Sexually Transmitted Infections Flashcards
What is PID?
Infective inflammation of endometrium, uterus, fallopian tubes (salpingitis), ovaries + peritoneum
What are the clinical features of PID?
May be asymptomatic Deep dyspareunia Menstrual abnormalities Post-coital bleeding Dysuria Abnormal discharge - purulent/smelly
If severe:
- fever
- nausea + vomiting
How is PID diagnosed?
Which additional investigations should be done?
Endocervical swabs (for chlamydia + gonorrhoea) High vaginal swab (for trichomonas vaginalis + bacterial vaginosis)
Additional:
- full STI screen
- urine dipstick +/- MSU (exclude UTI)
- pregnancy test
- transvaginal USS
- laparoscopy (if very severe + diagnostic uncertainty)
What is the treatment for PID?
Broad spectrum antibiotics:
- doxycycline, ceftriaxone + metronidazole
- OR ofloxacin + metronidazole
When might a patient require admission for PID?
If pregnant, especially if risk of ectopic
Severe symptoms: N&V, fever
Signs of pelvic peritonitis
Unresponsive to antibiotics, need for IV therapy
What are the complications of PID?
Ectopic pregnancy (scarring) Infertility Tubo-ovarian abscess Chronic pelvic pain Fitz-Hugh Curtis syndrome (perihepatitis --> RUQ pain)
What are the different subtypes of chlamydia?
Chlamydia trachomatis:
- types A-C –> ocular infection
- types D-k –> genitourinary infection
- types L1-L3 –> lymphogranuloma venereum (LGV)
What is LGV?
Chlamydia infection in men who have sex with men –> proctitis
- rectal pain, discharge + bleeding
What are the symptoms and signs of chlamydia in women?
Many asymptomatic Dysuria Abnormal discharge Intermenstrual or post-coital bleeding Deep dyspareunia Lower abdominal pain
Signs:
- cervicitis +/- contact bleeding
- mucopurulent discharge
- pelvic tenderness
- cervical excitation
What are the features of chlamydia in men?
Urethritis –> dysuria + urethral discharge
Epididymo-orchitis –> testicular pain
How is chlamydia diagnosed?
NAAT –> nucleic acid amplification test, 14 days post-exposure
- women: vulvo-vaginal swab
- men: first catch urine sample
If indicated - swabs from rectum, eye + throat
What is the treatment for chlamydia?
Doxycycline 100mg twice daily for 7 days
or Azithromycin 1g stat followed by 500mg daily for 2 days
What advice should be given regarding sexual intercourse following chlamydia diagnosis?
Avoid sex (including oral) until they and/or their partner have completed treatment
What are the complications of chlamydia infection?
PID Ectopic Infertility Conjunctivitis Sexually acquired reactive arthritis/Reiter's syndrome Transmission to neonate Fitz-Hugh Curtis syndrome
What causes gonorrhoea?
Neisseria gonorrhoea - gram negative diplococcus
How does gonorrhoea present and how is it diagnosed?
Very similar to chlamydia
NAAT - screening test
Microscopy if symptomatic
Culture if micro +ve
How is gonorrhoea treated?
Single dose IM cefriaxone 1g
- if symptoms suggestive, treat without waiting for test result
Usually treat for chlamydia at same time
TEST OF CURE FOR ALL PATIENTS
What are the complications of gonorrhoea?
PID Epididymo-orchitis Prostatitis Disseminated gonococcal infection --> joint pain + skin lesions Gonococcal meningitis
What causes syphilis?
Treponema pallidum - spirochete gram negative bacteria
What happens in primary syphilis?
Chancre - painless ulcer on genital site
What happens in secondary syphilis?
3 months post infection:
- rash on hands and soles
- fever
- malaise
- arthralgia
- weight loss
- headaches
- condylomata lata (warts in moist areas)
- painless lymphadenopathy
- silvery grey mucous membrane lesions
What happens after secondary syphilis?
