Genitalium
Gram statin for Gonorrhoea?
Gram negative intracellular diplococcus
Primary sites of infection for Gonorrhoea?
mucous membranes of the urethra, endocervix, rectum, and pharynx
Presentation of Gonorrhoea in males ?
Asymptomatic - ≤10%
Urethral discharge – >80%
Dysuria
Pharyngeal/rectal infections – mostly asymptomatic
Presentation of Gonorrhoea in females ?
Asymptomatic (up to 50%)
Increased/altered vaginal discharge (40%)
Dysuria
Pelvic pain (<5%)
Pharyngeal and rectal infection are usually asymptomatic.
Complications of gonorrhoea in the lower genital tract?
Bartholinitis Tysonitis Periurethral abscess Rectal abscess Epididymitis Urethral stricture
Complications of gonorrhoea in the upper genital tract?
Endometritis PID Hydrosalpinx Infertility Ectopic pregnancy Prostatitis
Diagnosis of gonorrhoea?
NAATs (screening test) >96% sensitivity
Microscopy (Symptomatic)
Urethral 90-95% sensitivity
Endocervical 37-50% sensitivity
Culture (if Micro +ve or contact of GC)
Urethral or Endocervical
Treatment of gonorrhoea?
First-line: Ceftriaxone 500 mg IM
Second-line: Cefixime 400 mg oral (only if IM injection is contra-indicated or refused by patient)
Test of cure in all patients
