Sexually Transmitted Infections Flashcards

Question

How does gonorrhoea infection present in a man?

Answer 1

Often asymptomatic Usually develop symptoms 2-5 days following infection Mucopurulent urethral discharge Dysuria Epididymal tenderness Rectal – usually asymptomatic, anal discharge or anal pain/discomfort Pharyngeal infection – asymptomatic 90% of the time

Answer 2

Full STI screen Women – Vulvovaginal swab for NAAT, endocervical for NAAT or microscopy and culture Men – first pass urine for NAAT, urethral/meatal swab for NAAT or microscopy and culture Swabs for NAAT from throat, rectum or eye if indicated If NAAT positive culture for sensitivity Dual testing for chlamydia important Differentiate between Gonorrhoea and Chlamydia instantly with a gram stain Contact tracing

Answer 3

Treated empirically until culture returns and then target antibiotics if infection still present Single dose of 1g ceftriaxone IM Cefixime 400mg PO stat plus azithromycin 1g PO only if IM injection contraindicated or rejected. If allergic to penicillin or cephalosporins discuss with GUM Safe sex practices

Answer 4

PID Epididymo-orhcitis Prostatitis Disseminated gonococcal infection – joint pain and skin lesions – rare

Answer 5

STI caused by spirochete gram negative bacterium – Treponema pallidum

Answer 6

Sexually transmitted – motile bacterium enters through breaks in the skin Vertical transmission via placenta (congenital syphilis)

Answer 7

Bacteria divide forming an infectious hard ulcer called a chancre after incubation period of about 2-3 weeks this is called primary syphilis. Secondary syphilis follows that with symptoms and then it enters a latent phase, from here it is non-infectious. If left it can persist and cause systemic damage via obliterating arteritis – endothelial cells excessively proliferate eventually blocking the lumen of the vessel.

Answer 8

Primary syphilis Papule forms that ulcerates into a chancre which are painless. Usually singular, hard and non-itchy. These classically heal in 3-10 weeks.

Answer 9

Secondary syphilis Develops 3 months post infection. Features include: skin rash (hands and soles – non itchy or painful), fever, malaise, arthralgia, weight loss, headaches, condylomata lata (elevated plaques like warts in moist areas of the body), painless lymphadenopathy and silvery grey mucus membrane lesions.

Answer 10

Tertiary syphilis Presents many years later and is categorised into: • Gummatous syphilis – forms in bone, skin and mucous membranes of the upper respiratory tract, mouth and viscera or connective tissue e.g. lung, liver and testis. • Neuro syphilis – Tabes dorsalis (ataxia, numbness, loss of pain, temperature and reflexes and lightning pains), Dementia, Meningovascular complications (cranial nerves, strokes and cerebral gummas) and Argyll Robertson pupil – constricted and unreactive to light but accommodates. • Cardiovascular syphilis – aortic regurgitation and aortic root dilation, angina due to stenosis in coronary arteries and dilation and calcification of the ascending aorta

Answer 11

Dark ground microscopy of the chanchre fluid PCR testing of swab from active lesion Antibody tests: Treponemal ELISA (IgG/IgM) +ve for life, TPPA or TPHA +ve for life Non Treponemal tests, RPR/VDRL – rises in early disease, negative after treatment Lumbar punctures – CSF antibody test in neurosyphilis

Answer 12

Early syphilis – Benzathine penicillin – 2.4 MU IM single dose Late Syphilis – Benzathine penicillin – 2.4 MU IM 3 doses at weekly intervals Neurosyphilis – Procaine penicillin 1.8 MU 2.4 MU IM OD plus probenecid 500mg PO QDS for 14 days OR Benzylpenicillin 10.8-14.4g daily given IV in 4 hourly doses for 14 days Also ``` Full STI screen Patient education regarding safe sex Abstinence until cured Contact tracing Follow-up serology to determine response to treatment ```

Answer 13

The result of infection ascending from the endocervix, causing endometritis, salpingitis, parametritis, oophoritis, tubo-ovarian abscess and/or pelvic peritonitis. Most common between ages 20-30

Answer 14

``` Young age (15-24) Recent partner change Lack of use of barrier contraception Multiple sexual partners Low socioeconomic class IUCD ```

Answer 15

Often polymicrobial Most commonly due to chlamydia trachomatis or Neisseria Gonorrhoea Also, can be due to Gardnerella vaginalis, mycoplasma genitalium or hominis

Answer 16

``` Pyrexia, pain in lower abdomen iliac fossa area Deep dyspareunia and PCB Abnormal bleeding Abnormal discharge Dysuria History of STI Fever Cervical excitation (pain on examination) Purulent cervical discharge ```

Answer 17

Ectopic pregnancy, ruptured ovarian cyst, endometriosis or urinary tract infection.

Answer 18

``` Urine dip and pregnancy test Endocervical and high vaginal spear STI screen TV USS Laparoscopy Contact tracing ```

Answer 19

Start treatment whilst awaiting swab results Ceftriaxone IM STAT, Metronidazole and Doxycycline for 14 days Symptomatic management of pain Avoiding sexual intercourse Contact tracing – nausea, vomiting and high fever

Answer 20

``` Admit to Hospital if: Pregnant or risk of ectopic pregnancy Severe symptoms Signs of pelvic peritonitis Treatment failure Requires emergency surgery ```

Answer 21

``` Tubo ovarian abscess Higher risk of ectopic pregnancy Infertility Chronic pelvic pain Fitz-Hugh-Curtis Syndrome – RUQ pain and peri-hepatitis following Chlamydial PID ```

Answer 22

Overgrowth of candida Albicans, a normal vaginal commensal

Answer 23

``` Cleaning products Use of antibiotics Oral contraceptives Steroids Pregnancy Obesity Diabetes Immunosuppression – HIV ```

Answer 24

``` White curd like discharge that is odourless Itchy and irritated vulva Erythematous Dysuria Superficial dyspareunia ``` pH < 4.5

Answer 25

Rule out differential diagnoses of bacterial vaginosis, trichomonas vaginalis and UTI. Check for diabetes If uncomplicated then no investigations required Swab Litmus test for pH

Answer 26

Intravaginal antifungal – clotrimazole or fenticonazole Oral antifungals – fluconazole or itraconazole (single doses) Topical imidazole cream – can be given as an adjunct

Answer 27

If recurrent or treatment failure Consider alternative diagnosis Consider predisposing factors and treat them Check concordance with medication Consider use of induction-maintenance regime with daily treatment for a week followed by maintenance treatment weekly for 6 months.

Answer 28

Anaerobic flagellated protozoan parasite infecting the vagina. Passes on exclusively as an STI.

Answer 29

Multiple sexual partners Unprotected sexual intercourse A history of other STIs Older woman

Answer 30

``` Female pH > 4.5 Yellow/Green frothy discharge that is fishy and offensive odour Pruritis Vaginitis Dyspareunia Dysuria Strawberry cervix ```

Answer 31

``` Male Urethral discharge Dysuria and frequency Pain and pruritis around the foreskin Inflammation of the gland penis – balanoposthitis ```

Answer 32

Female High vaginal swab from the posterior fornix Self-administered vaginal swab Full STI screen Males Urethral swab or first void urine sample Full STI screen

Answer 33

Metronidazole BD for 5 days or large STAT dose 2.5g (avoid in pregnancy or breast feeding) Treat partner simultaneously or contact tracing Alternatives Tinidazole Abstain from intercourse whilst taking treatment