Sexually transmitted infections

Question 1

features

Answer 1

transmissibile
Asymptomatic most of the time
all manageable but not always curable
avoidable

Question 2

activity required for transmission•

Answer 2

• Genital contact only:
o Pubic lice (Pthirus pubis)
o Scabies (Sarcoptes scabeii)
o Warts (human papilloma virus types 6 & 11)
o Herpes (Herpes Simplex Virus types 1 & 2)
♣ Both types cause cold sores, the key difference is recurrence risk.
♣ HSV type 1 prefers to be “above the belt” and HSV type 2 “below the belt.”
♣ Therefore, HSV 1 on the genitals is far less likely to shed sporadically or cause recurrent cold sores and the same goes for herpes 2 in the mouth.

Question 3

systemic symptoms

Answer 3

fever
rash lymphadenopathy
malaise
infertility

Question 4

history

Answer 4

o Ask direct questions about symptoms
♣ E.g. “discharge from the penis/pain in abdomen?”

offer HIV test

Question 5

normal occurenes

Answer 5

o Fox-fordyce spots
♣

Small, painless, raised, pale, red or white spots or bumps 1 to 3 mm in diameter that may appear on the scrotum, shaft of the penis or on the labia
o Vulval papillomatosis/Vestibular papillomatosis
♣ Pink, asymptomatic, fine projections of the vestibular epithelium or labia minora. It is the female equivalent to hirsuties coronae glandis
o Hirsuties coronae glandis (also known as “pearly penile papules”)

Question 6

non sti microbial problems

Answer 6

vulvovaginal candidosis
candida albicans

o	If symptomatic: “thrush”
♣	Itch
♣	Discharge – classically thick, ‘cottage cheese’ but often just a report of increased amount.
♣	Risk factors:   
•	diabetes, oral steroids
•	immune suppression (HIV) 
•	pregnancy

investigation:
gram stained preparation
culture

treatment:
azole antifungals

Bacterial vaginosis
-commonest cause of abnormal vaginal discharge
-imbalance of bacteria
♣ increased gardnerella / ureaplasma / mycoplasma /anaerobes
reduced lactobacilli
o Symptoms:
♣ Asymptomatic in 50%
♣ watery grey/yellow ‘fishy’ discharge
♣ may be worse after period / sex
♣ sometimes sore/itch from dampness
assoc with
endometritis if uterine disturbance
assoc with premature labour
increased risk of HIV
♣ Amsel’s criteria require at least three of the following for diagnosis:
• Homogeneous discharge
• Microscopy showing vaginal epithelial cells coated with a large number of bacilli
“clue cells”
• Vaginal pH >4.5.
Fishy odour on adding 10% potassium hydroxide to vaginal fluid
Ison/Hay criteria:
• Grade 1: normal. Lactobacilli predominate.
• Grade 2: intermediate. Some lactobacilli, but other organisms present.
• Grade 3: BV. Other organisms predominate. Few or absent lactobacilli.
o Treatment:
♣ Metronidazole
• Oral (avoid ethanol)
• Vaginal gel
♣ Clindamycin – vaginal

Balanitis (inflammation of the glans, or the head, of the penis, due to infection or another cause.)
-candidal balanitis
o Impetigo – Staph aureus (or Strep pyogenes sometimes)
Erysipelas – Group A Strep
Tinea cruris