Sexually Transmitted Infections Flashcards
What organism causes Chlamydia?
Chlamydia Trachomatis
What type of bacteria is chlamydia trachomatis?
Gram negative
Give the male presentation of chlamydia
70% asymptomatic
Slight watery discharge
Dysuria
Conjunctivitis
Epididymo-orchitis
Give the female presentation of chlamydia
80% asymptomatic
Vaginal discharge
Dysuria
Dyspareunia
IMB and PCB
Conjunctivitis
What investigation is used in chlamydia diagnosis
Nucleic acid amplification test (NAAT)
- Male, first pass urine
- Female, vaginal swab
How is chlamydia managed?
Doxycycline 100mg twice daily for 1 week
Azithromycin if pregnant or breastfeeding
Test for cure only required if rectal or pregnancy
Partner notification
Abstain from sex for seven days of treatment
Give complications of chlamydia
Epididymo-orchitis
PID
Ectopic pregnancy
Infertility, due to damage to fallopian tubes
Reactive arthritis
Conjunctivitis
Preterm delivery and premature rupture of membranes
Neonatal infection
Lymphogranuloma venereum
What organism causes gonorrhoea?
Neisseria Gonorrhoeae
What type of bacteria is neisseria gonorrhoea?
Gram-negative diplococcus
What is the incubation period for gonorrhoea?
5-6 days average (range from 2 days-2 weeks)
Give the male presentation of gonorrhoea
10% asymptomatic
Thick profuse odourless yellow discharge
Dysuria
Epididymal-orchitis
Rectal or pharyngeal infection
Give the female presentation of gonorrhoea
50% asymptomatic
Odourless purulent yellow discharge
Dysuria
Pelvic pain
IMB and PCB
What investigation is used in gonorrhoea diagnosis?
Nucleic acid amplification test (NAAT)
- Male, first pass urine
- Female, vaginal swab
Charcoal swab for culture and sensitvities
How is gonorrhoea managed?
Single dose IM ceftriaxone
Test of cure at 2-6 weeks
Partner notification
Abstain from sexual activity for 1 week of treatment
Give complications of gonorrhoea
Epididymo-orchitis
PID
Infertility
Conjunctivitis
Disseminated gonococcal infection, spreading to skin and joints
Super Gonorrhoea, due to anti-microbial resistance
What organism causes trichomonas?
Trichomonas Vaginalis
What type of organism is trichomonas vaginalis?
Protozoan parasite with flagella
Give the male presentation of trichomonas
Usually asymptomatic, more difficult to identify in men
Give the female presentation of trichomonas
10-30% asymptomatic
Frothy yellow/green foul smelling discharge
Dyspareunia
Dysuria
Pruritis
What investigations are used in trichomonas diagnosis?
Charcoal vaginal/PCR swab, from posterior fornix
No test for men
Nucleic acid amplification test (NAAT), to rule out chlamydia and gonorrhoea
What speculum sign is seen in trichomonas?
Strawberry cervix
How is trichomonas managed?
Metronidazole for 5 days
Partner notification and treatment
What is the incubation period for herpes simplex virus?
5 days-months
How does herpes present?
80% asymptomatic
Recurring symptoms monthly/annually
Burning/itching
Blistering/ulceration
Tender inguinal lymphadenopathy
Flu-like symptoms
Dysuria
Neuralgic pain in back, pelvis and legs
What investigation is used for herpes diagnosis?
NAAT on swab of ulcer
What is the primary management of herpes?
Aciclovir for 5 days
Lidocaine ointment
Salt water baths, passing urine in bath
How is herpes managed?
Lidocaine ointment
Oral aciclovir once daily until symptoms gone (1-3 days)
Longterm aciclovir if recurrences
How is herpes managed in pregnancy?
Oral aciclovir until delivery, and then delivery by c section
What points are important to cover in herpes counselling?
Typically first episode is most severe
May get recurrence, more severe and frequent if HSV 2
Most contagious when have symptoms but can cause asymptomatic shedding
Oral to genital spread is possible if one partner gets cold sores
Give complications of herpes
Autonomic neuropathy/urinary retention
Neonatal infection
Secondary infection
Herpes Encephalitis
HSV2 important co-factor in HIV transmission
What is the difference between HS1 and HS2?
HS1
- Associated more with oral herpes
HS2
- Associated more with genital herpes
What is herpes zoster ophthalmicus (HZO)?
Describes the reactivation of the varicella-zoster virus in the area supplied by the ophthalmic division of the trigeminal nerve
Give features of herpes zoster ophthalmicus (HZO)
Vesicular rash around the eye, which may or may not involve the actual eye itself
Hutchinson’s sign, rash on the tip or side of the nose, suggests future eye involvement
Anterior uveitis, conjunctivitis,
Ptosis
How is herpes simplex keratitis managed?
Topical aciclovir
What organism causes genital warts?
Human Papilloma Virus types 6 and 11
How are genital warts managed?
Podophyllotoxin
Imiquimod
What organism causes syphilis?
Treponema pallidum
What type of bacteria is treponema pallidum?
Spirochete
What is the incubation period for syphilis?
9-90 days until appearance of chancre
How can syphilis be transmitted?
Sexually transmitted
Vertical transmission from mother to baby during pregnancy
IV drug use
Blood transfusions and other transplants
How does syphilis present?
Often asymptomatic
Primary
- Painless chancre at site of infection
Secondary, resolves in 3-12 weeks
- Maculopapular rash
- Mucosal ulceration
- Lymphadenopathy
Tertiary, occuring years after infection
- Neurosyphilis
- Aortic aneurysms
- Gummatous lesions
How does neurosyphilis present?
Headache
Altered behaviour
Dementia
Tabes dorsalis (demyelination affecting the spinal cord posterior columns)
Ocular syphilis (affecting the eyes)
Paralysis
Sensory impairment
What investigations are used in syphilis diagnosis?
Antibody screening
Blood serology
PCR on ulcer sample
How is syphilis managed?
IM benzathine penicillin
What organisms can cause PID?
Chlamydia trachomatis
Neisseria gonorrhoeae
Mycoplasma genitalium
Give risk factors for PID
Existing STI
Multiple sexual partners and not using barrier contraception
IUD
How does PID present?
Constant lower abdominal/pelvic pain
Purulent vaginal discharge
Deep dyspareunia
Dysuria
Fever
Cervical excitation/cervical motion tenderness
IMB and PCB
Increased inflammatory markers
What is the management of PID?
1g IM ceftriaxone single dose, to cover gonorrhoea
100mg oral doxycycline + metronidazole for 14 days, to cover chlamydia and mycoplasma genitalium
400mg metronidazole for 14 days, to cover anaerobes
Severe cases require IV antibiotics
Give complications of PID
Tubal factor infertility
Sepsis
Tubo-ovarian abscess formation
Ectopic pregnancy
Chronic pelvic pain
Fitz-Hugh-Curtis syndrome, inflammation of liver capsule