Enter asymptomatic latent phase Tertiary syphilis can present may years after initial infection: - gummatous syphilis (granulomas) - neurosyphilis - cardiovascular syphilis
How is syphilis diagnosed?
Demonstration of bacteria from lesions or infected lymph nodes: - Dark Field Microscopy - PCR Serological testing: - antibody to pathogenic treponemes
What is the treatment for syphilis?
Benzathine penicillin IM
What causes genital warts?
HPV 6 + 11
How are genital warts managed?
Often resolve spontaneously over time Topical treatments: - Podophyllotoxin - Imiquimod Physical ablation: - excision - cryotherapy - electrosurgery - laser surgery
What causes genital herpes?
HSV-1 and HSV-2
Spread from sexual contact or oral sex with someone who has a cold sore
How is herpes diagnosed?
Swab from open sore –> PCR
What is the management for genital herpes?
Oral Aciclovir
Topical lidocaine 5% ointment if very painful
Saline bathing
Analgesia
What causes trichomonas vaginalis (TV)?
Anaerobic flagellated protozoa
vaginal UPSI, not through oral or anal sex
What are the symptoms of TV?
Offensive vaginal odour
Abnormal discharge - thick/thin/frothy and yellow-green
Itchiness or sore vulva
Dyspareunia
Dysuria
Strawberry cervix (punctate and papilliform appearance)
How is TV diagnosed?
High vaginal swab (female) or urethral swab/first void urine (male) for culture
How is TV treated?
Metronidazole
What is bacterial vaginosis (BV)?
NON sexually transmitted infection of lower genital tract in females
Due to disturbance in normal vaginal flora –> increase in vaginal pH
What are the risk factors for BV?
Sexual activity IUD Receptive oral sex Presence of STI Vaginal douching, scented soaps Recent antibiotic use Ethnicity (black) Smoking
What are the features of BV?
Offensive, fishy vaginal discharge
Thin, white/grey discharge
How is BV diagnosed?
High vaginal smear –> microscopy
- presence of CLUE CELLS
- reduced numbers of lactobacilli
- absence of pus cells
What is the treatment for BV?
Metronidazole
What are the risk factors for vulvo-vaginal candidiasis (thrush)?
Pregnancy Diabetes Use of antibiotics Use of steroids Immunosuppression
What are the features of vaginal thrush?
ITCH
White, curd like, non-offensive discharge
Dysuria
Erythema + swelling of vulva
Satellite lesions: red, pustular lesions with superficial white/creamy plaques that can be scraped off
What is the treatment for vaginal thrush?
Intravaginal antifungal e.g. clotrimazole
Oral antifungal
If not resolved in 7-14 days:
- consider alternative diagnosis
- consider predisposing risk factors and address
How is the treatment of vaginal thrush different in pregnancy?
DO NOT give oral antifungals
- use vaginal antifungals only
What kind of virus is HIV?
Single stranded RNA retrovirus that infects and replicated within CD4 cells (T helper cells)
What happens during the seroconversion stage of HIV?
2-6 weeks after exposure - flu-like illness:
- fever
- muscle aches
- malaise
- lymphadenopathy
- maculopapular rash
- pharyngitis
What happens after the seroconversion stage of HIV?
Latent asymptomatic phase
Then symptomatic phase
What happens during the symptomatic phase of HIV?
Weight loss
High temperatures
Diarrhoea
Frequency minor opportunistic infections e.g. herpes zoster or candidiasis
If left untreated –> AIDS
How is the development of AIDS characterised?
AIDS defining illnesses (infections + malignancies):
- pneumocystis jiroveci
- non-Hodgkins lymphoma
- TB
How is HIV diagnosed?
Fourth generation tests
–> test for serum or salivary HIV antibodies and p24 antigen
How is HIV monitored?
CD4 count HIV viral load FBC U&Es Urinalysis ALT, AST and bilirubin
How is HIV transmission to the baby avoided in pregnancy?
Antenatal antiretroviral therapy during pregnancy and delivery
Avoidance of breastfeeding
Neonatal post-exposure prophylaxis
